About the Student Health Insurance Plan
On Thursday June 28th, 2012, The Supreme Court of the United States upheld the Affordable Care Act. The American University Student Health Center is committed to ensuring that our students continue to have access to affordable, quality, comprehensive, health insurance. We continue to monitor developments related to the Affordable Care Act to frame our approach to providing health care on campus. Over the next few years there may be additional changes plan based on governmental mandates. The Student Health Insurance Plan for the upcoming plan year includes several plan design changes that have been implemented to not only comply with, but also to mitigate the effects of the Affordable Care Act. Changes to the plan design (benefits) were made with careful consideration of feedback from the enrollees in our plan. Surveys have indicated that the most important factor in choosing or remaining on the AU student health insurance plan is an affordable premium (annual cost of the insurance). We have worked very hard to achieve the lowest cost health insurance without greatly affecting the quality of the benefits currently offered in the plan. To provide insight into the changes to the AU student health insurance plan, please see below. If you have additional questions, please do not hesitate to contact us our insurance carrier GM Southwest at 1-877-885-3298.
What is the cost of the AU student health insurance for the plan year beginning August 21, 2012?
The Student Health Center collaborates with a health insurance consultant every year to negotiate the best rate and benefits for students enrolled in the student health insurance plan.
The table below illustrates the rates for the 2012-2013 policy year.
Why did the cost of the student health insurance plan decrease from $1720 (2011-2012) to $1680 (2012-2013)?
There are many factors that impact health insurance premiums. These factors include but are not limited to:>
- effectively educating students on how to use the plan appropriately
- increasing the focus on educational counseling during routine appointments and recommendations on how to live a healthy lifestyle
- emphasizing on seeking treatment at the student health center first
- encouraging the utilization of in-network specialists
- providing services at the SHC that will not financially impact the policy
- utilizing generic prescriptions by plan enrollees
- expanding the prescriptions that are available at the student health center
The biggest impact on a health insurance premium is related to claims experience. During the 2011-2012 the student health insurance plan experienced very few high dollar claims.
What benefits are being added to the plan to comply with the Affordable Care Act?
The Affordable Care Act mandated that certain preventative services and be covered with no cost sharing to the participant.
A full listing of these services can be found on the Health and Human Services Web site at:
Have any benefits been re-designed or eliminated? If so, why? What are the effects on the enrollee because of these changes?
Additional plan design changes to mitigate the effects of the ACA on the premium have been made to keep the premium from increasing 40 - 60%. These changes can affect enrollees adversely if they experience an unexpected accident or illness (or do not maintain the healthiest lifestyle possible) and include:
- The Academic year maximum per injury or illness has been decreased to $100,000 (from $250,000). There is an optional supplemental buy up available that will increase this amount to the maximum to $400,000 per injury or illness.
- The preferred care deductible has been increased to $250 (previously $150)
- The deductible for out of network care has been increased to $350 (previously ($250)
- Prescription Maximum has been increased to $100,000 from $4,000. There will also be changes made to the prescription drug copayments and reimbursement.
- The ER copayment has been increased to $150 (previously it was $50)
- The $4,000 out of pocket maximum has been removed from the plan
Have benefits been added to the plan? If so, why?
During the renewal process, the following benefits were added to the student health insurance plan based on requests from enrollees in the plan:
- Smoking cessation medication and counseling upon referral from the Student Health Center
- Allergy testing and shots
- Treatment of non cosmetic cystic acne
- Testing for sexually transmitted infections when conducted at the SHC
Was there a cost to add these benefits to the plan?
No. GM Southwest agreed to add these benefits without additional increase to the premium.
Does the AU student health insurance plan have pre-existing condition exclusion?
No. GM Southwest agreed to eliminate the pre-existing condition exclusion last year. The decision to eliminate this exclusion was based on enrollee feedback.
Is there anything else I need to know? Where can I obtain additional information?
For many years the American College Health Association (ACHA) has provided guidelines to colleges and universities recommending minimum levels of coverage and benefits that should be included in all student health insurance plans. The student health insurance plan offered by American University has met and exceeded these recommendations for several years.
The ACA mandate for colleges and universities focuses attention on schools whose insurance plans offered limited benefits, low coverage levels, and high deductibles. As the AU student health insurance plan has met many of the standards for coverage included in health care reform, very few changes needed to be made to our plan this year. Over the next few years, some benefit levels within the plan will change in order to comply with the ACA.
Department of Health and Human Services
American University Student Health Center
American College Health Association