On Jan. 1, 2012, USNH will move to a self-insured health care plan. For any benefits-eligible employee who is nervous about what that might mean, there’s this: USNH is currently self-funded for its Delta Dental coverage.
What’s more, USNH has been self-insured in the past, using a combination approach of being partially insured and partially self-insured.
According to Joan Tambling, director of Human Resources, USNH annually reviews the options to insure, self-insure or partially insure. Decisions are based on the discounts that can be negotiated with the pharmacy and insurer’s health provider, the quality of the claim experience for employees, the ability to negotiate a reasonable price for the services of a third party administrator (TPA), and the plan design options available from “off-the-shelf” programs compared to customized programs.
With the self-insured option, an administrator is hired to manage the health care plan. USNH will pay its own claims, resulting in less administrative fees being paid to the insurance company. For 2012, Harvard Pilgrim will act as the administrator, or TPA. The same network of providers and discounted rates Harvard Pilgrim negotiates for those services are part of USNH’s self-insured contract.
“Harvard Pilgrim has received excellent national marks for the quality of its services to employees, and indeed, USNH has been very satisfied with the responsiveness of Harvard Pilgrim to claim administration and follow ups to questions and appeals,” Tambling says.
“USNH will have the same claim service unit as it had in 2011. Faculty and staff should not feel a difference in submitting claims or in the follow up.”
Prescription drug benefits will be self-insured. Caremark Pharmacy Services, a subsidy of CVS Caremark Corp., has been selected to provide the service. Caremark provides members access to a nationwide network of approximately 65,000 pharmacies including more than 7,200
CVS Pharmacy stores. The change to an independent pharmacy service would not have been possible had USNH remained traditionally insured with Harvard Pilgrim.
According to Tambling, the move is expected to save USNH more than $180 per employee per year without any changes to the plan design.
Employees will receive a new health care member card from Harvard Pilgrim and a Caremark member card for prescriptions by the end of December.
Medical plans for faculty and staff not covered by a collective bargaining agreement will include an in-network deductible, co-pay changes, and an out-of-pocket maximum. Details are available at http://www.usnh.edu/hr/pdf/usnh_newsletter0911_web2.pdf .
With the changes to self-insure, the new pharmacy discounts, the new co-pays and the new deductible, USNH medical premiums will rise by approximately 5 percent rather than the 11 percent overall rates are expected to rise in New Hampshire. The 6 percent reduction in projected costs is projected to save more than $900 a year per employee.
“Part of the reason for the difference can be attributed to Healthy UNH through its promotion of wellness initiatives and healthy lifestyle choices, encouraging employees to be patients who seek evidenced-based care, manage their risk factors, and consider provider cost variations when seeking care,” says Dick Cannon, vice president of finance and administration.
More information about Healthy UNH http://www.unh.edu/healthyunh/.