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The Mass Media

The Mass Media

The Mass Media

University healthcare explained

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The University Healthcare Clinic

Full time students from the University of Massachusetts Boston are required by law to have health insurance. UMass Boston automatically enrolls full time students in the Student Health Insurance Program (SHIP). The policy is negotiated bi-annually and put out to bid to major insurance providers like Aetna, the current provider. The insurance cost is factored into student’s tuition. The negotiation process has been made simpler by the passage of the Affordable Health Care Act (ACA).
The full year premium cost for student health insurance is $2,160 ($912 for fall and $1,130 for spring–latter longer semester through end of July).
“In the past it was up to each state to determine the minimum amount of coverage an Insurance provider could give an individual policy holder. The passage of ACA has set a national standard for minimum coverage,” explained Richard Arnold, Interim Director of General Medicine. The ACA requires insurance providers to offer 100 percent coverage of basic health care needs like physicals and immunizations, which means the University no longer has to negotiate those terms.
According to Arnold the ACA further simplified the negotiation process by eliminating insurance providers ability to place maximum benefit limits on total health care and prescription drug costs. The result is that the university no longer has to negotiate for high benefit limits.
If a student has insurance prior to enrolling at UMass Boston and wishes to un-enroll in SHIP, the student’s insurance must meet the federal requirements for minimum coverage. However, having what is termed “comparable coverage” does not guarantee the student will be allowed to waive the University health insurance policy. Even if the student’s insurance provides “reasonably comprehensive coverage of health services,” the University may still require the student to enroll in SHIP to attend UMass Boston.  
Arnold urged out-of-state students enrolling with health insurance to contact their providers to be sure they are not moving out of network. “Certain providers have geographic boundaries on what they consider to be in-network,” Arnold said. “In-network health care facilities receive more favorable rates and therefore the costs are lower to the policy holder. Seeking care at an out of network facility can result in significantly higher deductibles and co-pays for the policy holder.”
UMass Boston does not accept insurance polices provided by companies whose home operating base is outside of the United States. “Health care facilities usually do not even attempt to bill an insurance company that operates outside the U.S. because the facilities have no prior relationship with the foreign insurance provider and have no legal right to seek payment from them,” Arnold explained. “We do not want students with insurance from their home country to be surprised by this so we simply do not accept these polices.”
State law prohibits universities to accept health insurance polices that are subsidized or provided free by the state. People with Commonwealth Care plans, for example, would have to enroll in SHIP.
SHIP is negotiated system wide bi-annually. Each campus assesses its health care needs and submits a proposal to the central office of the University. The University then works with Health Connector, a private company that aids in the negotiation process between the University and health insurance providers, to come up with terms of coverage. Those terms are then submitted to major insurance providers. The insurance providers submit their proposals for meeting those terms. Health Connector works with the University to pick the best proposal and that proposal is submitted to the individual campuses for approval.
SHIP offers more coverage than is required by the ACA. What the university deems necessary to cover is determined by looking at what services are most used, balanced by the cost of providing that coverage. “When we recognize a demand we look at it and say are we meeting that demand? How can we better meet it going forward? And that often determines what we are bring to the negotiating process,” stated Arnold.
“What is interesting is that much of what we have recognized year after year as being important to students have been covered by the ACA,” Arnold said, “One major change is that insurance companies must cover primary or routine health care meaning physicals for both mean and women with no co-pay.”