Questions about Healthcare? An Exchange with Student Health and Counseling Services

There is so much about healthcare provisions on campus that just don’t seem to make sense! As our healthcare campaign has been growing, we have also been trying to collectively figure out stuff, beginning with updating the GSU Survival Guide over summer. On November 18^th, 2015, two GSU members on the Student Health Advisory Board wrote to Dr. Alex Lickerman, then Assistant Vice President of Student Health and Counseling Services, and Ms. Marcy Hochberg, then the university’s insurance coordinator. They asked a number of questions that had come up in the course of GSU’s organizing and research. We share below Dr. Lickerman’s response, with his answers listed under each question asked.

1. Should anyone wish to waive USHIP, the deadline for submitting proof of alternative insurance is 23rd October. However, since every grad is expected to have insurance from the first day of the quarter (“Active coverage from the day the student arrives on campus through either August 31, 2016 OR the end of their academic program (whichever comes first).”), it appears that this year, the insurance coverage must have begun on approximately September 28th. In effect, this would imply that a student must buy a plan that is valid starting September 1st, and therefore the actual deadline for students purchasing an insurance plan on the ACA exchange would be August 15th. Is this correct?

Many marketplace plans (but not all) begin on the first of the month. However, because it is still before the deadline and around the beginning of the start of classes, we accept plans beginning October 1^st to waive U-SHIP coverage. Many other alternate private plans begin coverage on the date when payment is received. Therefore, there is greater flexibility in alternatives than solely what is available through the marketplace (and in point of fact, many international students do not review those plans, because they are not eligible for subsidies.) Although we want students to have coverage from the time they arrive, we do try to allow students time to review requirements and research alternatives. Thus, as long as they can show active coverage by the U-SHIP deadline, they can waive successfully through the online system. Obviously, depending on which plans they are reviewing, the providers may place some constraints on application times, as far as when coverage commences.

Since open enrollment begins every year on July 1^st, and students have almost 4 full months to consider alternatives, and 2 months from when U-SHIP actually expires to apply for plans on the marketplace — although they can submit an application sooner, indicating that their coverage will terminate on Aug. 31 – we feel there is a generous amount of time provided to research marketplace plans.

2. The university announced over email last December (12/23/2014) that 6th and 7th year PhD students “who are at candidacy” would have their health insurance premiums funded. What happens to students who are not ABD by their 6th year? Do they entirely forfeit eligibility for health insurance coverage in the 6th and 7th years? Or, do they forfeit it only until they achieve ABD status? That is, if a student is not at candidacy by the beginning of their 6th year, but defends in Winter of the 6th year (for example), would they have forfeited their entire 6th and 7th year insurance coverage? Might it be possible to clarify if there is any university policy about this, or if this decision is left to the discretion of certain individuals? And further, is there any policy guidance on what kinds of criterion can lead to one being excluded from this coverage? Does one’s department have any say in this matter?

This inquiry should be directed to UChicagoGRAD and the Deans of Students offices. Student Health & Counseling Services administers U-SHIP but does not determine how funding is provided for graduate students, including for student health insurance.

3. Relatedly, we have recently learned of two students who have had somewhat contradictory experiences. A Humanities PhD student is receiving insurance from the university in what is now her 8th year. they said that since she had an external fellowship for one year, they will count this as her 7th year and have provided insurance coverage. On the other hand, a PhD student in Social Sciences who is in the same cohort, and who had been pro forma for a year as she was away for fieldwork, was told she will not be insured by the university this year since they would count her as an 8th year . Is there any clear university policy on who is eligible for the 6th and 7th year insurance coverage?

See answer to #2 above. Please direct this inquiry to UChicagoGRAD for clarity re: policy.

4. Following from the example of the Humanities student above, is it possible to defer the insurance provided by the university for a year or more? That is, if a student has a fellowship in year 6 or 7 that covers insurance, does the individual lose the insurance coverage that the university would otherwise have paid for that year?

See answer to #2 above. Please direct this inquiry to UChicagoGRAD for clarity re: policy.

5. One student who is away from the country for the academic year told us that she was required by the university to demonstrate that she has American insurance, though since she won’t be in the country (and will be in her home country) she will have no need for it. Could you please clarify the policy for students who are out of the country for fieldwork for a year or more? When I go to [home country] to do fieldwork for a whole academic year, possibly in 2017-18 (my 5th year), will I still need to either purchase the USHIP or provide proof of alternative American insurance?

The specific comparable coverage requirement that plans must be issued in the U.S. and have a U.S.-based claims administrator, phone number and address is a new requirement as of the 2015-2016 academic year. (This was based on feedback and data showing that an inordinately high number of international students studying on campus / in the U.S. with foreign-issued plans – many of which provide excellent coverage but require students to pay for medical expenses up front and be reimbursed – were not using their plans as intended but were seeking charity care from UCMC, i.e., reductions in their medical costs. This leads to hgher medical costs for the entire campus community.) Therefore, students studying in the U.S. must have U.S.-based plans.

Students who will be residing out of the country or who will be in pro forma status must still meet the University’s comparable coverage requirements, but they may do so with a local plan that provides coverage in the area where they will be studying / residing. As this is still a new process, it is still, being documented, but the UnitedHealthcare on-campus representatives can assist students studying out of the country with processing U-SHIP waivers, when needed.

6. There appears to be some confusion about the process of applying for mid-year waivers. One student has shared correspondence from Social Science admin stating that USHIP locks people into it for the whole year, but the university website suggests there is a policy to allow mid-year waivers. Could you please correct us if we are mistaken about the possibility of mid-year waivers, and if not, then could there be some kind of training for divisional admin to ensure that correct information is shared with students (such training may be helpful in any case: the same email makes another misleading point about plans on the exchange locking one in for the whole year – the point is qualified with “I think,” but better information would have helped the student concerned). Might it be possible to provide a more comprehensive list of events that qualify a student for a mid-year waiver? For example, does being in pro-forma status, or living in a place where in-network care is not accessible, qualify one for mid-year waiver?

U-SHIP is an annual insurance plan; however, it is possible that in conveying this information, the Social Sciences admin staff person was unaware that there also are circumstances when a student would be allowed to either waive or add coverage in the middle of the plan year, as a result of “qualifying life events.” While well intentioned, insurance is complicated, and this is why the University contract includes two UnitedHealthcare on-campus insurance representatives, whose job responsibilities include explaining plan benefits and policies.

We encourage students to review the SHCS insurance webpages, and also to contact the on-campus insurance representatives for U-SHIP policy information, as well as clarification regarding insurance requirements, deadlines, and University policies. Other units should not be presenting details about information they are not prepared to explain comprehensively.

7. Also, the mid-year waiver page linked above states that students are “responsible for the quarterly installment in which [their] requested change is being processed.” Does this mean that students with alternative coverage will in effect be paying for two insurance plans simultaneously for that quarter?

At this time, students are billed in three quarterly installments for U-SHIP coverage. UnitedHealthcare does not pro-rate these periods. Therefore, depending on when a student submits a requests either to waive or add U-SHIP mid-year, it is possible there could be an overlap of coverage, and related billing. Contact the UnitedHealthcare on-campus insurance representatives for more details regarding how mid-year changes would be processed.

8. Are there any grounds for a student to request an extension of the October 23rd deadline for demonstrating alternative insurance coverage? A student has recently been compelled to start looking for loans to pay the premium because an extension was not offered, and we were wondering if there may be any grounds at all for appeal, or people he should contact to plead his case?

No. Open enrollment runs from July 1^st through the 4^th Friday of the quarter, almost 4 full months. Most annual plans provide either a one-week or two-week open enrollment period. As such, students have practically a third of the year to make their annual selection. (In addition, although the deadline is in late October, UnitedHealthcare provides coverage beginning on Sept. 1 to students who haven’t even determined in mid-October if they are using this coverage, which requires taking on notable risk.) This cannot be extended any further.

9. We know from the figures of the SHCS patient feedback survey that a significant percentage of the student body doesn’t have access to SHCS because of where they live (just under 5% respondents live outside Chicago) – are they too required to go via the SHCS referral procedure to access insurance?

No. The policy clear states that referrals are not required from SHCS when students are more than 50 miles from campus.

10. Finally, here is the link for the UIC insurance plan, which is much cheaper than our USHIP plan (for example, the premium is about half ours, and there is no deductible). Are there approaches that UChicago can borrow from UIC? The plan administered by United Healthcare at UIUC also appears to be cheaper on most counts (premiums, deductibles, and out of pocket maximum).

UIC enrolls over twice as many students in its plan, and it is a self-funded, rather than fully funded plan. I do not know if UIC’s or UIUC’s plans provide national or international coverage, and they have other constraints that do not compare to U-SHIP.

Please request a review from Willis, our insurance brokers, comparing how these two plans differ and why it is problematic to simply compare premiums, as they are not comparable insurance plans, even though both are offered through UnitedHealthcare.