MHECare

New Student Healthcare Option for the West: MHECare

In the last decade, as the price of a college degree has skyrocketed, so too have student healthcare costs. Most recently, the Patient Protection and Affordable Care Act, the healthcare reform law, has set dramatically higher coverage limits for student health policies, driving up the cost of medical coverage on many campuses.

One new solution for the West’s institutions and students: MHECare, a health program offering vetted, competitively priced medical benefits. WICHE is partnering with the Midwestern Higher Education Compact (MHEC) to offer MHECare to Western institutions beginning in fall 2012.

MHECare, which MHEC developed and designed with funding from Lumina Foundation, provides colleges and universities with health insurance for their students at significant cost savings (achievable by working collaboratively across institutions). UnitedHealthcare StudentResources (UHCSR), a division of national healthcare carrier UnitedHealthcare that specializes in student health insurance plans, was chosen to underwrite the program through a competitive bid process. UHCSR is known for its large, national network of providers, excellent web-based enrollment and support tools, and affordable rates. Mercer was selected as the program administrator, again through a competitive bid process.

 

Multiple Plans

MHECare offers a variety of benefits plans, including standard high or low PPO (preferred provider organization) options. The plans, reviewed by the MHEC Student Health Benefits Advisory Committee, include provisions and exclusions appropriate to a student population. The chart below presents some of the key provisions of the two options and shows the student’s out-of-pocket costs. Currently, these and all MHECare plans offer medical benefits only (not vision or dental insurance). For institutions that will have fewer than 300 students enrolled in the plan or institutions that don’t currently offer a plan, premiums for the high and low PPO plans will be community-rated and blended with UHCSR’s book of business claim data – not based on the individual school’s claims experience.

Institutions with more than 300 students enrolled have two additional plan options. They may opt for a plan with features tailored to their student population; or they can request a quote for their current plan design with any changes that are required by the Patient Protection and Affordable Care Act. The cost for “large” plans will be underwritten based on the institution’s claims experience and utilization. As more campuses offer MHECare, rates will become more stable as risk is spread and the impact of large claims is reduced.

With WICHE and the New England Board of Higher Education joining MHECare, institutions in 31 states are now eligible to participate. Participating institutions must agree that MHECare will be the only plan offered to all of their eligible populations. Since MHEC has already completed its due diligence in selecting UHCSR as the carrier, it may not be necessary for institutions to conduct a formal request for proposal, saving both time and resources.

Key MHECare Plan Benefits

Benefit

Low Option

High Option

 

In-network

Non-network

In-network

Non-network

Maximum benefit each policy year

$100,000

$500,000

Deductible

$300

$600

$100

$200

Out-of-pocket maximum

$5,000

$10,000

$2,500

$5,000

Student coinsurance for most services, after deductible

20%

40%

20%

40%

Preventive care

Plan pays 100%

No benefit

Plan pays 100%

No benefit

Hospitalization

20%

40%

20%

40%

Surgery

20%

40%

20%

40%

Emergency room

$150 copay per visit

$150 deductible per visit

$150 copay per visit

$150 deductible per visit

Physician office visits

$25 copay per visit

40%

$20 copay per visit

40%

Lab & x-ray

20%

40%

20%

40%

Prescription drug copays, 31-day supply UnitedHealthcare Network Pharmacy

$15 Tier 1

$30 Tier 2

$50 Tier 3

No benefit

$10 Tier 1

$30 Tier 2

$50 Tier 3 

No benefit

Mental health outpatient visits

20% up to 50 visits each year

40% up to 50 visits each year

20% up to 50  visits each year

visits each year

Student health center charges

Plan pays 100%, deductible waived

Medical evacuation & repatriation

Benefits provided by Scholastic Emergency Services, Inc.

Accidental death & dismemberment

$1,250 - $5,000 maximum

Preexisting conditions, in excess of $1,000*

Not covered, except for individuals who have been continuously insured under the school's student insurance policy for at least 6 consecutive months. The preexisting condition exclusionary period will be reduced by the total number of months that the student provides documentation of continuous coverage under a prior health insurance policy, with similar benefits to this policy.

*A preexisting condition is one for which the student has had treatment within 6 months prior to the effective date.
Preexisting conditions do not apply to students under age 19.