StudentResources Loyola University Chicago Presented by Slide 1 of 29 15COL3202-1291 Confidential...

StudentResources

Loyola University ChicagoPresented by

Slide 1 of 2915COL3202-1291

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

Mandy LanceSenior Account Executive800-237-0903 [email protected]

Today’s Presentation

Introduction

Accessibility to Health Care

Health Care Reform

Technology

UHCSR Support Team

Plan Enhancements

StudentResourcesSlide 2 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

Introduction

What sets us apart?

Slide 3 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

Personal Service Dedicated Expert Claims and Customer Service Consistent Management Dedicated Team to Help You

Industry Market Leader

One of the Best National Health Care Networks

Effective and Structured Implementation Process

Fully Integrated Administration

Online Tools

Technology

Introduction

Fully Integrated Solution

Underwriting

Legal/Compliance

Customer Service

Claims Administration

Premium Accounting

Marketing

Web-based Tools & Resources


Introduction

Company Background

UnitedHealthcare Rated A (Excellent) by A.M. Best(2nd Highest Rating Category out of 10)

StudentResources has Over 40 Years Experience Serving Students’ Unique Needs

Access to Resources within UHG to Understand and Apply the Rapidly Changing Regulations that are Exclusive to Student Health Insurance Plans (SHIPs)




Network Strength

UHC Choice Plus versus BCBS of Illinois



Local Network Strength

Preferred Providers within 15 Miles

Facilities• Hospitals: 58• Urgent Care: 11

Physicians• Primary Care: 6,502• OB/GYN: 1,214

Behavioral Health• Facilities: 40• Providers: 1,125

Above counts as of March 2015.


Health Care Reform

PPACA Compliant Student Health Plans2014–2015

Student Health Plans in 2014: Coverage for Pre-existing Conditions Unlimited Annual and Lifetime Benefits Coverage for Pediatric Vision and Dental (up to age 19) 80% MLR with Rebates to Students

• Calendar Year, not Academic Year

• National Aggregation by Insurance Company

All Individual Health Plans: Coverage for State-specific Essential Health Benefits Must fit into Metallic Bands

• Bronze: 60% +/- 2%

• Silver: 70% +/- 2%

• Gold: 80% +/- 2%

• Platinum: 90% +/- 2%


Health Care Reform

PPACA Compliant Student Health Plans2015–2016

Rating Methodology One Premium Rate per Plan per University

• Difference Allowed if Benefits in the Plans are Different

• Difference Allowed for Utilization Differences

Dependent Rate Rules (before PPACA fees)

Spouse = Student

Child = Student

Children = 2x Student

Family = 4x Student


Health Care Reform

What are “Metallic Bands”?


Platinum: 88%–92% Actuarial Value

Gold: 78%–82% Actuarial Value

Silver: 68%–72% Actuarial Value

Bronze: 58%–62% Actuarial Value

Technology: Plan Administration - Customer Service


● Telephony@Work (T@W) System Interactive Voice Recognition (IVR) Allows Students

to Access Automated Confirmation of Coverage and Claim Status Anytime, Day or Night

100% of Incoming Calls Recorded

New for 2015 Improvements to My Account, including

Improvements to Benefit Overviews, Access to Balances and Out-of-pocket Tracking, Knowledgebase, and Customer Service Interactions

Compliance with PPACA Requirements Around Collection/Securing of SSN’s for PPACA Health Insurance Mandate

Technology: Plan Administration - Claims Administration


● Claims Administration Department In-house Claims Adjudication Platform

Customized for Student Business 100% of Audits Performed Pre-payment

• 100% Audit of Claims over $5,000• Random Audit of Claims under $5,000

Accuracy/Quality Goals: 96% Procedural, 98% Financial

New for 2015 Compliance with ICD-10 implementation

according to Federal Guidelines Expanded Use of Web-based Tools to Expedite

Claim Payments

Technology: UHCSR Web Services


School Administrator

Partner Center

• Manage Students• Manage Waivers• Early Enrollments• Insurance Management

Student Health Center Administrator

Partner Center• Ledger Claims• SHC Referrals• Insurance Management

Student

Partner Center’s Student Waiver Tool

• Waiver• Early Enrollment

UHCSR.com(items with * are also available on the UHCSR Mobile App)

• My Account• Plan Brochures• Ancillary Products• Online Enrollment• ID Card*• Recent Claims*• Provider Search*• Contact Link *

Technology: Partner Center Waiver Tools

Online Waiver Tools


Client Waiver Administrator

Partner Center

• Manage Students• Manage Waivers• Early Enrollments• Insurance Management

StudentPartner Center’s Student Waiver Tool

• School-specific Website• Custom Welcome Page• Waive Coverage• Elect to Enroll

Waiver Management Student Management Waiver Requests Enrollment Component Archive eMail Notifications Automated File

Transfers Reporting

Insurance Management Search Insureds View & Print ID Cards

SHC Claims Management Ledger Billing Referrals

Technology: Administrators’ Partner Center Tools


Technology: Ledger Billing


● Claims Entry Upload from SHC Patient Management System Enter into an Online Form Upload Spreadsheet Template

● Automatic Eligibility Verification

● Hold File System Sweeps

Hold File Daily User Deny Ineligible

Claims

● Claims Search

Technology: SHC Referrals


● Streamline ClaimsProcessing Matched to Students

Automatically in our System

Matched to Claim in our System

● Retrieve SubmittedReferral Data Export Search Results

to Excel for ReportingPurposes

Distribution of Electronic Messages to Insureds ID Cards EOBs Claims Letters (including acknowledgement letters) Notifications of Request for Info from Providers

Online Data Input from Insureds Provide Accident Details (upload police reports) Provide Other Insurance Information Authorize Individuals to Discuss PHI (PRA form) Demographic Updates

1095B (“Proof of Insurance” Form) Online Communications to Students Online Input of SSN Online Electronic Consent for 1095B

Technology: Students’ Tools


Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

View, Fax, or Email ID Card

Create an Account

View Recent Claims (60 days)

Provider Search

Customer Service and ClaimsContact Information

Available on GooglePlay and the App Store

Technology: Students’ Tools with Mobile App

Slide 19 of 29

Exclusive to UHCSR insureds:

Technology: Video Marketing


Embedded Video for Parents on uhcsr.com

Email Blasts Link to Video

Sent to Students

Link to Video Sent to Parents

UHCSR Support Team

The UHCSR Support Team

Account Management Team

24/7 Online Tools forStudents and Administrators

START Implementation Process


UHCSR Support Team: START

START Implementation Process

Standard Approach to Implementation Project Manager assigned throughout process

Brings Together all Stakeholders

Processes Include: Preparing New Plan Implementation Obtaining Information Needed to

Administer Plan Documenting and Resolving all Decisions

and/or Issues


UHCSR Support Team: Customer Service


● Customer Service 7:00am–7:00pm, CST (after hours automated support available)

Fields 3,000 Calls Daily from 135 Incoming Lines, and 200 Emails Daily with 24-hour Email Turnaround Time

80% of Calls Answered in 30 Seconds or Less

Spanish-speaking Representatives availableplus AT&T Language Line (160 languages)

● Claims Department 6:00am–5:00pm, CST (after hours

automated support available)

Dedicated Claims Unit

Our highly effective customer service team knows the student market because they only support the student market.

NurseLine

Student Assistance Program

UnitedHealthcare Global

UnitedHealth Allies® Discount Program

Plan Enhancements


Plan Enhancements: NurseLine


NurseLine

24/7 Clinical Nurse Triage Service

Personal Health Management viaTelephone

Registered Nurses with Average 15 Years Clinical Experience

170 Languages via Translation Service

1,100 Pre-recorded Topics inHealth Information Library

Plan Enhancements : Student Assistance Program


Student Assistance Program

Master’s Level Licensed Clinicians available 24/7, 365 a year

Legal/Financial Consultation

National Network of over 2,000 Mediators

Over 90,000 National & Community Resources

Innovative Web-based Services

Solution-Focused Consultation Techniques

Plan Enhancements : UnitedHealthcare Global


UnitedHealthcare Global

Medical Evacuation and Repatriation Benefits Domestic Students Covered Worldwide Except within 100

Miles of Home or Campus International Students Covered Worldwide Except in their

Home Country

Additional Services Include: Dispatch of Doctors/Specialists Monitoring of Treatment Return of Dependent Children Transportation to Join Patient Translation Services Legal Referrals And much more

Plan Enhancements : UnitedHealth Allies® Discount Program


Saving Students Money

Discounts on: Dental and Vision Care Textbooks (through McGraw Hill Professional) Sports Apparel and Fitness Centers Smoking Cessation Programs Weight Loss Programs Nutritional Products Relaxation Resources

Savings of 5% to 50%

Online Provider Lookup

In Closing

StudentResourcesSlide 29 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

Direct Relationship between UHCSR and Loyola University Chicago


One of the Best National Health Care Networks

Personal Service

StudentResources Loyola University Chicago Presented by Slide 1 of 29 15COL3202-1291 Confidential...

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