Aetna Student Health Waiver Audit Program
Make sure your students are insured.

Requiring insurance is becoming a standard practice at universities. Yet, administering the school’s health insurance requirement involves multiple steps to ensure students understand and make the right decisions about their health insurance needs. Aetna Student Health offers a waiver audit program to assist universities in the management of their requirement policy. Our program includes on-line administrative tools, data analysis, reporting, customer service and plan communications support. By participating in the audit program, clients will be able to:

• Validate waivers through a random or targeted audit
• Compile data on waiver results
• Determine common plan limitations
• Develop critical coverage requirements for the campus

This past year, 25 schools participated in the Aetna Student Health audit program. We found a waiver failure rate of student data among the participating schools to be an average of 9%-- meaning we were able to confirm that the student either didn't have insurance or had coverage that did not meet the school's waiver requirements.

Why utilize an audit waiver program?

Requiring students to carry adequate insurance can assist universities with promoting access to health care on their campus. Without adequate coverage, a student could have financial burdens and health issues that would impede their ability to stay in school. Although a requirement may aid in limiting this issue, students may not understand how their current plan compares to the school sponsored plan, and choose to "waive out" of the school plan – whether their current plan meets school requirements or not. They should look at premiums, deductibles, benefits provided and time covered when comparing plans.

To summarize, we have found that failed waivers are largely due to the following missed criteria:

• Plan is with an out-of-state HMO (where local coverage was limited). For example, it cannot be confirmed how/if an out-of-area HMO program will work on campus in another part of the country. Many students waive the university plan even though their other coverage has limited access to emergency services when in the campus area.
• Student has an international insurance plan with limited coverage.
• Current plan is an emergency or prescription plan only.
• Plans have a coverage termination date prior to the end of the academic year. Aetna Student Health plans cover the entire calendar year.

"Some parents and students do not realize that their employer plans may not be the best option,” according to Barbara Madden, Vice President, Aetna Student Health. "It only takes one high visible student accident or difficult medical situation before a university starts discussing the concept of mandating insurance for students."

Important Features of the Audit Program

• Online hard waiver system -  An online hard waiver system is an integral element of our audit process. The tool captures waiver information, generates emails on status of the audit and supplies reporting and viewing capabilities regarding audit results.  The system has the capability of selecting waivers for audit based on a pre-defined percentage of submitted waivers or configured by specific student types, insurance carriers or plan types.
• Reporting - Waiver audit reports including details of the transactions are sent to the school on a daily or weekly basis.
• Customer service process - The entire Aetna Student Health customer service staff is trained on each school’s unique process, so they can effectively manage calls from parents and students.
• Plan communication - Students and parents continue to be challenged by the unique process of comparing health plans and assessing their individual insurance.  We can never communicate enough to students (and their parents) on the importance of considering health insurance as a critical part of their planning process. While important information is contained in brochures, additional materials are provided by Aetna Student Health to help clients communicate the plan.

To learn more about the Aetna Student Health online waiver and auditing capabilities, contact your Account Executive. If you are not currently an Aetna Student Health client and would like to learn about our solutions and services, contact our sales department at 1-877-480-3843.

Aetna SmartSource^SM
Helping students find health information and resources easily.

Aetna SmartSource^SM, Aetna’s industry-leading health information online search tool, is now available to all registered Aetna Navigator® users. It scans Aetna’s vast resources to deliver relevant information specific to the user and their search topic. This means that users no longer have to search multiple websites because Aetna SmartSource makes it easy for your student members to access a host of services and products already available to them through one central source.

Aetna SmartSource:

• Is personalized and relevant to the user: Members receive information based on their individual profile, including gender, age, zip code, and health plan so the search results are relevant to their specific health care needs.
• Brings resources together: This one reliable online location provides data gathered from across Aetna’s vast resources, including such tools as Aetna InteliHealth® (health and symptom information), DocFind® (to locate providers), Cost of Care (average costs for various services), Reawakening Center (emotional health).
• Delivers easy access to other Aetna resources: Members are directed to products and services already available to them that can help them make better health decisions and save money.

SmartSource also can use a member’s personal health experience to refine the information to be more specific to the member.  This easy search ensures more relevant and useful results for members. But as sophisticated as this technology is, the beauty of it is that it delivers a very intuitive, easy-to-navigate online experience for the user.

Already, Aetna SmartSource has been identified as a differentiator in the marketplace. It has been featured in articles in the New York Times, Wall Street Journal, and other newspaper online news sites and blogs. In November, SmartSource received a merit award for the National Health Information Awards program for best Health Promotion Web Site in the Insurance Company category. The National Health Information Awards program is organized by the Health Information Resource Center (HIRC), a national clearinghouse for consumer health programs and materials. This awards program recognizes the best consumer health information materials and programs from organizations throughout the nation.

If you’d like more information about Aetna SmartSource, or test drive what your students see when they use the tool, please click on aetna.com/showcase/smartsource/.

Aetnastudenthealth.com is in the news!

The recent Wall Street Journal article, Fit on a Budget, highlights Aetna Student Health wellness tips and tools for college students.

Aetna Student Health provides a wealth of information and tools that will help your students keep informed and on a budget. Make sure your students check out our wellness resources and Facebook page – both updated regularly with relevant information. Better yet, provide a link into our wellness resources page on your school website. Need help, contact your account manager and we will work with you to Fan us on Facebook.

Protect Your Athletes – Provide a Sports Accident Policy

When it comes to student health insurance, it is important to consider the unique requirements of college athletes.  Even if you offer a student health insurance plan, you may want to add an additional sports accident plan for intercollegiate, club/intramural sports teams and athletic departments.  And here’s why.  Students who sustain a sports injury may be left with large and unexpected medical bills, even if they are covered by an insurance plan. Many health insurance plans exclude coverage for Intercollegiate sports or provide limited coverage for Intramural and Club sports.  If a student is under their parent’s plan, coverage may also be limited for out-of-state treatment.  To address this issue, the National Collegiate Athletic Association has started requiring universities to make sure athletes have insurance before competing, although the type of insurance is not mandated.  This means the athlete could still have inadequate coverage if injured, putting both them and the university at risk.  The N.C.A.A. does offer catastrophic insurance, but the deductible will soon be $90,000, a very high cost to incur before getting financial support.  All these factors point to the need to add supplemental sports insurance.

A sports policy is separate from the student health insurance plan in that it is designed to cover sports related injuries only.  It usually requires mandatory enrollment, is considered secondary coverage to another plan, and is managed and paid by the athletic department. By offering a sports plan, an institution protects itself from potential liability from students injured in a school-sponsored sport.  It isolates claims related to sports, so the loss experience is not passed on to the student medical plan.  Also, no matter when the injury occurs, you can choose how many weeks of coverage your students receive – usually 104 week benefit period. This means if an athlete is injured 2 days before the plan ends they still will be covered for the time specified, enabling them to get the physical therapy required or any other pertinent follow-up treatments.

When looking at a sports policy, you should take into consideration the participation your school has with intercollegiate athletics such as the NCAA (National College Athletic Association), NAIA (National Association of Intercollegiate Athletes), and the NJCAA (National Junior College Athletic Association).  Based on your school’s level of participation, you can determine what type of plan is the best fit.   Make sure to review the options available to you from various carriers.  If you have a student health insurance plan, it would make sense to obtain the sports plan from the same company for a more unified approach. 

As a leader in student health insurance, Aetna Student Health offers customized sports plans designed to protect intercollegiate, club and intramural sports teams and athletic departments for games, practice, competition and special events, as well as travel to and from competitions. Working with colleges across the United States has provided us with the experience and insight needed to help develop a plan that meets the unique needs of each university.  Below are some of the advantages of an Aetna Student Health sports policy:

• Coverage to coaches, athletic trainers, managers or staff members in addition to athletes.
• A.M. Best rating of A (excellent)*
• Flexible plan development for each college or university's unique sports needs
• Access to Aetna’s nationwide network of healthcare professionals

Creating and managing an insurance plan can take a lot of time.  Instead of leaving that burden to you, we organize a multi-disciplinary team to set up the plan.  Once the policy is in place, we provide unified and dedicated plan administration, including a single point of contact to manage the coordination of benefits and claims processing.   With this kind of support, management of the plan is easy.  Your athletic department can focus on what they do best – sports.  Plus, most important, your athletes and school are protected with a customized sports accident policy.

For more information about at Aetna Student Health sports plan, please contact your broker or your school account manager.

*Aetna Annual Report 2006

Top Ten Customer Service Questions

Ever wonder what happens when our customer service representatives interact directly with your students and their providers? We’ve compiled a list of the Top 10 most popular inquiries from students and providers calling our customer service center. Trained to answer questions in a timely and effective manner, our customer service staff is here to help.

• ID card requests – Students call because they have not received their ID card.
• Claim status/Explanation of Benefits (EOB) inquiry – Students call because they received a bill from their doctor or an EOB and do not understand why the plan did not pay any/some of the charges.
• Claims status – Providers call as they have not yet received EOB/check for services.
• Pre-existing condition investigations – Providers and students call in about pre-existing condition investigations. Providers often need to send in response to a letter they received requesting information. 
• Benefit details – Students simply asking "I want to know what this plan covers” with minimal or no prior knowledge of their plan.
• Benefit details – Providers call to inquire about copay information, referral requirements, etc.
• Eligibility dates – Providers call to confirm that a member is still actively covered.
• Coordination of benefits – Providers call to determine if we have other insurance listed on file for a particular member so they can coordinate that member’s benefits.
• Enrollment questions – Calls typically come in from parents who are considering removing their child from their plan and would like to find out more about what our coverage offers.
• DocFind® search help – Students/parents call when they have difficulty navigating the DocFind site, particularly when it comes to searching for specialists.

Fully insured school health insurance plans are underwritten by Aetna Life Insurance Company (ALIC) and administered by Chickering Claims Administrators, Inc. (CCA). Self insured plans are funded by the applicable school, with claims administration services provided by Chickering Claims Administrators, Inc. Aetna Student Health is the brand name for products and services provided by ALIC and CCA.