An estimated 2,000 more students were initially denied the option to waive the Student Health Plan for the 2018-2019 academic year compared to the previous year, according to Christopher Payne, director of administrative services at Cornell Health.
The increase in initial denials — which, if not successfully appealed, change a student’s payment from $370 for a Student Health Fee to about $2,800 for the SHP — is attributed to a change in the process which reviews waiver applications. According to Payne, in the 2017-2018 academic year, 95 percent of waiver applications were approved, as 10,695 out of 11,224 waiver applications were accepted.
According to the Student Health Benefits website, students are automatically enrolled in the Student Health Plan each June for the upcoming academic year, and “eligible domestic students” can request a plan waiver. For a waiver to be approved, four basic components must be met: The insurance needs to be active in the United States, have no policy maximum, be active throughout the student’s academic year and reimburse coverage in Ithaca for at least 70% of charges.
Payne said about 40 to 50 percent of those rejected in past years when requesting the plan waiver appealed the initial denial. Most of those appeals were approved. The total numbers of waiver applications, approvals and appeals for 2018-2019 have not yet been released.
Meghna Srivastava ’19, who had her waivers approved for the previous three years, felt “irritated” that she now had to pay the “premium for SHP with no explanation as to why the requirements had changed.”
According to Srivastava, at the time her waiver was denied, no explanation or clarification was offered on the Student Health Benefits website, and repeated calls to Gallagher Student Health were unhelpful. The SHB website now offers a “2018-19 Waiver Process FAQ” page addressing the waiver denial issues. Srivastava appealed the denial, and her appeal was approved.
Rejections are handled automatically through Gallagher Student Health, the company that reviews the waiver applications on behalf of Cornell Health, according to Payne. This company is supposed to automatically audit applications, and reject those with an out-of-network coverage rate of less than 70 percent.
Recently, Cornell Health discovered that this minimum coverage component was not being audited by Gallagher.
“The waiver requirements have not changed,” Payne said. “The big change was the audit process which yielded a dramatic increase in the number of initial denials.”
The University’s policy reads that students’ insurance must have Cayuga Medical Center in its network. CMC is the only “hospital, emergency room, and diagnostic center that is accessible through public transportation” according to the SHB FAQ answers.
Ithaca College also requires its students to enroll in a health insurance plan. This plan costs $1,795 for a student for the 2018-2019 academic year compared to $2,832 for a full-time student at Cornell.
Payne suggested that the difference in cost could be attributed to many differences in the coverage quality of the plan, including distinct student demographics between the two schools.
According to Payne, one factor behind the cost discrepancy could be “the value level of the coverage that is built into the insurance.” He said another factor might be differences in claims experiences, using the example that a Cornell student who visits the E.R. would pay a flat $100 copay, while an IC student would pay a $50 copay, plus 20% of the cost.
According to Payne, Cayuga Medical Center does not accept UnitedHealthcare plans. UnitedHealthcare is the largest health insurance provider in the country, according to Fortune 500. The Sun could not reach representatives of CMC for comment.
For students who successfully waived the SHB requirement last year but were denied their waiver this year, Cornell Health acknowledged the issue in answers on the SHB website, noting that for some students, “the denial comes as a surprise.” As a result, the University decided to approve waivers for those with at least a 50-percent coverage at CMC. This is currently only a short-term decision, according to Payne.
Students who meet that 50-percent coverage requirement, and who successfully waived last year, must give written acknowledgement of risks associated with not meeting the recommended 70-percent coverage requirement. These risks include high costs and potential delays, according to the SHB website.
Last year, 19,551 students utilized Cornell Health’s resources, according to Payne. All University students — whether on SHP or just paying the student health fee — pay a ten-dollar co-pay for professional services.
Payne said the 70-percent minimum out-of-network coverage requirement is not a national standard, and the Affordable Care Act does not mandate any minimum out-of-coverage requirement.
The established minimum coverage requirement will be discussed in the fall by the Student Health Benefits Advisory committee, according to Payne, who advises the committee. The SHBAC, composed of students, faculty and staff, meets for the first time this academic year in September, he said. The role of the committee is to advise on the SHP, SHP-Medicaid and the Student Health Fee, according to the SHBAC website.
The minimum standard “will likely be the crux of the discussion this fall,” Payne said. “I think the focus will be: Do we set minimum standards for what health insurance coverage looks like, and if we do, what are those minimum standards?”
According to Payne, the committee will aim to release its recommendations by November 1.