studentresources loyola university chicago presented by slide 1 of 29 15col3202-1291 confidential...
TRANSCRIPT
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
Slide 4 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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)
Fully Integrated Administration
Slide 5 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Accessibility to Health Care
Network Strength
UHC Choice Plus versus BCBS of Illinois
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Accessibility to Health Care
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.
Slide 7 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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%
Slide 8 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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
Slide 9 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Health Care Reform
What are “Metallic Bands”?
Slide 10 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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
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● 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
Slide 12 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
● 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
Slide 13 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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
Slide 14 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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
Slide 15 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Technology: Ledger Billing
Slide 16 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
● 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
Slide 17 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
● 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
Slide 18 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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
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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
Slide 21 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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
Slide 22 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
UHCSR Support Team: Customer Service
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● 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
Slide 24 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Plan Enhancements: NurseLine
Slide 25 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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
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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
Slide 27 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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
Slide 28 of 29Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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
Fully Integrated Administration
One of the Best National Health Care Networks
Personal Service