university health plans, inc. student health insurance plan presented to:

University Health Plans, Inc.

Student Health Insurance Plan Presented to:

UNIVERSITY HEALTH PLANS

UHP’s Success

•20+ years experience

•Pioneered web-based enrollment/waiver system

•100% Student Health Programs

•60 College and University Clients

•Accountable Management/Decision Making

UHP’s Client Services

•Represent the Client

•Competitive Premiums

•Enrollment/Waiver Billing


UHP’s Client Services (continued)

•Customer Service

•Student/Client Advocate

•Secure Website

•Toll Free Number

•On-Site Training Available


UHP’s Client Services (continued)

•Quarterly reviews/discussions

•Plan Evaluation/Plan Design

•Claim Reports

- detailed claims analysis

- claim run-out

- prescription drug detail


UHP Client Services (continued)

•UHP claims audits

•UHP is the student/client advocate

•UHP’s complimentary products

•State Reports


Customized On-Line ServicesUHP has developed several on-line resources to meet the needs of each school:

•Brochures and other forms on-line or downloadable

•On-Line Waiver and Enrollment

•On-Line Eligibility look-up

•On-Line Claims Status look-up

•On-Line ID Card request

•Preferred Provider and Member Pharmacy look-up

UNIVERSITY HEALTH PLANSwww.universityhealthplans.com

BCBSMA PromiseTo Always Put Our Members’ Health First

Blue Cross Blue Shield of Massachusetts

Your long-term partner should have a long-term vision

Our Mission…Our Philosophy

Blue Cross Blue Shield:

• Social Contract

• Long-term cost & quality focus

• 1% - 2% contribution to reserves

• Views healthcare delivery and administration as local with a national reach (one size does not fit all)


Membership & Growth Year end 12/31/06

• Total Members 3,050,000• New members 128,800• Dominant market share 40%

Service ExcellenceYear end 12/31/06

• Strong Member Satisfaction 85%• Strong Provider Satisfaction 88%• Account Retention 95.8%

Financial StabilityYear end 12/31/06

• Earned Premiums $6.81B• Cash & Investments$2.6B• After Tax Net Income $122M• Statutory Reserves $1.6B

World Class Performance...Sustained Excellence

Why Choose Blue?


Brand Strength

• #1 market share in all 50 states

• Most recognized brand inhealthcare among consumers

• #1 in delivering the lowest overall costs (Fortune Magazine, Sept. 2005)

• 75% of Fortune 100 companies (9 of the top 10)

• 94 Million covered lives (1 in 3 Americans)

Unaided Brand Awareness

10%

18%

24%

CIGNA

United

Aetna

71%

Source: Brand Strength Measure Survey (2005)

The Blues are the Brand leaders among employers and consumers

Network Access and Discounts


*Includes Adult PCPs, Pediatricians, Ob/Gyns, Specialists

The Blue Cross Blue Shield Network Advantage

Local Networks• Over 15,000 providers*• 85 hospitals• Stable mature networks (consistent local benefit delivery)

Regional Networks• Over 32,000 providers*• 181 hospitals throughout New England• Stable mature networks (consistent regional benefit delivery)

National Networks• Over 1,000,000 providers*• Over 6,000 hospitals• Stable, mature networks (consistent national benefit delivery)• Only nationwide network with secondary and rural locations

More claims processed in-network provides savings; unsurpassed access to care allows consolidation ease

Benefit to Bentley College

Benefit to Bentley College


The Blue Cross Blue Shield Network Advantage (cont.)

Assessing network value:

• Low unit cost (per claim discounts)

• Care Management (utilization controls)

• Depth & Breadth of networks (access to care)

Blue Cross Blue Shield is the recognized industry leader in network value


Healthy Member Interventions

Prevention and wellness communications and programs

• Healthy Blue Programs

• Worksite Wellness Programs

Comprehensive e-health and communication strategies to address a large population with non-complex health issues

• www.ahealthyme.com

• www.bluecrossma.com Award Winning Web Sites


Healthy Blue Programs

Support: • LIVING HEALTHY Babies• Living Healthy Smoke-Free• Blue Care Line – 24/7; (888) 247-BLUE• DecisionCare Guide

Campus Wellness• Healthy Blue at School• Personal Edge (fee for service)

Incentives: • Fitness Benefit - $150 per yr.• Weight Loss Benefit - $150 per yr.• Discounts (bike helmets, safety products)• Living Healthy Naturally:

— 20% discount on acupuncture, massage therapy, nutrition counseling

• Living Healthy Vision:— Up to 25% discount (frames, lenses,

contacts)


Care Management

Program Goals

• improve health status, quality of life, lower rates of complication and inpatient admissions

Member Identification

• claims data, PHRAs, episodes of care, physician referral, member referral

Specialized Programs

• transplants

• outpatient therapies

• pediatric focus

• rare diseases – multiple sclerosis, cystic fibrosis, Parkinson's


Blue Cross Blue Shield’s View of the Future…

Old Thinking: Quality is a given. So, contain costs.

• Gaps in care

• Unsustainable rise in costs

• Think once, Order twice

• Pay for metrics (HEDIS based)

New Thinking: Promote quality and costs will be contained.

• Fewer adverse events

• Reduced waste

• Think twice, order once

• Pay for performance (evidence based)

© 2006 Blue Cross Blue Shield Association. All Rights Reserved.


Claims Processing

• Average turnaround time – 3.6 days (year end 2006)

• Auto adjudication rate – 91.2% (year end 2006)

• Claim payment accuracy – 99.7% (year end 2006)

• Financial accuracy – 99.9% (year end 2006)


BCBSMA Student Business

• History— Harvard University

— Massachusetts Institute of Technology

— Northeastern University

— UMass Dartmouth

— UMass Worcester

— Berklee College of Music

• Underwriting Rationale


Bentley College Student Plans

• PPO Benefit Plan

— Referrals not required

— 100% in-network nationally

— 80% out-of-network nationally


PPO Benefits (option 1 – 100/80)Benefit In-Network Out-of-Network

Maximum Unlimited Unlimited

Deductible None $250 per member

Office Visits $15 Co-Pay then 100% 20%*

Emergency Room $50 Co-Pay then 100% $50 Co-Pay the 100%

Maternity Care (inpatient) No charge 20%*

Vision Exam Co-Pay then 100% 20%*

(1 per 24 mos.)

Prescription Drugs (ESI) $10/$25/$45Co-Pay ** Not Covered

*Deductible applies

**No annual maximum

Option 1 = $984.00 annual student rate (add $5.00 for on-call travel assist and $3.00 for $10,000 AD&D coverage)




Deductible $250 per member*** $250 per member***


Emergency Room $100 Co-Pay then 100% $100 Co-Pay then 100%

Maternity Care (inpatient) 10%* 30%*

Vision Exam $15 Co-Pay then 100% 20%*

(1 per 24 mos.)

Prescription Drugs (ESI) $10/$25?$45 Co-Pay ** Not Covered

*Deductible applies

**No annual maximum

***In and out-of-network combined





Deductible $250 per member*** $250 per member***


Emergency Room $100 Co-Pay then 100% $100 Co-Pay then 100%

Maternity Care (inpatient) 20%* 40%*

Vision Exam $20 Co-Pay then 100% 20%*

(1 per 24 mos.)

Prescription Drugs (ESI) $10/$25/$45 Co-Pay ** Not Covered

*Deductible applies

**No annual maximum

***In and out-of-network combined



Blue Cross Blue Shield

Member Services

https://www.bluecrossma.com/member/view/MSSLogin/MSS_login_page.jsp?goto=https://www.bluecrossma.com:443/member/service/?headerRepId=Repositories.HeaderButtons.memberSelfService.xml&levelOneCategory=GENERAL&targetTemplate=titleBody.jsp


Why Choose Blue?

• Brand strength and value

• Network access and discounts

• Innovative products and health care solutions

• World class concierge service

Uniquely positioned to be Bentley College’s long-term partner

Nationwide Life Insurance Company

http://www.nationwide.com/nw/index.htm


Nationwide Facts:

•Rated A+ by A.M. Best

•Insuring student plans for over 6 years

•$100 Million in student insurance premium

•$30 Million in UHP/Nationwide premium

•Access PPO’s for best possible discounts, including

Multi-Plan/PHCS and FirstHealth (HCVM, CCN)

•ExpressScripts Rx Plan

Consolidated Health Plans (CHP)Claims Administration Services

CHP Facts:

•Headquartered in Springfield, MA

•Providing claims payments services for over 10 years

•Over 100 College and University clients

•$40 Million in paid claims

•Flexible Benefits


CHP Claims Payment Statistics:

•Average turn around time 5-7 business days on “clean”

claims

•Payment at 99% accuracy

•Random audits performed to ensure consistent accuracy

•Utilization review on claims over $10,000


CHP Customer Service Statistics:

•Same day response for calls received before 2:00 pm

•24 hour response time for all email inquiries

•Continual customer service training to ensure accuracy of

responses


CHP On-Line Services:

•Available 24/7

•Eligibility status look-up

•Claims status inquiry

•On-Line “EOB”, including date of service, payment date,

PPO savings, patient responsibility, etc.

•Preferred provider look-up

•On-line/printable brochure

Member Services

http://www.consolidatedhealthplan.com/student_health/your_school.html


Option 1Benefits

Aggregate Maximum $50,000 Per Condition per Policy Year

Physician's Office Visit 100% after $15 Copay In-network or $25 Copay Out-of-Network

Emergency Room 80%

Inpatient Hospitalization 80%

Surgical Charges 80%

Lab and X-Ray 80% (100% for labs when samples are taken or drawn at Health Services)

Prescription Drugs 100% after $10 copay for generic or $15 copay for brand name $500 maximum per Policy Year

Premiums

Student Only $828.00

Spouse Only $1,800.00

Child Only $1,325.00

2nd Year Cap of no more than 14%


Option 2

Premiums





Benefits

In-Network Out-of-Network

Aggregate Maximum $50,000 per condition per policy year $50,000 per condition per policy year

Physician's Office Visit 80% after $15 copay 70% after $15 copay

Emergency Room 80% 70%

Inpatient Hospitalization 80% 70%

Surgical Charges 80% 70%

Lab and X-Ray 80% (100% for labs when samples are taken or drawn at Health Services)

70% (100% for labs when samples are taken or drawn at Health Services)

Prescription Drugs($500 max per policy year)

100% after a copay of $10 generic or $15 for brand name



Option 3

Premiums





Benefits

In-Network Out-of-Network

Aggregate Maximum $50,000 per condition per policy year $50,000 per condition per policy year

Physician's Office Visit 100% after $15 copay 80% after $15 copay

Emergency Room 100% 80%

Inpatient Hospitalization 100% 80%

Surgical Charges 100% 80%

Lab and X-Ray 100% 80% (100% for labs when samples are taken or drawn at Health Services)

Prescription Drugs($500 max per policy year)




Benefit Modifications

Benefit Modification Student Only Rate (Dependents will be proportional)

1.) Increase maximum prescription drug coverage to $750 $18

2.) Immunizations (all combined) $11

3.) Routine physicals (up to $100 per year) $12

4.) STD screening package (all combined) $10

university health plans, inc. student health insurance plan presented to:

Documents

members health

sustained excellence

uhps client services

uhp client services

student health programs

online resources

student health insurance

uhp claims audits uhp