National and College health care undergo separate shifts

Last spring as Congress geared up for the current battle over health care reform in both the House and Senate, Vassar College expanded health insurance coverage for students who opt into Vassar's Student Accident and Sickness Insurance Plan. With the Nov. 7 Congressional approval of the Stupak-Pitts Amendment to the Affordable Health Care for America Act—also known as simply "the health care bill"—the issue of coverage for certain procedures under a public insurance option came under scrutiny. But as to whether coming developments in national health care—particularly limits to the public option—will change health insurance coverage for Vassar students, Director of Health Services Doctor Irena Balawajder could only say, "I really don't know."

"We will undoubtedly discuss the impact of legislation with [our provider] Gallagher Koster in the spring term, when we consider our renewal for 2010-2011," wrote Vice President for Finance and Administration Elizabeth Eismeier in an e-mailed statement. But for now, the impact of this legislation is "very hard to say."

Regardless of the outcome of the current health care debate in Congress, in order to attend Vassar, all students are and will be required to be enrolled in a health insurance plan. At the beginning of every academic year, students are automatically enrolled in Vassar's student health insurance plan through the insurance company Gallagher Koster. Students are allowed to opt out of paying for the Gallagher Koster plan if they can prove that they are enrolled in a comparable plan either as dependents on their parents' health insurance plan, or through another private source.

According to Eismeier, enrollment in Vassar's student health insurance plan is down somewhat from years past—there are about 900 students enrolled this semester—despite this year's adoption of an enhanced plan for the 2009-2010 academic year. Enrollment in the plan costs students $934 for the full year, and $556 for the spring semester. Eismeier anticipates an increased volume of students enrolling in the plan for the spring semester.
Balawajder confirmed that "it typically works out so that about 45-50 percent of students over the years have the student health insurance, and slightly over 50 percent don't on an average."

Major Changes in Coverage
Neither Eismeier nor Balawajder could pinpoint why a slight shift has taken place, in spite of expansion of coverage. To give a clearer idea of the extent of the expansion in coverage,  Balawajder said, "The biggest difference is that the previous plan had about a $50,000 maximum and this one has $250,000. That is the single most important difference."

The second major coverage increase is in the way the plan deals with prescription drugs. According to Balawajder, "The previous plan had no prescription drug benefits. But the change in the plan now that students have a prescription card means that they have a co-pay [at the pharmacy]."

Balawajder believes this is an improvement over the previous program, and now students obtaining coverage from Gallagher Koster through Vassar will have access to a wider variety of medications, and be responsible for only a small co-pay at the pharmacy, usually no more than $20 for a $90 drug.

Balawajder emphasized a third change that she considers an improvement to the student health insurance plan: referrals to outside specialists.
Before this semester, "there was quite a large cost if we referred people out to specialists. Now it's really nice that we can refer people to specialists with practically no cost to the student. So they really do have access to some of the best care in Dutchess County" said Balawajder.

Health Services is able to refer students to specialists because Vassar's student health insurance is now part of a "preferred provider" system called MultiPlan in which care from "in-network providers" is completely covered. An in-network provider is a hospital, physician or specialist that agrees to accept a given insurance plan, so that students who are referred to their services will not be required to pay anything. When a student is referred to a provider who is "out-of-network," the Student Accident and Sickness Insurance Plan will pay for 80 percent of the fees.

According to Balawajder, the shift in coverage appears not to have affected Baldwin's operations, except that now "we're writing more prescriptions and referring more people out to specialists."

Student Experiences and Rationale Behind the Shift
Five years ago Vassar conducted a review of its insurance coverage "and selected Koster—now Gallagher Koster—as the broker," said Eismeier. She continued, "We recognized the limits of the past policy" and developed ways "to make sure that the student policy had higher limits and broader coverage."

Part of the decision came from a review of the coverage at Vassar's peer institutions. The New York State Council on Independent Colleges and Universities recommended Gallagher Koster to the College because it is the most favored insurance company for its member colleges and is considered a "high quality and cost effective" insurance carrier, according to Eismeier.

Balawajder praises Gallagher Koster for its accessibility to students and believes that may be part of the reason why it is so preferable for independent colleges such as Vassar. The company has a website (gallagherkoster.com) dedicated to Vassar's plan in particular. It includes a "Frequently Asked Questions" section and a variety of resources and documents for help filing claims and understanding what procedures and medications are and are not covered by the plan.

However, that didn't mean that students are always satisfied with their coverage. Last year Mandana Nakhai '10 underwent a minor medical procedure with an off-campus provider,and she described her experience with Vassar's insurance plan as "underwhelming." Nakhai attempted to pay for the procedure using her student health insurance card, but received a confusing response from the specialist she saw.
"I got a call from the people at the doctor's office off campus, and they said that Vassar's insurance might not cover it and that I wouldn't find out until afterwards," said Nakhai. "It was a small procedure, but the hospital bills would have been huge."

Nakhai, who is also enrolled as a dependent on her mother's insurance through the University of Arizona was able to pay for the procedure with the University of Arizona insurance.  Without her secondary plan, "I guess I just would have had to pay for it myself," said Nakhai.

Nakhai has not had any problems with Vassar's Gallagher Koster plan this year, although she admitted that this year she hasn't required medical care the way she did the previous year. Whether it's an improvement, Nakhai wasn't able to say, but she doesn't consider it worse than last year's coverage.

Every spring the office of Risk Management and Insurance—a subset of the office of Finance and Administration—meets to decide either to renew or to amend the insurance Vassar offers. The office of Risk Management and Insurance works with Health Services, Student Accounts, and the Benefits Manager in Human Resources to review the plan.
Additionally, according to Eismeier, the most recent changes to the coverage were decided in conjunction with the Dean of the College, the Dean of Students, and the Assistant Dean and Director of International Programs. When the committee met last spring, it decided to up Vassar's revised coverage in part because of in-network issues like Nakhai's in the spring of 2009.

The Role of Health Services
Balawajder is the first to admit that the "world of insurance" is confusing and pointed out that part of why Baldwin Health Services exists is to work with students and insurance companies and help explain how it works to students. We walk students through what health insurance is because [students] are health care consumers—but also health care learners—and this is part of an education."

One of the primary health concerns for undergraduates is the fact that "unexpected things can happen, and they do happen," said Balawajder. "The thing is about student health service is that we also try and educate students about what insurance means and how to work it."

Health Services will provide students with guidance and aid filling out forms and learning how to make a claim, regardless of whether a student is enrolled in the Vassar plan or not. 
When a student visits Baldwin and care is provided without aid from an outside provider—such as a specialist or hospital—the student incurs no fee. Students pay an annual health care fee to the College regardless of insurance enrollment, which goes toward care at Baldwin. Payment for medical treatment only becomes more complex when a student requires the joint care of Baldwin and an outside provider.

For example, suppose a student requires a blood test. The staff at Baldwin can collect the actual blood sample, but it then sends the sample to an outside lab for testing.

For a student on the Vassar insurance plan, all fees are covered, and the student will never see a bill for this service. Alternatively, a student covered under her home insurance plan will receive a bill for that service and will be responsible for filing a claim with her insurance company.

Lessons Larger than the College
"Some people say that student health insurance is a good model, in some sense, for health care systems" said Balawajder, "because you have a good primary care service and easy access to appointment times, and then a good referral when necessary." Despite any complaint Vassar students may have with Health Services, students are more likely to see medical staff more quickly at school than at home. Getting an appointment at Baldwin is often easier than it would be to get an appointment with a primary care doctor outside of the College. Balawajder continued, "One of the things you have to realize is that the student health service really provides students with easy access to care." 

Balawajder considers the plan likewise cost –effective. "By having a sort of primary provider group [at Baldwin], that really lowers costs by having skilled staff who know where to make the referral that also cuts down on cost if you're talking about health insurance costs, and also if you're talking about good practice."