Penn State Re-signs Aetna For 2015-16 Healthcare Contract

After what the Graduate and Professional Student Association calls a “competitive bidding process,” Aetna was again selected as the Penn State Student Health Insurance provider. The plan is considered a platinum value plan, one which covers the highest proportion of expenses allowed to be covered by an individual plan under the Affordable Care Act. Aetna will cover “nearly all” visits and procedures at University Health Services, the GPSA website says.

Though the complete plan brochure has yet to be released, a summary of the plan is available below, via the GPSA website:

  • Annual Deductible: $250 individual/$500 family
  • Out of Pocket Limit: $1,300 individual/$2,600 family in-network; $15,000 out-of-network
  • Non-UHS Primary Care Physician Office Visit: 100 percent after $10 copay preferred care/30% coinsurance non-preferred care
  • Specialist Physician Office Visit: 10 percent coinsurance preferred care/30 percent coinsurance non-preferred care
  • Outpatient Mental Health: 100 percent after $10 copay preferred care/30 percent coinsurance non-preferred care
  • Inpatient Hospitalization: 10 percent coinsurance preferred care/30 percent coinsurance non-preferred care
  • Emergency Room: 10 percent  coinsurance after $150 copay (waived if admitted)
  • Lab/X-Ray: 100 percent at UHS/10 percent coinsurance preferred care/30 percent coinsurance non-preferred care
  • Prescribed medicines: 100 percent at UHS and Hershey Medical Center/$10 (generics); $30 (formulary brand name); $60 (non-formulary brand name) copay in-network/50 percent coinsurance out-of-network
  • Treatment at UHS: 100 percent coverage with deductible waived

The plan also includes annual premiums of $3,195 for first-year medical students; $3,054 for undergraduate, graduate, law, and medical students; $3,054 for spouses and dependents of students; and a $254.50 monthly premium for visiting scholars. Graduate students with assistantships or fellowships will have part of this premium subsidized, and while the exact amount remains undecided, last year the university subsidized 80 percent of the premium cost. These premiums reflect a 7.8 percent increase for students, but a 57 percent decrease for spouses. ACA requirements state that premiums for individuals within the same age bracket cannot be different for individual care plans, so spouses and student rates are similar, as are rates for each dependent. The GPSA website notes that the plan premiums are subject to annual adjustment based on overall cost changes, utilization, and total enrollment in the plan.

Just as in the 2014-15 plan, prescriptions at UHS and Hershey Medical Center will still be fully covered, and prescriptions at out-of-network pharmacies will be covered at 50 percent. There is more flexibility built into the new 2015-2016 plan, as well. Prescriptions at pharmacies beyond the Aetna provider network will be available for $10, $30, or $60 copays.

Changes to Penn State’s healthcare plan were necessary after the Affordable Care Act implemented guidelines that required individual care plans, like Penn State’s student plan, to follow particular requirements for funding from the insurer. The current and upcoming plans that Penn State signed Aetna for are “platinum plans,” in which the insurer covers about 90 percent of an individuals healthcare costs. This is a drop from pre-ACA plans, in which the insurer covered closer to 99 percent. This drop in coverage was met with criticism from the student body, as any healthcare beyond UHS carried with it a high deductible that students said deterred them from seeking care.
After this drop in coverage, “the GPSA health insurance committee, as well as the health insurance liaisons, began working on gathering information from the student body about what they would like to see with regard to plan design in the future,” GPSA Representative Alison Franklin said. “The most significant concern we heard was with regard to mental health care and children who cannot be seen at UHS.
“The health insurance liaisons who serve on the Student Insurance Advisory Board went back to administration and Aetna relaying what the students preferred,” she added.
Franklin said she’s fairly satisfied with the outcome of the 2015-2016 negotiations. Students especially sought copays for mental health, primary care physicians outside of UHS, and prescriptions outside of UHS, she said, which are all present in the updated plan.
“Although I and others would have liked to see the premium rates lower, the rates that Aetna quoted us were among the most competitive,” she said.

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About the Author

Melissa McCleery

Melissa is a senior majoring in Women’s Studies, Political Science, and Spanish. In the little free time she has, Melissa likes to cook, spend all her money at The Phyrst, and add to her collection of blue and white striped clothing. She can be reached via Twitter (@mkmccleery) or email ([email protected]).

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