Loyola University Chicago Presented by Mandy Lance Senior Account Executive 800 -237 -0903 x 6266 mlance@uhcsr. com 15 COL 3202 -1291 Slide 1 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group. Student. Resources
Today’s Presentation Introduction Accessibility to Health Care Reform Technology UHCSR Support Team Plan Enhancements Slide 2 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group. Student. Resources
Introduction What sets us apart? 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 Slide 3 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Introduction Fully Integrated Solution Underwriting Legal/Compliance Customer Service Claims Administration Premium Accounting Marketing Web-based Tools & Resources Slide 4 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Introduction Company Background United. Healthcare Rated A (Excellent) by A. M. Best (2 nd Highest Rating Category out of 10) Student. Resources has Over 40 Years Experience Serving Students’ Unique Needs Access to Resources within UHG to Understand Apply the Rapidly Changing Regulations that are Exclusive to Student Health Insurance Plans (SHIPs) Fully Integrated Administration Slide 5 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Accessibility to Health Care Network Strength UHC Choice Plus versus BCBS of Illinois Slide 6 of 19 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
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 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Health Care Reform PPACA Compliant Student Health Plans 2014– 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 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Health Care Reform PPACA Compliant Student Health Plans 2015– 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 • Children = 2 x Student • Family = 4 x Student Slide 9 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Health Care Reform What are “Metallic Bands”? Platinum: 88%– 92% Actuarial Value Gold: 78%– 82% Actuarial Value Silver: 68%– 72% Actuarial Value Bronze: 58%– 62% Actuarial Value Slide 10 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Technology: Plan Administration - Customer Service ● 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 Slide 11 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Technology: Plan Administration - Claims Administration ● 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 Slide 12 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Technology: UHCSR Web Services Student Health Center Administrator Student Partner Center Manage Students Manage Waivers Early Enrollments Insurance Management Partner Center • • • Ledger Claims SHC Referrals Insurance Management Partner Center’s Student Waiver Tool School Administrator • • • 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 * Slide 13 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Technology: Partner Center Waiver Tools Online Waiver Tools Client Waiver Administrator Student Partner Center • • Manage Students Manage Waivers Early Enrollments Insurance Management Partner Center’s Student Waiver Tool • • School-specific Website Custom Welcome Page Waive Coverage Elect to Enroll Slide 14 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Technology: Administrators’ Partner Center Tools Slide 15 of 29 Waiver Management § Student Management § Waiver Requests § Enrollment Component § Archive § e. Mail Notifications § Automated File Transfers § Reporting Insurance Management § Search Insureds § View & Print ID Cards SHC Claims Management § Ledger Billing § Referrals Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Technology: Ledger Billing ● 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 Slide 16 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Technology: SHC Referrals ● Streamline Claims Processing § Matched to Students Automatically in our System § Matched to Claim in our System ● Retrieve Submitted Referral Data § Export Search Results to Excel for Reporting Purposes Slide 17 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Technology: Students’ Tools 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 1095 B (“Proof of Insurance” Form) § Online Communications to Students § Online Input of SSN § Online Electronic Consent for 1095 B Slide 18 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Technology: Students’ Tools with Mobile App Exclusive to UHCSR insureds: View, Fax, or Email ID Card Create an Account View Recent Claims (60 days) Provider Search Customer Service and Claims Contact Information Available on Google. Play and the App Store Slide 19 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Technology: Video Marketing Embedded Video for Parents on uhcsr. com Email Blasts § Link to Video Sent to Students § Link to Video Sent to Parents Slide 20 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
UHCSR Support Team The UHCSR Support Team Account Management Team 24/7 Online Tools for Students and Administrators START Implementation Process Slide 21 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
UHCSR Support Team: 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 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
UHCSR Support Team: Customer Service Our highly effective customer service team knows the student market because they only support the student market. ● Customer Service § 7: 00 am– 7: 00 pm, 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 available plus AT&T Language Line (160 languages) ● Claims Department § 6: 00 am– 5: 00 pm, CST (after hours automated support available) § Dedicated Claims Unit Slide 23 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Plan Enhancements Nurse. Line Student Assistance Program United. Healthcare Global United. Health Allies® Discount Program Slide 24 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Plan Enhancements: Nurse. Line 24/7 Clinical Nurse Triage Service Personal Health Management via Telephone Registered Nurses with Average 15 Years Clinical Experience 170 Languages via Translation Service 1, 100 Pre-recorded Topics in Health Information Library Slide 25 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Plan Enhancements : 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 Slide 26 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Plan Enhancements : United. Healthcare 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 Slide 27 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
Plan Enhancements : United. Health Allies® Discount Program Saving Students Money Discounts on: § Dental and Vision Care § Textbooks (through Mc. Graw 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 Slide 28 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group.
In Closing Direct Relationship between UHCSR and Loyola University Chicago Fully Integrated Administration One of the Best National Health Care Networks Personal Service Slide 29 of 29 Confidential property of United. Health Group. Do not distribute or reproduce without the express permission of United. Health Group. Student. Resources
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