Health insurance in the United States can be complicated and confusing, especially since there are many parties involved in making sure that your plan runs smoothly and seamlessly. In this blog, we are going to explore who these parties are, what they do, and how they work together to provide care for your students in the event they need medical care.
What is an insurance company?
The insurance company also referred to as the insurer, assumes the risk of an insured. The insurance company creates a quote, sells the policy, provides coverage, and pays out the claim. The “insurance company” is a general way to refer to insurance, but depending on your plan structure, there can be many additional parties listed under this umbrella that we will explain below.
What is a third party administrator (TPA) or plan administrator?
Insurance companies can also outsource various duties to a third party administrator (TPA). A TPA is an organization which can assist in managing an insurance plan. They can be responsible for the underwriting which includes pricing and plan design. They may also be instrumental in providing customer service for their members, and process the claims in-house.
What is the insurance plan’s network?
A provider network is a list of contracted doctors, hospitals and clinics that members can go to for medical treatment. Because of the contract in place with these providers, they often offer discounted rates, direct payment and ease of claim filing. Insurance companies may have their own network or they may also contract a separate network for their members to use.
Who is the assistance company and what do they do?
Insurance companies may also work with an assistance company that provides emergency transportation and arrangements in case a crisis occurs. While this may be a service offered in-house by the insurance companies or TPAs, in many cases the insurance company will use an outside company that has worldwide relationships to coordinate care around the world.
Who is the underwriter?
The underwriter is a separate organization that insures and spreads out the risk that the insurance company is taking on. Insurance plans are typically backed by an insurance carrier that will help cover the expenses in case the insurance company is unable to pay. Examples include Sirius International and Lloyd’s of London, and it’s important to verify their ratings through third parties such as AM Best and Standard and Poors.
What does a broker do?
The responsibility of a broker is to understand the health insurance needs of their clients and work with the insurance companies to provide adequate coverage. A broker’s role is to offer guidance and outline the various pros and cons of potential plan options, so that informed decisions can be made, along with having an extra layer of support for those insured on a plan.
Depending on the insurance plan, there may be multiple parties at play. Before signing an insurance contract, it is important to understand how the insurance is set up, who the parties are involved, and how they all work together.
If you are looking for health insurance, ISI is an insurance broker that has been a trusted industry leader since 2001. ISI specializes in international students offering both group and individual plan options. Learn more about us!
This year, so far, has been a transformational one for higher education. Many colleges and universities have decided to offer only remote, virtual programs; offer a hybrid of virtual and in-person; have opened completely only to move to virtual programs in light of COVID-19 infections among students who returned to campus. For those on campus, students and faculty are being asked to perform a daily health screening and are required to wear face coverings. Schools are also attempting to limit large social gatherings of students as that seems to be the nexus of where the contagion spreads.
COVID-19 presents unique challenges for colleges and universities. It has rewritten how they offer education; safety services and preserve their financial health. And the end is not in sight. A recurrence is beginning in most parts of the country and the most apparent decision schools must keep their campuses safe is to close/continue online programs throughout the Fall.
While the country continues to battle the coronavirus, college health professionals are also monitoring a growing crisis among young adults struggling with mental health problems, including suicidal ideation, anxiety and depression related to the pandemic. Several recent surveys of students suggest their mental well-being has been devastated by the pandemic’s social and economic consequences, as well as the continued uncertainty about their college education and post college careers. Still reeling from the emergency closures of campuses across the country during the spring semester and the sudden shifts to online instruction, students are now worried about the fall semester and whether campuses that reopened for in-person instruction can remain open as COVID-19 infections spread among students and panicked college administrators quickly shift gears and send students who’d recently arrived back home.”
Student mental health has always presented challenges for colleges and the COVID-19 pandemic situation has increased the awareness of this issue. A way to address some of the issues that students are struggling with is telehealth and teletherapy which have become quite prevalent during COVID-19. Not only does this provide almost immediate access to care, but it also provides the confidentiality that most college students want when attempting to deal with mental health issues.
All of this is occurring with a backdrop of overall decreasing college enrollments which is not solely the cause of COVID-19. The numbers of college age students in the US have been steadily dropping over the last 10 years and institutions must look elsewhere to fill those gaps. The best way is to recruit more international students and from areas other than the traditional locations—China and India. And to do that, recruiters need to adopt a more international lens to recruitment.
One of the best ways to help ensure the health, attraction and retention of students is with a health benefit program that align/addresses the needs of both the students and the school. COVID-19 has presented many health challenges and it is imperative that benefit programs offered to students reflect and align with the current needs. Does the program cover all COVID-19 related health issues? Does it offer coverage for pre-existing conditions? Is adequate coverage for mental health included and does it offer Telehealth benefits? With all the pandemic issues and regulations facing schools today, it is important that they can design benefit programs that meet all the needs of the institution as well as those of their students.
In this ever-changing landscape of healthcare, delivering benefits that are comprehensive; competitively priced and supported with a concierge-level of customer service takes experience, expertise and a singular focus and commitment to and a full understanding of the international student and business travel market.
International Student Insurance believes that one-size doesn’t fit all. We work with our clients to understand their insurance/risk objectives and develop tailored programs that best fit their needs and those of their students and/or business travelers.
Now is the time when many schools are looking to evaluate their group insurance options. There is often a lot of confusion about the process and what you actually need to provide to get a new quote. You may ask yourself, why are they asking for my current brochure? Why do they need to know the cost of my plan, shouldn’t they be able to tell me what the price is? Or, you may be wondering why they are requesting a copy of your group’s claim history and if this is necessary information to share. In this blog, we hope to provide some clarity and transparency about what information is useful, why it is requested, and how it will impact the proposal you receive.
Initial Discussion
Whether you are speaking directly with the insurance company or a broker, you will likely be asked many questions after expressing interest in getting an insurance plan quote. Commonly asked questions include:
How many students do you have?
What are their ages?
What is the average length of stay?
What type of visas are they on?
Can you provide your insurance brochure and current price?
Proposed plan design if different from in-place plan
What is your renewal rate?
Can you provide your claims history for the last 3 years?
Will your plan be mandated? If there is a waiver, who can waive and under what circumstances?
This may seem like a lot of questions, but each of these questions are important from an underwriter’s perspective to appropriately evaluate a plan and provide a realistic price.
Demographic Information
As you can imagine, the age, length of coverage, and number of students you have on your plan can all impact the rate of your plan. Some insurance carriers may even ask if you know the gender breakdown of students and how many dependents (if your group plan covers dependents) you will have on your plan.
Because of the impact of demographics, an insurance company may ask for a census of your currently enrolled students to get an idea of the overall age distribution of your student population. Let’s examine each one individually.
Age
Not surprisingly, students who are older tend to have more medical issues and thus a higher utilization compared to younger students. Because of this, the older your student or scholar population, the more expensive your insurance plan will be.
Length of Coverage
Students who are on the insurance plan for a short time will typically have less claims than if they are on the plan for multiple years. Most international students are typically in the US for 2-6 years, and thus most international student insurance plans may already account for this.
Number of Students
The larger your student body, the more premium will be generated to cover claims, and it would be more likely that if there is a high-dollar claim, your plan will still have a solid loss ratio (meaning that the generated premium will be able to cover the cost of the claims).
Families
Many group insurance plans are not extending coverage to spouses or children, and a big reason for this is because of how expensive it can be to add them. If family coverage is provided on the group plan, there is typically a separate rate that will apply to them (and it is oftentimes more expensive).
Eligibility
Other questions are often asked about where students are from, where they need coverage, and the type of visas they are on. This is often asked for two reasons. The first is to confirm eligibility of all participants. Especially when you are evaluating an international student or study abroad plan, the carrier will need to confirm that students are outside their home country and may also need to verify that they are traveling for educational purposes.
Secondly, the insurance company will also need to know where students will be traveling to. Costs across the United States and abroad vary quite extensively, so many underwriters will want to know the cost of medical treatment in that area to correctly rate the plan.
Requested Documentation
While you might think that the demographic information is enough to get a quote, additional documentation can help the underwriter both design the plan more appropriately based on your needs as well as guide the correct pricing of your plan.
Brochure
While not always required, your existing group brochure is a good guide to see what your current benefits are, and for them to see what the pricing was based on. It can also be a good place to start as you can take what you have and make further modifications. If there is no existing group plan in place, you may be asked specific benefit questions so that the insurance proposal will reflect the benefits you and your students need.
Current Pricing, Renewal Rate, and Claims History
Stability is the key to a successful insurance plan, no one wants a cheap plan only to find out that at renewal, the rate will jump dramatically. This is why current pricing is requested, why the renewal rate is helpful, and why your claims history is requested. These can help dictate a trend, and more than that, it can also help reduce your rate.
Example. Let’s suppose you have an older population of students that need insurance coverage. Based on their age, you may get a high rate. But, let’s say that you have had very little claims over the past few years. In this case, the insurance carrier may be able to offer you a more competitive rate based on your claims history.
And why 3 years of claims? Three years can help determine a trend and will help to offset any outliers that you may have had.
Underwriters use all of this information to generate a competitive quote. If you do not share this information, then the underwriter will typically use their existing book of business to determine what the rate should be, and will make any necessary adjustments at the time of renewal. Depending on the underwriter, this will typically be a more conservative approach and can mean a higher price than what you would have had if more information was provided. The alternative can mean that you get a low price but that your rate will have to be adjusted at renewal, and thus you might have an unexpected rate increase at renewal.
Administration
The final piece to getting a quote is how your plan will be administered. Many underwriters will want to know whether everyone will be required to purchase the plan, or if students will be able to waive and purchase alternative coverage. If they are able to waive, they will want to know the circumstances in which a student can waive.
The reason for this has to do with adverse selection. Oftentimes, school insurance plans are more comprehensive than what a student would purchase individually. If a student has the option to waive, the market has found that healthier students may choose to opt out of the school’s insurance plan and buy individually since they think they are healthy and may not need to use the insurance. Those who choose to stay on the school’s insurance plan tend to need a more comprehensive insurance plan for medical care.
Because of this, having a mandated group plan helps to reduce adverse selection and provide a more stabilized insurance plan, which could result in a better rate on the plan.
As students and faculty make decisions about returning to campuses this Fall, many bring with them concerns-mainly health safety and financial. Many families have faced financial hardships and money that was earmarked for student’s college education, in many cases, have been diverted to support or supplement basic everyday needs. Many students for either safety or financial reasons have decided to either defer the Fall semester or elected to attend a state school or community college.
Colleges have also faced a large number of challenges and decisions regarding whether or not to resume in-person classes; virtual classes or a combination of both. Some colleges, Notre Dame, University of North Carolina Chapel Hill and Georgetown University for example, have announced that they had to rethink their plans for in-person classes. Many schools are only permitting certain cohorts back to the campus. The Chronicle and Davidson College recently published a reopening model that indicate the national breakdown as:
TBD 24%
Primarily in-person 19%
Hybrid 16%
Fully online 6%
Fully in-person 2.3%
Other 6%
Any of these models are very expensive choices and none of them represent “business as usual” models. Many of them represent loss of revenue for the school in addition to the cost of health and safety processes that need to be in place. Some of the schools we have spoken with indicate that they are experiencing losses ranging from $83 million to over $100 million. Schools are also establishing additional resources to handle the needs of students who are attempting to cope with all the changes and isolation. According to a new survey by TimelyMD, an overwhelming majority (85%) of college students say they continue to experience increased stress and/or anxiety as a result of COVID-19.
Many students have also expressed concerns regarding their readiness to have a college experience that was fully or mainly online. Also, many students from families struggling to meet financial obligations may not have the appropriate technology that will allow them to be successful in a virtual environment. One way schools have attempted to “level the playing field” is to ensure that each student has the tools necessary to successfully access online classes. As an example, Rutgers University recently sent students Apple iPads to make certain they were ready to begin virtual classes.
For many students, having some or a majority of classes online doesn’t present much of an adjustment. Many have grown up with the technology and are quite familiar and proficient with it. What has become somewhat of a major issue with many students is the way in which their lives have been disrupted. Some students have or may experience social or emotional impacts that these life changes have created. Students are typically social animals and the restrictions that COVID-19 has presented can be emotionally upending for some. For most of them, what they are experiencing now is not the life that they were expecting. In an article in the Chronicle Review, David Rosowsky, a professor from the University of Vermont, suggests “More than ever before, students will be thirsting for belonging, for feeling secure and confident, and for the knowledge that people are looking out for them”.
At this point, it is difficult to determine the full impact of all this on students and higher educational institutions. What can be done is provide the students will tools and services that will best address their medical, social and emotional needs. Even though classes may be virtual, many student health centers continue to offer counseling services.
Healthcare became the topic of almost every conversation overnight thanks to the current pandemic. In the US, it brought up painful reminders about the health and safety of the international community and the healthcare system as a whole.
As someone living in the US, medical debt is not uncommon. In fact, according to a study done by Health Affairs in 2018, one in six people in the US have past-due medical bills. Imagine now if one of your international students, that may not speak English fluently, came to you with astronomical medical bills. Unpaid medical bills create a great deal of anxiety for anyone, especially when you’re not familiar with the medical system in a foreign country. The US healthcare system is very complex and very expensive.
If your students are being contacted by hospitals or collections agencies, there are ways to help them and guide them. Here are some ways to deal with medical debt:
Gather the information
It might seem like detective work, but it’s important to cross all t’s and dot all i’s so you are able to advise your students correctly. Is your student insured? If so, did they file a claim with their insurance company? Are the bills they are receiving their out-of-pocket expenses or have the claims not been processed yet? Were claims denied?
If an international student is uninsured, you’ll want to gather all of the bills that they’ve incurred and the contact information for all providers. Gathering all of the information will help your student with the next step.
HIPAA Authorization:In the United States, private information, including medical, is protected under HIPAA. If you want to contact an insurance company or a provider on behalf of your student, they must have a written authorization from the student so they can disclose the information to you.
Options Available
Many hospitals and providers in the United States have a financial assistance policy or charity care policy in place. In fact, by law, nonprofit hospitals are required to have these assistance policies. Contact the billing office at these places and inquire about possible options:
The provider might agree to reduce the bill
The provider might offer a payment plan
The provider could forgive the entirety of the debt if the student is able to provide proof that they are not able to pay for their medical expenses
Persistence is the name of the game. You or your student should open a channel of communication between you and the provider. Explain the situation, use words like “financial hardship”, “no sources of income”, and listen to the options they give you.
The Negotiation Phase
Much like a realtor does when helping you purchase a house, you can also negotiate medical bills. To our surprise, not many people know this. If your student is uninsured, a hospital will charge him or her based on their chargemaster rate, or the full sticker price if you will. It’s important to do some research and find out how much the hospital would bill an insurance company, Medicaid or Medicare. Insurance companies remind their clients often to use their contracted providers and there is a reason for it. They have already negotiated how much a hospital can charge their members.
Useful Resources
Like the insurance company, when you or your student are trying to negotiate medical debt, ask for the lower price. You might find the Healthcare Bluebook helpful as it provides fair pricing for medical procedures. This will give you an idea on what pricing you can ask for.
Another useful resource once you or your student have exhausted all negotiations with the hospital is to bring in an expert. The National Foundation for Credit Counselingcan pair you with a credit counselor and help you navigate medical debt with a medical provider or a collections agency. They offer assistance in English and Spanish which might be useful for many international students.
When it comes to tackling medical debt, your international student is not alone. You can refer them to our student blog on How to Deal with Medical Debt in the US for more information. We also offer many free resources for you and your international community like our educational videos about the intricacies of the US healthcare system available in eight different languages.
As you and your students prepare for a fall unlike any other, we are here to offer continued support and be a resource for your students in times of need. International Student Insurance will be hosting a live webinar event to provide your students with detailed information on Navigating the US Healthcare System During COVID-19.
When: Wednesday, August 19th
Time: 10am Eastern
Where: YouTubeLive
We invite your students to join insurance expert, Sally McLeod, who will provide a breakdown of the US Healthcare system, and help your students understand the importance of choosing a comprehensive insurance plan that works well for them and their school, while navigating a global pandemic. Sally will provide information to help those gain a better understanding of insurance terminology and common benefits and exclusions to be on the lookout for. Your students will be equipped with information on where to go, how and when to seek treatment, and have all their questions answered.
We are happy to announce that the Student Secure plan has been relaunched on May 15, 2020, and is now available for purchase. Students can enroll individually, or this plan can be purchased as a group, and is designed with the unique needs of international students, scholars, and students on OPT.
Available in four levels, Smart, Budget, Select and Elite, this plan allows students to enroll in the plan that meets both their needs and their budget. Benefits of this plan include:
As of April 1, 2020, all students will now have access to the UnitedHealthcare Network, one of the largest and well-recognized networks in the US. While it’s not required to go inside the network, these providers have agreed to accept direct payment and offer discounts for medical services.
Optional Sports Coverage
The plan has been enhanced to allow students the option to either include or exclude optional organized sports coverage. This means that students who need school sports can add this for an additional premium, giving those that don’t the option to save a bit of money.The sports option includes coverage for intercollegiate, interscholastic, intramural, and club sports on the Budget up to $3,000 per accident and on the Select/Elite levels up to $5,000 per accident.
Enroll Online
The plan can be purchased online with same day coverage. Rates start at just $31/month and students will have the option to pay in full or monthly. Students will get the policy documents immediately after purchase which will include the ID card, receipt and plan details.
If you are looking to receive the brochures in the mail, please contact us and let us know how many you’d like.
In the world of COVID-19, we expect that many orientations will be done virtually, and that much of the information presented to students will be in some sort of digital format. While this is a new format for many schools, the main advantage is that schools can make these videos available to engage students, and they can be recorded to review later.
We all know that insurance and the US healthcare system is complicated, and when you add additional barriers such as language, a foreign healthcare system, and jargon, it makes seeking care that much harder! Because of this, we wanted to help support the schools and students we work closely with by developing an International Student Insurance Orientation Video.
This video will walk your students through the following topics:
This video is about 10 minutes in length and includes subtitles in English, Spanish and Chinese. You are welcome to use this video in orientation, share on social, link or embed on your school’s webpage, and you can also include it on a free customized landing page developed just for your school.
If you are looking for an individual insurance option for your international students, scholars, exchange students, language students, or those on OPT, then our Student Health plan may be a good option. Available in four levels, students can choose the plan that works best for them based on the benefits they need and the price they can afford – and they can have coverage for maternity, mental health, organized sports, and more.
If you are interested in speaking to a representative about our individual insurance plans or school resources, you can contact us directly at:
Risk Management: “a properly implemented holistic risk management strategy enables an organization to maintain tolerable uncertainty, drive profitability and growth, ensure legal and regulatory compliance, pursue social responsibility and reduce the cost of risk and the deterrent effect of hazard risk.”
As written in the Chronicle Review recently, if one were to invent a crisis uniquely and diabolically designed to undermine the foundations of traditional colleges and universities, it might look very much like the current global pandemic.
Amid the global response to the COVID-19 pandemic, U.S. colleges and universities are confronting unprecedented change. Many have transitioned to an almost-universal distance learning model, shifted to remote work for most employees and cancelled collegiate athletics events. Other significant developments include transition to pass/fail grading, waivers of standardized testing and systematic closures of residence halls. And many seniors and their families find themselves disappointed at the postponement or cancellation of commencement ceremonies.
A recent URMIA article entitled “COVID-19 Conversations: Returning to Work and Reopening Campuses” stated how the global impact of COVID-19 has presented higher education with sudden and complex challenges. But this new frontier also presents opportunities for them to engage in innovative ways to provide quality education and research. The coronavirus crisis has – in what seems like an instant – upended much of modern life, and higher education has not been spared. Uncertainty and fear cloud the future. In the short term, students scramble to figure out their fall plans, the faculty faces hiring freezes, and administrators debate once-unimaginable options. The pandemic might also permanently change the character of higher learning in America’s culture, its role in society and in the economy.
With all of these pressing and important issues in mind, we reached out to higher education Risk Managers with a straightforward question: “What are some of the most critical issues you are dealing with today regarding COVID-19?”
From the many responses, here are three that capture the challenges:
I can think of no worse planning environment than one in which you don’t have (and can’t have) a reasonable understanding of the underlying risk. In just the few months that we’ve been responding to COVID-19, the nature of the risk and the guidance as to how to respond to it has continued to evolve in an environment where we don’t yet have conclusive science. We were all initially told that casual contact posed little risk and now we are all wearing masks when we go to the grocery store and everywhere else. The result is that it is difficult to help clients plan when accurate advice currently has a shelf life of barely a week. These complications with ascertaining risks and developing mitigation strategies are compounded exponentially when considering international operations. Every country has a different approach and it has added whole new challenges such as assessing access to health care in locations that heretofore were not an issue at all.”Right now, we have these issues that we are attempting to deal with across many facets of the university:
What will our ultimate acceptance yield be for new Freshman students? How many deposits have we expected vs what we will receive?
If the decision is to open the campus in the Fall, how do we propose to safely house students. Do we only bring in Freshman on campus and have a one student/one room strategy?
Schools will undoubtedly have to refund housing, meal and academic fees for the Spring-maybe Fall. Schools would have to charge less for online learning. Colleges that have lost enormous sums of money will be attempting to attract students from families who have lost income and savings. That does not seem like a recipe for success.
What will be the post-pandemic effect on higher education? How will students/families behave? Will students want to return to college campuses? Are there courses and subjects for which distance learning can work-perhaps a hybrid model of in-person and online courses? These are some of the important issues that we have several high level task forces working on today. “
Spread of Covid-19 cases on campus – How to minimize the risk of spreading to others, and how to protect employees and students when they return to campus
Significant liability exposure if we choose to resume “normal” operations in the Fall. If we reopen, how to restrict student gatherings to continue some level of social distancing
We housed approximately 10,000 students on campus – the challenge of packing, storing and mailing student’s property left on campus
Significant revenue shortfall due to a diminished on-campus presence
Immediate impact of halting all study abroad and Summer programs
Impact on current research and future funding
Delayed construction projects (campus improvements)”
As McKinsey and Company has stated, crises can create paralysis and fear. Rigorous scenario planning can help leaders map the potential damage and devise ways to deal with it. Universities need to look beyond the immediate crisis to create effective long-term strategies both to get through the present and to safeguard their futures in the new normal that will follow.
All of this leads to the question: “What actions can colleges and universities begin to take now”? Risk and Insurance Magazine has suggested that even though many institutions hope to reopen their campuses for the Fall semester, they need to create contingency plans in case that does not happen. This includes investing in more robust IT infrastructure and professional development for faculty that support a higher quality online learning experience. Schools should also develop a recruiting strategy that will help them tap into that category of prospective students for whom virtual learning is a good fit. At the same time, they should develop a long-term plan to address the inequities that prevent some students from succeeding with online learning. They should also look for ways to monetize or sell properties that continue to sit idle on campus. The possibility of a “normal” Fall will be decided by how effectively we are able to control the virus-which right now does not seem to be possible. Risk Managers cannot predict the course of the virus, but they are planning their own responses to not just reopening in the Fall but to reopen successfully for all constituents. Whatever the outcome, Lynn Pasquerella, president of the AAC&U states it best: “We are likely to see a new world order of higher education-more global, more online, more focus on return on investment, and overall, more student-focused.”
HIPAA Authorization: In the United States, private information, including medical, is protected under 
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