5C health care plan reduces coverage and increases costs due to low enrollment, among other factors

Graphic by Ugen Yonten

Costs are up and coverage is down for 5C students on the consortium’s Student Health Insurance Plan, a result of lower enrollment and higher usage rates.

Starting this academic year, those on SHIP have to pay out-of-pocket to visit doctors off-campus who are outside the network of Aetna, SHIP’s health care provider. This is a significant change from SHIP’s previous policy, which used to cover 90 percent of those costs, according to plan details on the Pomona College student health website.

SHIP cost $2,356 per student for the 2018-19 academic year, a 12.5 percent increase from last year’s price.

Sharon Basso, Claremont McKenna College’s vice president of student affairs, said via email that the decrease in coverage was necessary to keep the program affordable; keeping the same coverage plan would have increased student premiums by 50 percent instead, which was “not a viable option for most students,” Basso said.

SHIP premiums rose because of low enrollment — only 25 percent of 5C students participate in SHIP — and high rates of use among those enrolled in the plan, among other factors, according to Basso.

The 5Cs’ insurance broker, Relation Insurance Services, re-evaluates coverage and alternative options annually, Basso said.

Health insurance is mandatory for all 5C students. Students not enrolled in their own insurance policy or who do not provide proof-of-enrollment of that policy are automatically enrolled in SHIP.

Following negotiations with Aetna, the plan also decreased the amount it pays for in-network medical charges after the deductible the amount the consumer pays before the health care plan will start paying from 100 percent to 80 percent, according to the 2017-18 and 2018-19 plan snapshots.

In addition, patients’ out-of-pocket maximum for in-network coverage, which is the maximum cost a student would pay for their care, was increased from $5,000 to $7,350. No student on SHIP will have to pay any more money for in-network care if they have already spent $7,350 during the year.

The new plan also covers fewer types of prescription drugs. The old plan covered 153 categories of drugs, while the new one covers 139 different categories. Drugs such as antiseptics, disinfectants and folic acid vitamins are no longer covered, and students must pay out-of-pocket for them.

Many students rely on SHIP’s out-of-network coverage. Arielle Davis PZ ’18 said it was extremely helpful in treating her chronic condition.

When I was on last year’s version on the plan, I found the coverage to be fantastic, and my co-payments were minimal and reasonable,” she said.

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