New grad insurance plan offers 'limited' compromises

An official decision may be a few days away, but likely plans for next year's health care coverage for graduate student appointees reflects a host of compromises, according to those close to the issue.\nThe changes, which were designed to minimize the effects of a proposed 58 percent increase in health care costs by IU's insurer, Chickering, are varied and include some cuts, said Julie Swando, a graduate student on the committee. She said likely changes include:\n-- A reduction in the lifetime maximum amount paid per medical diagnosis. Currently the maximum is set at $500,000 per diagnosis; under the new plan the maximum would lower to $250,000 for graduate appointees and $100,000 for their spouses and children. \n-- An increase in the in-network deductible, from $100 currently to $250 per person. It does not apply at the IU Health Center or for prescriptions of any kind. \n-- Increases in co-pays for doctor visits outside of the health center, from $10 to $15.\n-- An annual $5,000 prescription cap for medicines purchased outside of the health center. \n-- The addition of a co-pay of $10 for prescriptions at the IU Health Center. Currently there is no co-pay for prescriptions purchased at the center, Swando said. \n-- A reduction in payments to out-of-network doctors. Currently, Chickering pays 60 percent of outside doctor's fees. The employee pays up to $3,000, after which the insurer pays the total costs. Under the proposed plan, Chickering would eliminate the maximum paid by the policy holder and would only cover 50 percent of the doctor's fees.\n"It's not great; these changes are not good, but I think they could have been a lot worse than they were," Swando said. \nCurrently, the entire $1,007 cost of the graduate employee health insurance plan is subsidized by the University. \nIU had offered to pay nearly 69 percent, or $1,409, of the proposed increases, leaving the graduate appointees to pay $181.20, said Neil Theobald, vice provost of budget and administration. \nBut Theobald said effective negotiations with the insurer lowered the price of the increase below $1,409, although he did not have specific figures available. As a result, graduate appointees will not pay for the insurance. \nHe said in addition to negotiations, further cuts and reductions were made to lower the price of the coverage for those required to purchase a plan, such as some international students. \n"The concern here is that there are international students that have to pay for this out of their own pocket," he said. "The changes to the coverage were by choice in order to hold down the price that the students have to pay for themselves."\nSwando said the tentative cost of student insurance would likely be around $1,375 a person, while the premiums for spouses and children, not covered by the University, would rise to $3,270 and $2,480 per year, respectively.\n"That may go up, that may go down, but it's probably in the ball park of what we're looking at," she said. \nTheobald said the University would still pay their initial pledge of $1,409 to the graduate students and would take the surplus between the $1,409 figure and the lowered price to help students in the graduate school. \n"The amount of money sent out of the campus will still be 40-percent (of the initially proposed 58 percent increase), but the difference will go to the graduate school for the benefit of graduate students," he said. \nBut Paul Rohwer, moderator of the Graduate and Professional Student Organization, which represents graduate students, said the changes in coverage were fair, but would still affect graduates and those using the plans. \n"All in all students will have to adapt in how they use health insurance," he said. \nHe said students with dependents, such as a spouse or child, would be the most affected because their plans are not subsidized by the University. \n"If you have a dependent, or if you're planning to start a family you need to look at state welfare agencies," he said. \nTo deal with the issue, the GPSO plans to present a resolution to the board of trustees next week to ask for 50 percent of the dependent subsidy granted to employees, Rohwer said. Many appointees -- which include graduate associate instructors, graders and research assistants -- have .50FTE status, meaning full-time employment status, he said. \nThe Graduate Employee Organization, which supports unionization as a way to deal with many issues facing graduate students, also supports the resolution, said Adrianne Wadewitz, a co-coordinator of the steering committee for the group. \nDan Rives, IU's associate vice president of human resources, cautioned, however, that no insurance plan has been finalized and said negotiations with Chickering were still underway. \nHe said he expects a quote on premiums by early next week, and said he would then pass it to the Student Academic Appointee Health Benefits Committee, Dean of International Programs Patrick O'Meara and Theobald for input. Upon their review, the plan would then require approval by O'Meara and interim provost Michael McRobbie, Rives said. \nFor her part, Swando said she was not particularly concerned with some aspects of the plan, such as the $10 co-pay for prescriptions at the health center, because she said such practices are standard in most insurance plans. But she said she was worried about the reduction in the maximum amount paid to dependents per diagnosis.\n"I feel that that's a low maximum," she said. "It's just too drastic a cut in coverage."\nShe also cautioned graduates using the plan to be careful when receiving medical treatment, and to ensure that both their doctor and medical facility are part of the insurance network. \n"If you use a network doctor at an out-of-network facility it will be paid at the out-of-network rate," she said. "It's sort of a sneaky way insurers get around (in) shifting some more of the costs to the patient."\nRohwer also encouraged the use of the health center, as he said it offered more cost-efficient care to graduates.