The APU health center fee will jump from $275 to $850 per semester. Students with outside insurance will need to apply for a waiver in order to waive the charge. Graphic by Hunter Foote
To comply with higher standards of the Affordable Care Act, also known as Obamacare, APU student health insurance will more than triple starting next school year from $275 to $850 per semester, according to Todd Ross, executive director of Undergraduate Academic and Student Financial Services.
However, students who are also covered under an outside plan that meets certain requirements will be able to opt out of the mandatory per-semester fee by going to a specified website, which should be available May 15, according to Brian Gleason, APU’s risk manager. The website will be hosted by APU’s broker, Gallagher Student, and the waiving process should take 5-10 minutes, Gleason said.
To opt out of the health fee, a student’s primary insurance must meet the following requirements, according to a draft sent by Gleason:
- Compliance with the Affordable Care Act
- Out-of-pocket maximum per person per policy year of $6,350
- Minimum of 70 percent coverage paid by insurance providers in the Southern California area
- Coverage within 30 miles of the Azusa campus while students are enrolled in classes (for all HMO, federal, state-sponsored plans)
- Emergency/urgent care-only plans are not acceptable
- Coverage for the following: ambulatory patient services, emergency services, hospitalization, illness and injury services, laboratory and X-ray services, maternity and newborn care, mental health and substance abuse services (including behavioral health treatment), prescription drugs, rehabilitative and wellness services and chronic disease management
Students will have from May 15 until the fall semester add/drop date to submit their waivers and prove their outside insurance, according to Ross.
Students and parents will be officially notified via email and postage, respectively, of the policy change by the end of this month, he said.
Previously, all undergraduate students with seven units or more or who were living on campus were required to purchase APU health insurance, regardless of any outside policy, but Ross acknowledged that “there’s no need to double-cover.”
“The problem before was we just wanted to make sure they had insurance, and it’s a labor-intensive process to try and figure out how to waive [the fee,] and we didn’t have that option to set up a website and do all of that,” Ross said. “Things have changed and we decided [to] give students an option to waive out and try to reduce that cost. … [The previous requirement] supported them using the health center and it was a fairly low fee and most schools had that type of philosophy previously.”
This philosophy states that all students need to have health insurance so the school can care for them in the event of illness or emergency.
“It’s our way to help students stay healthy, stay in class and not have these huge bills,” said Gidget Wood, nurse practitioner at the health center.
Similarly, the ACA requires all Americans to have health insurance, but the quality of the required insurance is much higher, boosting prices for middle- and high-income families.
“For the type of coverage, the APU price is a pretty amazing price,” Ross said. “On the California exchange (California’s marketplace for Obamacare) … it was really expensive, unless you can get subsidies because you’re a very low-income family.”
Ross said although officials began dialoguing before Christmas about how to implement ACA at APU, they could not confirm the new health fee price until this month.
“Part of the struggle is that the way health insurance works, they can’t give you a price for a certain number of months before the new plans start because there’s a bidding process to what it’ll cost to offer the services,” he said.
Gleason, the risk manager, said the school has been increasing the benefits for student health insurance for the past three years to comply with ACA. The student plan, which was “a very basic policy” before, had a limit of $50,000, Gleason said. Two years ago, that limit went up to $100,000; this year it’s half a million dollars; and starting next year, it will be unlimited.
Roughly 30 to 40 percent of APU undergraduate students are not covered under an outside health insurance plan, such as one under their parents, according to Wood. These students will still be required to pay the mandatory health fee per semester.
“It will be more like a traditional insurance plan that a staff member would buy through APU,” Ross said. “[It’s] a little different from the [old] student plans, which was a very basic coverage in case of emergencies. But this will be the full HMO or PPO type of health plan.”
According to Wood, the biggest changes include elimination of caps and pre-existing conditions. So students who will continue using APU’s health insurance will see better coverage, but for a higher cost.
“Three years ago, it used to be that the insurance capped off at $50,000. Now it’s unlimited,” Wood said. “There’s no limitation to how much the insurance company will pay for any injury or illness. That’s why it’s so expensive.”
Additionally, the ban on pre-existing conditions ensures that any person can get health care for any illness or condition.
“That’s a big thing for students who come in as freshmen and maybe didn’t have insurance for a time, or a student who took a semester off and came back but didn’t have coverage,” she said. “Anything that occurred during that time was not covered by the insurance company. … That’s no longer. There’s no such thing as a pre-existing condition.”
The increased price is hitting APU as well. According to Gleason, the previous $275 health fee would “more than cover” the insurance policy cost. Now, the health insurance costs APU almost the $850 per semester that students will be charged.
All students will still be able to visit the health center for free, regardless of whether they are on the APU insurance or not. What will change, however, is whether they will get reimbursed by their insurance companies. Students with HMOs and Kaiser insurance who need extensive lab tests will see a change, while students with PPO insurance plans, which allow them to choose where to go for services, will see no change.
“If somebody just needs a strep test, or … just simple labs like a CBC (complete blood count) or a mono test, those are pretty inexpensive, so students would probably opt to pay for them anyway, because they’re going to have to pay co-pay to see a doctor anyway,” Wood said. “But if they need extensive labs or an X-ray, the students that have HMOs and Kaiser are going to have to go through those doctors to get those services.”
The APU health insurance is PPO and pays for 80 percent of services provided to a student by an in-network provider. The student is responsible for the other 20 percent.
The health center currently has 11,000 visits per academic school year, according to Wood. Numbers of unique students who use the center are not available.
To accommodate more students, the health center will be physically expanding next school year — since the Office of Career Services moved from Magnolia Court to the East Campus modular offices area in fall 2012, both the health and counseling centers will expand into where career services used to be, Wood said.
Wood said higher student enrollment spurred the career services move and helped it become more central on campus.
“SGA was very instrumental in saying that the health center and counseling center needed more space to see more students,” she said.
In addition, this fall the health center will have electronic medical records and an on-site kiosk for check-ins, according to Wood.
Students will be able to make appointments, look up lab results and access immunization records online.