Category: Costs and Coverage

by Elizabeth Marks, Senior Strategy Consultant

On December 27, 2020, the No Surprises Act (NSA) was signed into law as part of the Consolidated Appropriations Act of 2021. This act addresses surprise medical billing at the federal level. The regulations generally apply to group health plans and health insurance issuers for plan and policy years beginning on or after January 1, 2022.   The regulations specifically note that Individual health insurance coverage includes coverage offered in the individual market, through or outside of an Exchange, and includes student health insurance coverage. The applicable provisions will go into effect on the 2022-23 plan renewal date.

Thinking about self-funding your student health plan? If so, it’s important to conduct due diligence to determine whether it is appropriate for your institution and conduct a feasibility study.  This article suggests five steps to consider before proceeding.

Properly adjudicated claims are a key goal of claims administrators, colleges and universities, and student members alike.

Inaccurately processed claims can end up being timely and costly. Overpaid claims will negatively affect claims experience leading to higher premium renewals. These can be especially harmful for self-funded plans where the college or university holds the risk. Underpaid claims can lead to additional time processing claims and handling appeals and some unhappy members.

The good news is that claims administrators take this very seriously and have comprehensive processes in place to ensure timely and accurate claims processing. That said, there may still be some that initially slip through the cracks.

Elizabeth Marks, AHP’s Senior Strategy Consultant, teamed up with her colleagues at Risk Strategies to discuss the impact of COVID-19 on higher education student health and employee programs and how to manage them going forward. Learn more at ahpccare.com or contact us.