The Insurance Dead Zone

By: Sam Laughlin

Motions Editor-in-Chief

“Your insurance failed.” 

Not a sentence anyone likes to hear standing in line at a pharmacy, especially a law student about to start a new semester.

The pharmacist in this instance explained, around 5:30 PM on August 16, that the student’s health insurance was no longer valid.  The student frantically calls the insurance company, discovering that it carries no record of the student in its files.  Representatives at the law school could not be reached, since it was after five o’clock.  That student was, seemingly, cut-off from healthcare, and not only with a fresh prescription but a doctor’s visit from earlier that day to pay.

I know all this because I was that student.  I called several more students that night and confirmed that my ordeal was not an isolated incident.  Any law student with USD’s student group health plan had, apparently, lost coverage.  At least, it seemed that way.  What on Earth was going on?

As I discovered, this incident is not a fluke or a glitch or anyone’s failure to fill out an obscure form.  No one, technically, lost their insurance coverage.  This is a system designed intentionally to behave this way, what is called the “Hard Waiver” insurance system.

USD requires all law students to carry medical insurance.  Every year, law students are given two options regarding their healthcare: elect to take USD’s group plan, which is the default, and automatically activates if the student takes no action; or waive the plan and find personal health insurance elsewhere.  Many students fresh from college choose to waive the plan, as they remain covered under their parents plans until reaching the age of 26.  For those of us in our late 20’s and beyond, the student health plan is a viable option for health coverage.

One key component of the student health plan is that it automatically renews itself every year.  Every student I have personally spoken to insists that this facet of the healthplan was clear and easy.  Most students signed up for their health coverage in the first few weeks of their 1L year, and have completely forgotten about it since.  After all, with so much running through our heads already, why would law students continue to worry about their health insurance when told it’s automatic?

That “automatic” renewal is the source of the confusion.  All student health plans terminate on August 14 of every year, and all cards issued to students under that plan cease to function.  The automatic renewal does not take place until sometime in mid-September, around the last day to drop or add classes.  The time between?  This is, what I call, the USD insurance dead zone.

“It should be made clear that coverage is retroactive to the start of the policy, which is August 15,” said Dr. Moisés Barón, the Assistant VP for Student Affairs for Student Wellness who oversees all wellness and medical insurance administrative programs at USD.  “The coverage is in place, just retroactively,” he said.

Why does this period of time exist at all?

“There is an actual contract that the university has with Gallagher Koster and Aetna that all of its law students will be covered from August 15th on,” said Law School Assistant Dean for Student Affairs Emily Scivoletto.  “The definition of ‘student,’” she said, “is why we get into that September period, because we don’t know who will stay a student.”  As a result, the plan does not officially renew until after the drop-out date to avoid giving a year’s worth of medical insurance to students who end up cutting ties to the law school, both Dean Scivoletto and Dr. Barón independently explained.

During the dead zone period, students remain covered via an agreement with Gallagher Koster, USD’s insurance broker who acts as an intermediary between the school and the insurance company, presently Aetna, Inc.  Students who need proof of insurance (via a health insurance card) during the dead-zone period must elect to “enroll” in the coverage before August 14.  There is nothing automatic about enrollment in the dead zone period.  Students who sit and do nothing between August 14 and mid-September carry expired insurance cards for that time period.

“Students are enrolled in health insurance by their own will by visiting the Gallagher Koster website or by us on or about September 9th when they release all the cards,” said Dean Scivoletto.  “Everyone has the potential for health insurance.  You will have it as a student.  But whether or not you actively enroll is up to the students.”

The timing has nothing to do with the actual coverage, legally – only the ID card to prove students have insurance.  “Any student who needs healthcare during that time period will be reimbursed byAetnaor issued a temporary card by enrolling via the Gallagher-Koster website,” said Dr. Barón.

I am not the first USD student to need healthcare in mid-August.  “That happened last year where we had students that had to be reimbursed,” said Dean Scivoletto.  “The process took longer than I liked,” she said.

That is all well and good, but what happens if a student, crippled in a car accident, cannot verify to a hospital proof of insurance, and receives either poor medical care or no care at all?  “That student needs to immediately reach Gallagher Koster […] and get emergency cards,” said Dean Scivoletto, “That is the ideal. But,” she said, “the thing that can happen and has happened is a student calls Gallagher Koster and customer service has no idea what to do with that request.  That is something we have talked to Gallagher Koster about, for a couple years running now, and we are being told that is going to get better.”

“I get reports every year, and no situation has ever occurred with a student not getting the healthcare that they need,” said Dr. Barón, who genuinely is concerned about the confusion.  “There should not be any surprises in this,” he said.  “People should not have the experience of going to the drug store and being panicked about insurance.”

This system is presently secluded to the law school.  A few other USD students have similar hard waiver plans, such as USD student athletes and international students.  The rest of the undergraduates either continue under their parents plans or opt for a “volunteer” insurance option, which the school utilized for all students before the hard waiver.  Under the volunteer system, students do not have to get coverage, and can choose the USD plan or not.  There is no default automatic rule like the hard waiver.

To help students with the hard waiver process, students can elect to “enroll” earlier than the automatic September renewal.  Every student received an email earlier this summer addressing this issue, asking students to enroll in July if they wished to avoid any problems.  Because many law students were under the impression that they were already enrolled, many ignored or only skimmed this email.

The usage of the word “enroll” is one potential source of confusion, admits Dr. Baron, who explained that future communications to students will attempt to make this process more clear.

One other source of confusion concerns who students call in the event of an emergency like the hypothetical car accident mentioned earlier.  Who do you call?  Visiting the school websites directs students to call Gallagher Koster in the event of an emergency, but Gallagher Koster closes for business after 5:30PM and is not open on weekends.  Attempting to navigate the Gallagher Koster phone system tends to direct students to Aetna.  If a law student is in the middle of the dead zone, Aetna will have no record of their existence.

Instead, Dr. Barón encourages students to call the USD Public Safety Dispatch – reached at 619.260.222.  The dispatch will then find a school administrator who can directly contact Gallagher Koster, “Who will send someone to the office immediately,” said Dr. Barón.  Contacting Dean Scivoletto personally may also help in the event of an emergency.

Students who know they need continuous health coverage for the months of August or September should enroll early, according to USD.  But accidents happen, and until the school fixes its communications issues with its insurance, confusion over the hard waiver system will persist.

Over the next few years, the future of student healthcare will change dramatically as the federal government implements the Affordable Care Act.  “[The Act] affects student insurance,” said Dr. Barón.  “We are having conversations right now about what that is going to look like.”

Motions will keep an eye on the healthcare situation at USD as it develops.

 

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