Click on the links below to access the answers to Hulse / QM®'s Frequently Asked Questions:
- What is so unique about Hulse/QM®'s services?
- Where is the school's Student Insurance Office?
- How does Hulse/QM® advocate for ill or injured students?
- What about special advocacy for athletic injuries?
- Why would a school choose a hard or soft waiver program?
- What types of Student Health Insurance Programs are there?
- What are some facts and issues of Mandatory Health Insurance?
- How do we protect private information?
- How does a school make informed decisions when they buy student health insurance for its students?
What is so unique about the Hulse/QM® services?
Imagine a special office in your school organization with highly trained staff managing the various tasks of your school's student insurance program. Hulse/QM® enables the school to staff such an office for less expense by making use of Hulse/QM® staff assigned to the school.
Imagine an office with expertise in the following:
- Designing the benefit plan for student illnesses and injuries
- Preparing sophisticated Requests for Proposals (RFP) holding insurance companies accountable to promises made during the bidding process
- Intervening when students experience claim denials or unacceptable delays
- A go-to office for students, parents and school staff needing answers, information, counsel and assistance on matters concerning ill or injured students at school and away from home
- An office staff wholly accountable to the school for its performance
These are the benefits of outsourcing the school's student insurance program to Hulse/QM®, your satellite Office of Student Insurance.
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Where is the school's student insurance office?
While physically located in Mechanicsburg, Pennsylvania, the "office" is accessible to all your students, parents and staff through the use of current technologies, such as:
- Wireless communications.
- A school specific data management system.
- A website with pages customizable to school information needs.
- A dedicated toll-free telephone line specific to the school and answered by staff trained on Student Health Insurance Programs.
- On campus participation in various school events by our Healthcare Advocates (orientation, health fairs, student education events, etc.)
Our website is available 24 hours a day/7 days a week.
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How does Hulse/QM® advocate for ill or injured students?
Five Different Areas of Hulse/QM® Advocacy Expertise
- Advocate for the student in need of medically necessary healthcare when ill or injured.
- Directional assistance to student/parent in finding a network provider or presenting their insurance claim for benefits.
- Intervention strategies performed by Hulse/QM® when a student's claim is denied or partially paid.
- Assist students/parents to evaluate their insurance options when selecting the right health insurance while at school.
- Proactive evaluation and development of the school's current student benefit plan(s) including indentifying strengths and potential improvements.
- Identification of the best possible benefit/cost ratio for the school's student insurance program.
- Negotiation on behalf of the financial viability of the school's strategies for student medical insurance.
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What about a special advocacy for athletic injuries?
When a student athlete is injured in the practice of or participation in intercollegiate sports, special burdens fall upon athletic trainers. Not all injuries can be treated by athletic trainers. Referrals to outside healthcare providers are necessary for diagnostic and treatment purposes. In most cases, such referrals will require the student to present evidence of their personal medical insurance.
A hard waiver requirement makes certain that the student athlete does have personal medical insurance. Either their insurance will be the Benefit Plan sponsored by the school, or it will be a personal plan by which the student waived the purchase of the sponsored plan.
But the problem does not stop there. A student's personal insurance, generally through their parent's insurance, may not work well away from home. Perhaps it is out-of-network. Perhaps it has special limits upon certain procedures.
In most cases, it falls to the athlete's trainer to assume the burden of helping the student athlete navigate the back-offices of the insurance company, or of particular healthcare providers. It becomes a necessary task for trainers as they try to get needed medical care for their athletes.
It is a burden unless the school contracts with Hulse/QM® to do the work. Hulse/QM® employs a certified athletic trainer who specializes in solving coverage issues and obtaining insurance benefits for the injured athlete. Now the athletic trainer gets required signatures from the athlete and turns over the back office work to Hulse/QM®.
Because of the special expertise and experience Hulse/QM® brings to the work, we can do the various tasks with greater efficiency and expertise. In other words, Hulse/QM® can do the work, so the school's athletic trainers can focus on the athletes.
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Why would a school want a soft or hard waiver rule?
Student success & healthcare needs
A recent study discovered that those students without health insurance are less likely to finish college than those who are covered by medical insurance.1
A student without medical insurance makes it difficult, at times impossible, for a health center or sports medicine department's ability to perform its stated mission to school students away from home.
Growing student healthcare needs
Risky behaviors by an increasing number of college students creates increased needs for healthcare and referrals to outside specialists.
90.3% of health center directors reported a rise in the number of students coming to counseling who are already on psychiatric medication- which represents 366 college counseling centers nationwide.2
Another study indicated more students enter college with severe psychopathology, mental health centers are prescribing more medications, and suicide is the second leading cause of death among students.3
Today's healthcare involves a very significant increase in sophisticated technology, medical specialties and related inflation in healthcare expense.
Reducing school liability
Making medical insurance available to its students impacts favorably upon the potential liability of a college or university with respect to its care of students away from home.
A voluntary program has a greater risk of inadequate premium to pay the claims against the plan. As only those students who need health insurance purchase the plan, the claims from those students often amount to more dollars than have been collected in premium. This results in increasing premiums and decreased benefits in future years, as the insurance company tries to balance the amount of premium needed to pay claims against the plan.
A soft or hard waiver generally makes possible a much broader level of healthcare benefits.
1 Some of the facts stated are from a study done by the Heinz Family Charities and the Chickering Group.
2 Other statistics come from a 2005 National Survey of Counseling Center Directors.
3 2005 study by the American Psychiatric Association and its Presidential Task Force on Mental Health on College campuses.
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What types of Student Health Insurance Programs are there?
Mandatory -- All students are required to buy the student insurance policy required by the school. There is no option to opt out.
Hard Waiver - The college or university requires students to be covered by health insurance everyday of their college career and requests this information from each student. Students who do not respond will be automatically enrolled in the school-sponsored plan with the cost of insurance applied to the student account. Student Accounts is the most often used enforcement tool.
Modified Hard Waiver -- The college or university requires student's to be covered by health insurance everyday of their college career and requests this information from each student. Students who do not respond receive a punitive action that prevents certain administrative functions, such as class registration or graduation. This option is used in cases where rules and regulations prevent the use of student accounts as an enforcement tool.
Soft Waiver - The college or university requires student's to be covered by health insurance everyday of their college career and requests this information from each student. No penalty is incurred if the student does not have insurance.
Voluntary - The college or university does not require a student to carry health insurance. A voluntary plan is available for students who are in need of health insurance.
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What are some facts and issues of Mandatory Health Insurance?
In March of 2008, the federal General Accounting Office published a report on students of higher education and medical insurance.4 It found that 20% of all college students 18-23 were uninsured in 2006. It also published in the report the following statistics as regards uninsured students.
- 18% of 18 year olds uninsured
- 16% of 19 year olds uninsured
- 16% of 20 year olds uninsured
- 19% of 21 year olds uninsured
- 25% of 22 year olds uninsured
- 35% of 23 year olds uninsured
The growth trend as students grow older probably reflects the fact that they ceased to be dependents on their parents insurance.
The need for college students to be covered by medical insurance has risen as more students enter higher education under a physicians care and as student behaviors become more risky. In fact, the health and psychology centers, as well as the athletic sports medicine departments, have a difficult job when caring for an uninsured student.
Legislatures have begun thinking about mandating insurance for college students as one avenue for solving today's uninsured medical insurance problem. Some states have already passed mandatory health insurance laws.
Colleges and universities that adopt a mandatory or hard waiver health insurance policy and offer a group medical plan to their students, can expect student medical insurance premiums to be substantially lower than those premiums that a student would pay if they purchased medical insurance on an individual basis. Premiums will be higher than the traditional catastrophic plans that have been offered in the past. Further, parents that cover their student through employer based medical insurance might find their premium to be more expensive than that of a school's mandatory health insurance program.
4 Report to Committee on Health, Education, Labor, and Pensions, US Senate, GAO-08-389.
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How do we protect private information?
Hulse/QM® commits itself to the privacy of student personal information. Private information arises in two different areas in Hulse/QM® operations.
An Enrollment/waiver process during which student information is received from the student or their parent, or by downloads from a university or college.
During intervention assistance when students seek help from Hulse/QM® regarding a claim they have submitted to the insurance company.
Hulse Associates Inc./QM Services Inc. are not covered entities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The privacy of student information is of the utmost importance to Hulse/QM® and we have chosen to mirror the administrative, physical and technical safeguards that are present in HIPAA.
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How does a school make informed decisions when they buy student health insurance for its students?
By outsourcing the matter to Hulse/QM®, a university or college acquires a highly-specialized capability for its Request For Proposal (RFP) process.
The first step is consultation with various school departments as to their needs and concerns for the school's student insurance program. Needs and concerns could focus upon:
- The benefit plan
- Student eligibility for the sponsored benefit plan.
- Special needs of specific student populations
- Administration of the student insurance plan
- Content of communications with students/parents
The next step is to balance the concerns of all interested in the Program, and collect and analyze past loss data in preparation for negotiations with various insurance underwriters regarding rates and benefit plan.
Now a complex and complete RFP is created and presented to various insurance underwriters, requesting proposals according to critical requirements when bidding on the school's student insurance program.
A critical step requiring significant expertise is that of analyzing each proposal, reading carefully all the fine print while negotiating with underwriters about various terms, clauses and specific benefits.
Hulse/QM® makes a presentation to the school, explaining the details and options, providing guidance where needed until the school resolves issues to its satisfaction and makes a buying decision.
Hulse/QM® then awards the benefit plan to the school's carrier of choice, making certain the insurance policy and administrative process are according to agreement.
In a very real sense, the university or college adds the resources of Hulse/QM® to its own. The school can expect a very thorough and technically competent process for informed decision making regarding its student insurance program.
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