UC SHIP Advisory Board votes to eliminate coverage cap

A sign reading "University Health Services" points into the Tang Center, UC Berkeley's health center
Randy Adam Romero/Staff

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Officials in charge of the UC Student Health Insurance Plan voted on March 22 to lift the plan’s coverage caps, one move in a series of steps before the final decision regarding the caps is made.

The UC SHIP Advisory Board, which consists of student and health care representatives from each UC campus and from the UC Office of the President, voted unanimously in favor of eliminating the $10,000 annual prescription drug coverage cap. All but one campus voted in favor of eliminating the $400,000 lifetime coverage cap and instead voted in favor of raising the lifetime limit to $500,000, according to UC spokesperson Brooke Converse.

For months, students have been urging UC SHIP officials to have the plan voluntarily comply with the Affordable Care Act’s ban on lifetime and annual prescription drug limits on essential care. As a self-funded insurance plan, UC SHIP is exempt from the health care reform law.

Few students actually surpass the coverage caps, but for those who do, like Kenya Wheeler, a former graduate student in city planning at UC Berkeley, the effects can be devastating. Wheeler began treatment for primary central nervous system T-cell lymphoma in November 2011. Since then, he has met the lifetime coverage cap and has had to pay at least $10,000 in out-of-pocket expenses for his treatment.

“The advisory board that oversees UC SHIP considered removing the caps last year, too, but didn’t recommend making that change for the 2012-13 academic year because of the increases to student premiums that would have resulted,” said UCOP spokesperson Shelly Meron in an email. “It was the intent of the advisory board to reconsider the removal of the plan benefit limits and to time that with the implementation of the Affordable Care Act in 2014.”

The movement to lift the caps comes as UC SHIP is facing a projected $57 million deficit by the end of the current plan year. The UC Office of the President has considered raising premiums by an average of 25 percent systemwide as a way to close the deficit.

Lifting the coverage caps would not affect the deficit, Converse said, although it would require another premium increase that is expected to be significantly smaller than the proposed 25 percent.

The advisory board’s recommendation will now be considered by the UC SHIP Executive Committee, a group of top UCOP and campus health officials, at its April 24 meeting. Following its recommendation, the Council of Chancellors will make the final decision on lifting the caps. The council is scheduled to meet May 1.

Several lawmakers have expressed support for eliminating the caps. Reps. Nancy Pelosi, D-San Francisco, and Barbara Lee, D-Oakland, urged in a letter in February to align UC SHIP with the national standards set in place by the Affordable Care Act. State Assemblymember Richard Pan, D-Sacramento, introduced a bill in February that would force health insurance plans run by a university or college to comply with the section of the Affordable Care Act that lifts limits on lifetime and annual coverage of essential health benefits.

Mitchell Handler covers academic and administration. Contact him at [email protected]