SGA makes emergency changes to health and dental plan coverage to “try to stop the bleeding”

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By Jessica Robinson, Editor-in-chief

Effective December 1, 2017, the SGA is implementing emergency changes to their health and dental plan coverage in hopes of halting the debt they are currently incurring exponentially.

Health practitioner claims include acupuncture, athletic therapy, chiropractic, massage therapy, naturopathy, occupational therapy, osteopathy, physiotherapy and podiatry appointments. Until now, they have all been covered in full up to a combined $500 per year. Now, appointments will be covered at $50 per visit, up to a combined $500 per year.

Diagnostic and preventative dental care was also covered in full up to a combined $1000 for all dental claims per year. It will now be covered at 75% per visit, up to the combined $1000, and oral hygiene instruction and fluoride will be restricted.

As of January 1, 2018, OHIP+ will take effect and offer additional prescription drug coverage, which will reduce the number of prescription drug claims through the SGA plan as well. All students with OHIP ages 24 and under will be fully covered for 4,400 different prescription drugs. Claims for prescription drugs are the most common claims on the SGA plan.

These changes will not affect any claims students have already made for the 2017/2018 academic year.

“Based on the SGA claim trends, consultants projected that by August 31, 2018, the SGA would be $826, 929 in debt.”

The emergency motion to reduce some of the health and dental plan coverage was put forward by SGA President Roch Goulet to the SGA Board on Monday, November 20.

The consultants at Student Benefits, the health and dental plan provider, had analyzed the SGA’s plan usage from two years ago to now to ascertain problem areas and claim trends.

Based on the SGA claim trends, they projected that by August 31, 2018, the SGA would be $826, 929 in debt.

“There are really only three options on the table [at this point],” said benefits consultant Paul Tucker. “You raise the fee; you lower the coverage; or you terminate the plan completely. And terminating the plan isn’t really a viable option, because the value in the amount of claims that the students have made far exceeds the onus being put back on the student to pay just a little bit more.”

Despite the fact that these changes are coming three months into the school year, Goulet explained that the timing is in fact fortunate. If not now, the soonest the SGA could have implemented the changes would be January 22, 2018.

“[The changes are] urgent because we’re dealing with a lot of money, and a lot of students,” President Goulet said. “We were trying to recover the damage from last year already done, but it’s not happening.”

“Looking at the data already from this year, two months in, we’re not doing well,” he said. “If we waited to discuss this in January, that would be four months. There’s no signs of healing; it felt appropriate to do it now.”

In response to learning about the state of the health and dental plan, some students at the SGA board meeting questioned whether or not the SGA could redirect funds allocated for events to pay back the debt, instead of changing the coverage. Goulet explained that this is not a viable option.

“Any savings by the SGA in the future is going into a contingency plan; we’re going to be passing a policy as a board later in second semester to develop a plan to recover this debt and other debts that we’ve collected,” he said.

“This year, we’ve been really efficient in our spending; so while the budget reflects a certain amount set aside for our contingency plan, we’re hoping to recover significantly more than that, just because we’re aware that we’re not in the best position [financially].”

“A comment was made at the SGA board meeting about taking money from the construction of the student centre to make up this debt,” Goulet continued. “The student centre was passed through referendum, a committed referendum vote that partnered Laurentian University and the SGA. The expense revolved around stopping that would be an additional disaster to what we can call this situation here.”

The SGA executives and the consultants worked together to figure out what coverage could be reduced to have the biggest impact on debt management.

“We have an understanding that the two areas we’re struggling with are health practitioners and diagnostic and preventative dental,” Goulet said.

The consultant report pointed out that for claims made in both of these sections, students are “barely paying anything out of pocket; very little onus is being put on [the] students to find practitioners with reasonable fees.”

“The new set of coverage creates an additional onus on the student, because the student will incur a portion of out of pocket expenses,” explained Owen Ralph, a consultant from Student Trust, “which will make it more likely for a student to consider making a claim or not.”

Of course, Ralph said, “Nobody here is a fortune teller. No matter what we say, claims are always undetermined. What we do is we use trends and models to produce what should happen, based on the claim patterns from members in the past.”

Ralph pointed out that, even with the changes, this is “still a great plan, at a very competitive price.”

“It’s not something we would’ve ever wanted to do; it’s not something we planned to do.” – Roch Goulet, SGA President

There will not be a second opt-out period due to the changes in the plan.

“It’s group insurance,” said Ralph. “The concept of group insurance is that you’re in or you’re out. If you’re already covered by another plan, you’re able to leave; you are not able to leave if you’re not covered. Everybody who was entitled to opt-out was given the opportunity at the beginning of the year. It has nothing to do with the plan itself.”

To mitigate the impact of the changes on students moving forward, Ralph said that they will be “communicating with all health practitioners, dentists and benefit plan members that have made a claim in the past year and a half.”

“There are also places that offer reduced fees for students,” Ralph continued, “so when we’re contacting health practitioners, we’ll be asking to see who will be willing to do the work within the $50 limit.”

Goulet confirmed that the SGA will also be doing their own research to find the cheapest services, particularly when it comes to health practitioners, “so that students, whenever they do use these services, hopefully don’t have to pay out of pocket.”

In addition, Student Benefits will be providing the SGA with all new updated materials. The SGA marketing team will be working to relay the message through social media.

“It’s really about communication,” said Goulet. “The V-desk will be informed about these changes; anyone that interacts with students [at the SGA] is fully aware of the changes. Social media will be a big push. We’ve contacted the services offered on campus.”

“I want students to now that we’re not affecting utilization,” he continued. “We just want students to be critical of the necessity of these services. I think where we’re targeting these changes is appropriate, because of how great our health plan is. Now we’ve maybe reduced a great plan to a solid good plan, in bold.”

“I also want students to know that this was an informed decision; despite being urgent, the vote was moved forward with the information required,” Goulet said.

“It’s not something we would’ve ever wanted to do; it’s not something we planned to do. But with the information at hand, it was necessary for the SGA of today, and of the years to come.”

“These things need to change now, if we want SGA Students to have consistent coverage for the years ahead,” Goulet said.

The resolution was passed with the mandate for the SGA to provide monthly updates.

“We’re committed to that, so that everyone is aware of the progress these changes make,” Goulet said.

For more of the background on the SGA debt, see our feature piece from last issue here.