As the only health insurance company built for students, Wellfleet is continually looking for ways to optimize its plans to better serve the student population.
We created the True Choice Student Health Insurance Plan (SHIP) to do away with traditional provider networks, helping to increase provider choice and reducing healthcare costs for our members.
The True Choice plan is an ACA-compliant student health insurance plan with a “student health center first” approach bolstered with comprehensive coverage of:
- Medical care – including preventative and emergency care
- Behavioral healthcare
- Pharmaceutical care
- Telehealth care
- Inclusive care
The True Choice SHIP takes a different approach than standard PPO plans, and these distinctions help us improve the students’ experience — by increasing their freedom to choose a provider and aiming to reduce their costs of care.
What does True Choice cover?
True Choice is a SHIP that retains the excellent coverage of our PPO student health plans. True Choice covers a wide range of medical and behavioral health services. While specific coverages depend on each school’s needs, True Choice plans generally include coverage for:
- In-person and telehealth visits
- Urgent care and emergency care
- Prescription medications
- Imaging, such as x-rays, CTs, and MRIs
- Surgeries and procedures
- Chiropractic care and physical therapy
Our True Choice plans can include Wellfleet Rx, our pharmacy solution focused on providing medications at an affordable cost, offering 40+ medications with a $0.00 copay.
Additionally, our True Choice plan also gives students access to these excellent resources that make getting care more convenient, such as:
- Telehealth and behavioral health visits through Teladoc®
- SilverCloud® by Amwell®, a digital cognitive behavioral healthcare program
- CareConnect, a 24/7 behavioral health hotline
- Consultation with a registered nurse through Nurseline
Furthermore, our True Choice SHIP also offers value-added services, including dental and vision care discounts and travel insurance for students who travel internationally.
How does True Choice work?
True Choice takes a different approach to provider reimbursement compared to a traditional PPO health plan.
With PPOs, insurers contract with providers and facilities, creating networks.1 Members of the health plan are encouraged to use in-network providers to receive the lowest rates for their care.1
For example, the average PPO health plan reimburses the provider with a discount of 50%, which means that for a $5,000 medical bill, the average PPO would pay $2,500.4 Commercial health plans pay an average of 224% of Medicare.4
However, with True Choice, we use a reimbursement model called referenced-based pricing, which pays providers a fair price for the services they provide — instead of simply using predetermined discounts. We review data from Medicare, actual costs, accepted payments, and negotiated rates to determine a fair price.
Health plans like True Choice that use reference-based pricing reimburse providers an average of 150% of Medicare, which is significantly lower than the average for most commercial health plans.4 So, for a $5,000 medical bill, the average RBP plan would pay more than the Medicare rate, but less than the standard rate most commercial plans pay — saving money for the student member and plan.
For context, 96% of providers accept a data-driven fair price.3 And if needed, we work with the provider to negotiate payment rates and resolve the claim.
How can this plan produce cost savings for schools?
Claim payment rates matter because having lower plan spending reduces future premiums. That’s because premium rates are influenced by how much their insurance carrier needed to pay to cover claims the prior year. The True Choice plan’s projected premium savings are up to 20% when compared to a commercial PPO plan.2
How can students use their benefits?
Just as with other health insurance plans, True Choice SHIP members should show their ID card when accessing care from a provider or facility. If the provider has any questions about the True Choice plan, they can contact our team via the phone number on the card.
Students can learn about their coverage, find care, and manage claims all through the Wellfleet Student mobile app or mobile-responsive web dashboard — both user-friendly resources that simplify health insurance navigation. If students have questions, our customer service care team is available via phone or chat to help guide students on their care and benefits.
What providers can students visit, and how can they find a provider?
With True Choice, students aren’t limited to “in-network” providers, unlike with standard PPO plans. With this plan, providers are not classified as in-network or out-of-network. That means providers are equally accessible to members.
Students can search for the provider that’s right for them and check their availability, credentials, and patient ratings to determine where they would like to set up an appointment. This setup grants students more say in who they go to for care compared with a PPO.
Students can find a provider in many ways, such as:
- Using the Wellfleet Student mobile app
- The provider locator identifies providers who have previously accepted members
- Contacting Wellfleet Customer Service
- Web searches
- Provider referrals and recommendations
Learn more about Wellfleet’s True Choice health plan
At Wellfleet, we’re all about finding ways to optimize care and lower healthcare costs.
That’s why we created True Choice — our goal is to make getting the right care easier and less expensive.
Learn more about Wellfleet’s True Choice Student Health Insurance Plan by visiting our site. Connect with our team to see how a tailored True Choice health plan can benefit your students.
References
1 Rivelli, E. (2023, Nov 23). PPO Insurance: What Is It? Forbes Advisor. https://www.forbes.com/advisor/health-insurance/ppo-health-insurance-plans/.
2 Average client savings based on 2022-2023 plan year claims data. Savings vary based on plan structure, performance, and client.
3 AMPS. (2023). The more you know member packet. Data provided by AMPS regarding the commercial use of the reference-based pricing model.
4 RAND Corporation. (2022, May). National Evaluation of Health Care Prices Paid by Private Health Plans. https://www.rand.org/pubs/research_reports/RR4394.html.
*True Choice is not available in all states. Contact Wellfleet for more details.
This policy has exclusions and limitations. For costs and complete details of the coverage, call your insurance agent or the company [whichever is applicable]
CSR-SHIP-FEBRUARY-2024-04
