AcademyHealth Stateside - 03/10/2005  (Plain Text Version)

In an effort to reduce the nation’s uninsured population, a coalition of large employers recently unveiled the National Health Access program. Targeting workers (part-time, seasonal, contractors, and pre-65 retirees) and their dependents that generally are not eligible for employer-sponsored insurance, the National Health Access program pools workers across 60 large employers and offers a choice of six plans. Each employer will determine group eligibility.

Participants can select among six options ranging from a discount network to a Health Savings Account (HSA) combined with a high-deductible health plan. The UnitedHealth Group was selected to be the primary carrier, but CIGNA and Humana will participate in limited markets. Participants can select among the following plan options:

Level 1: Discount Network (Not Insurance)

·        Provides medical, pharmacy, dental, and vision discounts within network.

Level 2: Scheduled Wellness Benefit

·        Level 1 discount plus: 80 percent reimbursement for office visits, 100 percent preventative care, $20 per prescription (up to five per year), two dental visits, one vision visit. All benefits subject to plan maximum of $350.

Level 3: Scheduled Outpatient Benefit

·        Level 1 benefit plus: 100 percent office visits, outpatient surgery, and preventive care. Level 3 pays $20 for up to 10 prescriptions per year, two dental visits, one vision visit. All benefits subject to plan maximum.

Level 4: Scheduled Inpatient and Outpatient Benefit

·        Level 3 benefit plus: $800 per day inpatient surgery (30 days) and 100 percent emergency room visits. All benefits subject to plan maximum.

Level 5: Major Medical—HSA eligible

·        HSA combined with high-deductible health plan. Plan details include: $2,000 deductible for individuals and $4,000 for families, out-of-pocket maximums of $5,000 for individuals and $10,000 for families, 70 percent co-insurance, pharmacy, and access to Level 1 discounts. All benefits subject to plan maximum.

Level 6: Major Medical—Limited

·        Level 5 benefit plus: lower deductibles ($1,100 single/$2,200 family), and a lifetime annual benefit cap of $1 million.

While the pool does not receive employer subsidies at this time, premiums are estimated to range from $4 per month for a discount network to more than $300 for major medical coverage. Premiums will be calculated using age, gender, geographic location, and some options will impose waiting periods. Rates will be capped for the first 18 months of the program.

Proponents of the plan argue the National Health Access program offers greater flexibility and lower costs versus the individual insurance market. As many as three million workers and their dependents may benefit from the plan. Pending state regulatory approval, the plan will begin open enrollment on September 1, 2005.