Both bidders win high-risk pool contracts
Elizabeth Slowik

Priority Health and Physicians Health Plan of Mid-Michigan, the only two bidders to provide temporary high-risk pool health coverage, both have been awarded contracts.

Rob Pocock, associate vice president of communications for Priority Health, said Monday that the health care provider now must wait for the state Legislature to apply to the federal government for the $141 million available under health care reform to cover the extra costs incurred by high risk patients.

“What the state ended up doing was accepting the lower bid for each county,” Pocock said. “PHP did get some counties we applied for because they were the lower bidder. The entire state has the potential to be covered by either PHP or Priority Health during this two- year period.”

If the Legislature chooses not to apply for the federal funding, Pocock said, high-risk patients in Michigan would have the option for coverage under a plan offered by the federal government. In either case, enrollment is expected to open in September with coverage available as of Oct. 1.

 The bid from Physicians Health Plan, which is owned by Sparrow Health System, applied only to Clinton, Eaton, Gratiot, Ingham, Isabella, Ionia and Shiawassee counties. Priority Health’s proposal  covered 60 counties, including Kent and Ottawa. They overlapped in only two counties.

The federal health care reform law, the Patient Protection and Affordable Care Act, sets aside $5 billion to support coverage for high-risk individuals until 2014, when insurers will be prohibited from denying coverage based on pre-existing conditions for adults, and health insurance exchanges are to open.

“We would prefer that Michigan residents can select a plan that’s managed by a Michigan firm,” Pocock said. “We have to rely on the state to make application for the money.”

A spokesman for the state Department of Technology, Management and Budget was unavailable for comment.