- change ups
Small Firms Have New Health Option
“As a young company it was not possible to provide traditional insurance to our nine employees. The affordability of Plan C will help retain our current staff and will improve our ability to recruit good staff as we grow,” said Tom Kusmierski, owner of Mier Finish and Woodworks.
Last month, Kent Health Plan unveiled a discount prescription program for Kent County seniors 65 years of age and older who are without prescription drug coverage. That program is being done with Claimspro, a pharmacy benefits manager.
Kent Health Plan put Plan C together with help from the Grand Rapids Area Chamber of Commerce, the Alliance for Health, The Employers’ Association and a few other organizations.
The plan offers coverage to firms in Kent County with four to 15 employees. At least 80 percent of those workers must reside within the county. Workers must earn an average of $10 per hour or less during the first year of coverage to qualify. Spouses of employees are eligible for coverage, but children aren’t.
“Plan C coverage means that members will have better access to health care that is much more affordable,” said Chuck Zech, Kent Health Plan president.
Zech told the Business Journal that there are hundreds of small businesses in the county that either can’t afford to provide coverage for their workers any more or who have never been able to provide coverage.
“Our focus here is on those employers who are struggling to become strong businesses. Our mission is to help them attract and retain employees so they can grow their businesses to be stronger, and then to graduate out of Kent Health Plan within six years into the commercial market,” said Zech.
The initial enrollment target between now and the end of the year is 300 employees. By limiting the initial enrollment period to firms with four to 15 workers, Kent Health Plan hopes to have about 30 companies on the Plan C roster by Dec. 31.
“That gives us a better opportunity to serve a larger number of employers,” said Zech. “Our goal in this initial period is to make sure that we are helping a number of businesses and their employees as opposed to, for example, two larger businesses that eat up all the membership slots.”
This doesn’t mean that larger small businesses won’t be eligible in the future. Down the road, Kent Health Plan wants to stretch the company employee range from four to 199.
Employee coverage for Plan C is $165 per month, shared equally among employer, employee and Kent Health Plan. The monthly cost for each is $55. Kent Health Plan’s share will come from its general fund.
“Our general fund is comprised of contributions from local, state and federal sources. Local, for example, includes foundations, the United Way and the county. At the state level, they help us draw down federal matching dollars on local contributions, and the federal match is the primary source of our funding for Plan C,” said Zech.
Coverage will be through the PPOM Network of many local hospitals and hundreds of area physicians. The plan does not cover out-of-network services. U.S. Health and Life Insurance Co. is the underwriter.
The plan covers early intervention services such as doctor visits, diagnostic services and prescriptions. It also includes inpatient hospital services, emergency room services, urgent care, outpatient surgery, lab tests and radiology procedures. Most services have an annual maximum limit and some require a co-payment.
For example, inpatient hospital services have a yearly maximum of $25,000 and a 20-day stay. The co-payment is $100 for each admission. The annual maximum benefits from the plan is $35,000 annually and $200,000 over a lifetime.
An employer cannot have had health care coverage for the past two consecutive years to qualify for Plan C. But a firm that is eligible can carry Plan C coverage for up to six straight years.
Employers wanting more information on Plan C should go to www.kenthealth.org or call (800) 211-1534.
As for the organization’s senior prescription drug plan, Zech said about 4,500 have been enrolled or are being processed. The first set of cards went out last Thursday.
“The response has been wonderful and very gratifying,” he said.
Kent Health Plan is a nonprofit organization that was created last year to improve access to health care for thousands of the estimated 55,000 county residents who are without coverage.