Cooking Up A Plan B For Plan C
GRAND RAPIDS — Small employers who pay their employees small wages can provide those workers with health insurance coverage for a small monthly premium.
The nonprofit Kent Health Plan has offered such affordable coverage to small businesses in the county for the past six years. But there have been few takers and the current enrollment in Plan C, as the offering is called, is hovering around 20.
Kent Health Plan President Lynda Zeller is disappointed the plan has so few enrollees. Plan C does what most politicians, business types and backers of free enterprise want a low-income health plan to do: subsidize the premiums of existing private health insurers.
“This is interesting because the (President George W.) Bush plan and the (Senator Carl) Levin plan want to see us do exactly what we’re trying and failing miserably to do with Plan C, which is to build expansion on real insurance by subsidizing premiums. We have not been able to make that take off,” said Zeller.
Why Plan C hasn’t succeeded is open to debate, but the plan’s cost and benefits likely aren’t talking points in that discussion. A monthly premium for a qualified employee is $200 and is shared equally among the business, the worker and Kent Health Plan at a cost of $67 a month. The annual premium for each is $804 per year. The PPOM Network, which has hundreds of local physicians and the area’s hospitals as members, is the plan’s provider.
The plan’s annual maximum benefit is $35,000 and it covers employees and spouses for most services as long as these are done within the network. There isn’t any out-of-network coverage. But coverage is provided for emergencies, office visits, surgeries, urgent care and more. Plan C doesn’t cover an employee’s children because kids of low-income households have other low-cost insurance options.
But Zeller hasn’t given up on Plan C. She said she has been talking with major insurance carriers about taking the program in a slightly different direction now that these companies offer plans that are fairly similar to Kent’s. She would like to offer one of their products in the program and continue to subsidize the premium through local funding sources.
“When somebody sees a Priority (Health) product or a Blue Cross (Blue Shield) product or an Aetna product, it catches their attention,” she said.
Zeller also wants agents who sell the product to receive a commission for each sale. Right now, she said Plan C pays a small signing bonus instead of a commission, so there isn’t much incentive for agents to get the word out.
“So I’m beating the streets at the state level and having discussions with these folks. I don’t have anything I can share yet, but I can tell you that it is looking good,” she said.
For a company to qualify for coverage under Plan C, an employer’s primary business must be located in the county, the firm must have from four to 50 employees, and 80 percent of those workers have to reside in the county.
In addition, the hourly wage of 51 percent of the employees that would be enrolled in the plan must average no more $12.50 for the first year of coverage.
For more information on Plan C, including its benefits schedule, visit kenthealthplan.org or call 726-8204.