• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Uninsured No More; Stripped-Down 'Mini-Meds' Put Health Coverage Within Reach

Posted on: Saturday, 11 March 2006, 00:00 CST

By Joe Morris

What's covered? Southeastern Agency of Athens, Ohio, and Chicagos Acordia Inc. are two of the most recent entrants into West Virginias market for mini-med health insurance. Heres a look at their plans at the minimum level of coverage: Acordias CashPlan

* Monthly premium comes to about $40 * $300 in accident coverage per accident * $75 per emergency room visit, at $300 a year * Up to six doctor checkups a year, at $50 a visit * $100 a day in hospitalization * $200 a day in intensive care unit treatment * $5,000 in life insurance coverage for the main beneficiary, $2,500 for spouses and $1,500 for children * Drug discounts * Access to a 24-hour nurse line

Southeastern Agencys CashPlan Plus

* Monthly premium starts at a little less than $37 * Up to six doctor checkups a year, at $50 a visit * Up to 60 days in the hospital, at $200 per day * $500 in accident coverage * Up to $300 a year in outpatient X-ray and laboratory costs * Up to 30 days of substance-abuse treatment, at $100 per day * 30 days of intensive care, at $400 a day * $5,000 in life insurance

NOTE: Services covered in CashPlan Plus must be provided by participants in the 4Most Health Network, which is made up of 1,500 primary-care doctors, 2,800 specialists and 67 hospital facilities. Partnering with the network, which is administered by Charleston- based Physician Services L.P., guarantees reduced-rate services, agent Tom Kosthoryz said. There are no network limitations in Acordias CashPlan.

morris@wvgazette.com

People who can't afford full health benefits usually end up with no benefits at all. There hasn't been much of a middle ground, until now.

More and more insurers have been rolling out "limited medical benefit" plans, which cover routine checkups and prescription drugs - but not major medical expenses.

Known in the insurance industry as "mini-meds," the plans can cost less than $40 a month for individuals. And at those prices, insurers say, they hold the promise of including legions of part- time and low-wage workers for the first time into the ranks of the insured.

"There's a whole set of clientele that we've ignored in the past," says insurance agent Tom Kostohryz, president of Athens, Ohio- based Southeastern Agency. "To a lot of people, comprehensive coverage is just not affordable, but there's a way we can provide some coverage as opposed to nothing."

Though mini-meds have been on the market since the '80s, the industry has only recently started marketing them in a big way. Giants like Aetna Inc. and UnitedHealth Group Inc. began selling them only within the past few years, while others including Nationwide Mutual Insurance Co. and Coventry Health Care have been expanding their offerings lately.

In West Virginia, where the uninsured population numbers nearly 300,000, limited-benefit plans remain a rarity, according to Kostohryz. "It's kind of a virgin market," made up probably of just a few thousand participants, he said.

The health-care reform package that Gov. Joe Manchin has been pushing this year would expand the business considerably by allowing the marketing of mini-meds to individuals and encouraging companies to sponsor group plans.

This past January, Southeastern Agency and Chicago-based Acordia Inc. began marketing mini-meds to West Virginia businesses. Both agencies' plans are designed by Austin, Tex.-based Fringe Benefit Group and underwritten by Pan American Life Insurance Co. of New Orleans.

Their target customers are employers that haven't been able to provide any health coverage in the past, such as temp agencies, restaurant chains, construction outfits and startup companies.

"We don't want to be anywhere close to [companies with] major medical," says Charleston-based Acordia agent Karl Gattlieb.

Mini-meds aren't a cost-saving tool for companies that can already afford full group health benefits, and they're not marketed that way, Gattlieb stresses. Rather, "They're for people who have no insurance at all."

Fringe Benefit's plans "are never marketed as a replacement for major medical," said Brian Robertson, the company's executive vice president. "These are very affordable plans meant to help people without coverage." Major medical coverage "is a totally different world."

An employee at one new Gattlieb client - a single, mother-of- four restaurant waitress from Princeton - broke down in tears when he explained to her the kind of coverage she would be getting, he said. "She was just so thankful."

A few weeks earlier, one of her sons had cut his hand and she decided to treat the wound herself rather than incur emergency-room costs. "You mean I could take him to the emergency room with this plan?" she asked Gattlieb ecstatically, he recalled.

In fact, even the baseline plans offered by Southeastern and Acordia cover emergency-room visits and accident care. Monthly premiums start at about $40. Comprehensive health plan premiums, by contrast, tend to cost several hundred dollars for individuals and upward of $1,000 for families.

But without comprehensive coverage, a major medical catastrophe will likely mean a financial catastrophe as well. At the Southeastern mini-med's highest coverage level, participants can count on no more than 30 days of intensive care, at $1,200 a day - even though such hospitalization tends to cost much more.

In essence, mini-meds are health plans for the healthy, designed to prevent rather than treat serious illnesses.

"It's not for the person who has a lot of medical needs, but it's great for the majority of people," says Marie Lewis, the chief financial officer of Manpower Inc.'s West Virginia franchise. The temp-agency franchise, which staffs people in clerical and manufacturing jobs, is Southeastern's first corporate customer in West Virginia.

The reception among Manpower's employees - who number from 1,300 to 1,500 a week - has been overwhelmingly positive, Lewis said. "There have been no complaints," she said.

So far, Acordia's mini-med has four or five business clients, representing about 50 to 60 covered people. Gattlieb wouldn't identify the companies, but he would say that they're restaurants and hotels. He's in talks with companies employing thousands, he said.

As long as mini-meds' limitations are understood, it's clear they represent a step in the right direction, said Sonia Chambers, chairwoman of the state's Health Care Authority.

"The only debate [over Manchin's health-care proposals] is whether we should be doing more," she said. "Will this help everyone get comprehensive health coverage? No, so we need now to turn our attention to affordability."

For workers like Manpower's, mini-meds seem to provide a real service, says insurance advocate Perry Bryant, executive director of the West Virginians for Affordable Health Care coalition.

"What you don't want is a race to the bottom - you don't want people with existing comprehensive coverage migrating to limited benefits," Bryant said.

"But something is better than nothing, and for part-time and seasonal workers, it's probably a better match."

To contact staff writer Joe Morris, use e-mail or call 348-5179.

Source: Charleston Gazette, The

More News in this Category