May not be for everyone but it can save a lot of money
By Mark Reaman
Healthcare is not something people love dealing with, as it is never simple and rarely cheap—okay, it is never cheap. Some get health coverage through their employers, while others are enrolled through the Affordable Care Act, or Obamacare, and still others roll the dice and go without any insurance. Now there is a local alternative.
The Crested Butte-Mt. Crested Butte Chamber of Commerce is offering an alternative to traditional health insurance for its members, an option that could save close to 60 percent of normal healthcare costs.
Chamber executive director Ashley UpChurch said the organization has partnered with the Small Association Leadership Alliance (SALA) to provide a comprehensive and cost-effective alternative to traditional health insurance plans. She emphasized that the program is not insurance but is an affordable healthcare program for employers, employees and sole proprietors that is more “medical cost sharing” than insurance.
“While not health insurance, the program provides 100 percent coverage for preventive care and addresses unforeseen medical expenses, such as illness and injury,” UpChurch explained.
UpChurch said the chamber joined SALA in August, so now chamber members have access to the healthcare program. “Employers can use this healthcare option themselves and offer it to their employees; everyone signs up through the chamber,” UpChurch said. “It’s up to employers to decide whether they will offer this as an employee benefit or simply tell employees and potential employees that, by working for them, they have access to this plan.”
How it works
The SALA program covers all healthcare needs after four years of membership in the plan, but it covers pre-existing conditions, including pregnancy, only on an increasing percentage basis for the first three years.
“A significant difference between this plan and traditional insurance is that instead of premiums and deductibles, it has premiums and ‘initially un-shareable amounts’ [IUAs],” UpChurch said. “You choose your IUA, which is the amount you will pay for any accident up to three times a year [for individuals; families pay their IUAs up to five times a year], and that determines your premium.
“For instance, if you choose an IUA of $1,000 and you break your leg hucking cliffs, you will pay $1,000 yourself for any doctor’s visits involved with your healing process, including your MRI, surgery, a brace, physical therapy, etc.,” said UpChurch. “The SALA healthcare program, which has more than a million members, shares anything over $1,000. Then, if you have a rough winter and slip on the ice a few weeks later and break the other knee, you’ll again pay up to $1,000 for all related costs, and the plan would cover the rest.
“Next, let’s say you’re having an unlucky streak, and, just a few months later, you go over the handlebars on your first mountain bike ride of the year and fracture your wrist,” UpChurch continued. “You’ll again cover $1,000 of costs, and the rest is shared. Finally, and this would seriously be the worst year ever, you made the poor decision of playing softball this particular season and break your other wrist in the first game. This time, the fourth time, all of your costs are covered by the plan; if you have any other crazy accidents throughout this year, those costs are also all covered.”
Because it is not traditional insurance, the billing process is very different as well. Instead of presenting an insurance card at checkout after an MRI, surgery, or whatever, UpChurch said you would tell the provider you are a cash-pay customer and ask to pay some amount right there. You would then be billed by the provider (your doctor, the hospital, the physical therapist, etc.) for the remainder of the bill, and you’d send that bill off to SALA.
“SALA would write a personal check back to you, and you’d be responsible for writing a check to the provider,” UpChurch said. “It basically takes out the middle-man insurance company and puts the onus on the you, the patient. Preventive care is more aligned with traditional insurance, in that you have a co-pay for a set amount of doctor, specialist and urgent care visits each year.”
The chamber website (www.cbchamber.com) makes it clear this program may not be for everyone. “The application for medical cost sharing has a limited number of health history questions, but all potential members must agree with and attest to statements including: ‘I agree to refrain from the usage of any form of illegal substances.’ Accordingly, medical cost sharing plans are not for everybody, but a practical solution to managing costs for health conscious individuals,” the site makes clear.
Costs are significantly less
UpChurch said this SALA medical cost sharing program is just over a year old and is being utilized in Vail, Steamboat Springs and Leadville, to name just a few places.
“As I mentioned before, there are more than a million members in this health share program around the nation,” UpChurch noted. “The Vail Valley Partnership has been running their program for almost a year now and have received positive feedback from people in the Vail Valley who have used the plan. It is also based on a model of cost-sharing that is over 30 years old and has proven successful.”
As for actual costs, UpChurch said it depends on the plan, the age of the person covered and the family situation.
“Based on a brief search, I found that a hypothetical individual in their 30s would pay between $500 and $900 per month for traditional, ACA insurance. Depending on the IUA this person chooses, their SALA costs would range from $250 to $350 per month,” UpChurch explained.
“The traditional insurance plans available to this individual have very high deductibles and most only cover things like doc visits and prescriptions after that deductible is met. With the SALA plan, on the other hand, our hypothetical Buttian would have a set amount she’d be required to cover each time she’s injured [her IUA], thus giving her a better understanding of exactly what she may pay during a very bad year [only up to three times her IUA].
“On the preventive side,” UpChurch continued, “any preexisting conditions would not be covered fully until she’s paid into the program for three years, but co-pays are lower for things like regular doctor’s visits and urgent care. Again, this is not insurance, and it is not for everyone. Folks with serious pre-existing conditions may not find this plan suits them, nor would individuals thinking about having children within four years of joining this program. This is just one option in a vast sea of healthcare opportunities, and the chamber is pleased to provide it for our local employers and employees.”
Chamber members, their families and their employees are eligible for this program, and a chamber membership starts as low as $275 per year or $150 per year for non-profits. Individuals (and 1099 employees) can also join the chamber at the community level membership of just $100 per year to be eligible for this program.
UpChurch is also organizing two explanatory webinars to learn more about the program and get answers to specific questions. The webinars will be hosted at the chamber’s conference room, which has limited space so only 20 people will be able to attend each session. The first opportunity to attend the webinar will be at 5:30 p.m. on Tuesday, October 15, and the second will be at 8:30 a.m. on Thursday, October 17.
“If there is higher demand for the webinars, I’ll schedule more at a location where I can also host more people,” UpChurch promised. “I also plan to hold these throughout each year for future interest, probably in the off-seasons.”
If you want to attend, let UpChurch know by calling 349-6438.