Cheaper health insurance option is minus the ER 

South Florida Business Journal - May 25, 2007
by Brian Bandell

Health insurance is an expensive proposition for many in South Florida, where more than one of every five people under 65 is uninsured. While some see these 1 million uninsured residents as a crisis for the health care system, Jerry Sternstein sees them as a market niche for his company.

 Hallandale-based Care Access Health Plan offers partial health coverage that starts at $59 a month for young men and runs $169 a month for people nearing their senior years. It includes preventative and routine care using the HMO gatekeeper referral model, mental health counseling, rehabilitation, durable medical equipment, urgent care centers and a $100 a month pharmacy stipend.

The plan leaves out hospital coverage, which often leads to the biggest expenses for health plans. However Care Access members can get limited hospital coverage by purchasing supplemental insurance through insurer ACE INA. For instance, it could cover $1,000 a day for each of the first three days of hospital care.

"Our goal is to make sure our members go to their doctor," Sternstein said. "Care delayed can become something greater and then you need to go to the hospital."

A 2006 study by the Urban Institute found that 30 percent of the working uninsured in the United States have access to health coverage but decline to participate. Affordability is the most frequently cited reason.
Blue Cross Blue Shield of Florida has advertised reduced benefits plans to small businesses in a marketing campaign that helped sign up 300,000 members in the state last year, bringing its commercial membership to 3.9 million. Yet since its members are in HMOs and PPOs with many state-mandated benefits, its plans are more expensive than the coverage Care Access offers.

Care Access is licensed in Florida as a limited benefit health plan, which allows it to offer fewer benefits and a smaller network than an HMO or a PPO. Most of these plans are limited to a few clinics and are often owned by organization in charge of the clinic. But Care Access includes 1,200 physicians in South Florida and is operated independently of them.

Sternstein said the company got its group license in mid-2005 and now has 650 members. He expects the plan to grow, as it recently got approval from the Miami-Dade School Board, Miami-Dade College and Florida International University to offer the plan to part-time and temporary employees. It also offers the plan to dependents of employees at Miami-Dade Schools. The employees are often asked to fully fund the dependents' health insurance premiums.

Care Access is a good coverage option for MDC's 3,700 part time staffers, said interim vice provost for human resources Iliana Castillo-Frick. The university's nearly 83,000 students, with an average age of 27, will be eligible as well. MDC won't pick up the cost, but the group rate makes it cheaper the more people sign up, Castillo-Frick said.

"For an organization that is not able to afford the cost of health coverage, providing this type of coverage makes it available at a lower price so you maintain these employees longer," she said. "For smaller employers with a large part-time workforce, this could be a great retention tool."

Sternstein said Care Access clients include restaurants, a security firm and a symphony orchestra. He hopes to expand membership by getting approval to market through other large government employers in South Florida and chambers of commerce.