By Carol Gentry
10/23/2008 © Florida Health News
United Healthcare of Florida Inc., one of two companies the state chose as statewide contractors for Cover Florida, will offer a preventive-care plan for an average premium of $80 a month and one that adds hospital coverage for $200 a month, CEO David Lewis says.
United’s premium prices are higher than those of the other statewide vendor, Blue Cross and Blue Shield of Florida. But its lifetime maximum per person is also much higher.
The companies put their coverage designs together without knowing what one another would offer, beyond the requirements the state set. The Agency for Health Care Administration chose six vendors – BCBS, United and four that cover just a county or two.
“This is an exciting opportunity for carriers to play a positive role in something that’s good for everyone,” Lewis said in a phone interview Wednesday.
BCBS talked about its premium prices two months ago, but United has remained mum since negotiations weren’t complete. Now the template is firm, Lewis said; he expects the contract with AHCA to be signed by the end of this week, with the coverage to begin Jan. 1.
Cover Florida is the state’s attempt to provide bare-bones plans that some of Florida’s 3.8 million uninsured people may be able to afford and will be willing to buy. To qualify, individuals have to be uninsured for at least six months and be between ages 19 and 64.
The cash-strapped state is putting no money toward the project but is setting the rules, one of which is that the plans are “guarantee-issue.” That means companies have to take all comers – no more screening out the sick.
The experimental coverage program pits Florida’s largest insurer, BCBS, against the nation’s second-largest insurer, United. Several major insurers, including Humana, Aetna and Cigna, opted not to participate.
Two companies, Total Health Choice and Medica, will sell plans in Miami-Dade and Broward counties. JMH Health Plan will be available in Miami-Dade and Florida Health Care Plan will be sold in Volusia and Flagler counties.
BCBS’ Director of Market Development Chip Kenyon said the company’s less-expensive plan – names haven’t been chosen yet – will cover doctors’ office visits up to $50. If that doesn’t cover it, the patient can get the company’s discounts at any of the more than 20,000 physicians in “Network Blue.”
Here’s an example of how it would work: If the doctor’s office usual charge were $160 and the BCBS “allowed amount” for payment were $60, then the patient would owe $10.
The plan will also pay 100 percent of the costs of laboratory tests if they’re done at the lab where BCBS has a contract. In addition, Kenyon said, the plan pays up to $15 per prescription and up to $50 for dental visits.
For the “catastrophic” plan, as the state calls the one with hospitalization, BCBS would have a $4,000 deductible, after which the patient would pay 20 percent, based on BCBS’ contracted discounts.
The annual maximum payout on the catastrophic plan is $25,000 and for a lifetime is $50,000, Kenyon said. This is far below the lifetime cap on the United catastrophic plan for Cover Florida, $500,000. Most commercial policies have a lifetime cap of at least $1 million; state employees have a $2 million cap.
On the other hand, premiums for most policies are much higher than those that will be available in Cover Florida. “These are really designed to be affordable,” Kenyon said.
Lewis declined to share information about United’s deductibles and co-pays. Until the contract is signed, he said, “we’re choosing to keep this stuff in our briefcases.”
--Carol Gentry can be reached at 727-410-3266 or Carol.Gentry@FloridaHealthNews.org.