Health plan for businesses unveiled Md. proposal puts average cost at $3,080 per worker

November 05, 1993|By Patricia Meisol | Patricia Meisol,Staff Writer

Maryland took the first step yesterday toward making health insurance more affordable as a state task force unveiled a package of standard health benefits that insurers would be required to offer small businesses at an average cost of $3,080 per worker.

The package, presented to the state Health Care Access and Care Commission, is aimed at reducing the number of uninsured Marylanders, estimated at 600,000.

The plan would spread the cost of insurance over the entire pool of people being insured. Currently, employers' health plan costs vary widely because premiums are based on the cost of benefits paid for a single company's employees, and companies with employees who are older and require more medical care or who suffer a major illness can be hit by unaffordable cost increases.

Small businesses accounted for more than 700,000 jobs, more than one-third of all workers, in Maryland as of December 1992. A number of those employers do not provide health insurance for workers because of the cost. Many who do offer coverage provide limited benefits and do not extend them to family members.

A public hearing on the plan is set for Nov. 19, and the commission is expected to approve a standard package at its meeting on Dec. 2. Insurance companies would then have to develop benefit plans acceptable to the state and offer them for sale by July to continue doing business in Maryland.

The package unveiled yesterday would cover employees of small businesses for catastrophic illnesses, including hospitalization, medical equipment, laboratory tests, rehabilitation, pregnancy and childbirth, abortion and other services.

The plan would require the employee to pay the first $250 each year for prescription drugs and to be vigilant over his own health care to avoid paying other costs. For instance, people who used an emergency room for problems that didn't require hospital care would end up paying most of the resulting bill.

"We tended to take the position [that] people are responsible for more day-to-day costs themselves, but [should be] covered for the big stuff," said Don S. Hillier, senior vice president of human resources for Maryland National Bank who was chairman of the commission's health benefits subcommittee.

In some areas, the bare-bones plan is not as generous as the benefits the state now requires employer health plans to include. For instance, it excludes coverage for in vitro fertilization and many organ transplants, and provides only 20 days of hospitalization coverage for mental health and substance abuse problems.

Insurance companies are now required to cover 30 days of in-patient substance abuse or mental health treatment. Moreover, the plan requires a patient who needs more than 30 outpatient treatments a year to pay 50 percent of the cost.

The package also excludes coverage of experimental treatments, unnecessary cosmetic surgery, custodial home care, smoking cessation programs, wigs, eyeglasses and care for injuries or sicknesses because of "voluntary participation in a riot."

Insurance companies could offer the benefits in four ways: through a traditional indemnity insurance plan or three managed care products -- preferred provider organizations, point-of-service plans or health maintenance organizations.

The state health reform law requires the cost not to exceed 12 percent of the average Maryland wage, or $3,500. The subcommittee is proposing a benefits package worth only $3,080, less than 12 percent of the average wage, in an effort to ensure that it will not exceed 12 percent three years from now.

The package assumes that 75 percent of the cost would pay for benefits and the remaining 25 percent for the insurers' overhead and profits.

The commission hopes companies will compete for business by reducing expenses and offering even lower prices.

Purchase of the standard insurance would be voluntary. Employers would pay 80 percent of the cost and the worker would pay 20 percent, except when the employee obtained care outside of the chosen plan.

Workers would pay out-of-pocket expenses ranging from $354 to $1,696, depending on the plan they chose, according to an analysis by Foster Higgins, a benefits consulting firm. Companies could purchase additional coverage.

William C. Richardson, president of the Johns Hopkins University and chairman of the health access commission, said yesterday that he thinks the package would be affordable to small businesses now excluded because of cost. He also said the lower price could entice companies now paying top dollar for health insurance because a single employee has a serious health problem.

"We'll find out on the 19th whether that's the view of the key players," he said.

In a statement yesterday, the state's largest insurer, Blue Cross and Blue Shield of Maryland, supported the standard benefits package and the choice it affords workers.

But the company expressed alarm at the provision requiring people to pay for emergency room services and at a proposed three-year lock on the average price of the plan.

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