A look at Utah's health care options for employers and employees

Published: Tuesday, Oct. 1 2013 8:33 a.m. MDT

"People never used to plan a trip without using a travel agency, but these days you can find everything you need online," Conner said. "And you can compare those costs just as you can now compare health insurance rates using the marketplace."

Employers and employees

Avenue H offers real-time enrollment, with hardly a delay for services to begin. Enrollment is also offered throughout the year, instead of just once, as the individual marketplace offers and plans extend for one calendar year.

It takes about 15 minutes for an employer to set up an account, and employees can take their own time to peruse the options available to them, depending on the amount they want to spend and what their employer is planning to contribute to each plan.

Of the more than 64,000 employers and small businesses in Utah, 357 are already enrolled in plans managed by Avenue H, with almost 8,200 people covered, including employees and their dependents. It's grown from just 11 in the marketplace's first year of testing and approximately 87 percent renew year after year.

"We're covering groups that didn't have an option to offer group insurance in the past," Conner said, adding that 64 percent of Avenue H subscribers did not offer insurance prior to the marketplace's existence.

She said Avenue H was up and running before the ACA took effect and will continue to function regardless of what happens in Washington, D.C. It is not funded by the federal government.

Other states, as well as the federal government, have yet to produce the workings of their marketplaces, whereas Utah's serves as an example, with most of the wrinkles and hangups already ironed out, Conner said.

Avenue H also offers rate calculators and comparison columns to give consumers a positive experience shopping for health care, which is important if everyone needs to get and keep coverage, per the ACA.

"We're trying to get people to buy insurance," Conner said. "By making it affordable for some and giving them the choice, they at least end up buying a policy instead of ending up in the emergency room."

Care and coverage

The new health care act requires all plans to offer at least 10 mandatory benefits, although the scope of coverage is not defined. Doctor's visits and outpatient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services and behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care, make up the minimum standard of benefits set by the U.S. Department of Health and Human Services, which sets forth ACA regulations.

All plans available on Avenue H, Conner said, are "good, quality plans."

Another benefit of selecting a plan from Avenue H, if an employer has registered with the marketplace, is that all payments to the system are pre-tax, resulting in long-term savings.

If an employee doesn't like what is offered through their employer on Avenue H, they can purchase their own plans commercially or take part in the individual marketplace, which is available at www.healthcare.gov and is managed by the federal government. Based on household income, individuals can qualify for tax subsidies to offset premium costs on the individual marketplace.

The individual marketplace also pre-screens people for Medicaid, making sure anyone who is eligible for it has the opportunity to apply.

"We're witnessing a trend where consumers are more and more interested in shopping for their own insurance," Dr. Jason Hwang, a physician and co-author of "The Innovator's Prescription: A Disruptive Solution for Health Care," told stakeholders gathered at Utah's Health Summit on Thursday.

Hwang said the trend indicates consumers are taking on the personal responsibility of their own health care, realizing it costs more if they are unhealthy.

And that's the idea behind health care reform, Conner said. Giving people the opportunity to determine how money is spent on their behalf is intended to help change their attitude about health care in general.

"Employers can't tell their employees to participate in weight management courses to reduce their overall costs," she said. "There has to be accountability at each level. If it takes money out of your pocket to ensure your health, maybe you'll take on that level of responsibility."

Avenue H is available at www.avenueh.com.

Email: wleonard@deseretnews.com

Twitter: wendyleonards

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