Laura Seitz, Deseret News
SALT LAKE CITY — Cindy Deverall manages health insurance benefits for local Prescott Muir Architects. With all the changes taking place in health care this year, she was not looking forward to it.
And she's not alone.
A recent Salt Lake Chamber of Commerce survey reveals that 81 percent of small businesses in Utah are unclear about what's required by the Affordable Care Act, a major part of which goes into effect Jan. 1.
"This is the first year they've had to pay out of their own pocket for health care, so we wanted to make it as easy on them as we could," Deverall, office manager and accountant for the small business, said.
To steer clear of confusion, an insurance broker pointed Deverall to Utah's small-business health insurance marketplace — Avenue H — which has been operational for more than three years.
The marketplace, which offers consumers a choice between 70 health care plans, proved a perfect solution for Prescott's budget. The business could designate a specific amount toward each employee's health care, and yet each employee could decide how that benefited them.
"We had one employee select a plan vision coverage because that was really important to them, and another chose a plan that covered chiropractic care, which was really essential for their family, so they got to tailor it to what works for their family," Deverall said. "One even chose a plan that cost less than we alloted for her because it included a Gold's Gym policy and that was something she really wanted."
While small businesses — those with fewer than 50 employees — aren't required under the Affordable Care Act to provide health insurance coverage to their employees, the law states that beginning in 2014, every American must carry a policy or pay a fee with their taxes.
The law also requires all businesses, large and small, to inform employees of their options to buy health insurance by Tuesday.
Getting health coverage
The chamber survey found that 90 percent of businesses want to offer health care options to their employees, as good benefits are an important part of recruitment and retention. Statistics show that healthy employees are also key to productivity.
Understanding what's available and how to obtain it, however, is a different story.
Prescott, which has fewer than 20 employees, decided it would offer a similar amount to what was paid for each employee's benefits in the past and let the employees decide what to do with that allotment in the marketplace.
Under the auspices of Avenue H, group rates are already negotiated, and for an extra small administrative fee, billing and processing can be fulfilled each month in one streamlined transaction.
"It's an opportunity to come in and shop for health insurance policies and make comparisons between the companies that offer them," said Patty Conner, director of the state's Office of Consumer Health Services, which runs Avenue H.
Conner is an expert on the ACA and specifically knows the ins and outs of the law for businesses. She was hired to run Utah's already functioning marketplace in 2010 and is working on plans to extend it to the state's large employers when lawmakers give the go-ahead and provide funding for potential expansion.
Avenue H, Conner said, offers a number of tools to help navigate what is available online, as well as access to brokers who understand the rules and regulations that small businesses face. She expects it all to get more familiar to people as time moves on.
"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.
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