COD E R E D

Firstplan xxvi,12Moore County, MichiganOverviewFirstPlan is a private, partially subsidized, small group coverage product with choice ofopen or closed network. Premiums are based on a shared contribution among employers,employees and health care providers. Unlike the “3-share model” seen in Muskegon Countyand other communities, FirstPlan is sponsored by a local safety net health system. It providessubsidies when necessary, and uses an actual insurance vehicle that is obligated to meet allstate insurance requirements. The plan emphasizes disease management for high-riskenrollees, and has an educational component that teaches new enrollees how to access thesystem.EligibilityIn 2005, over 1,375 workers in 132 businesses weree enrolled in FirstPlan products;including dependents, there were over 2,000 members, nearly 380 of whom were previouslyuninsured. Members receiving premium subsidies numbered 218 and 63 businesses receivedpremium discounts in the form of “CareCredits” through First Plan. “Care Credits” wasdeveloped by FirstCarolinaCare.FirstPlan does not specifically target the uninsured. Rather all small businesses with 50employees or fewer are eligible to purchase FirstPlan products. Premiums may be subsidizedfor workers earning $9/hour or less, if the business has 100% employee participation and theemployer contributes at least 50% of the premium. The amount of the subsidy is based on theemployer’s perception of the employee’s ability to pay. The employee contributes around $50per month for employee only coverage and the subsidy amount makes up the difference of thefull premium.FirstPlan premiums for a business may be reduced up to 20% as permitted by NorthCarolina Department of Insurance. FirstPlan utilizes CareCredits based on criteria related to:employer contribution rate for employees and dependents; participation level among workers;and coverage history. Using these criteria, FirstCarolinaCare is able to look at the final ratesmore favorably. A firm that had not offered coverage before, for example, could get a 5%premium reduction. So far, reduced group premiums average 7% to 10%.FirstCarolinaCare has given 40 businesses CareCredits to date. All insurers in NC havea flexibility of 20% higher or lower with their filed rates. FirstCarolinaCare plans to enroll 500previously uninsured members annually, and can subsidize up to 1,000 low-wage workers.Benefits and ServicesWhen designing FirstPlan, FirstCarolinaCare considered an HMO product with limitedchoice, but analysis indicated it would bring only minor price savings compared with moreflexible plans. As a result, FirstCarolinaCare offers health plans similar to those offered to otherbusinesses. The health plans have the choice of open or closed network. Benefits includepreventive care, physician care, inpatient and outpatient care, lab/X-ray, OT/PT/chiropractic12 Personal Communications with Rebecca Ballard, Community Voices Project, May 2005D-18