COD E R E D

Benefits and ServicesEnrollees can choose from five health plans that cover a full range of inpatient,outpatient, emergency, diagnostic and prescription drug services. The provider networkconsists of private physicians. Enrollees are assigned a PCP/gatekeeper who authorizesaccess to specialty care. The co-payment for physician visits and prescription drugs is $5.Supplemental riders are available for an additional premium charge. For example, vision andexam coverage is available for an additional 6 cents, dental for $3.29, and unlimitedhospitalization for $1.86.Premium costs are divided equally (one-third each) among the employee, theemployer, and the HealthChoice program. The employee’s share of the cost of coverage forsingle coverage is $42; for employee and spouse is $90; for employee and one minordependent is $70; for employee and two minor dependents is $78; and for employee, spouse,and one to three minor dependents is $120.FinancingThe program is financed through enrollee premiums, employer contributions and theHealthChoice program. HealthChoice’s share of the cost of coverage is funded through ahospital indigent care pool, which is financed by state Medicaid funds, federal Medicaidmatching funds and county general funds. The annual budget, based on premiums for basichealth coverage for a projected 20,000 enrollees, is $16.8 million.MarketingRadio and television advertisements and some direct marketing are funded by theprogram. Each participating plan employs a sales staff that targets the plan to small andmidsize businesses.Access Health xxviii,xxix,xxxMuskegon, MichiganOverviewAccess Health is a private, subsidized, small to medium-sized group coverage programwith a closed network. The program is financed through a three-way shared buy-in whereemployers, employees and the community each cover a portion of the cost.EligibilityBusinesses with up to 150 employees are eligible to participate in Access Health if theyhave not offered health insurance to their employees for the past year and the median wage ofeligible employees is $10 per hour or less. Access Health encourages Medicaid-eligible adultsto enroll in Medicaid, but allows them to participate in Access Health if they do not wantMedicaid coverage. In addition, employers must offer dependent coverage, although familiesare encouraged to enroll Medicaid- or CHIP-eligible children in Medicaid or MIChild (Michigan’sCHIP program).D-20