COD E R E D

The program targets up to 3,000 full- or part-time working uninsured individuals and upto 500 small to medium-size businesses in Muskegon County. By 2004, the program wasserving more than 420 employers and 1,150 employees and dependants.Benefits and ServicesAccess Health covers physician services, inpatient hospital services, outpatientservices, emergency services, ambulance services, prescription drugs (formulary),diagnostic lab and X-ray, home health, and hospice care. Individuals are not excluded or ratedaccording to pre-existing conditions. The program does not cover any care received outside ofMuskegon County. Co-payments are required for most services. For example, PCP office visitsrequire a $5 co-payment and specialist visits require a $20 co-payment. The co-payment rateswere designed to encourage primary and preventative care. Access Health members arerequired to select a PCP and have an office visit within a year.The cost of coverage is shared among the employee (30%), the employer (30%), andthe community (40%). In 2004, the employee’s share of adult coverage was $46 per month.The employee’s share of dependent coverage was $29 per month.Almost all Muskegon physicians participate in Access Health. Access Health servicesare paid for on a negotiated fee-for-service basis.FinancingThe program is financed according to a three-way “shared buy-in” among theemployer, employee and community. The employer pays 30% of the cost of coverage,the employee pays 30% and a community match pays the remainder. The community match isunique in that it is comprised of federal DSH funds as well as local government, community andfoundation funds. In addition, 10% of provider fees are donated back to the program forongoing administrative costs.MarketingIn 1999, Access Health began a public relations marketing campaign (includingbillboards, and TV, radio and newsprint ads) that was designed to establish the program’sidentity. Aggressive enrollment began in 2000 and a full-time sales person was hired to sell theproduct to eligible businesses.Alliance Group Care xxxi,13Alameda County, CaliforniaOverviewThe Alliance Group Care was created to provide coverage to the county’s home careworkforce, who generally do not have access to employment-based insurance. It is asubsidized product with funding from public and private sources.13 Personal Communications with Luella Penserga, Community Voices Project, May 2005D-21