Pre-Existing Coverage Village Coverage All residents
back to Infrastructure Menu How We Can Insure Residents?
It must be understood that there will be a drastic difference in health benefits between the first year and twenty years after startup. This is because of the hopeful increased health of the population, the size of the populations, the changing age of the population, the number of residents drawing outside health benefits, as well as our government’s involvement in Medicare, Medicaid and health coverage.
Health benefits during the third year of operation might be as follows
Those persons currently covered by health benefits under entitlements such as retirement benefits, Medicare, etc. would keep their coverage. This group might be as high as 25% of the overall population.
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A group catastrophic health policy could be purchased covering those not owning entitlement health coverage. For example, a group health insurance policy with a $50,000 deductible, covering up to $3,000,000 per person, has been available through Lloyd’s of London.
The Village may join with other groups in creating an alternative to health insurance, to cover the costs up to $50,000. This system is not an insurance company, and does not guarantee the payment of any debts. It is, however, the full intention of the Village and the members of the health payment system, to meet the members health costs every month.
Medical costs will be initially reduced by joining a medical discount group, such as Care Entrée www.careentree.com or USA Benefits. Costing only $40 -70 monthly per family, these groups contract with PPOs so that provider costs are reduced to the rates available to large third party payers. The requirement to pay full hospital and other provider charges is thus avoided, and the health care costs incurred by the members will be subsequently significantly reduced.. There will be no exclusions from this discount membership for pre-existing conditions, elective procedures, or preventative care services. Members have the freedom to choose any health care they wish, and pay the reduced rate.
The health benefits plan will preferentially pay for alternative and complementary care which has been found to be less expensive, more effective, and safer than standard medical care. For example, home birth with a midwife for normal pregnancy meets these conditions. Members electively choosing hospital birth will be reimbursed at the rate for a home birth with midwife. They will be responsible for the difference in costs. Still, their hospital and obstetric costs will be reduced by up to 40% or more, due to the participation in the discount group and its PPO contracts.
Members anticipating procedures or courses of treatment which have a reasonable and effective alternative will be required to consult with a plan provider about the alternatives before the elective procedure is pre-authorized. For example, a member with chronic sinus problems, who has been advised by his ENT to have sinus surgery, will be given the opportunity to learn about homeopathy, herbal treatments, and autoimmune desensitization (Allergostop) before being pre-approved to undergo the surgery. In other self-insurance plans, just having a consultation with a knowledgeable alternative physician available markedly reduces medical and drug costs overall.
Each member or family will have a deductible of $100 to $250 per member, per illness, depending on the type of participation they choose. This deduction helps to put the responsibility for health care back onto the individual or family. In this way, the current problem of entitlement, or expectation that someone else will remove one from all responsibility, will be reduced. Once the members had learned to accept responsibility for their own health, and for each other, the full amount might be paid by the Village.
The necessary (non-frivolous or non-cosmetic) medical costs which are incurred by each member are then shared among the members on a subscription basis. For example, a $2,000 MRI scan might be paid for by the monthly subscription of 20 members paying $100 each. Subscription fees will be such that 10% of the subscription fees will go into an escrow account. In this way, a buffer of money is gradually accumulated, and maintained in escrow for the members, to cover catastrophic needs which cause an unforeseen demand on the monthly subscription contribution.
In the event that one month’s subscription funds are sufficient to pay only a percentage of that month’s unusually high incurred costs, and money held in escrow is insufficient to cover the cost overrun, then each need will be funded only to that same percentage. For example, if subscription funding covers only 85% of the total needs that month, then only 85% of each need will be reimbursed. If subsequent months have a surplus, this could be applied to the previous month’s deficit. In the event that costs consistently and significantly surpass monthly subscription income, monthly subscription rates will be increased. In the event that subscription income consistently surpasses needs, then subscription rates will be decreased.
Contract will be made with an internal or outside health facility to provide preventative health care and health education. This care will be paid for by the membership. Ideally, each village or group of villages will have its own medical clinic, providing standard and alternative health care, homeopathy, nutritional supplements, and other treatment modalities.
Mini-medical insurance plans may be incorporated into this system of benefits, which would provide a base line of insurance coverage at a higher deductible
A Pre-Existing Medical Condition clause may be required to protect the Village from being overburdened by current catastrophic conditions. This clause would probably be required by the catastrophic insurance provider, but might apply to the Village self insurance as well. As the Village grows in size, and shares risk with other similar villages, this requirement will probably be dropped.
In the event of a pre-existing condition, that person could still obtain medical assistance but at the expense of the medical industry as an indigent. The Village would still be in a position to give other support.
Self insurance benefits might change from year to year based upon budget constraints. Administration of this plan will initially be with an outside third party administrator, but could be assumed by the Village as they are trained. The Village would maintain insurance clerks, advisors, actuaries, budget analysts, medical advisors and others necessary to provide a viable health maintenance plan. Medical policy would be managed by the “How Do We Vitalize Ourselves” focus group.
A separate non-profit corporation would administer the self insurance coverage, thus insulating the land and buildings from risk.
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Preventative maintenance systems would be maintained by the Village and available to all its residents, keeping in mind that 80% of medical problems are stress related.
These systems might include:
Dieticians Exercise equipment and trainers.
Active sports Massage therapists
Yoga and Meditation Medical Aids
Nurses to assist with research and advise when a doctor is needed.
Advise and help with alternative healing.
Free vitamins and supplements.
Family planning and contraceptives.
Maternity Assistants, including Midwife, Labor Doula,
Lactation Consultant, Fertility & Maternity Counselor
Entitlement Advisor (expert on outside systems that can assist you)
Substance Abuse Addiction help