Saint Mary's new health plan balances costs, benefits

A fast-growing segment of the healthcare market small companies that are bailing out of health insurance for their workers entirely was targeted by Saint Mary's Health Plans as it developed its new FlexFit product.

The health plan rolled out by the Reno-based health carrier this month targets small business customers that are struggling with the double whammy brought by the weak economy and rising healthcare costs, says Glen Padula, vice president of sales and marketing for Saint Mary's Health Plans.

Creation of plan that balances workers' desire for good coverage with business owners' need to find an affordable plan wasn't easy, Padula says.

Saint Mary's staff began developing the product early this year as they saw that the recession was bringing increased difficulties to small business customers that already struggled with healthcare costs.

Staff of the health plan interviewed insurance brokers and owners of small businesses, Padula says, then began weighing proposed benefits against the additional cost they'd bring to businesses that would buy the plan.

They determined, for instance, that most health care consumers schedule five or fewer visits a year to a physician's office. The plan they developed provides five visits a year (with a co-pay) for visits to primary-care physicians and specialists.

The plan also emphasizes wellness, offering 100 percent payment (after a copay) for prevention, screening and wellness expenses.

"This is designed to be a great plan for a younger, healthier population," Padula says.

It's also a stripped-down version that doesn't offer a lot of extras and requires copays and deductibles throughout. Deductibles kick in on accident and injury benefits, for instance, after $1,000 in billings each year.

"It got massaged a lot," Padula says of the balancing act between benefits and costs.

The plan limits hospital use to Saint Mary's Regional Medical Center. Like the health plan, it's affiliated with Catholic Healthcare West, the San Francisco nonprofit that's the eighth largest hospital system in the nation.

About 90 insurance brokers showed up when Saint Mary's Health Plans introduced FlexFit, and some of the brokerages now are scheduling sessions with their own customers.

Despite a strong introduction, Padula says executives of Saint Mary's Health Plans won't have a good reading on the plan's success in the marketplace for six months or so.