Steamboat Springs Chamber offers alternative health care program
January 13, 2019
STEAMBOAT SPRINGS — In an effort to help entrepreneurs and small businesses thrive, the Steamboat Springs Chamber began offering a new healthcare program to members in late November.
It is not insurance, stressed Chamber Membership Manager Vic Walker.
The Small Association Leadership Alliance (SALA) healthcare program is also not sponsored by the Chamber, Walker noted, but is a partnership through which members can "access a comprehensive and cost-effective alternative to traditional insurance plans."
The program is available to full-time, part-time and seasonal employees of any business that is a chamber member.
From an economic development perspective, "We know it's a problem for small businesses," Walker said. "I know people who did not start a business because of health insurance."
Insurance premiums in the Northwest Colorado region are some of the highest in the entire country.
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Responding to a clear need for more affordable options, and "how we could bring better health care or insurance options to our members," Walker said, the Chamber first pursued sponsoring their own plan, as can be found in other states.
But, due to a lack of networks, difficulty finding an underwriter and not getting approval from the state insurance commission, the cost-sharing alternative was pursued.
So how does it work?
The program offers two different levels of preventative care plans paired up with the medical cost-sharing program. The first part of the plan covers the basics, including preventative care and a co-pay for prescriptions. In the event of a bigger injury or illness, the second part operates as a cost-sharing plan, which works somewhat like a deductible. Once a certain amount is met by the participant, the membership shares the rest of the cost.
"In medical cost sharing, the patient deals directly with the doctor or hospital without an insurance company actuary," according to the Chamber's website. "Secondly, the patient becomes a responsible, cost-conscious consumer rather than only being responsible for a co-pay and no concern what is charged to the insurance company. Medical cost sharing plans are not for everyone but are a practical solution to managing healthcare costs."
There are risks and benefits to this alternative approach, Walker said. And people must first do their homework to see if it is viable option.
First, the plans have shown savings from 40 to 60 percent lower than traditional insurance plans, he said.
When Walker looked on the Colorado Health Exchange for a plan for himself, the cheapest option was more than $700 per month with a nearly $6,000 deductible.
Through the Chamber's program, Walker was able to find an equivalent plan for about $220 per month.
There are also no networks, so participants can go to any doctor in the country. The member presents as a self-pay patient and then has a professional health care agent negotiate with the hospital.
Another benefit is that, once the patient has covered their initial agreed upon amount, everything beyond that for that diagnosis is covered, unlike a traditional plan where the deductible is reset each year.
On the down side, the program does not cover pre-existing conditions, Walker said. The program also does not come with the regulations that govern traditional insurance, and the partnering cost-sharing company, Sedera, does not disclose its financials. And there is a little more work for the patients throughout the billing process.
So far, Walker said member businesses have expressed a lot of interest in the new option. And it has a rolling enrollment with no deadline.
Providing another option, Walker said, is a step in helping Steamboat's long-term economic development.
In the complex and high-cost world of health care and insurance, "This is not a magic bullet," he said. "It doesn't cover everybody. But it does cover an important part of the people we serve — really small businesses and entrepreneurs who want to start a business."