Health Access Plan (Winnebago County, IL)

Overview: Health Access Plan (HAP) is a community-wide health coverage iniative developed by the Rockford Health Council, Rockford, Illinois, and administered by Health Access Plan, NFP. HAP provides modest health coverage to the working uninsured through their employers. Health Access Plan is not an HMO or a traditional insurance product. It is a health insurance produce that has been designed to fill in the gap between no insurance and commercial product. The program targets a tier of small to mid-sized businesses unable to provide health coverage through commercial sources. At full enrollment of 5,000 adults, it is projected that Health Access Plan may generate up to $9 million annually in new financing for Winnebago County health providers. Development costs have been underwritten by a Community Access Program Grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration, awarded in September, 2001. The Illinois Department of Insurance has been actively engaged in development.

Location: Winnebago County, Illinois, HAP is administered by Health Access Plan, NFP, of Rockford

Targets: 500 Winnebago County businesses. The program plans to accommodate up to 5,000 full-or part-time working uninsured individuals. Dependant coverage is available, although families are encouraged to enroll eligible children in KidCare (Illinois' State Children's Health Insurance Program) or Medicaid.

Number of Participants: A "beta test group" of small business (totaling 300 employees) is currently being enrolled in the program. All heathcare providers in Winnebago County will be eligible to participate, and a provider network is under development, currently with over 150 providers signed on.

Time Frame: Health Access Plan began enrollment of a test group on July1, 2003. The program is not designed to be time limited or a pilot. Enrollment will be ongoing to eligible businesses, with maximum enrollment in 2003 - 2004 linked to available premium subsidy funding.

Eligibity:

• Small businesses with from 3 to 25 employees in Winnebaro County (e.g. "eligible" full- or part-time emlployees). Non-eligible employees include seasonal and temporary employees and employees covered by other insurance.
• Business must not have been providing insurance to employees for the past 6 months.
• The median wage of eligible employees is $12.00 per hour or less.

Amount of Subsidy: The cost of coverage, $150 per month, is to be shared among the employee (one-thirs), the employer (one-third), and through a community subsidy (one-third). For the first year, the community subsidy will be underwritten by a grant from the U.S. Small Business Administration, secured for us by Congressman Manzullo. Thareafter, we are planning to partner with local providers and the State of Illinois to create an intergovernmental transfer mechanism to leverage unclaimed in federal funds to support the community share.

Coverage: Health Access Plan contracts with an insurance compant (Pan American Insurance) through Crossroads, Inc., with modest benefits toward physician services, ER visits, inpatient hospital services, surgical services, intensive care, skilled nursing survices, in-patient mental health care, wellness care, prescription drugs, diagnostic lab and x-ray. Individuals are not excluded because of pre-existing conditions. The program does not plan to cover an care recieved outside of Winnebago County.

Pharmacy: HAP plan offers pharmacy benefits at pharmacies located throughout Winnebago County. Health Acess Plan members have a co-pay of $10-20 per generic prescription and a Brand Name drug discount that averages 19%.

Outreach/Marketing: HAP is being marketed by local insurance agents, working with Crossroads Consulting and Brokerage of Table Grove, IL, who represents Pan American Insurance. A list of local agents is available.

Financing: The program is financed by a thre-way "shared buy-in" among the employer, employee, and community. The employer, employee, and the community will each pay one-third of the cost of coverage. The employer and employee each pay $50 a month to participate in the program. The community match will be comprised of federal funds and local government, community, and foundation funds. Contact for more information: Becky Cook Kendall, President, Health Access Plan, NFP, (815) 395-5701, or Gloria Dillard at (815) 395-5708.