Health insurance with no copay or deductible? – InsuranceNewsNet

No discount. No additional payments. No out of pocket expenses. No prescription drug costs. All health insurance benefits.

That’s the idea behind a new health insurance option launched by healthcare company Curative Central Texas this month.

The plan applies to employers with 51 or more employees who live or work in Travis the Williamson counties. Curative, which made its name building COVID-19 testing platforms, expects to expand within a year to more counties in Central Texas and then in a few years throughout Texas before expanding nationally.

Therapeutic established functions in The Angels, Austin and Washington, while providing testing and vaccinations in more than 40 states during the COVID-19 pandemic. He was looking at what’s next for health care after the pandemic ends. He noted that many health care systems were not set up to not collect co-payments for the free testing or vaccination that was part of the pandemic.

Healthcare “isn’t built for innovation,” said Curative’s CEO Fred Turner. “What’s next? What do we want to spend the next decade building?”

The Curative health insurance plan is based on the idea that if people engage in preventive care early, they can save money and so can their health insurance company. It’s also based on the idea that providers can streamline the process without having to collect a deductible or co-pay.

When insurance companies raise premiums and deductibles, people put off care, Turner said. “There is a short-term reduction in costs because people stop getting care, but they don’t stop getting care. They stop doing preventative things — mammograms, colonoscopies. Health care costs go up again with what they put off … they end up in the ER and he didn’t need to be there.”

Turner compares Curative’s health plan to Netflix. You pay one price every month and get access to everything. In insurance, this monthly cost is that the employer pays some and the employee pays the rest of the monthly premium. He estimates that for a single person, most monthly premiums for a single person will be between $400 to $800, which Turners said is comparable to other PPOs. Premium amounts are based on the number of past insurance claims and risk factors each employer group has. Family premiums will vary more widely, Turner said, because some employer groups could have many employees with many children and some could have very few.

Insurance industry experts at Texas and Nationwide declined to comment on the exact plans, but described Curative’s approach as unusual in the industry.

To receive non-deductible benefits, out-of-pocket benefits and non-copay benefits, people must have an annual basic health visit with Curative within 120 days of starting the plan. After this period, if they have not had this baseline visit, they will then have one $5,000 deductible for one person or $10,000 for a family. These numbers double if the visit is with an out-of-network provider. Children do not pay a discount as long as one parent has made the initial visit.

“Planning is a big economic driver for preventive health,” Turner said.

The baseline visit establishes that the person has a primary care physician and has received regular preventive care. If they don’t or haven’t been in a while, during the initial visit, blood tests would be taken and they would be connected to a primary care physician.

Even if they’ve seen a doctor recently, Curative will offer some advance diagnostics to its members that look at deeper things like heart risks, as well as a whole-genome sequencing test to help a member and their doctor get more tailored health care decisions.

This test, Turner said, can help determine which drugs would work best for that person and what the genetic risks might be and what inherited traits they might pass on to future children. Genome sequencing is not required, but will be free to the patient and available for future use in medical decision making.

“It’s all part of the long-term investment in the patient,” Turner said.

Curative currently has a care network that includes; Health of Saint David hospitals, Austin Diagnostic Clinic and Austin Regional Clinic. Members also have 24/7 access to a local doctor via telehealth.

Austin Regional Clinic is excited to partner with Curative and its innovative approach to health insurance,” said Dr. Anas Dagestanits president and CEO Austin Regional Clinic. “Providing access to high-quality, connected care has always been part of ARC’s commitment to our patients and communities, with a focus on keeping our patients healthy and helping them achieve their goals. Curative’s model is designed to do just that.”

If a member wants to see an out-of-network doctor, they will pay copayments and have a deductible for that office visit, just like any other PPO. However, if they can demonstrate that there is no in-network option, or if their referring doctor can argue that another doctor is not medically appropriate for that patient, that specialist will be covered as in-network.

The same is true with medicines. Curative has its own pharmacy that delivers to your home as well as uses EBR pharmacies. Recipes are divided into levels 1, 2 and 3. Level 1 is a $0 copayment. Tier 2 is $50and Tier 3 is $250. For each type of drug there is at least one Tier 1 drug, but if there is a medical reason why that drug will not work for the member, they can get a Tier 2 or Tier 3 drug that is covered as Tier 1.

If a person seeks emergency care at a non-network hospital, they will still be covered as in-network. However, if they have surgery scheduled, they will have to prove it is medically necessary to be at that hospital instead of an in-network hospital to pay the $0 in-network cost percentage.

Curative is currently negotiating with more healthcare providers and systems to reach agreements to expand the directory within its network to January 1st, when most people start new health plans. At the moment it has not of Austin Level 1 trauma hospitals for adults or children still in network.

At this baseline visit, the health navigator the member meets with will also go over how to take advantage of everything in the Curative plan, as well as what is not covered, and connect them with services they may need.

Curative also opens the Curative Commons in January at 900 Congress Ave. which will feature a gym, classes and nutritional counseling for its members.

Curative invested the first three years of expected costs for the health care plan. It has used its own funding to do so, Turner said. It has added 70 positions to start the health insurance program and expects to add more as it grows.

Curative expects to turn a profit on health care insurance in two to three years, Turner said.

Editor’s note: This story appeared on Wednesday American Statesmanbut we repeat it here because part of the story was omitted in some versions due to a production error.

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