Health insurance without copays or deductibles? – InsuranceNewsNet

No deduction. No extra charge. No out-of-pocket costs. No cost for prescription drugs. All health insurance benefits.

That’s the idea behind a new health insurance option that healthcare company Curative is launching Central Texas this month.

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

Curative established operations in The angels, Austin and Washington, while providing testing and vaccinations in more than 40 states during the COVID-19 pandemic. It looked at what’s next for healthcare after the pandemic ends. It was noted that many health care systems were not set up to not collect co-payments for free tests or free vaccinations that were part of the pandemic.

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

The health insurance treatment plan is based on the idea that if people engage in preventive care in time, they can save money and so can their health insurance company. It’s also based on the idea that providers can simplify the process by not having to collect co-pays or co-pays.

When insurance companies raise copays and deductibles, people put off care, Turner said. “There is a short-term cost reduction because people stop getting care, but they don’t stop getting care. They stop doing preventative things – mammograms, colonoscopies. Health care costs are going up again with everything they put off … they end up in the emergency room and they don’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 expense is that the employer pays part and the employee pays the rest of the monthly premium. It is estimated that for a single person most monthly premiums for a single person will be between 400 dollars to 800 dollars, which Turners said is comparable to other PPOs. Premium amounts are based on the number of previous insurance claims and the risk factors each employer group has. Family premiums will vary more widely, Turner said, because some employer groups may have many employees with many children and some may have very few.

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

To receive the benefits with no deductible, no out-of-pocket and no co-payment, people must have an annual baseline medical visit with Curative within 120 days of starting the plan. After this period, if they have not completed the primary visit, then they will have 5000 dollars deductible for an individual or 10,000 dollars for a family. These numbers double if the visit is with an out-of-network provider. Children do not pay, they have a deductible as long as one parent has the primary visit.

“Design is one big financial incentive for preventive health,” Turner said.

The basic visit establishes that the person has a primary care physician and has been receiving regular preventive care. If they don’t, or haven’t been in a while, blood work will be done at the baseline visit and they’ll be connected to a primary care physician.

Even if they’ve recently seen a doctor, Curative will offer some pre-diagnoses to its members that look more in-depth at things like heart risks, as well as a whole-genome sequencing test to help a member and their doctor make more personalized healthcare solutions.

This test, Turner said, can help determine which drugs will work better for that person and what their 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 network of care that includes St. David’s Healthcare 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 collaborate with Curative and its innovative approach to health insurance,” said Dr. Anas of Dagestanpresident and chief executive officer of 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 a co-pay and have a deductible for that office visit, just like any other PPO. However, if they can prove that there is no in-network option, or if their referring doctor can prove that another doctor is not medically appropriate for that patient, that specialist will be covered as in-network.

It’s the same with medication. Curative has its own pharmacy that delivers to your home as well as uses HEB pharmacies. Recipes are divided into levels 1, 2 and 3. Level 1 is a $0 surcharge. Level 2 is $50and level 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 won’t work for the member, they can get a Tier 2 or Tier 3 drug covered as a Tier 1.

If a person seeks emergency care outside of a network hospital, they will still be covered as a network hospital. If they have surgery scheduled, however, they’ll have to prove it’s medically necessary to be at that hospital instead of an in-network hospital in order to pay $0 price on the web.

Curative is currently negotiating with more healthcare providers and systems to reach agreements to expand its network roster with January 1, when most people start new health plans. There is none at the moment of Austin Level 1 trauma hospitals for adults or children are still in network.

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

The healing is also the opening of Curative Commons in January at 900 Congress Ave. which will have a fitness center, classes and nutritional counseling for its members.

Curative has invested the first three years of the expected cost of the healthcare program. He used his own funding to do this, Turner said. It added 70 positions to launch the health insurance program and expects to add more as it grows.

Curative expects to turn a profit on its health insurance business 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 is omitted in some editions due to a production error.

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