Healthy plans

An obscure health-insurance plan started by doctors in Marion County more than 30 years ago has become a big hit with doctors from Tampa to Naples.

“At first it sounds almost too good to be true,” says Mitchell Zeitler, a physician with Anesthesia Associates of Naples, who is also the president of the Collier County Medical Society.

Collier doctors who are members of the society say they expect their annual premiums will be 10% to 30% lower than their current plans when they sign up for one of 11 Blue Cross Blue Shield plans offered by the Marion County Medical Society Insurance Trust Fund. Open enrollment is underway now for the first time for members of the Collier County Medical Society and the Lee County Medical Society.

Hundreds of doctors and their staffs in Hillsborough, Sarasota and Manatee counties have become plan members in recent years and rave about its stable premiums and ease of administration. “This is our third year and we haven't had increases in premiums,” says Tampa surgeon Michael Wasylik, who is also one of the plan's trustees for Hillsborough County.

“We've saved in the last two years 25% in premiums,” says Sharon Galantino, the chief operating officer for LoCicero Medical Group in Tampa.

The health-plan enrollment process is usually the bane of every human resource department, but Galantino says the trust handles the paperwork using an online portal that makes filing easy. “It's pretty phenomenal from a workflow standpoint,” she says. “The forms are painless. I can honestly say it's that easy.”

The Marion trust is a rare entity called a multiple employer welfare arrangement, which is designed to give small employers access to low-cost health coverage. Because it's not required to hold the same high level of reserves as regulated insurance companies, it can market insurance coverage at rates substantially below those of regulated insurers.

The plan is such a good deal that not everyone is keen on talking about it, lest it bring unwanted scrutiny, some doctors and administrators say. “I don't think the doctors want to put that out there,” says Ann Wilke, executive director of the Lee County Medical Society. She referred questions to the association's president and Fort Myers physician Peggy Mourcade, who couldn't be reached for comment.
Debbie Trammell, the executive director of the Marion County Medical Society and the plan administrator fiduciary, declined to discuss how the trust works or even talk about its history. Trammell referred questions to Thomas Buss with the Ocala insurance firm of Barrett Liner, but he could not be reached for comment. Trammell says Barrett Liner is the trust's third-party administrator.

Privately, some say they fear that the government might change the rules and take away such plans. But for now, the plan for physicians and their staffs brings respite in the form of lower premiums, easier administration and more control over costs. That's important because doctors aren't seeing any increases in patient income as government and insurance reimbursements shrink.

“If my revenues can't increase, maybe I can do something with expenses,” says Zeitler. “The way things are going in health care, people want to save any way they can.”

It started in Marion
Although Trammell declined to discuss how the Marion County Medical Society Insurance Trust Fund was started or how it works, the plan's website shares some details about the organization's roots.
In 1981, more than 50 Ocala-area physicians banded together to create the plan. The goals were to provide affordable health insurance to physicians, their families and employees; use each others' premium dollars to pay claims; avoid “gatekeepers” of managed care; provide premiums that didn't discriminate against those who had incurred large claims in the past; provide access to virtually all medical providers in the state; and provide insurance for the spouse and children of deceased physicians.

Today, medical societies in 10 counties including Lee and Collier are now participants in the plan, says Donald Raimey, the managing member of Leading Edge Benefit Advisors in Fort Myers who has helped the trust expand to Lee and Collier.

“It's been a huge success story,” says Raimey. “The track history speaks for itself.”

For medical societies, the plan offers a desirable benefit to its members and the savings often exceed the annual dues. For example, annual dues for the Collier County Medical Society are $400 for a physician. “We're trying to get the word out to those who aren't members,” says April Donahue, the executive director of the Collier County Medical Society.

Paul Dorio, a physician in Naples, estimates he'll personally save as much as $5,000 this coming year in premiums for him, his wife and three children by switching to the trust plan. “The employees plus the owners all told will probably save 10% to 15%,” says Dorio, whose radiology practice has nearly 100 employees. “It's clearly worth doing.”

Dorio and other doctors in Collier are encouraged by the experience of their colleagues in Hillsborough and elsewhere. “The last two years, the participants who joined the program saw zero increase in their premiums,” says Debbie Zorian, executive director of the Hillsborough County Medical Association. “It's working very, very well.”

Historically, insurance brokers have avoided medical practices because they tend to attract employees who need medical care. And when doctors get sick, they tend to spend more on medical care. In particular, smaller medical practices don't have the opportunity to save as much as bigger firms, doctors say.

Administrators say they love the trust plan because of the ease of use. They say the forms are simple and the trust administrator in Ocala, Barrett Liner, handles the paperwork smoothly. “This thing has been a piece of cake,” says one longtime medical-practice administrator in Bradenton who requested anonymity. “It's the best business decision we've made in a long time,” she says.

Managing the premiums
The medical societies say the trust is established as a multiple employer arrangement (MEWA), which can be created by two or more unrelated employers to provide health and welfare benefits.
Employers send money to the MEWA, which is used to either pay premiums for health insurance or to pay for benefits directly. The organizers of the plan determine the amount of contributions needed in order to fully pay claims.

Although U.S. Department of Labor and state insurance commissions regulate the arrangements, such plans aren't required to build the same high level of reserves that regulated insurance companies do. This is the key to affordable premiums, but it could also create losses if substantial claims arise, warns Mark Weinstein, the president and CEO of Independent Colleges and Universities Benefits Association. Weinstein's association has such an arrangement for its members too, and it suffered losses in its first years after inception in 2003.

Trustees of the plan know that a year of high-cost claims could drive up costs. “There's no guarantee that it will remain less expensive,” says Wasylik, the Tampa physician who is one of the Hillsborough trustees. “However, it's always been less expensive.”

The Marion County Medical Society Trust Fund has established a board of trustees for each county where it operates, says Wasylik. If there's money left over at the end of the year, each county can decide what to do with the funds. “We're able to buy down the premium increase in a bad year,” he says. “The trust allows us to build up a reserve.”

But such arrangements are rare and they're likely to remain that way. “There's not that many [MEWAs], and the reason is because you need to have the authority of the state to operate,” says Weinstein.

Executive Summary
Industry. Insurance Trend. Finding lower-cost health insurance Key. Some employers have banded together to seek out lower health-insurance premiums.