By Maureen Bayless Balleza
When Kimberly Calhoun traded her corporate job for a better position in a privately owned restaurant, she left her big company health benefits behind as well. For the next year, as her employers struggled to find an affordable plan for their workers, she did without.
“Terrifying is a good word for it,” said Calhoun on being without a medical safety net. “Any day something might happen.”
Then the restaurant signed up for the Multi-Share Plan, formerly known as the Galveston County 3-Share Plan. The program, developed at the University of Texas Medical Branch in 2008, was designed to help small businesses in Galveston County provide health benefits to employees.
“The UTMB Multi-Share Plan is a benefits program, not health insurance, offered to employees who work for small businesses in Galveston County that employ between two and 50 employees,” said Craig Kovacevich, associate vice president of health care transformation at UTMB.
In recent years, as the American economy has gone through upheavals, shedding jobs through the downturn and the wholesale decline of some industries, the traditional route to health insurance — the private employer — has disappeared for millions of Americans.
And many find themselves in the so-called “doughnut hole” of insurance — without access to private insurance through their workplace, too young for Medicare and earning too much for Medicaid.
The original UTMB plan became a model for two other multi-share programs in Central Texas and Harris County. Together, they form the TexHealth Coalition, designed to reduce costs and promote programs that emphasize primary and preventive care.
“One of the primary goals of the TexHealth Coalition is to provide vitally needed health care benefits to the working uninsured in Texas,” Kovacevich said.
In Galveston County, the Multi-Share Plan works with 127 employers — 57 on the island and 70 on the mainland — with an average of 3.4 employees. The total enrollment is 444 members, with 260 women and 184 men, with an average age of 46 and 47, respectively; and 165 are island residents with the remainder living on the mainland.
The program works by dividing the cost of benefits three ways — the employer, employee and a contribution from the state. The plan has a network comprised primarily of UTMB health facilities and providers within the 873 square mile radius of Galveston County. Some of the key benefits include:
• $50,000 annual maximum and $250,000 lifetime maximum per member;
• Primary, specialty, mental health and urgent care visits (20 visits a year with applicable co-payment);
• Hospitalization (five-day annual maximum with applicable daily co-payment);
• Emergency room visits (two visits a year with applicable co-payment);
• Scans and images;
• Outpatient surgery;
• Physical or occupational therapy (six visits a year with approval of primary care physician); and
• Outpatient pharmacy coverage ($1,200 a year maximum with applicable co-payment).
Calhoun said some of the plans originally considered would have cost half her monthly pay, whereas the Multi-Share Plan is within her price range.
Before she signed up, she didn’t go to the doctor for year. But since becoming a member, she’s been able to take care of medical issues as they occur and before they get worse.
“It’s a really great plan,” Calhoun said. “It’s been nothing but an excellent experience.”
At a glance
WHAT: UTMB Multi-Share Plan Administrative Office