Agency for Health Care Administration Uninsured Study Group The Pre-Paid Health Clinic Chapter 641, Part II Septemb

2. A Pre-Paid Health Clinic Plan� Can it be one of the solutions for Florida�s Uninsured?

3. Overview of Ch. 641 Part II The Products Available The Uninsured Care Access Health Plan Topics

4. How Part II of Chapter 641 began� Enacted in 1984 as a response to the growth and desire for regulation of the one-stop Cuban medical clinics Senator Jack Gordon�s bill designed to assist in the legitimization and regulation of the comprehensive clinic model dispensing health care in Miami Dade post-migration from Cuba in early 1980�s

5. The Pre-Paid Health Clinic License Office of Insurance Regulation Under Chapter 641 Part II, may issue a Certificate of Authority for the �so-called� pre-paid clinic, a limited benefit health plan - Required surplus - Required filings The Certificate of Authority designation is not for a major medical plan and does not allow hospital coverage There are currently five (5) licensed entities under this designation Model not available in other states

6. The Pre-Paid Health Clinic or Limited Health Benefit Plan Traditional Indemnity Insurance Traditional Managed Care Organizations/HMO�s Limited Benefit Plans Mini-Meds /Partial Benefits Discount Medical Plans Medicaid/Government Programs

7. Licensed Pre-Paid Health Clinics

8. Pre-Paid Health Clinic Plans Currently Pre-paid Health Clinic Plans are located in South Florida Large Uninsured Population Managed care familiarity Small business base Large Hispanic Population used to the clinic model and varied forms of health plan coverage

9. Who Would Benefit from a Pre-Paid or Limited Benefit Health Plan? Those individuals working or self employed, those currently uninsured Part-time employees, independent contractors, and seasonal workers not offered benefits Employers with no current health plan

10. Who would not benefit from a Pre-paid or Limited Health Plan? Not for everyone� Those with existing serious illnesses No hospital coverage No catastrophic coverage Those who have full coverage now, as it is not designed as replacement coverage Those needing a major medical plan, with unlimited medical and hospital

11. U.S. Census Bureau Statistics released 2 weeks ago, compiled by Families USA reported in Friday�s Jacksonville Times Union Number of Uninsured at 47 million Of the Uninsured African-Americans and Hispanics have the highest number of uninsured 50% of non-citizen, non-elderly residents were without coverage

12. WHO ARE THE UNINSURED?

13. Uninsured Floridians by Age

14. Care Access First pre-paid limited benefit plan accredited by URAC for quality health care delivery Corporate goal to cover a portion of the population not previously covered, or that segment of the population ignored by traditional health care coverage; affordable cost with comprehensive and routine preventive ambulatory health services outside the hospital Provides a medical home base for delivery of primary and specialty services and a health care assessment all provided by a large network of credentialed, private practice physicians

15. Care Access OIR approved for Individuals and Groups with various co-pays and no deductibles Individual rates for the Low Option start as low as $59.00 Coverage is portable Yearly Maximum Coverage Benefit is $25,000

16. Care Access provides coverage for� Comprehensive Routine Care To help keep Members well and out of the hospital through benefits which include: Immunizations, Mammograms, well-visits, outpatient surgery, diagnostic tests, limited prescription drug benefit Establishes the PCP as the Member�s medical home base Preventive Care Reduce more costly hospitalizations, by diagnosing more serious illnesses earlier Health Care Assessment Program

17. Challenges... Knowledge of the Plan by the public Access to correct information about what the Plan offers and does not offer Bridge for those coming off public plan Payroll deductibility