Second Meeting with Superintendent of Insurance

The second meeting was today with Deputy Superintendent Judy Shaw. Ms. Kofman had a prior engagement. This session consisted of the Bureau of Insurance putting forth Maine insurance codes options. There were seven code options that were discussed. Some made good sense, some made none at all, where direct care workers are concerned. The options presented were: Private Purchasing Alliance, Small Group Health Plan, Multi-Employer Welfare Arrangement (MEWA), Trustee Group, Labor Union Group, Association Group and Other Group. The Private Purchasing Alliance is a corporation that is set up to provide health insurance to its members through one or more affiliated carriers. There are certain insurance laws and rules that the corporation operates under. One nice thing about this is that it can include workers who are not affiliated with an employer, like our Alpha One folks. These unaffiliated workers do become a separate risk pool. I hate that term "risk" but it is term that insurance companies use. A risk pool is a rated group of individuals. It has nothing to do with how "sick" that group is. I think it has to do with the type of work you do, your age and possibly where you live that puts you into a certain "risk" pool. I think SEIU Local 503 in Oregon has set up its health insurance for its members this way. The Small Group Plan is one that is for employers with 50 or fewer employees. One drawback with this is that insurance companies require that 75% of all eligible employees have to participate in the plan. One plus is that eligible employees must work at least 10 hours per week. Community rating applies to these plans. Community rating is that rates cannot differ based on health status. This would be something that would work for Direct Care Workers. The Multi-Employer Welfare Arrangement did not seem like a good way to go. Those employers in the arrangement pool their risk and collectively self-insure. They create their own healthcare insurance plan. The MEWA defines what the plan looks like and what it offers and what the rates are. A big draw-back of MEWAs are that the employers in the arrangement are held liable for the obligations of the MEWA. If the MEWA cannot pay its obligations, the member employers pay an assessment. Another draw-back, those who are not employed by an employee of the arrangement cannot get coverage. A Trustee Group is a group of individuals insured under a policy that is issued to a trust that is established by two or more employers or by two or more labor unions or similar worker organizations. The trust is the policy holder. Those eligible are all the employees or the employer or all the union or organization members. SEIU Local 775 out in Washington has set up its healthcare insurance this way. The group wanted more information on this. Labor Union Group was the next code. The union/organization is the policyholder and those members of that union/organization may be insured. This group may not be eligible for small group community rating. More information was requested for this code. Association Group is a lot like the Labor Group in that a group of individuals may be insured under a policy issued to an association or a trust. The association must have at least 50 people. It must be organized and run in good faith for other purposes, not for just buying insurance. It must be in existence for at least two years before obtaining insurance. The association is the policyholder. The insurance is available to individuals and employers. The last code was Other Group. This is a group formed under 2808, an insurance law or rule. The only thing I have on this is that Dirigo is an example. Under the Small Group Plan, there was discussion as to the definition of employee in the purposes of insurance code. The group will hear from someone in the Department of Labor on that definition. You wouldn't think it would or could be so complicated, but it definitely is. Either you're working for an agency that matches you up with consumers, and that agency runs payroll to pay its workers; or you work independently, directly for a consumer. That consumer handles your payroll and workmen's comp. Either way, you're an employee. There was talk of "underground employees," those who are matched up with a consumer and unknowingly to the consumer, the consumer bears the burden of insurance and comp. All in all this meeting went well. There was concern that workers themselves were not being considered, it was mostly employers that were. My take was that the Insurance Bureau was giving us some tools to work with. The next meeting is scheduled for Monday July 14th at 10 am at the Bureau of Insurance Offices in Gardiner. These meetings are open to the public. If there are any direct care workers out there, interested in attending, please get in touch with me helen.hnsn@gmail.com I can fill you in a little on what the next meeting will be about and how this is all working.