San Benito Independent School District is embarking on a new health plan that centers around their in-house primary care clinic. Controlled referrals add to plan savings, or at least that is the theory.
By Fernando Del Valle
SAN BENITO — Felly Rosales said she sees the benefits of the San Benito school district’s new health care plan that is modeled after the Affordable Care Act.
The district-run managed care plan reduced her monthly insurance payments from $69 to $25, Rosales, a teacher’s assistant, said.
“I feel very blessed,” Rosales said.
Tuesday, the district unveiled the managed care plan that replaced Blue Cross Blue Shield, which was the district’s third-party administrator for five years.
School board members in April voted 4-3 to approve the health insurance plan. Board member Anna Cruz, who voted against the plan, warned the district would use its employees as “guinea pigs.”
Of the district’s 1,600 employees, 82 percent enrolled in the managed care plan while the remainder kept their previous insurance coverage, Glenn Hillyer, the district’s insurance consultant, said.
The new plan requires that the district’s primary care clinic refer employees to medical specialists who are part of the plan’s network of doctors, officials said.
“The clinic is a by-product of Obamacare from the perspective that primary care can be delivered at a low cost,” Richard Garza of the clinic operator ISD Managed Care Services said.
Officials said the new plan charges employees no co-payments, offers no-cost lab work and imaging while deductibles decreased from $1,000 to $250 for in-patient hospitalization.
Hillyer said more employees are taking advantage of the new plan since it opened on Tuesday. An average of 55 employees have visited the clinic per day for health care since Tuesday, an increase from an average of 38 per day under the previous health care plan, Hillyer said.
“The whole concept is the more people who use the clinic stay out of the health care system and that saves money,” Hillyer said.
Hillyer said the new plan offers medications such as insulin at no cost.
Under the previous plan, about 300 employees or their dependants could not afford an average insulin prescription costing $180 a month, Hillyer said, adding insulin can help diabetics avoid dialysis treatments that cost an average about $30,000 a year.
“What we’re trying to do is give (employees) the tools they need to stay healthy,” Hillyer said. “That brings costs down and you have more productive employees.”
