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Morgan County Insurance Board approves joining Samaritan Fund to cover high-cost employee medicals
Summary
The Morgan County Insurance Board voted to participate in the Samaritan Fund program, which would let the county pay a one-time amount to move qualifying high-cost claimants off the county group plan and onto donor-funded individual coverage; board members stressed selection will be subject to underwriting and county final approval.
The Morgan County Insurance Board voted to participate in the Samaritan Fund program during its Sept. 15 meeting, approving a motion to allow the county to enroll qualifying high-cost claimants in donor-funded individual plans.
Board members said the Samaritan Fund, introduced to the board by Apex, would be voluntary for employees and would move approved participants off the county group plan onto a marketplace plan whose premiums and out-of-pocket costs are paid by the Samaritan Fund while the person is enrolled. "If they are approved and they go through and they're, approved. They come off your plan. They go on to the marketplace. Their premiums are paid at a 100%. And they're given a debit card that equals their out of pocket maximum," the benefits presenter explained to the board.
Under the program as described to the board, the county would pay a one-time fee of approximately $55,000 to remove a single covered member from the group plan for one year; the county would pay an additional $15,000 for each dependent moved off the plan, up to a $100,000 family maximum. Board members and the presenter emphasized that applicants must show projected ongoing claims that would exceed the program's threshold and that Samaritan Fund underwriting and clinical review would determine eligibility. The presenter described the target participants as employees with chronic, continuing high costs such as active cancer treatment, leukemia, multiple sclerosis or sustained high pharmacy costs rather than one-time, nonrecurring surgical costs.
Board members asked how the Samaritan Fund is financed; the presenter said the fund is supported by donations from individuals and organizations and that many donors remain anonymous. Apex, the broker/consultant who brought the program, will work with applicants to select market plans and coordinate enrollment during open enrollment; the marketplace is expected to open Nov. 1 for selections. If a member is approved, the county will be invoiced for the one-time payment required to move that member off the group plan.
Board members stressed they retain final approval over individual enrollments. The presenter said Samaritan Fund reviewers will send recommended candidates to the county for a "final approval" decision; underwriting and clinical review will consider the health of dependents when weighing whether a family should be moved together.
Concerns discussed included the possibility that a member moved off the plan could die shortly after enrollment (leaving the county to have paid the one-time amount with limited benefit), and what would happen if multiple families sought enrollment. The presenter said underwriting is intended to reduce those risks and that the county would only be charged for members who are selected and enrolled.
The board approved a motion to participate in the Samaritan Fund program; members voted in the affirmative by voice vote.
