N.J. Health Insurance Options Growing
By Lindy Washburn, The Record (Hackensack, N.J.) | |
McClatchy-Tribune Information Services |
The two upstarts are
"These innovative new entrants are shaking things up for the entire industry," said
With millions of new paying customers buying insurance nationwide, thanks to Obamacare, the market is wide open and attractive to both traditional and new insurance carriers. More than half a million people in
So far, the start-ups have barely made a dent in the
Their biggest impact, however, may lie in the way they disrupt business as usual. "The new players typically are more nimble. They are more consumer-friendly," Connolly said. "That is serving as a wake-up call to the entire industry." They are forcing insurers, who long have dealt with human-resources directors or other big purchasers, to focus on individual customers.
Each will do that somewhat differently: Oscar appeals to digital natives with its smartphone apps and integration of "tele-health" into all its plans.
Oscar brought humor to the staid world of health insurance when it debuted its
That message will be coming soon to the Hoboken and
Founded by three friends who graduated from
The company is built around its technology platforms, which are designed to make health insurance easy for individual consumers to buy and use. Ninety percent of its members have created personal logins to use the insurer's website, said Schlosser. And 90 percent of those completed a health assessment and agreed to have their health history imported into the insurer's data bank, he said _ part of an Oscar promotion in which patients receive
The company focuses on the retail experience _ on the one hand, employing customer service staff at their headquarters in
"I think the advantage we have is that we're fully focused on the individual market," Schlosser said. "That's it. That's what we do best _ no small groups." All of their marketing is tailored to people who are making their own decisions about which coverage to buy _ not to benefits specialists or small-business owners. They aim their pitch at people who work for themselves, web-using freelancers such as Uber drivers and the errand runners of TaskRabbit.
Oscar also features doctor callbacks (guaranteed within an hour, usually within 10 minutes, said Schlosser) from board-certified doctors licensed in the state where the policy is sold. Notes from the doctor's call appear on a private, Facebook-like timeline for each member that includes details of each interaction with the insurer and the health system.
If medication is prescribed, the site links to drug information. It also guides the prescribing doctor to in-network pharmacies mapped out like a restaurant app around the member's location. For parents with small children, the ability to get a pediatrician on the phone in the middle of the night is welcome, Schlosser said, from firsthand experience, and he believes it will end up reducing insurance costs by cutting down on unnecessary ER or doctor visits.
Members in
A few insurance brokers interviewed said they were unfamiliar with Oscar, and not sure of the need for it, particularly because the QualCare network is also used by
"I think they will attract the younger crowd," said
Poonam Alaigh, a former
The company received its
Tucked into the massive federal health-reform law was a provision that aimed to create non-profit competitors to the big for-profit companies that dominated the insurance industry. In Western states, co-ops provide electricity and water services. The Affordable Care Act essentially funded an experiment to see if the same principles would work in health care.
"It's historic," said Dr.
Across the country, these new non-profit plans enrolled 400,000 people for 2014, and were the biggest sellers on the exchanges in
"We're the only true not-for-profit [insurance] company in the state," said
What that means in practice is that the law requires surpluses to be returned to members. In the future, Martin said, a board dominated by members of the cooperative will decide how to spend the company's operating surplus. "We can either return some of that premium to members," he said. "Or we can expand our offerings. Should we cover some of the non-traditional aspects of medicine that are very popular with people?" he added, joking that he'd like to issue Fitbits to every member. "They will vote on how to do this."
The first consumer board member will be elected from
First, however, the company needs enough customers to generate a surplus.
So far, they've had a tough road. For a start-up with no name recognition, the technical problems with HealthCare.gov were challenging. The marketing the company could do was limited by the terms of its federal loan. In addition, company executives said they were surprised to see their prices undercut by competitors whose premiums were based on coverage through a narrow network of hospitals and doctors. All of
This year, the company plans to offer new types of plans _ some with enhanced coverage for using selected providers _ and also move aggressively into the small business market.
In response to member feedback, the company has added "wrap-around coverage," to enable patients to see doctors in neighboring states, and eliminated the need for a referral from a primary-care doctor before seeing a specialist. All members will get a 24/7 telemedicine benefit, allowing them to call a board-certified in-state doctor with medical questions. A check with the state
Those adjustments, said Jay, illustrate the co-op philosophy. "One of the things we pride ourselves on is customer service and listening. We get back to people quite quickly. We hear what they're saying." She adds: "There's a huge humanistic element to health care. There's a doctor-patient relationship that you can't discard through mobile apps."
Over the next four months, the competition will play out in face-to-face marketing, such as Horizon's walk-in center in
Longtime players point to their track records and brand identity: "Our focus is on the needs of our more than 3.7 million members, not our competitors," Horizon spokesman
Whether the new start-ups survive in a business based on risk remains to be seen. The changes they bring _ in marketing, customer service and data transparency _ also are just beginning to unfold.
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