No deductible. No co-pays. No out-of-pocket expenses. No prescription drug costs. All the health insurance benefits.
That's the idea behind a new health insurance option that health care company Curative launched in Central Texas this month.
The plan is for employers with 51 or more workers who live or work in Travis or Williamson counties. Curative, which made its name creating COVID-19 testing platforms, expects to expand in a year to more counties in Central Texas and then in a few years throughout Texas before expanding nationally.
Curative established operations in Los Angeles, Austin and Washington, D.C, while providing testing and vaccinations in more than 40 states during the COVID-19 pandemic. It was looking at what's next in health care after the pandemic ends. It noticed that many health care systems weren't set up to not collect a co-pay for the free testing or free vaccination that was part of the pandemic.
Health care "is not set up for innovation," said Curative CEO Fred Turner. "What's next? What do we want to spend the next decade building?"
The Curative health insurance plan is based on the idea that if people engage in preventative care early, they can save money, and so can their health insurance company. It's also based on the idea that providers can simplify the process by not having to collect a deductible or co-pay.
When insurance companies increase co-pays and deductibles, people put off care, Turner said. "There's a short-term decrease in costs because people stop getting care, but they don't stop getting care. They stop doing preventative things — mammograms, colonoscopies. Health care costs go up again with everything they put off.... they end up in the ER, and they didn't need to be there."
Turner compares Curative's health plan to Netflix. You pay one price every month and you get access to everything. In insurance, that monthly cost is the employer paying some and the employee paying the rest of the monthly premium. It estimates that for a single person, most monthly premiums for a single person will be between $400 to $800, which Turners said is comparable to other PPOs. Premiums amounts are based on the number of previous insurance claims and risk factors each employers' group has. Family premiums will vary more widely, Turner said, because some employer groups could have many employees with a lot of children and some could have very few.
Insurance industry experts in Texas and nationally declined to comment on exact plans, but described Curative's approach as unusual within the industry.
To get the no-deductibles, no-out-of-pocket and no-co-pays benefits, people have to do an annual baseline health visit with Curative within 120 days of the plan beginning. After that period, if they haven't done that baseline visit, they would then have a $5,000 deductible for an individual or $10,000 for a family. Those numbers double if the visit is with an out-of-network provider. Children don't pay have a deductible as long as one parent has done the baseline visit.
"The design is one big financial incentive for preventative health," Turner said.
The baseline visit establishes that the person has a primary care physician and has been receiving regular preventative care. If they don't or haven't been in a while, during the baseline visit, blood work would be taken and they would be connected with a primary care physician.
Even if they have seen a doctor recently, Curative will offer some advance diagnostics to its members that look deeper into things like cardiac risks as well as a whole genome sequencing test to help a member and their physician make more tailored health care decisions.
That test, said, Turner, can help establish which medications would work better for that person, and what their genetic risks might be and what inherited traits they might pass on to future children. It's not required to do genome sequencing, but it would be free to the patient and available for future use when making medical decisions.
"It's all part of the long-term investment in the patient," Turner said.
Currently Curative has a network of care that includes St. David's HealthCare hospitals, Austin Diagnostic Clinic and Austin Regional Clinic. Members also have access 24 hours a day, seven days a week to a local physician through telehealth.
"Austin Regional Clinic is excited to collaborate with Curative and its innovative approach to health insurance," said Dr. Anas Daghestani, president and CEO of Austin Regional Clinic. "Providing access to high-quality, connected care has always been part of ARC's commitment to our patients and communities, with a focus on keeping our patients healthy and on helping them achieve their goals. Curative's model is designed to do just that."
If a member wants to see a physician out of network, they would pay co-pays and have a deductible for that office visit just like any other PPO. However, if they can prove that there isn't an in-network option or if their referring doctor can make a case that another doctor isn't medically suited for that patient, that specialist would be covered as in-network.
The same is true with medications. Curative has its own pharmacy that delivers to your home as well as uses H-E-B pharmacies. Prescriptions are divided into tiers 1, 2 and 3. Tier 1 is a $0 co-pay. Tier 2 is $50, and Tier 3 is $250. For each type of medication there is at least one Tier 1 drug, but if there is a medical reason why that medication will not work for the member, they can get a Tier 2 or Tier 3 medication covered as a Tier 1.
If a person seeks emergency care not at an in-network hospital, it would still be covered as in-network. If they have a scheduled surgery, though, they would need to prove that it is medically necessary to be at that hospital instead of an in-network hospital to pay the $0 cost in-network rate.
Curative is currently negotiating with more health care providers and systems to reach agreements to expand its in-network roster by January 1, when most people start new health plans. Currently it doesn't have Austin's Level 1 trauma hospitals for adults or children as in-network yet.
At that baseline visit, the health navigator the member meets with also will go over how to take advantage of everything in the Curative plan as well as what is not covered and connect them to services they might need.
Curative is also opening up the Curative Commons in January at 900 Congress Ave. that will have a fitness center, classes and nutritional counseling for its members.
Curative has invested the first three years of the expected costs for the health care program. It has used it's own funding to do so, Turner said. It has added 70 positions to launch the health insurance program and expects to add more as it grows.
Curative expects to turn a profit on its health care insurance in two to three years, Turner said.
Editor's note: This story appeared in Wednesday's American-Statesman, but we are repeating it here because a portion of the story was omitted in some editions due to a production error.