An Affordable Plan for Larry Harbour?
These are the basic terms of the initial Preferred Provider Option health insurance plan developed by broker Brian Urban for Larry Harbour and his wife:
Premium: $200.20 per month
Co-pay: $40 per doctor's visit in-network
Deductible: $3,500 per year each for Harbour and his wife
Co-insurance: Harbours pay 40 percent of all costs after reaching the limits of their deductibles
Maximum out-of-pocket costs: $7,500 per year each for Harbour and his wife
Maximum lifetime limit on insurer's payout: $5 million
Deductible waiver: There is no deductible for costs associated with accidents in the first 30 days following the accident.
Preventive care: Insurer pays up to $1,000 a year per person for preventive care
Generics - $15 or 20 percent, whichever is higher
Brand name - $250 deductible per person per year, then $30 or 30 percent, whichever is higher
Non-formularies - $250 deductible per person per year, then $60 or 50 percent, whichever is higher
Insurance broker Brian Urban couldn't believe his ears. A caller told him about our NPR story that claimed a small business owner in Nebraska couldn't afford health insurance because premiums would cost him $24,000 to $40,000 a year.
"Just the size of the numbers was far out of what the market would dictate even for someone with some severe medical conditions," Urban recalls. "And according to the story, these were healthy individuals."
Urban knows the Nebraska health insurance market because he's CEO of Corporate Resource Group, an insurance brokerage in Omaha, Neb. Urban is also the Nebraska legislative chairman for the National Association of Health Underwriters.
The mind-boggling premiums were described by Larry Harbour, the 33-year-old owner of LB Custom Chrome and Detail in Broken Bow, Neb. He had done the best he could to try to convey the confusing and complex quotes he had gathered while searching for affordable insurance. And he was very happy to get a phone call from Urban, who offered to help Harbour get to real and affordable numbers.
"It's very confusing," Harbour says of the health insurance search. "It's very tough to understand unless you have someone, so to speak, holding your hand, walking you through the process."
The phone call from Urban was the first of several aimed at finding affordable insurance for Harbour and his family.
"According to the story, he was uninsured, and I don't find that acceptable," Urban says. "It's my job to make sure as many people are as insured as possible."
Urban also wanted to set the record straight. He didn't want wild and inaccurate premiums affecting the health insurance debate.
"We're not opposed to reform," Urban adds. "It's just that we want to make sure we're dealing with real-life facts and numbers and we focus that reform in the areas it's truly needed."
So, Urban conducted a market analysis for Harbour and his wife. This is precisely what Harbour needed. He hadn't had health insurance since he was a kid. His own two children are covered by a state plan, but with a new business, he figured it was time he and his wife were also insured. So he dialed toll-free numbers advertised on TV and radio, and slogged through pitches bursting with jargon and numbers.
Harbour had never heard of health insurance brokers like Urban. Even if he had, Urban says, he'd probably have little idea how to find one.
"One [idea] would be if he's at a cocktail party, look for the person that's alone in the corner of the room," Urban jokes. "That's probably the insurance agent that no one's talking to."
Urban suggests going to the National Association of Health Underwriters Web site, where people searching for health insurance can punch in a zip code to get a short list of local and licensed brokers.
Even if Harbour had taken that step, he'd still be wary.
"I know everyone needs to make money," he explains. "There are also those people out there who have to make their certain quota. Or, they want to aspire in the company and they do what they can to get as many policies [as possible]."
Urban understands the skepticism. He recommends independent brokers and agents not tied to specific insurance companies and plans. It's also smart to comparison shop, he says, for insurance plans and for brokers and agents.
"Much as you would check the difference between the TV at Best Buy and the TV at Target, and determine the features and benefits and costs," Urban explains, "you can do the same thing with insurance products."
Urban found a plan for Harbour and his wife with a premium of just $2,400 a year. Harbour says it sounds affordable, but he still has a lot of questions.
"That's just the tip of the iceberg, I'm sure," Harbour notes. Then he says with a laugh, "There's probably about 50 feet worth of ice underneath that policy that I have to try to explore and figure out before I can even figure out if it's a good policy for me or not."
Urban vows to stick with Harbour until he finds an affordable plan that meets his family's needs. Harbour is grateful for the confusion and failed fact-checking that put Urban on his trail.
"Larry is not different from a lot of the people I speak to," Urban concludes, especially if they've had employer-provided coverage or no coverage in the past. Individual and family insurance is new to them, and "they're somewhat confused."