PARIS – The Oxford Hills Rotary Club welcomed Sharon Roberts as the speaker on Jan. 26. Roberts was involved in the deliberations on Gov. John Baldacci’s health care reform package, the Dirigo Health Act, and continues to be involved in the development and implementation of the reforms enacted.

As director of stakeholder relations for Anthem Blue Cross and Blue Shield in Maine, Roberts is responsible for coordination, management and direction of interactions with numerous stakeholders in Maine.

Anthem is the underwriter of Maine’s new Dirigo Choice Health Plan, which came out of an independent agency established by the Dirigo Health Act.

The mandate given to that agency was to develop an affordable health care insurance plan that the self-employed could purchase for themselves, or employers, particularly small-business employers having fewer than 50 workers, could purchase and offer to their employees as a benefit.

Such a plan, the mandate continued, would focus on and encourage preventive care.

“Maine,” Roberts said, “has high health care costs because of its low incomes, small, dispersed population and an above average number of citizens with habits that are bad for their health.”

The plan that evolved is a preferred-provider-option style, she said, and 100 percent of the state’s hospitals and 93-94 percent of the state’s doctors are signed up on the list.

The policy covers all preventive care at 100 percent. Premiums for the plan, which can be purchased from Anthem or through various insurance brokers, are paid by a combination of employers’ contributions and payroll deductions from employees.

Self-employed workers can purchase a plan with a $1,750 annual deduction, while employers can select from a $1,250 annual deduction plan or $1,750.

As of January, about 1,800 people had enrolled, and another 1,800 are expected to enroll. Typically, employers are expected to cover 60 percent of the cost of single-person coverage on full-time employees, i.e., those who work 30 or more hours a week. The employee, in turn, pays 40 percent for himself and 100 percent for any qualified family members.

Roberts said, depending on the employee’s income, the cost for family coverage could be 60 percent of the set amount and could be further reduced by discounts; also, the deductible could be reduced to $500 or less.

“Discount-dollars,” she said, accrue to the employee, who can redeem them for health care costs by using a card that is similar to an ATM card. Employers do not get the same discounts their employees may get; however, if 75 percent or more of a company’s employees choose a preferred physician and get the health-needs assessment, the employer gets a small discount.

Also coming out of the Dirigo Health Act implementation was another initiative: the Healthy ME program. A consumer who enrolls in the Dirigo Choice Plan and chooses a preferred-provider option not only is on the way to developing a relationship with a doctor, he or she receives a $25 bonus for having selected a preferred doctor and can get another bonus for having that doctor do a health-needs assessment.

Enrolling in Dirigo Choice does require a somewhat lengthy process, about 30 days, during which time the health-needs assessment is done and, if applicable, a confidential application, which includes financial information, is made to the state for the discount-dollars.

Once accepted, the consumer receives insurance cards to be presented for comprehensive medical care, including a prescription drug benefit. Roberts said the estimates so far indicate about 20 percent of the previously uninsured have joined.

The Oxford Hills Rotary Club meets at 7:30 a.m. every Wednesday at the First Congregational Church. Anyone interested in attending a meeting should contact President Patty Rice at 743-7777 or check out www.oxfordhillsrotary.org.


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