When TSG Financial looked for a product for Minimum Essential Coverage, ACA compliant health insurance program offering both low cost and high quality for low wage employees, they couldn't find what they wanted. 
With the help of MobileHealth and CityMD, they designed their own product.

Q&A with Paul Essner about TSGF SmartplanSM
What is TSGF SmartplanSM?
 
TSGF Smartplan SM  is a Minimum Essential Coverage, ACA compliant health insurance program designed to provide low-cost, high-quality health care to low wage employees where the employer is on a specified budget for coverage cost and cannot provide full Mininum Value health insurance.

Why did you feel it was important to create this product?

Home Health Care Agencies struggle with conflicting solutions to the requirements in Nassau, Suffolk, Westchester and the five boroughs of NYC to provide benefits, in lieu of compensation, that are quality, meaningful and ACA compliant .

Our mission was to create a product that addresses the employer's wish to provide a benefit, and in doing so protect their exposure to overtime expense (i.e. if you pay the wage, rather than provide the benefit, you will be forced to pay time-and-a-half on paid wage - this is very expensive as there is not funding for OT) and help protect their exposure to ACA penalties.

How does TSGF SmartplanSM provide value to both the employer and the employee?

We set our sights on a program that provides protection to the HHA to ACA individual mandate penalties of $695 per person in 2016 for not being insured. In satisfying this basic need, we then set our sights on a program that would be valuable to both the employer and employee, as follows:
  1. HHA's are required to do post-employment annual screenings including PPD, Drug Screen, Health Review and Immunizations. Mobile Health, the most widely used and recognizable provider in the marketplace delivers these services, often (but not always) paid for by the employee. In the case of the employee expense, we include the cost of these required, post-employment screenings in our program.
  2. When the HHA is visiting with the practitioner at MobileHealth to do the required screening, they can inquire as to whether they are being screened for other diseases, as provided by the ACA preventive description for Minimum Essential Coverage. It facilitates bringing quality prevention and wellness to our healthcare workers - we are all in the healthcare business and need to promote this.
  3. One great waste of time and resources is using the ER as an urgent care facility. In our program, we teamed with CityMD, the largest provider of storefront urgent care to offer up to 5 visits per year, at a small copayment for HHA's.

Why did you pick MobileHealth and CityMD as partners?

MobileHealth is the largest and best known outsourced provider for pre- and post-employment medical screening in the home care industry. CityMD is the largest provider of storefront urgent care in the NY Metro area and they maintain a level of quality, service and follow up that is unparalleled. Finally, MobileHealth, as a direct result of this relationship, is working to extend their reach to include many CityMD centers to perform pre- and post-employment medical services, making it easier for the HHA to locate a center and familiarity in case of urgent care need.

Who is your audience?

Initially, licensed home care subject to NYC, LI and Westchester's Wage Parity Regulation, as they have a requirement to spend up to a prescribed amount on benefits and/or compensation. When used properly, TSGF Smartplan SM  will not interfere with an employee's Medicaid program. We can also work with providers in other states, so please contact us today to discuss your options.

ACT NOW to learn how to save money and provide quality health care coverage for your low wage employees before MARCH 1st, 2016!