Bring Value to Health Care: An Alternative Model 1. State Sponsored Catastrophic Stop Loss Coverage: Mirroring Successful Programs Under the proposed model, the State would provide catastrophic stop loss coverage to all school districts. This approach mirrors other successful State and Federal programs to address catastrophic insurance claims. For example, the Michigan Catastrophic Claims Association (MCCA), an unincorporated non-profit association, was created by the state Legislature in 1978. The MCCA reimburses auto no-fault insurance companies for each Personal Injury Protection (PIP) claim paid in excess of $350,000. That means that the insured's insurance company pays the first $350,000 of medical expenses and the MCCA reimburses costs over that amount. Similarly designed programs are provided on the federal level for consumer protections of bank deposits, catastrophic natural disaster insurance claims and large claims resulting from acts of terrorism. In the proposed model, the State, or its agent, would be responsible for the management of the catastrophic pool. All claims that reach a pre-established dollar threshold (attachment point) for payment would be paid through the catastrophic pool. In order to ensure that individuals with catastrophic health care costs receive the necessary care, the State program would include a comprehensive case management program. |
