UUA health plan blends insurance with social justice

When Jim Sargent, director of the Unitarian Universalist Association’s health plan, stood up at a UUA all-staff meeting in October and announced that diagnostic tests would be covered by the UUA’s insurance plan in 2010, the staff applauded. The vast majority of the UUA’s 225 national employees have been covered by the self-funded plan since it started in January 2007.

Concerns among UUA employees about their health insurance coverage mirror the larger concerns among Americans about the availability of health care benefits. Five years ago, the UUA was at a crossroads in terms of health insurance. Although UUA staff were offered coverage, many UU ministers and congregational employees across the country were either uninsured or had inadequate coverage.

So the UUA decided to create its own self-funded health care plan. Among the plan’s top goals was the provision of good-quality health insurance at an affordable price. But the plan also had a social justice mandate that provided coverage to domestic partners, offered elective abortions and gender reassignment surgery, and included coverage of people with pre-existing conditions. This melding of standard medical care with special consideration for the needs of women, gays and lesbians, and the chronically ill, make the UUA’s health plan unique, say organizers.

The Rev. Gail Geisenhainer, senior minister of the First UU Congregation in Ann Arbor, Mich., knows this from personal experience. Geisenhainer’s partner was ill and needed brain surgery in early January 2007, right after the plan began. Her partner had run out of COBRA on her previous insurance and was essentially uninsurable, Geisenhainer said. Thanks to the health plan, she got the surgery she needed and is doing well. And the family was spared from bankruptcy, which would have occurred if they had had to pay the $150,000 bill out-of-pocket. “The well-being of entire families and family systems is affected by the inclusivity of this insurance,” Geisenhainer said. “This is who we are religiously and it’s not theory—it’s practice.”

Although the plan officially began in January 2007, work on the plan began many years earlier. In the past, the UUA had insurance for UU ministers with Blue Cross Blue Shield of Massachusetts, but in 1996, Blue Cross Blue Shield told the UUA that they would be canceling the plan. “About half a dozen years later,” said the Rev. Ralph Mero, former head of the UUA’s Church Staff Finance Office, now retired, and one of the prime movers behind the plan, “we learned there were approximately 400 people working for UU congregations—ministers and other staff—who lacked health insurance or who had policies that were inadequate or very expensive.”

Mero began investigating different insurance options, including a self-funded plan. Since the UUA was a member of the Church Benefits Association, an interfaith coalition focusing on benefits programs for ministers and church employees, he was able to learn about the self-funded plans offered by other denominations. Many denominations in the Church Benefits Association had chosen Highmark Blue Cross Blue Shield of Pittsburgh as the agency to administer their self-funded programs, and the UUA followed suit.

The UUA’s Committee on Committees selected five trustees for a board, choosing UUs with extensive experience and expertise in health care management and insurance. They include Paul Bluestein, Mindy Scharlin, Brent Wilkes, Kathy Burek, and David Tedesco. Bluestein is this year’s chair. The UUA’s treasurer and financial advisor are ex-officio voting members bringing the total number of committee members up to seven.

Using a small amount of capital from the Church Staff Finance Office’s operating budget, the UUA Board of Trustees established the Employee Benefits Trust in January 2007.

“There was a great deal of caution at the administration and board levels,” Mero recalled. “But we were able to demonstrate with the evidence that such a self-funded plan would work for the UUA if it had a sufficient number of enrollees.” That number had been set at 500. Had that number not been reached, the plan would not have been launched.

Jim Sargent, a UU with extensive experience in health care management was chosen to promote and market the plan in 2006.

To ensure the plan’s success, UUA President William G. Sinkford delivered the majority of the UUA’s national staff as the program’s first enrollees. Previously the staff had had local HMO plans to choose from. These were cancelled, and staff members were given the option of choosing the UUA’s health plan or finding one on their own. Some signed on to a spouse’s plan. But 170 out of the total of 199 benefits-eligible employees enrolled in the plan, according to Kati MacDonald, the UUA’s human resources manager. Since then, the total number of enrollees has increased to 745 national and congregational employees with 500 dependents.

Complaints at the beginning were rife, according to Rob Molla, the UUA’s human resources director. Employees complained that their benefits under the UUA plan were not comparable to those they had been receiving under their old plans. But each year, as benefits were added to the plan, complaints decreased, Molla said. “I think the plan we’re offering now is comparable and in some ways better than any HMO that we’d have had through one of the off-the-shelf insurance carriers.”

Based on a comprehensive survey of UU professional groups, Sargent estimates that the UUA’s health plan has offered insurance to around 300 of the original 400 ministers and congregational employees who had no or inadequate coverage.

The plan has many advantages, according to Sargent, who is now in his third year of managing the plan. Since the plan is not set up to make a profit, any surplus that is accrued is used to increase benefits, stabilize rates, and offset any negative claims experience. So far, the trust has shown steady increases in its reserve and as a result, new benefits have been added each year. In 2008, a comprehensive eye exam was added, and covered outpatient mental health visits increased from 20 to 40 per calendar year. In 2009, the plan achieved mental health parity meaning that mental health claims were paid the same as any other medical claim. It also lowered the deductible from $2,500 to $2,000 per individual in the High Deductible Plan. In 2010 diagnostic tests will be covered in full, with no deductible or coinsurance.

One of the things distinguishing this plan is the fact that congregational employees are included. At the plan’s start, part-time church employees could qualify for coverage if they worked 1,000 hours a year. In 2008 that number was reduced to 750 to allow more employees to participate. The industry standard is 1,000, Sargent said.

UU ministers like the plan’s portability. Formerly, many ministers would find coverage in the area they were serving and then have to get new insurance when they moved. “There’s no way to know if you move whether you can get insurance or what kind of insurance you can get,” said the Rev. Kate Rohde, minister of First Unitarian Church in Omaha, Neb.

The UUA’s plan provided Rohde with necessary coverage when she needed knee surgery right after she began her ministry in Omaha. “I was in a new job, and my father had come to live with us. It was a tough time and having that insurance and knowing that everything would be taken care of really made a difference,” she said.

The plan also enables churches to better take care of employees. The Rev. Richard Nugent, head of the UUA’s Office of Church Staff Finances said that it was part of his job to encourage churches to become more responsible employers. “In the past, congregations have felt that they’re primarily a faith community,” he said. “Salaries and benefits were low, and health insurance was out of reach for some congregations. Now that we have the health plan going, we’re keeping folks informed about being responsible employers and paying 80 percent of the cost, which is standard.”

The Rev. Carolyn Price, minister of the UU Church of Santa Paula, Calif., is grateful to her small congregation for offering her the insurance. “I am a single mother and minister of a small congregation, who in their generosity compensates me fairly. However, in this part of the country those earnings are often not sufficient to meet the high cost of living with any margin of comfort. I can say with some certainty that without this insurance, you would be counting me among those forced to declare bankruptcy due to medical costs.”

Insurance rates are calculated based on a person’s age and their geographical location. Because the UUA is based in Boston and Boston’s medical rates are higher than in other places, there was grumbling among the Boston-based staff in the beginning about the high cost of premiums, Molla said. But the UUA’s human resources department has worked closely with the Office of Church Staff Finances to make sure the program serves both the national staff as well as ministers and congregational staff.

It’s important to keep the bigger picture in mind, said Nugent. “The national staff of the UUA needs to understand that they’re part of a larger community, and there are some trade-offs they will have to make to open up a major outlet for others with no or inadequate coverage,” he said. “For those folks working in our congregations who had inadequate or no coverage, our health plan is a life saver, literally, a life saver.”

No one knows this better than Geisenhainer. And she is aware that some staff members are paying more so that coverage can be extended to a larger national group. “We’re deeply mindful that for so many people living in Massachusetts, the UUA health plan is more expensive,” she said. “We’re very clear that we’re not bankrupt because of what came out of the pockets and paychecks of the people we know and love.”

Sargent said that there are fewer complaints among the Boston staff as the plan has been able to increase the number of benefits it offers. He also asserted that the UUA’s health plan has not increased in price at the same rate as plans offered by commercial carriers. “We did a cost-benefit comparison of the old plan and the new one over the past three years of the plan’s operation,” he said. “There’s no doubt that this plan is priced at 25 points below where the old plan would be.”

Nugent added, “We’re not here to make a profit. When the private insurer’s rates go up, we can come in under that. We don’t have Wall Street to answer to.” Nugent also stressed the fact that if any of the plan’s participants are having problems accessing medical services, they can appeal to the plan’s board. “We have outside medical folks evaluate what the Highmark doctors decide,” he said. “Their recommendation comes to a small group within the health plan to make the ultimate decision. It’s going to be us making a decision that I believe will be compassionate and in the best interest of everyone involved.”

Sargent added that no one in the past three years has had a claim that was not resolved through the standard appeals process with Highmark.

Although the UUA has a great deal of control over the plan, it has no control over external forces that affect the health insurance industry as a whole. One of the most critical, said Paul Bluestein, MD and EBT chair, is the rising cost of health care. “The technology is expensive,” he said. “In the 1960s, X-rays were used for diagnostic imaging. Today there are MRIs, PETscans, and CAT scans that are many times more expensive than X-rays. In the same way, genetic testing and therapy is probably a reality in the future, but an expensive reality.”

Bluestein also said that people were demanding medical services in ever-increasing numbers.

He identified two other trends in the health care industry that would be impacting its cost: the promotion of health and wellness among the general population, and assisting people with decisions about treatment, mostly at the end of life.

With the latter trend, Bluestein said that a significant amount of medical care is used in the last year of life. With the Baby Boom generation, the largest demographic cohort in the country, approaching the end of its expected lifespan in the next three decades, there will be increasing treatment options and a greater need to educate people about those treatment options. “This will influence to a great extent the cost of medical care,” he said.

Related Resources

• UUA’s Health Plan.Includes information about enrolling for 2010. (UUA.org)
• Frequently Asked Questions about the UUA Health Plan.(UUA.org)

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