A health co-op may be accredited by the US Health Alliance when it:
1) charges a maximum $300 per person per year (adjustable annually for inflation); Our intent has always been to make co-op membership accessible to lowest-income residents. We have sought to prove that small amounts of money, multiplied by large numbers of people, can fund nonprofit systems that serve better than for-profit systems. Our small health plan has already enabled people to buy lower-cost higher-deductible standard coverage. Yet, since even $100/year is more money than many can afford, we invite donations to a fund which donates memberships.
2) pays claims without requiring a deductible; Community ownership of a health system means more than just paying medical bills. It means funding free clinics, providing preventive care and/or health education, advocating for healthier cities, and so on.
3) pays claims billed by any credentialed health provider anywhere; Because we pay only for specified non-elective care (emergencies) we do not need to leverage provider discounts and can afford to pay any doctor. We are not a preferred provider network.
4) permits members to vote for board of directors annually and to initiate referenda; Essential to the democratic process, voting allows members to restrain their governing body.
5) requires that board members reside within the county where the organization is incorporated or within counties adjacent; Local boards are potentially more accountable because board members must preserve their community standing. Alliance members can lobby board members on the street.
6) requires that all board meetings take place in the county where incorporated; This makes access easier for the majority of members. Several general members who have attended board meetings have become candidates for the board.
7) pays to administrative employees not more than twice the local livable wage regionally adjusted; Staff-driven organizations divert money from the original mission to ever-expanding salaries and benefits. Alliances are operated by people motivated by generosity rather than greed. People who are more keen to accumulate gratitude than consumer goods.
8) does not hire commision agents; Selling memberships on commission encourages shortcuts that undercut service and honesty.
9) maintains a website which presents: bylaws; covered categories and maximum amounts paid; current balance sheet (including general fund total, income and expenses by category and by month and by year, detailed expense sheet, list of each payment and each denial of payment by member number), time and place of next board meeting, minutes of board meetings, statements by board candidates; The internet has become an essential tool for communicating with members, for bringing in new members, and for keeping the organization honest and accountable. No other health plan lists its payments and denials of payment.
10) maintains a listserve for members which facilitates publication of monthly reports and electronic voting; As above, email enables two-way communication with greatest ease and least cost.
11) enrolls at least 51% of members from the county where incorporated and adjacent counties; This retains maximum democratic control, by enabling more members to attend meetings and serve on committees.
12) publishes conspicuously and in bold-face type not smaller than ten point type, on the first page of any literature, that "This organization does not operate under the supervision of the ___ State Insurance Department; This is required in NYS for compliance with section 4522.
13) publishes its annual report to the state's Insurance Department, detailing compliance with the above; We prefer that a state's Insurance Department look over the shoulder of the co-op sector, to assist in the credentialing of health alliances.
14) publishes atop its list of covered categories, in bold-face type not smaller than fourteen point type, that "This Fund is not a major medical plan. It covers only the categories listed below, to the maximum amounts specified."; We do not encourage people to drop their major medical coverage if they can afford to keep it. Members should be reminded that,while the co-op is small, they may need help beyond our capacity.
15) complies with HIPAA regulations. Whether required to protect privacy or not, we prefer to do so. Privacy is so important that we feel the federal government itself should not have access to member records. Members are to be notified when government copies their records.
16) endorses universal health coverage which emphasizes preventive and holistic care, funded primarily by the corporate sector.