Servium Plan raises insurance questions
Fam Pract Manag. 2005 Jan;12(1):14.
To the Editor:
I applaud the approach taken by the authors of “‘Insuring’ the Uninsured” [September 2004, page 51], but as assistant director of the life and health division of the Georgia Office of Commissioner of Insurance, I offer some words of caution to those contemplating starting their own such program.
In Georgia, a plan very much like the Servium Plan was reviewed by the Georgia attorney general over 20 years ago and found to meet the definition of the transaction of insurance. The basis for that opinion was that the arrangement involved a contract between parties, a consideration, determinable contingencies (the potential need for some services) and risk distribution (where one member’s “share” of contributions go to offset another’s overutilization of potential services). Those elements worked together to meet the legal definition of insurance and its transaction.
State laws regarding insurance may vary significantly on matters like this, so there may be no problem with the authors’ plan in Texas. Doctors may want to check how such a plan squares with the laws that regulate insurance and insurers in their own states.
We are not aware of any insurance regulations that we are violating, nor will we worry about it at this time. This does not imply any disrespect to applicable laws, but if such exist, then perhaps this is the time to bring to the table how these regulations inhibit physicians’ ability to address the needs of their patients.
Here in Texas, one in three have no health insurance. While the government and insurance industry try to find a solution, people are dying of preventable diseases and lack of continuity of care. We can either choose to stand idle and hope for the best while people suffer or be proactive in finding solutions that make sense.
There comes a time to take a stand for what you believe.
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