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The benefits of a not-for-profit health insurance company

Security Health Plan of Wisconsin, Inc., is a not-for-profit health maintenance organization. We are committed to improving members' health, managing health care costs and providing our members with a high-quality health care experience. Our history in helping members obtain affordable health care goes back to 1971 when we were founded as the Greater Marshfield Community Health Plan, the first health maintenance organization (HMO) in Wisconsin, and the first rural HMO in the nation. The health plan became Security Health Plan in 1986.

You may wonder what makes a not-for-profit health insurance company different from those that are for-profit.

It all comes down to one thing: more of your premium is invested back into services for you and other members.

As a not-for-profit health plan we do not have stock holders, but rather are focused on our members and the communities we serve. So why is that valuable? Take a look at the dollar infographic here .  The numbers here represent the average cost across all plans from Security Health Plan.

Dollar image

 

 

 

 

 

 

 


 

 

 

 

As illustrated in the infographic, for every one dollar you pay in premiums:

  • 29¢ is paid out for doctor office visits – this covers both inpatient and outpatient visits with your provider including preventive exams as well as office visit with other health care provider you see, like nurse practitioners, physician assistants and physical therapists.
  • 23¢ is paid out for outpatient services. This includes all non-drug related outpatient services provided, such as surgeries, X-rays, chemotherapy, counseling and lab services, as well as emergency room services.
  • 21¢ is paid out for hospital stays – this covers the cost of the hospital room and board, including any equipment or supplies used during the hospital stay.
  • 14¢ is paid out for prescription drugs from a pharmacy or medications administered in a doctor’s office.
  • 8¢ is used to cover all administration costs. Administration costs are what it costs Security Health Plan to administer your plan. This includes fees used for human resources, legal, facilities, compliance, risk management, communication costs and more.
  • 3¢ is used to cover any ancillary services – these services include the care you receive from your primary care provider, like laboratory services, diagnostic imaging, physical therapy and chiropractic services.
  • 2¢ is the health plan’s total net profit. This is Security’s actual profit after all other expenses have been paid. These profits are held in reserve to help pay for medical care in years when our expenses exceed our revenue. Every insurer in Wisconsin is required to hold a minimum reserve to ensure a stable future for our members.
America’s Health Insurance Plan (AHIP) a national association whose members include insurance companies – both not-for-profit and for-profit – from throughout the United States, recently reported the average breakdown of how much of members' premium dollar    goes toward certain costs. To help illustrate the difference with Security Health Plan, take a look at this chart:

 

Security Health Plan

AHIP

Doctor office visits

29¢

12.1¢

Outpatient services

23¢

25.8¢

Hospital stays

21¢

19¢

Prescription drugs

14¢

21.5¢

Administration+

15.3¢

Ancillary services

*

Emergency room costs

*

3.2¢

Net profit

+ AHIP figure includes reported costs for the following categories: taxes and fees, other fees and business expenses, cost containment, quality improvement, other administrative expenses.

*Costs are combined within another category on the chart.

 

While the comparison may not be “apples to apples” you can see the typical health insurance company spends nearly double what Security pays to administer a health plan.

“Being a not‐for‐profit health insurance company allows us more flexibility to decide how best to spend our members’ health care dollars. We look at putting more of that money back into helping our members,” Security Health Plan Chief Clinical Officer Melissa deGoede said. “For example, by offering additional benefits like our over‐the-counter program or free, unlimited Care My Way visits, we have the ability to be more flexible and put more of that health care dollar to work on behalf of our members.”