Cross-Border Plan Offered by Health Net

Health Net of California is expected today to announce the state’s first private insurance plans for people who want to see doctors either in Mexico or the United States.

The company said several new plans costing as little as $75 a month would be offered directly to individuals and families, rather than through employers.

The plans would be available in Los Angeles, Orange and Ventura counties, and are targeted at the estimated 2 million uninsured Latinos who live there -- many of whom are self-employed or work for small businesses that do not offer health insurance.

Five years ago Health Net began offering employers group insurance plans that allow workers to see doctors locally or in Mexico, where healthcare is less expensive and preferred by some immigrants to the U.S. Until now, however, families that buy insurance privately have had few affordable options.

“The good news is that the health plans are realizing there is a large need” for such coverage, said Dr. Michael Rodriguez, a UCLA associate professor who is a family physician and an expert in immigrant and cross-border healthcare.

“The disadvantage is that there are fewer safeguards for the care of individuals and less oversight when problems occur,” he said.

Woodland Hills-based Health Net, California’s third-largest for-profit HMO, said it was able to guarantee a high level of care by working with Sistemas Medicos Nacionales, the only Mexican health plan licensed by the state of California. The two have collaborated in employer-sponsored plans offered by Health Net.

Mexi-Plan, one of five new cross-border Health Net plans, began as a collaboration with the Mexican Consulate General in Los Angeles, which found that after immigration issues, access to health coverage is the top concern of Mexicans living in the Los Angeles area.

Through focus groups drawn from visitors to the consulate, along with other research of Latino health coverage in Southern California, Health Net said it estimated that 600,000 people traveled to Tijuana each year for healthcare.

Some of those people have insurance, but chose to pay out of pocket in Mexico because of lower costs or because they were more comfortable with a Mexican health provider, said Ana Andrade, Health Net’s vice president of Latino Programs.

“We are confident that this program will be a landmark in this market and will attract many, many customers,” said Mexican Counsul General Ruben Beltran. “We hope that many other private companies will follow suit and will cater to the needs of this underserved segment of the population.”

Under Mexi-Plan, the least expensive plan among Health Net’s new offerings, a person age 19 to 39 would pay $75 a month. Families would pay about $300, Andrade said.

A visit to the doctor’s office in the U.S. would cost the patient $15, generic medications would require a $5 co-pay and hospital visits would be covered at 75% with a $2,500 deductible and a maximum annual out-of-pocket cost to the member of $5,000.

In Mexico, however, members would pay less, with a $5 co-pay for office visits, $5 for generic medications and 90% coverage for hospital stays with no deductible.