Sunday, October 6, 2013

Enrolling in Arches Health Plan

Thank you for your interest in enrolling in Arches Health Plan. Arches is committed to help you enroll in the way that suits you best.
To enroll you will need to know the following:

  • What you filed as your income on your W-2 (Spouse's W-2)

  • The Social Security Numbers for each person that you would like to cover

  • The Date of Birth for each person that you would like to cover
More Info : enroll health utah

Eye-Opening Lessons from Arches ‘Ask the ACA Experts’ Telethon on KUTV Channel 2

Last Tuesday Arches held an-all day ‘Ask the Experts’ telethon on KUTV Channel 2 giving the public a chance to ask questions about the Affordable Care Act. The all-day event offers important lessons on the public’s need for help navigating their choices on the new marketplace for insurance…
arches channel 2
- The Utah public may not be ready for October 1, when enrollment is open on the new marketplace.
- The key to engaging the young immortals may be their parents and grandparents.
- Seniors are scared about changes to Medicare, though they have no reason to be.
- As a community, we need to have something coherent to say to the many Utahns who would qualify for the Medicaid expansion if state leaders choose to opt in. For now, Arches would suggest these individuals connect with policy groups working on this issue like Utah Health Policy Project
- See more at:

Monday, September 30, 2013

Arches on Good Things Utah

Arches on Good Things Utah Oct 01, 2013
Watch us from 9:00-11:30am. We will be debunking the myths of the ACA and explaining subsidies and what that means to families. We will also discuss the benefits of our plans

Arches on Fresh Living

Arches on Fresh Living
Oct 01, 2013
Watch us from 9:00-11:30am. We will be debunking the myths of the ACA and explaining subsidies and what that means to families. We will also discuss the benefits of our plans
Contact Arches Health Plan
5505 S. 900 E. Suite 100
Salt Lake City, UT 84117

Your Guide through the Affordable Care Act, Nathan Johns

My name is Nathan Johns and I am the Chief Financial Officer with Arches Health Plan. Arches Health Plan is a new cooperative health insurance company focused solely on Utah to serve Utahns with affordable and accessible healthcare insurance.
- See more at: Your Guide through the Affordable Care Act, Nathan Johns

5 Terms Every CFO Should Know

As the full implementation of the Affordable Care Act (ACA) gets closer, CFOs are taking upon a stronger role with those they are responsible for, recognizing that this new law directly impacts human resources, finance, internal audit and tax. Many CFOs are estimating that it may take up to 18 months to budget, plan and implement compliance-driven changes. With open enrollment starting in October 2013, understanding the basic terms of the ACA must be at the forefront of every CFO’s agenda.

SILVER-Level plan - Arches Health Plan

This SILVER-Level plan is for people who want to partner with their physicians for better, more deliberate and informed health care. New benefits like telephone consultations and secure internet diagnostics are covered, as are extras like no-deductible accidents, a health action plan, and shared decision-making tools.

Monday, September 23, 2013

The Importance of Eating Healthy and Being Active

One of the most frustrating yet potentially powerful conversations I have with patients is about their lifestyle. It is not uncommon for me on a daily basis to discuss patients poor lifestyle and how it is affecting not only their health but their wallet. Being sick costs a lot of money and good years of life. It is estimated 2/3 of us in the USA are either obese (BMI 30+) or overweight (BMI 26-30). Along with being overweight, there is an increased risk of high blood pressure, diabetes, arthritis, high cholesterol, heart disease, stroke, cancer, sleep apnea, heart failure, depression, liver disease, menstrual problems, infertility, gallbladder problems, etc. Holy-smokes, that is a boat load of problems and all because of me not doing the things every day to invest in myself.

Read More:  The Importance of Eating Healthy and Being Active

Are You a Person or a Part??

I remember back when I was going to Medical School in Wisconsin. I had grown up in a nice area of Salt Lake City and was raised around a number of physicians who were great specialists in different areas of medicine. One of those was the best back surgeon in town and the other was an outstanding Perinatologist. I remember saying, “I will never be a primary care doctor!” I thought primary care was the type of medicine practiced by those who had no other options and lacked the intelligence of a quality medical student. I thought, “If you were really smart you obviously chose to go into a specialty that made lots of money!” My uneducated dream choice was to go into Anesthesia because I knew some anesthesiologists that made a great living and seemed to have a pretty sweet lifestyle. That’s what I hoped I would fall in love with.

Read More:  Are You a Person or a Part??

Who is Dr. Douglas Roland Smith?

It is my goal and passion to develop new and inventive ways to provide quality care to patients in a fiscally constricted environment. To accomplish this lofty goal and disrupt the market with payment reform, I took a position with Arches Health Plan as their Chief Medical Officer last year.

Dr. Douglas Roland Smith
Dr. Douglas Roland Smith

I was born and raised in Salt Lake City. Following graduation from the University of Utah with a Bachelor of Science in biology, I was fortunate to spend five years conducting medical research while attending the Medical College of Wisconsin in Milwaukee, Wisconsin. - See more at:

Win Dinner with Kyle Beckerman!

Contestants must be 18 or older to enter.
The winner will be announced on Oct 23rd during half-time of the Real game.
Complete the form on  Win Dinner with Kyle Beckerman! for a chance to win a private dinner with Kyle Beckerman

Sunday, September 8, 2013

Arches Q&A Video

Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117

Arches Perfect Day Commercial

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5505 S. 900 E. Suite 100, Salt Lake City, UT 84117

Arches Around the House Commercial

Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117

Arches Health Plan

Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117

Arches Health Plan Extended

Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117

Sunday, July 28, 2013

Small Business Owner Learns Affordable Care Act From Arches

Kathie Chadbourne  Avenue Bistro on Third Director talks about her business and why she chose Arches Health Plan for her employees.

Learn More:
Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117

Sunday, July 21, 2013

Individuals and Families - Arches Health Plan

Arches Health Plan is the only nonprofit
coop in Utah, and as such offers a new
delivery care model for members. Without shareholders, profits instead go to
reducing premium costs or improving benefits for members. Additionally, because the
coop is member owned, the best interests of members are always assured.
The Arches model for delivering care allows for greater communication and
collaboration between doctors and patients. This approach encourages members to
take responsibility for their own health through a health action plan that they develop
themselves with their doctor. The results are simple yet powerful: better care and
lower costs. And speaking of costs, the Arches model provides true price
transparency, meaning that we attach fixed costs to all medical procedures. Unlike any
other health plan, we actually tell you what something will cost before you have to pay
for it — yet another example of the Arches difference.

Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117
utah health insurance

Sunday, July 14, 2013

Finding a Quality Health Care Plan that Benefits You

No one wants to or has plans to get sick but preparing for the situation is very important. Medical care
can be quite expensive and without health care insurance it be financially draining. In many cases,
people forego needed medical attention when they do not have a health care plan.
Getting a health care plan should be within the reach of every citizen. However, because of several
factors, many Americans fail to have one. Some of the challenges in getting health insurance include
affordability, payment terms, restricted coverage, and a complicated process. Anybody who is unfamiliar
with the health care system can have a difficult time understanding different plans. There is no single
health insurance plan that fits everybody.
Thankfully there are ways to find and afford a beneficial health insurance in Utah. Created with the help
of the government’s Affordable Care Act, Utah’s Consumer Operated and Oriented Plan (CO-OP), Arches
Health Plan, is a unique health care insurance provider because it is a non-profit organization privately
owned run by the members themselves.
Quality health insurance in Utah is not impossible to have. Always shop around to find the best plan that
fits your need and budget. If you’re a Utahn needing health insurance, you can check out Arches Health.
Plan for health care that really benefits you.

Monday, July 1, 2013

Opinion: Health Reform and Lower Hours for Employees

Last week the local airwaves carried the decision of the Church of Jesus Christ of Latter-day Saints to limit the hours of Deseret Industries (D.I.) part-time employees to 29 hours a week. This was in response to potential employer penalties enacted in the Affordable Care Act (ACA). Many derided the decision as cold and calculated.
Through miscommunication and lack of education, the mountain of confusion associated with the Affordable Care Act continues to grow. It is my opinion that last week’s initial gut reaction isn’t warranted and like the ACA or not, learning about the details of the ACA could help clarify the decision of the LDS church. Clarity with this issue will be paramount as other businesses make similar decisions this coming year.
Every business owner will agree, “Without Margin there is no Mission.” Deseret Industries was formed in 1936 in response to the Great Depression. Their mission was to “to help Church members help themselves.” From the time of its creation, it has spread its wings and now provides invaluable training to both LDS Church members and non-members alike. Their value can also be seen on a daily basis through the affordable goods provided to those in greatest need.
Those with a sincere conscious know the LDS Church desires continual success for both Deseret Industries and each of its employees. All businesses that flourish have a deep investment in maintaining their mission and vision. This service-oriented Church-owned company has not maintained continual growth for more than 75 years by accident. Logic and reason can be found behind every decision made by the D.I.
As a physician, I have cared for quite a few D.I. employees. Through each of these interactions one thing has been clear; they were employed by a company who treated them well and gave them a chance no one else would, whatever their circumstance.
D.I. provided each of them an opportunity to establish a life with more economic independence and a feeling of self-worth. We appropriately don’t have access to their accounting records and therefore are unaware of the financial sustainability of this program with the implementation of the new healthcare law.
At this very moment, many companies struggle with similar decisions and may be guided into the wrong decision if they are fearful of the uneducated and misguided rancor from employees or media. Depending on the number of employees, they will may ask the some of the following questions:
  • What is different if I have 1-49 employees versus 50 or more employees?
  • Prior to this year, I have been unable to afford health insurance for my employees, how can I now financially justify providing health insurance?
  • What are the financial penalty implications for me as a business owner?
  • If I choose not to provide health insurance, what penalties will I face and what are the other non-cost implications of the ACA?
  • Do I need to cut down my workforce and/or limit hours to avoid a penalty to maintain my business as the Church chose?
  • What alternatives are available to companies who choose not to provide health insurance?
  • I already provide health insurance, what are the benefits of disbanding my current plan and sending my employees to the health exchange and how do I do this?
  • How do I educate my employees on these decisions I am making so they understand, and then provide them assistance in making wise choices around their health insurance purchasing?
  • I already provide health insurance, is there a better option for me and my employees?
  • If I offer an employee only plan, will I be harming the families of my employees by preventing them the opportunity to take advantage of available subsidies?
  • Do part-time employees count towards the 50 employee number and what is part-time?
  • As a large business, I have to provide “Affordable insurance”, how do I figure out what “affordable health insurance” is?
  • What are the benefits of sending my employees to the health exchange?
  • Are there ways to use an HRA while taking the ACA penalties to cut my costs and at the same time providing my employees with health insurance?
These are only a select few of the many questions every business owner will ask in the coming months. The complexity of the Affordable Care Act should never be taken lightly. I have absolute faith the LDS Church seriously deliberated the decision to cut down the hours of their part-time employees. This decision was the best opportunity to continue the mission of Deseret Industries.
The Affordable Care Act will provide options for health care to those who have not been able to afford health insurance in the past. I invite everyone to take a deeper look into this new law. Like it or not, it is the law!
Through education, we will clearly understand how to best navigate the ACA and help our employees, family and friends. Do not settle for opinions of those seeking their best interest and may not have your best interest in mind. Seek the truth, the whole truth and nothing but the truth about the ACA and how it will affect you, your employees and your business.
If you want answers to these and any other questions you have, we at Arches Health Plan would love to talk and share answers with you so you can make your Best decision. Remember there are Good Decisions, Better Decisions and Best Decisions! Don’t settle for a Good Decision when a Better or even a Best Decision is available!
We believe we are the non-profit, member-oriented and governed organization to educate you in an unbiased manner. If we are your Best answer great, if there is a Better answer, great. If you are afraid of what is coming, we need to talk. Many we have talked with have found answers that helped alleviate their fears to one degree or another.
When you have questions about health insurance or health reform, visit our website at, email us at or call us at 801-312-9860 to set up a meeting to discuss your options further.

Douglas Roland Smith, M.D.
Family Medicine/Hospice and Palliative Care Medicine
Chief Medical Officer – Arches Health Plan


Sunday, June 23, 2013

Arches Health Plan Brokers and Consultants

Brokers and consultants - arches health plan from Arches Health Plan

Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117
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Arches Health Plan for Health Care Professionals

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Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117
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Arches Plan For Individuals and Families

Individuals and families - arches health plan from Arches Health Plan

 Arches Health Plan
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117
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Sunday, May 19, 2013

Marrying What Your’re GOOD at and what you LOVE!

So where do we start? I plan on these weekly blogs to become meetings where we talk about how to accomplish living a healthy life. These topics needs to be practical and worth yours and my time. Otherwise, what are we doing here? So onward! Last week we talked about Eating Healthy and Exercising to be simplistic enough. That’s great and all but now what? Start! “Where?”, you say. My response, “do something or a variety of physical activities that you are good at and that you like doing.” Find things you currently enjoy or in your past you enjoyed and focus doing them. I don’t believe the majority of people will succeed living a healthy life in the long term if they choose a physical activity they hate. I really don’t like lifting weights. Every once in a while I will try my hand at them again and guess what, still hate it. To me it seems pointless to pick up something heavy unless it is some heavy object which fell and is smashing someone. Similarly, I remember back in Junior High and High School I was a pretty good runner. In 9th grade I ran and 4:51 minute mile with very little training, it came naturally. I just ran as hard and fast as I could to win the race then collapsed on the track while struggling for air. I had a lot of raw potential in running but I hated it! Round and round and round that stupid black rubberized track. I thought, “How pointless, I put in all this effort and what do I get out of it? I end right where I started and all I see is the same boring scenery over and over and over again.” However, I loved to ride my bike. We lived near Millcreek Canyon and I loved to time trial 4.5 miles up to from the stop sign to the gate. I was able to do it in 19 minutes which was a 14 mph pace, ok for a 13-14 year old. Most of all it was beautiful and at the end I was able to effortlessly coast downhill viewing the majesty of this beautiful canyon. When I started at Skyline High School I played football and basketball. I was then asked to run long distance for the track team. I said that I would and began with the track team. I thought they would be good with me training the way I had in Junior High, on my bike! Unfortunately, they said I had to run on the track I hated so badly. I lasted two weeks and found myself not running track but I continued to ride my bike up the canyon a lot. How does this information help me know? First, I know from my history I was a pretty good natural runner. Additionally, common sense tells me most people typically like doing things they are good at. So why did I hate running so bad when I was younger? Second, I know I hate track and field tracks. Third, I love the canyons and mountain trails I grew up on. Fourth, aren’t there trails I can run on? I realized if I was more mature at 15 I would have negotiated to run on the trails instead the track. It seems so logical now. I learned that I love to run, I just don’t like to run on tracks. I enjoy the experience of getting away from the masses of folks in the city and being alone to think while I get in shape. Whether it is on a bike or a run, I like to get away on a secluded trail where humans are hard to find. The perfect marriage of what I love and am I’m good at. Each of us has things we are good at and things we love. I recommend right now everyone write down the physical activities you are good at, the physical activities you enjoy or love and then the other related things you love. If you love music and dancing then you have a place to start. If you love music and the mountains then Utah is your oyster! Armed with your Ipod and some time, you’re on your way. Just look at your list and find a way to marry what your good at and things you love and marry the two together. Dr. Douglas Roland Smith is a graduate of the Medical College of Wisconsin and Chief Medical Officer of Arches Health Plan.

affordable health insurance utah
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117

Arches Health Plan: Jorge Fierro

Jorge Fierro owner of Frida Bistro and Rico Brand talks about his businesses. About Arches Health Plan Find affordable health insurance coverage options. Individual, family, and group health plans from Utah's best insurance provider, Arches Health Plan. Arches is committed to making your health care better and more affordable by facilitating full collaboration between you and your physicians. Our unique health plan model has been proven to yield better health results for patients while saving them and their employers money. Arches. The way health care gets better. Our vision, as a CO-OP non-profit, is to align members and providers of care around value through care delivery, payment reform & appropriate benefit design.

 Arches Health Plan
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5505 S. 900 E. Suite 100, Salt Lake City, UT 84117

The Importance of Eating Healthy and Being Active - Arches Health Plan

One of the most frustrating yet potentially powerful conversations I have with patients is about their lifestyle. It is not uncommon for me on a daily basis to discuss patients poor lifestyle and how it is affecting not only their health but their wallet. Being sick costs a lot of money and good years of life. It is estimated 2/3 of us in the USA are either obese (BMI 30+) or overweight (BMI 26-30). Along with being overweight, there is an increased risk of high blood pressure, diabetes, arthritis, high cholesterol, heart disease, stroke, cancer, sleep apnea, heart failure, depression, liver disease, menstrual problems, infertility, gallbladder problems, etc. Holy-smokes, that is a boat load of problems and all because of me not doing the things every day to invest in myself.

My experience is when people change their lifestyle by eating the right things and exercising every day they lose weight and as they lose weight they also lose many things including medication, pain, depression and progression of the above mentioned problems. I have had the conversation many times which goes as follows, “I just want you to know that I do care for you and really enjoy you as a patient. But, when you go home tonight and have “your” stroke or heart attack, I will go to my home and have dinner with my wife and kids. When you are lying in your bed having someone change your diapers because you can’t, I am out riding my bike or enjoying a run. Though I do care for you as a person and patient, no one cares for you as much as you do! Will I lose sleep because of what you did to yourself? I will feel really bad for you but the answer is-No, If I did I would never sleep! Then I would be at risk of bad health.

So what do you need to do? Start! Start today to invest in yourself! If you’re worried about starting, see your doctor. Once you start do so moderately and don’t go out full steam which likely will set you back a few steps with an injury. Progress as you can tolerate and before you know it you will feel great! Go watch a great documentary which inspired me to take better care of myself called “Fat, Sick and Nearly Dead.” If they can do it you can. I hope this inspires you as much as it did me. Is change easy? No! Is it worth it? Only you know what is worth it to you but I would suggest it is!

Find us on Facebook in English and Spanish: Douglas Roland Smith is a graduate of the Medical College of Wisconsin and Chief Medical Officer of Arches Health Plan.

 Arches Health Plan
 medical insurance in utah
5505 S. 900 E. Suite 100, Salt Lake City, UT 84117

Monday, April 22, 2013

Information Campaign on Sugar

Sugar is Killing Us is a campaign to spread information about the negative effects of sugar and empower people to make better food choices.

Find out more at

About Arches Health: 
affordable health insurance utah
(801) 550-3197
5505S 900E, Ste. 100,
Salt Lake City, UT 84117

Tuesday, April 9, 2013

Bases para empezar a correr - Arches

No se imagina la cantidad de veces que me piden que vea por qué a alguien le duelen los pies cuando empieza a hacer ejercicio. La consulta típica es “Me propuse ponerme en forma y entonces decidí empezar a correr.

Read More Here:

(801) 550-3197
5505S 900E, Ste. 100,
Salt Lake City, UT 84117

Running Starters - Arches

I can’t tell you how often I am asked to see why somebody's foot hurts after they start to exercise. They typical story goes as follows, “I decided I was going to get in shape so I decided I was going to start running. I went to (insert your local sporting goods store-even running stores) to get some shoes and they told me I needed these shoes (as they held them up). For my brother in law he took the advice of a friend to buy a nice $200 pair of cushioning/neutral running shoes. My neighbor was directed to $150 dollar cushioning/neutral running shoe. My wife was given a $120 motion control running shoe. The next thing I did was make them take their shoes off, roll up their pants, let me evaluate their foot then have them walk across the room a couple times as I evaluated their gait. Each time they had been given the wrong shoe. The next step was asking them to show me the last running shoe they used and if it caused foot pain. Each time they said the old pair was fine, was the right shoe for their foot (chose them just by luck of the draw) and usually cost less. I then taught them a bit about running shoes and what to look for when they specifically bought a shoe for their foot not their friend’s foot.
Two weeks after my neighbor asked me for advice he came up to me at church excited that his foot pain was gone and the pair he bought cost him $70 instead of $150. To better understand your foot and what type of shoes there are I have included numerous links below. Spend some time learning about shoes and looking at your past shoes for tread wear. If you have any question you can go into one of the local running stores. I do however recommend you be careful. Two of my three examples went to the local specialty running stores and were directed to the wrong type of shoe for their foot. I have found if you have the owner of the store or at least the manager evaluate your foot on their treadmill you can get the better selection. Some of the newer employees may be a little inexperienced and in my anecdotal experience have led to most of the bad outcomes. For the store owners, I highly recommend you train these new workers better so I don’t have to keep seeing customers with foot pain and then having to recommend they return their shoes due to bad advice.
Assignment for this week: Read through all the links I have posted and go in and read some more. Find out what type of shoe you need then go out and get it. It doesn’t need to be expensive. Zappo’s has a great link to the different types of shoes you need with ballpark price ranges. I would then take this information and go to the local specialty running store (Wasatch front stores links area below). You can go in with your list for shoes in your price range, try them on, run on the treadmill with slow motion video evaluation to see if they work. In two weeks we will go over more equipment you may need.

Types of Shoes: Great pictorial guide to different foot types and shoes needed for each.
Neutral/Cushioning: Supinators=Have a tendency to roll to outside of foot
Motion Control: Severe Pronators=Flat Feet
Stability: Pronators=Feet are not flat but when walk collapse on the inside of foot
REI has a great link for you to read through to better understand what kind of foot you have. See link:
Great video review of shoe selection:
Good video to on shoe selection:
Running Stores on the Wasatch Front:

Dr. Douglas Roland Smith is a graduate of the Medical College of Wisconsin and Chief Medical Officer of Arches Health Plan.

Learning the Positive Effects of the Affordable Care Act on Utah Health Insurance

There is a lot of conflicting information regarding the Patient Protection and Affordable Care Act, otherwise known as Obamacare. Many people have heard negative things about what it does, what it could do, and even some things it doesn’t even do. While the ACA may have some effects on your Utah health insurance, it’s not a bad thing.

Two really important changes with the Affordable Care Act are providing subsidies to qualified people for the purchase of health insurance in Utah and guaranteed issue so that no matter if there are pre-existing health conditions you have access to healthcare insurance.  Premium subsidies will be available for individuals and families, who may not be able to fully afford health insurance in Utah. You can learn more about the ACA and how it will affect you on our website,

Many Utah health insurance companies and brokers are pushing their customers to immediately renew or buy old plans of health insurance, so they can keep their commission on the old plans in place. We believe it is smart to wait until October to evaluate all the Utah health plans, so you can benefit from the positives benefits of the ACA and the subsidies and that will be offered on the Marketplace Exchange. To check out how the subsidies are being structured, you can see your own benefits on this webpage,
When looking to purchase or renew your Utah healthcare medical insurance, it is always a great idea to do your research and protect your rights, especially with the changes that are occurring in health care. Affordable Utah health insurance is available, and the ACA can help make sure you and your family have access to affordable options.

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5505 S. 900 E. Suite 100, Salt Lake City, UT 84117

Sunday, March 24, 2013

Creating Gold, Silver and Bronze Benefits – Vanilla or Spumoni

I’ve talked to a lot of agents (and other folks) that believe that the Affordable Care Act requires all Exchange benefits to be basically the same – Gold, Silver or Bronze. They believe that these metallic benefits are highly regulated and will eliminate “qualified high-deductible health plans” (QHDHP) which support Health Savings Accounts. They think that there is virtually no wiggle room in Silver. At least that is the rumor. Fortunately this is not true, or at least it doesn’t have to be true.

First a recent counter-example: The California Health Benefits Marketplace exchange (called Covered California) announced that they were going to standardize their metallic plans and require all health plans offer only those identical plans. Competition would occur only by way of premiums and provider panels. Their reasoning was that consumers needed a true, identical apples-to-apples comparison to properly shop.

You can see their approved benefit structure here:

As you can see, Covered California will not offer QHDHP’s. Hopefully this will not become the norm with other state exchanges.

Most exchanges, including the federal marketplace, will allow health plans the ability to create their own plans – as long as they meet metallic guidelines and include required “essential health benefits”.  Various combinations of deductibles, coinsurance, copayments and out-of-pocket limits will be allowed – as long as they can be actuarially “scored” as proper metallic values. If a QHDHP can be created within the guidelines, they should and often will be allowed.


The rule for being certified metallic is that the “actuarial value” (AV) of the benefits comply with the following chart:

Bronze (60%) – must score between 58% & 62% AV

Silver (70%) – must score between 68% & 72% AV

Gold (80%) – must score between 78% & 82% AV

Platinum (90%) – must score between 88% and 92% AV

Catastrophic (57%) – with specific benefit requirements

What does actuarial value mean? It is the average expected payout by the health plan when a large standard population’s claims are run through the benefits. So if on “average” a particular health benefit plan design would pay 70% of the claims, then that would be considered a Silver plan. As you can imagine, there are numerous combinations of benefits (deductibles and copays, etc…) that could yield Silver benefits. It turns out that even a QHDHP can garner a Silver (or Bronze or even Gold) ranking.


I recently was referred to the government’s actuarial calculator. It is the exchange’s official scorekeeper. When an actuary comes up with a benefit plan, they run it through this calculator to get the official metallic certification. If the benefits do not meet the essential health benefit, then the calculator “fails” the plan and it cannot be sold in any exchange. If the official AV calculator certifies the plan’s unique benefits, then they are good to go in the appropriate metallic band (except in California of course).

The good news is that I was able to come up with all kinds of different Silver plans. I started with a few common plan designs and then, when I got comfortable with the AV calculator, I went wild. I thought up all kinds of goofy Silver and Bronze plans that no one would sell (or would they?!). It wasn’t too hard to come up with several Bronze and Silver QHDHP benefit designs. It was a bit more difficult with Gold, but do-able. Then I got serious about designing innovative (…or stupid, I’m not sure yet…) plan designs. It’s nice to be able to think outside the box, but not have to spend money on actuaries to rate each crazy idea.

If there are any doubts, I really had a blast with this.

If, like me, you think designing metallic benefits are a fun pastime (or if you are suffering from insomnia and want a non-chemical solution) try unleashing your inner actuary:

No password needed. Have fun!

Let me know if you come up with a winning plan design. We may use it for one of Arches Health Plans.


Every health plan within an exchange is required to offer at least one Silver plan and one Gold plan. If the plan chooses, they may offer a Platinum plan and/or a Bronze plan and/or a catastrophic plan (explained below).  Some exchanges, such as Covered California may require plans to offer all metallic products, not just Gold and Silver. Most health plans will want to offer Bronze and Catastrophic plans alongside of the required Gold and Silver. Most plans will not want to offer Platinum benefits, believing them to be a magnet for the really expensive cases.

The subsidy value is based on the premiums of the second lowest priced Silver plan of those available in the zip code of the enrollee. The actual subsidy is based the enrollees income. Once the subsidy is determined, then the enrollee may choose different plans, but would be responsible for the incremental difference in premium (whether higher or lower).  It is possible that in some unique cases, a particular Bronze plan may actually have zero premiums after the subsidy.

In addition to a premium subsidy, there are certain “benefit enhancements” required for Silver plans chosen by the lowest income families. When incomes are less than 150% of the federal poverty level, enrollees are entitled to enhanced “Silver” benefits. The exchange will assign Silver levels of 73%AV, 87%AV and 94%AV. These enhanced Silver plans are not “sold” but rather assigned by the exchange based on the enrollees income.

Covered California has published their required benefits for those enhanced Silver levels:

Another type of exchange product will be the “Catastrophic Plan”, with a 57% AV. The Catastrophic benefit structure is pretty well defined by code. It must include exactly three first dollar offices visits, but no other first dollar benefits. It is only sold to those aged 21 through 29 and to some strange situations where a person does not qualify for a subsidy, but Silver coverage is technically “unaffordable”. (This is a quirk where an older person, who has higher rates than a younger person, has income just outside the subsidy range but the Silver plan costs more than 9.5% of their income – rare but worth mentioning.)

Another required plan benefit design is exclusively for Native Americans with incomes less than 300% FPL. Qualified Native Americans are entitled to special benefits with 100% AV. Of course a 100% AV plan means that there are zero co-payments, deductibles and co-insurances due from the Native American enrollee. (Not much plan design work needed there.)

For all the enhanced benefit plans, the federal government will reimburse the health plans for any benefits paid beyond the standard benefits.


The bottom line is that the federal actuarial value calculator has surprisingly few restrictions. Many thousands of different plan designs are possible. The only limitations are the imagination of the health plan, the ability to administer the benefits and an exchange flexible enough for innovation and out-of-the-box thinking. In my view, it is unfortunate that Covered California will only allow vanilla plan designs. The benefit world is so much more satisfying with 31 flavors (or more).

Arches Health Plan will be benefit design innovators. Because if Arches Health Plan doesn’t change things, how is healthcare going to get better?

Thursday, March 7, 2013

Getting Real Health Care

Health care has always been a big issue for many Americans. There are millions of people in the United States concerned about the affordability of a quality health care plan, and those who do have it are also met with challenges from coverage to patient safety. That is why over the years, health reform has been a priority for the government.  They are constantly looking for ways to improve the quality of life. Most recently, the health insurance exchange provides a new way for consumers to shop, compare and choose the plan that suits their needs.

Now, thanks to the Affordable Care Act’s Consumer Operated and Oriented Plan (CO-OP), consumers have the option of getting health care insurance that is more affordable and consumer-friendly. As a non-profit organization run by their own customers, a CO-OP can provide the best solutions to the health care needs and concerns of its members. Without the pressure to meet investor expectations, all decisions ultimately benefit the members and no one else.

In Utah, Arches Health Plan exists for this purpose. Having received $85 million federal loan funding guarantees, it is available to serve individuals, small businesses and large groups in all 29 counties of Utah. Arches Health Plan is a standard-bearer in health reform where health care can be made more patient-centered,  and most important of all, affordable. Flexible terms, a more personal care delivery process, and a focus on what real health care should be all about gives Arches Health Plan a definite advantage over other options in a health insurance exchange. Their model is not only beneficial to patients but to health care professionals because they are not bound with insurance company rules, thereby enabling doctors to make the best decisions for their patient’ health.

So if you’re a Utahn looking to benefit from health care reform, consider a company that exists for your total benefit—Arches Health Plan. You can get the health care you deserve at a lower cost and higher quality.

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Salt Lake City, UT 84117
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