Altoona Area School Board piloting direct-pay plan

The Altoona Area School Board is piloting a direct-pay medical plan for employees that requires a monthly fee from patients for primary care, rather than fees for specific services.

Empower3 is a partnership of Altoona native and internist Dr. Zane Gates, Buffalo insurance expert Patrick Reilly, UPMC Altoona and UPMC Health Plan.

As a direct-pay physician practice, Empower3 doesn’t take insurance.

“If they (employees) selected this option, they don’t have to worry about copays or anything else. If someone shies away from seeing a doctor because of problems with the system, this is for them,” Superintendent Charles Prijatelj said.

“And it would lower the premium cost for the school district’s entire health care package,” he said.

With a unanimous vote Monday, the school board is extending the option to special education aides who are not covered by the district’s current health plan.

It is also an additional option for employees in the district’s American Federation of State County and Municipal Employees union in conjunction with the district’s HRA plans.

Prijatelj said there are employees who live paycheck to paycheck and are afraid of going to the doctor because of paperwork and fees in the current system.

The new model would be a monthly up-front cost that covers a long list of medical services that people need 90 percent of the time, according to Reilly.

While the Affordable Care Act provides federal subsidies for uninsured people to purchase health care, middle class employees who live paycheck to paycheck and don’t qualify for the maximum subsidy have difficulty affording health care through the Affordable Care Act exchanges, Gates said.

“I know what’s out there on the exchanges right now. The middle class is getting slaughtered,” he said.

The district intends to pilot the medical option with the AFSME employee union. However, negotiations with the union on a new contract are continuing.

AFSME President Gary Orner Local 2952 said the union’s contract is set to expire June 30.

The pilot program means individuals of the union can choose to participate.

Mirror Staff Writer Russ O’Reilly is at 946-7435.