AultCare: A plan developed with the community in mind

Success is a Reflection of Dedicated, Hard-Working Staff

In 1983, Aultman Hospital President Richard Pryce called in his young personnel director Rick Haines. “Rick, I have a project for you,” said Pryce. “We need to start our own health plan, our own insurance company.” The goal, said Pryce, was to develop a quality plan with low premiums. The premium savings to companies, both agreed, would benefit the community.
Haines, who joined Aultman in 1981, had been part of a team working to reduce costs in the hospital. Pryce foresaw Medicare reducing its payments to hospitals, Haines said, and he wanted Aultman to be ahead of Medicare’s cost- reduction curve. This was the first component to starting AultCare.
After a year of development, AultCare launched in 1985 with its first member – Aultman Hospital employees. From there, it expanded as an administrator of self-insurance plans for several local businesses. In 1989, AultCare added a fully insured product, mainly to serve small businesses.
By 1994, it grew to cover more than 60,000 people. Today, AultCare has more than 2,200 employer members and covers more than 420,000 people, including more than 20,000 PrimeTime Health Plan members who benefit from AultCare’s Medicare Advantage Plan.
Its structure remains the same, said Haines, who is President and CEO of AultCare. “Offer high-quality insurance coverage at an affordable price by capitalizing on Aultman’s low-cost structure and utilizing a local network of high-quality Primary Care and Specialist physicians who are dedicated to the health care of this community.”
That structure allowed the goal to be reached, said Haines. “If employers are paying less for health care, they can invest in their companies, they can hire more people,” he said, and that is good for this community. If it is good for this community, it is good for AultCare and Aultman and the local physicians.”
The key to reaching the goal was to operate on slim margins when compared to traditional for-profit insurance companies. Since 1989, AultCare’s profit margin has been less than 0.2%, purposely kept low, said Haines, so the savings could remain in the hands of local companies and residents and be used to benefit the local economy.
By many measurements, AultCare has been successful. One number in particular – retention rate of members – reflects how the community has embraced the company’s health insurance products. Annually, 95 percent of customers continue with AultCare. The retention rate for national insurance companies hovers around 75 percent. “We have a great insurance company, working with a great hospital and a great group of physicians,” said Haines, “and that is how you keep customers and benefit the community.”
Haines says the staff is Ault- Care’s best asset. “AultCare began with a group of dedicated employees and it continues with them,” said Haines. “Our success reflects their hard work. They handle more than $728 million in claims annually, with 99.9 percent accuracy. More than 7,500 calls per week flow into our service centers and that staff treats each one as if a neighbor is calling; after all, we are Stark County’s only local health insurance company, so the caller very well may be their neighbor.”
As the health insurance world changes, AultCare finds itself as the local resource for companies and residents trying to understand health care reform. In 2013, for example, more than 4,000 area people have attended AultCare informational meetings about health care reform.
AultCare adapted to the ever-changing health care industry in the 20th century and into the 21st century. It began as a local business and stayed that way by being innovative. It is some- thing that makes all AultCare employees proud. “As the years go by, we will continue to make strategic changes to keep our local business viable,” said Haines, “because we know if we do that it will contribute to the viability of the community in which we all live.”

This article appeared in Stark 100 | The Canton Repository. 

Efforts to improve the performance of the Online Marketplace shopping experience will continue

The Online Marketplace continues to be the focus of President Obama and his White House staff, as efforts ramp up to improve the performance of the online Marketplace shopping experience for individuals purchasing health care insurance. 

The Administration announced this week that it is appointing Jeffrey Zients to spearhead the efforts to get the site operating at greater capacity.

Zients previously held the position of Chief Performance Officer and Deputy Director for the Office of Management and Budget in the Obama Administration, where he was charged with streamlining processes, cutting costs and pursuing best practices across the government.

About 7 million Americans are expected to purchase insurance online during the Marketplace’s first open enrollment period, October 1 through March 31, 2014.

Read more about the administration’s efforts in the article below: 

Mike Novelli, Vice President Reform Implementation at AultCare

AultCare available on Insurance Marketplace

AultCare Insurance Company is a Qualified Health Plans issuer in the Federally Facilitated Marketplace (FFM). AultCare will offer multiple health insurance choices for individuals when the federal government launches its Health Insurance Marketplace on October 1.The health care reform law expands access to insurance and broadens insurance benefits. Beginning on October 1, 2013, individuals will be able to visit to view plans and pricing and choose their health insurance.

As expected, rates for the insurance are somewhat higher than in the past. Within that context, however, AultCare’s rates are very competitive. In addition, federal financial assistance will be available to help qualifying individuals and families pay for coverage. Nevertheless, even with assistance, some people will pay more for coverage than they do today. Costs will vary depending on the Marketplace plan they choose, plus where they live, their age and whether they qualify for federal assistance.

While AultCare is doing everything it can to incorporate the new mandated requirements in the most affordable way possible, these changes could have some impact to a person’s health care coverage.

Policyholders will see changes from their current policies to meet the minimum standards required by the reform law. Minimum benefit requirements are broader than what many individuals and small businesses currently choose to purchase, meaning they will have to purchase coverage that is more comprehensive, but also more expensive than they have today.

AultCare, Stark County’s only locally owned and operated health insurance company, will initially enter the marketplace with a three-county service area – Stark, Tuscarawas and Carroll counties. For more information on AultCare, visit


Out-of-pocket maximums delayed one year in health care law

Much has been written in the last few days about a delay in the out-of-pocket maximums for individuals and families that are part of the health care law, beginning January 1, 2014.  The statutory limit for all non-grandfathered health plans is governed by the limits of plans tied to Health Savings Accounts (HSA).  These HSA limits are published annually by the Federal Government and the limits for 2014 will be $6,350 for individual in-network expenses and $12,700 for family in-network expenses.

The delay that the national press has been writing about this week actually emanates from a Department of Labor (DOL) announcement on February 20, 2013.  In that announcement, the DOL gave transition relief to health plans that have separate vendors for medical coverage and prescription drug coverage.  The transition relief is intended to provide Pharmacy Benefit Managers (PBM), Insurers, and Employer Health plans time to integrate the data transfers required to implement a single out-of-pocket maximum for individuals and families across different technology platforms.  Those plans affected by the transition relief must comply beginning January 1, 2015.

For those plans health plans with a single vendor, such as AultCare’s Insured Plans and most of our self-insured plans, the out-of-pocket maximum will be integrated in 2014 for both the health plan and the pharmacy benefit to the limits of $6,350 for Individuals and $12,700 for Families.

Mike Novelli, Vice President Reform Implementation at AultCare

Enroll America launches campaign to help millions enroll on the insurance Marketplace

Enroll America, a non-profit entity whose mission is to generate awareness and understanding of how Americans can enroll in the Marketplace, began a media blitz last week in concert with the Federal Government.  

Enroll America’s website, Get Covered America, will provide information about the Marketplace, including helpful tips on what information will be required to complete an application online as well as an online chat feature and a toll free number for information about the Marketplace.

Their marketing plans include outreach via Facebook and Twitter as well as traditional marketing venues such as television and print media.  Open enrollment begins October 1, 2013 and it is expected that seven million Americans will enroll on the Marketplace with a coverage effective January 1, 2014.

For more information on the Marketplace and Health Care Reform go to:

Mike Novelli, Vice President Reform Implementation at AultCare

Health Insurance Marketplace in Ohio

Insurers intending to participate in the Health Insurance Marketplace in 2014 were required to submit Rate and Form Filings to the State of Ohio by May 31, 2013. On June 6, 2013, the Ohio Department of Insurance announced that 14 carriers, including AultCare Insurance Company, have made application to offer coverage to Ohioans in 2014 on the Federal Marketplace.

The 14 carriers have submitted 214 plans for approval.  In a press release, Lieutenant Governor Mary Taylor announced that the average rate will rise 88% in the Individual Market.  An analysis of the rates in the Small Group Market has not been released by the State.

A copy of the bulletin can be found here.

Mike Novelli, Vice President Reform Implementation at AultCare

A temporary tax for employers operating self-funded health plans

The Affordable Care Act contains a requirement that employers operating self-funded health plans must pay a Patient Centered Outcomes Research Institute (PCORI) tax of $1.00 per member per year for plan years ending on or after October 1, 2012. Plan years ending October 1, 2013 and after must pay a tax of $2.00 per member per year. This temporary tax expires on September 30, 2019.  The taxes are filed on IRS Form 720 and are due by July 31st of the year following a plan year end date.  IRS Form 720 and the instructions for filing Form 720 can be found below. 
For more information on PCORI and the Affordable Care Act visit

Mike Novelli, Vice President Reform Implementation at AultCare