Pub. 1 2021 Issue 1

18 M ontana automobile dealers have banded together to provide their employees with health insurance since the 1950s. Over the years, what this means and how it is done has evolved significantly. With the ever-increasing costs of new technologies and medical miracles combined with the for-profit and “fee for service” model adopted by most American hospitals, health care costs have consistently outpaced every other industry’s inflation. Today, the dealership’s collaborative employee benefits solution is classi- fied as a partially self-funded MEWA (multiple employer welfare arrange- ment). The official name is the Montana Automobile Dealers Group Benefits Trust. The trust is overseen by a board of dealers — five seats with lifetime appointments and two temporary seats filled by the association’s president and chair. Notably, two families have had three generations serve on the trust’s board: the Olson family of Bison Motor Company and the Aadsen and Ander- son families of Don Aadsen Ford. As a partially self-funded MEWA, the premiums paid by the dealers and their employees are pooled and used to pay the administrative costs and the health care claims experienced by the participants. The risk retention and risk pooling aspect of the trust means the participating dealerships and their employees benefit from the strategic management of administrative part- nerships and a healthier population. In the past decade, the board’s prima- ry strategy has been moving away from the broken PPO/carrier model, where the trust has to pay hospitals and health care providers based on a contract they cannot see and negotiate. In 2015, the trust partnered with ELAP to reprice and pay hospital claims around either 120% of Medicare or the hospital’s reported cost for the service. With no contract to lean on, the hospi- tals’ abilities are limited when inflat- ing their prices and forcing the trust to pay outrageous charges. For many Montana hospitals, this meant negoti- ating directly with the trust, leading to what has now become a narrow, trans- parent network. For other hospitals, it means they would balance bill the trust’s participants directly. However, ELAP provides defense and can often force the hospital and debt collectors to stop their actions. The hospitals that chose to provide fair, transparent pricing with the trust are proudly promoted. Members can find them on the MTADA website. Understanding the strategy mentioned above creates a unique value proposi- MONTANA AUTOMOBILE DEALERS ASSOCIATION GROUP BENEFITS TRUST