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S&S Benefits.....Opinion, Hearsay & News Review

Why be like everyone else?

S&S Benefits Consulting, Inc. 219 Darien, Dundee, IL 60118 Phone: 847-428-5353, Fax:847-428-9876,

Email: jseiler@ssbenefits.net IF YOU WOULD RATHER RECEIVE THIS VIA E-MAIL !!!! www.ssbenefits.net

Volume 4 Issue 4 Street Talk April, 2002 Issue


Crain’s says the University of Chicago PCPs have terminated their contract with HMO Illinois effective July 1st. This would be even more evidence of the power of the docs returning if it materializes, since HMO-IL (BC/BS) is the largest in the area. Over 14k members of HMO-IL use those docs.

By 2011 Americans are expected to spend $9,216 per person on health care (double the 2000 figure). According to the Centers for Medicare and Medicaid Services, health costs are expected to grow at a rate of 7.3% annually and healthcare spending could reach 17% of GDP.

The American Dental Association has sued Wellpoint for failing to pay actual charges for dental services. The ADA is against reasonable and customary limitations, the same for which they sued Aetna last August. Wellpoint shares moved higher on the stock exchange.

Georgia has fined One Health Plan of Georgia (Great West, GenAm and New England) $200K for violating the state prompt payment law. They insure 10,226 people in Georgia and previously were fined 95K in Dec. 2000 for the same. It is one of the larger fines given in Ga. The record goes to Humana for a $400 K violation.

PpoNEXT has announced the acquisition of Mastercare, Inc. which operates in NY, NJ, CT and PA. They have also purchased Healthstar Inc. of Chicago, Medical Control Solutions of Dallas, Healthcare Evaluations of CA and PHN of Irvine, CA to grow to 380K docs and 3,500 facilities in 48 states.

A RAND study compares the effects of obesity, smoking and problem drinking and says that obesity is associated with 36% higher inpatient and outpatient costs and 77% higher drug costs than average people. That percentage is greater than for smokers or problem drinkers.

Fortis has discontinued selling small business health insurance through online brokers. A trend?

The Supreme Court took a shot at the DOL by a 5-4 margin saying that the DOL overstepped its authority when it required employers to provide up-front notification to workers when a company’s leave policy runs concurrently with the 12 weeks of unpaid leave under FMLA. However, the court did not say that notification is not required. Lawyers advise that companies distribute leave policies which state how company leave interacts with FMLA.

The Winter 2002 Aon Survey says that to control health costs 31% of employers are increasing deductibles and 59% are increasing contributions. Seven percent are looking at "consumer driven" plans. Most are not looking at any plan or funding changes.

S&S Benefits Consulting recently distributed via email (to our email newsletter recipients) changes in the DOL/IRS penalties for non-compliance with 5500 form filing. If you wish to receive these special editions of our newsletter, you must be an email recipient and not a fax recipient.

S&S Benefits has been reviewing some products that may be of interest. If so, please let us know if you would like more information:

Is it time to consider short term health coverage for new hires instead of paying their COBRA premiums? This is an excellent cost saving strategy to employ if a new hire is healthy, since premiums for medical care are substantially lower than COBRA. The product could also be made available to those who are offered COBRA on the way out the door. It is well documented that COBRA is normally too expensive for those that would normally not need the coverage, but who would like the protection. Would it also be good to let former employees know there is less expensive temporary coverage available to meet interim needs while trying to locate new employment?

Mini-medical plans are becoming more in vogue for part-time and temporary workers since they are affordable and can be offered on a voluntary basis (which also helps to reduce employer payroll taxes). Catastrophic coverage can make the premiums and/or deductibles unaffordable, but if lesser paid employees just want to be able to cover their occasional doctor visits and Rx charges, mini-medical plans can help and also provide disability and dental coverage.

To get substantially lower stop loss premiums there is a product that is not for the faint of heart. Since aggregating specs are catching on, this may too. By eliminating specific protection and letting all claims count towards the attachment, premiums can be lowered substantially while maintaining a similar overall attachment point.

We also ran across a Group Medicare Supplement plan to offer to retirees that may reduce retiree liability for certain companies.