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

On July 14, the government released Interim Final Rules (oxymoron?) related to the coverage of preventive care under the PPACA. Grandfathered plans are exempt. The coverage need NOT be provided for employees who go out of network. Preventive care for non-grandfathered plans is covered without any cost sharing requirement or limits for evidence-based preventive services. Generally, covered services include breast, cervical and colon cancer screenings along with screenings for diabetes and vitamin deficiencies during pregnancy. Routine vaccinations must be included as well as specific guideline preventive care for children from birth to age 21, and preventive services for women.

Trustmark has selected CVS Caremark as the PBM for their fully insured and self-funded customers. CVS Caremark was also announced as an administrative partner for Aetna ’s PBM.

MultiPlan (PHCS, Beech Street ) has been acquired from The Carlyle Group and Welsh, Carson, Anderson & Stowe by private equity investors BC Partners and Silver Lake .

As part of the 2009 economic stimulus law, the federal government is Requiring that by 2014 all Americans have their BMI as part of their medical records.  If doctors and hospitals do not comply they will risk getting penalized in the form of diminished Medicare and Medicaid payments. No mention yet on what the penalty is for individuals who have a BMI above target. Broccoli diet or just take away your cookies? Just what we need, some government desk jockey to tell us how we need to live our lives.

The USA Today reported that non-profit BCBS health plans stockpiled billions of dollars in the past decade. Seven of 10 plans analyzed had reserves of three times the minimum requirement. Reuters noted that the plans had a surplus of $32 billion in 2008. BCBSIL had 5 times the minimum required reserves while BCBSAZ had 7 times the minimum. BCBS officials defended the reserves as needed in the wake of the uncertainty of health reform financial consequences. While S&S Benefits has pointed out for years how the Blues plans hide discount money from unsuspecting clients and ignorant brokers, they do have a good point about surviving health reform. However, the reserves were built up long before the “reform’ package was passed.

Weiss Ratings says the PPACA is expected to squeeze profits and finances of the nation’s small health insurers and force many to withdraw from the market. Of 585 companies studied, 96 received a rating of D (weak) and 186 were rated as a C (fair). Before any expenses mandated by health reform, 174 health insurers reported losses last year. Looks like PPACA is not really protecting many patients (another oxymoron?).

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The average cost of group health insurance premiums for family coverage in the nation’s 10 largest states was highest in New York and lowest in Ohio . The cost of family coverage in New York last year averaged $13,757 per employee in 2009. The national average was $13,027. Illinois had an average cost of $13,708. Texas ’ average was $12,631 per employee and Ohio had an average of $11,870. Of employees who opt for coverage nationwide, 50% opt for single coverage, 19.5% enroll in employee plus one coverage and 30.5% enroll in family coverage.

Since many insurance companies were dropping their child only health plans in view of PPACA, HHS has backed off the prohibition on not allowing exclusions for pre-existing conditions for children under age 19. According to National Underwriter, HHS officials now say they will let individual health carriers discourage adverse selection by selling individual health coverage to children only during regularly scheduled open enrollment periods. We seriously doubt that will stop the problem.

Not much more to report other than more depressing news about Obamacare, so we will just leave it at that for now. Enjoy the remainder of the summer!