Benefits.....Opinion, Hearsay & News Review
walking" has joined the list of allowed occupational hazards in Illinois in
the case of a prison guard at the Menard Correctional Center. Menard prison
guards reportedly have filed 230 repetitive trauma claims in recent years. Why
wouldn't they, when they can get away with this? Broken system in a broke state.
to Express Scripts 2011 Drug Trend Report, non-adherence to prescription
medication cost the U.S. health care system $317.4 billion in 2011. Sixty-three
percent of patients tested by Quest Diagnostics were taking medicine
inconsistent with physician's ordered doses. Forgetting to take medication
accounts for 69% of the non-adherence problem.
Starting with plan years after
October 1, 2012, PPACA is requiring plans to pay a per participant fee of
$1 to fund the Patient-Centered Outcomes Research Trust Fund. The next year the
fee will be $2 per participant. Insurance companies will pay for fully insured
plans. Self-funded plan are subject to the fee as well. How the fee will be
collected is still up in the air.
Cancer is now the leading cause
of LTD claims at 15% of all claims filed, followed closely by back disorders at
14.6%. For STD claims the leading cause is normal pregnancy for 18.9% of
Isn't it interesting that
although the tax/penalty to individuals for not purchasing health insurance
begins in 2014, there is no enforcement mechanism in the law for the IRS to
collect the tax unless the people would qualify for a tax refund? However, the
speculation is that the IRS will need 16,500 agents to enforce the law. Huh?
HCSC (BCBS IL, TX, OK, NM) is
reporting that only 4% of its customers will receive a loss ratio rebate under
PPACA, with no rebates to be issued in IL. We have information from one customer
in Texas that is receiving a 9% rebate. On a related issue, BCBS-IL maintains a
48% market share in Illinois as of 2011. UHC is creeping up, with a 10.24%
market share compared to 8.28% in 2009. In California, Anthem, Blue Shield Life
and Aetna have agreed to reduce rate increases for small group policies in
ranges from 1.3% to 2.5% at the request of the CA insurance commissioner. In
Michigan, the state insurance commissioner has ordered BCBS to stop using
"most favored nation" clauses in their contracts with hospitals.
According to BCBS counsel, BCBS has
so far not responded to the order, since the benefits may outweigh other issues.
Both Aetna and the DOJ have filed suit against BCBS-MI over those "most
favored nation" clauses.
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As part of PPACA, pre-existing
condition plans were created in the
states to cover those who could not get coverage elsewhere. The programs began
accepting enrollments July 1, 2010. The "huge" problem of pre-existing
condition people not qualifying for insurance has resulted in 73,333 people
enrolled as of May 31, 2012. The expected flood of people previously denied
coverage was probably mitigated by the fact that people have to pay for the
program, which is something Nancy Pelosi never told them.
The PPACA was also supposed to
establish state exchanges for people to buy insurance using federal subsidies.
However, a number of states have decided not to establish exchanges, in which
case the feds are to establish the exchange. However, the law does not allow
subsidies for those who enroll in exchanges run by the feds. Hmm, another
oversight in PPACA? How could that happen? Nancy Pelosi again- We have to pass
the bill to know what is in it.
Insurance companies continue
to branch out to alleviate the effects of PPACA. Cigna has purchased a 51% stake
in a Turkish lender so that they can sell their life and pension products
through the 500 retail branches of the lender.
Prudential has discontinued
offering its Group Long Term Care products effective August 1, 2012.
Walgreens ended its contract
dispute with Express Scripts that began in January and resulted in a 10% drop in
pharmacy sales. On the announcement, Walgreen's shares increased 13% in early
Deloitte says 81% of 560
employers surveyed will keep their health insurance plans in spite of PPACA.
However, 13% of employers with 50-100 employees anticipate dropping coverage
compared to just 1% of employers with 1,000 to 2,499 employees.
A National Business Group on
Health survey shows that 53% of employees doubt they could buy health coverage
the same or better than their employer provides. More than 60% were satisfied
with their coverage and 30% were somewhat satisfied. Most (62%) didn't know how
much their employer paid for coverage and 23% undervalued the cost of their
coverage, estimating the cost at less than $500 per month vs. the Towers survey
national average of $750 a month.