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

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

Email :jseiler@ssbenefits.net                                              http://www.ssbenefits.net/   August 2012 Issue

"Repetitive 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.


According 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 claimants.


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 trading.

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.