S&S Benefits.....Opinion,
Hearsay & News Review
HAPPY
HOLIDAYS !!! MERRY CHRISTMAS !!! Have a
safe and HAPPY
NEW YEAR !!!
According
to Medstat, the number of households receiving their primary health coverage
through the workplace declined from 49.9% last year to 48% this year. PPOs cover
44% of those households, up from 43%. HMOs were down from 28% to 27%. Roughly
51% of employers with less than 10 employees do not provide health coverage and
62% of those surveyed say that cost is the major barrier.
Manufacturer
prices for 193 brand name drugs rose 6.1% over the last year according to AARP.
Generic prices remained flat in the same time frame. This comes on the heels of
the Express Scripts study we cited last month that says that $20 Billion in
savings is possible through expanded use of generic equivalents. 95% of
gastrointestinal scripts issued could have generic substitution, vs. the current
substitution rate of 31%. The 7% generic anti-cholesterol rate could be 70%.
Generic anti-depressants could be issued 75% of the time vs. the current 41%.
High
deductible health plans minimum deductible amounts have been changed to $1,050
single and $2,100 family for 2006 with max out of pockets going to $5,250 single
and $10,500 family. The contributions to HSAs are maxed at the lesser of the
deductible or $2,700 single and $5,450 family for 2006 and catch up
contributions to HSAs for those 55 and older are increased from $600 in 2005 to
$700 in 2006.
Humana
has named a new CEO for
Illinois
. Julius Alberico left Humana and went back to New York Life. He will be
replaced by Dr. Hassan Rifaat from Humana in
Louisiana
.
According
to the Government Accounting Office, the 5 largest small group carriers
represent at least 75% of the market in 26 states.
The median market share of all BCBS carriers in the 34 states that
provided information was 44%.
FST
Associates has been bought out by the firm’s minority owners and is merged
with CSIG. The two will continue to operate under their own names. Pete Anderson
has been kicked upstairs to be Chairman of FST’s board.
MultiPlan
has announced a dramatic increase in its national PPO network as a result of its
integration with 8 PPO networks acquired from BCE Emergis. The network says its
size will increase by over 200,000 more physicians and facilities.
HCC
has announced that it will be acquiring the PERICO managing general underwriter
based in
St. Louis
. This merger is curious, but may enhance the somewhat tarnished reputation of
the MGU.
As
announced in our special edition, effective Nov. 30th, Aetna’s
contract with the
University
of
Chicago Physician
Group is terminating for Open Access, HMO and POS plans. As of this date we
have not heard of any changes to this termination.
The
Mercer study of national healthcare costs survey of nearly 3,000 employers shows
that costs rose by 6.1% in 2005. The average cost for a company of at least 500
employees went up 6.7% to $7,379PEPY, while those with less than 500 employees
reported costs up 4.9% to $6,670. For those with at least 500 employees, PPO
costs in the
Midwest
were $7,223, $7,364 in the West, $7,744 in the Northeast and $6,824 in the
South.
To
try to contain costs, an EBN-Forrester survey shows that 60% of self-funded
groups currently participate in Disease Management programs, while 29% plan to
offer the programs in the next year. The larger the company, the more likely is
participation in a DM program. 60% of those with at least 1000 employees
currently offer DM. The number drops to 32% of those companies with less than
250 employees.
The
AON Fall trend survey shows Medical/Rx trend at 13% for PPO plans. Rx stand
alone was at 13.1% for general and 22.5% for specialty. Medical without Rx was
12.7%, Dental PPO was 7.1% with indemnity dental at 7.6% and vision was at 3.9%.
HMO with Rx was at 13.2%, without Rx was 12.9%. CDH plans were trending at 12.7%
with Rx and 12.4% without Rx. An 11/28/05 BI article states that WellPoint is
now quoting annual trend at 8.5% with
Aetna
reported to be in the same neighborhood.
Cigna
plans to begin publicizing actual provider cost ranges in January as part of its
consumerism push.
