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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 click: mailto:jseiler@ssbenefits.net                                              http://www.ssbenefits.net/ December 2005 Issue


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 firmís 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 FSTís 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, Aetnaís 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.

To find out more about S&S Benefits Consulting, Inc. and how we can help your company, visit our website at www.ssbenefits.net and order our free CD. To be removed from the newsletter list, just send us an email or fax.

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