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

Thank you to all of you who participated in our survey as to how to distribute this newsletter. Unfortunately for us, but maybe fortunately for you, the results were inconclusive. Many people liked the pdf version and just as many preferred either HTML email or a WORD document…..so, in each distribution you will now receive all three (it’s not that hard for us to do).

UHC says its commercial enrollment will drop by as many as 1.5 million members next year as the company holds fast on pricing and deals with a weak economy. Total commercial enrollment will be in the 24 to 25 million member range for 2009. However, they expect enrollment to increase in their Medicare Advantage plans by over 100,000 members.

In the Segal 2009 Health Plan Cost Trend Survey, the survey predicts moderate health cost increases. Cost shifting in the form of HDHPs appears to have lowered patient utilization of hospital, physician and Rx services. That trend appears to be further influenced by a declining economy. Rx trend is predicted to drop from 10.7% to 9.8%. Physician trend is expected to drop from 9.9% to 8.9% and hospital trend is expected to drop from to 10.9% from 11.3%. Overall utilization is expected to fall from 3.2% to 2.5%. The NAIC reports that 22% of U.S. consumers said they had reduced the number of times they see a doctor (due to the economy) and 11% had cut their doses of prescription drugs. Some of this is disturbing since it may affect the health of the nation. Lower trends in usage of beta blockers, pap smears and diabetic testing were noted in the survey.

In a Watson survey of over 2400 employers, 17% of participants avoided doctor visits or cut back on Rx usage due to costs. Thirty-five percent of employees saved by purchasing lower cost Rx (a 7% increase from the prior year). Also, only 19% of employees (as opposed to 38% in 2007) are willing to pay higher premiums in order to keep deductibles and copays lower. Only 16% were enrolled in company sponsored wellness programs.

According to Milliman, the hidden tax paid on private insurance plans amounts to $88.8 Billion because of government underpayments to doctors and hospitals in the Medicare and Medicaid programs. The underpayments result in an increase in the annual cost for a family of four by $1,788 per year (including employee and employer contributions towards premium) for those covered under private insurance programs. In 2006, hospitals earned 23.1% for privately insured patients compared to a negative 10.8% for Medicare and Medicaid. Of course, unlike Congress, we recognize that we are going to pay for government insured patients one way or another, be it cost shifting or taxes. It is at least good to know what these government programs really cost us. Prepare for more.

In Illinois , after being arrested, Governor Blagojevich did sign a bill that mandated insurance cover treatment of autism for up to $36,000 per year. In 2009, insured group health plans must also cover Anorexia and Bulimia Nervosa and licensed marriage and family therapists for treatment of mental, emotional and nervous disorders.

Multi-Plan/PHCS has an agreement with Management and Network Services for skilled nursing services for Multi-Plan nationally and PHCS in IL, IN, KY and OH.

Walgreens has sued Express Scripts for more than $7.8M, two days after Express Scripts sued Walgreens for overpaying them by more than $25M. Walgreens claims Express Scripts engaged in unauthorized audits and wrongfully recouped $7.8M.

From 2001 to 2008 EBSA collected $11.9B by pursuing cases that violated federal regulations for employee benefit plans. For violations such as non-filing of 5500 forms, EBSA recovered more than $449 million for employee benefit plans and received 6,393 applications under the Voluntary Fiduciary Correction Program.

HAPPY NEW YEAR!!!                           Be safe.

If you wish to be added or removed from the distribution of this newsletter, please email jseiler@ssbenefits.net