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

Why be like everyone else?

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

New Email: ssbenefits@interaccess.com

Volume 1 Issue 7-Street Talk June 1,1999

.Disabilities seem to be the big news this month as we move towards the summer solstice on June 21st. Last month we told you about the new mental health parity laws that seem to be popping up in the states as Congress also moves towards making that coverage the same as any other illness. If you have any doubts about the cost of mental illness benefits, take a look at recent Americans with Disabilities Act (ADA) statistics which were recently published in the papers by the EEOC. Claims for psychiatric disorders have nearly doubled since the ADA act was passed in 1991. Psychiatric disorders now account for 16 percent of the nearly 18,000 claims received by the EEOC in the last year. Claims of all kinds have risen by 20 percent a year. Back problems accounted for 13 percent of the ADA claims.

INfertility is also now a disability according to the EEOC! In an April 27 determination letter, the EEOC found that a New York employee of a Salt Lake City company is entitled to ADA coverage of "medically necessary" infertility treatments under the company’s self –insured benefit plan. After being diagnosed with a hormonal imbalance, the employee and her husband tried to conceive through artificial insemination and the employee suffered a miscarriage. The plan denied all but $3,025 of $20,220 in medical claims. According to BI the ruling follows the U.S. Supreme court decision last June that an HIV infected woman should be considered disabled under the ADA because she is unable to bear children.

Call us insensitive in today’s politically correct society, but we can’t figure out why employers are to blame and should be held liable for people’s inability to have children.

HMO’s have a new solution that is being tried by some of the country’s largest plans. Remember the know all coordinator of care….the Primary Care Physician (PCP) that the HMOs have used to change the face of medical practice in the U.S.? Now some HMOs are restricting the PCP’s role at a crucial time. When a patient enters the hospital, the latest trend is to assign a hospitalist. These docs work full time in hospitals coordinating care, replacing the role of the PCP in that setting. The HMOs say that patients get more attention and reduced lengths of stay with the use of hospitalists, since the doctors are not splitting their time between office and hospital duties. The word is that tests get scheduled faster and patients go home sooner without care being compromised. One forgotten item may be that since most doctors also treat non-HMO patients, they must go to the hospitals anyhow to look after their other patients. Humana, according to one article, says that 85% of the patients surveyed would want the same hospitalist again if they were hospitalized. We are not surprised to hear the results of this study. Its kind of like that patient satisfaction survey results that HMO’s always quote.

BUt according to a Daily Herald article quoting Chicago based Citizens Action, there has been a 54% jump in patient complaints against HMOs according to Illinois Department of Insurance statistics.

Remember CALPERS? The California Public Employees’ Retirement System that was being ballyhooed as the model for all employers (with their 10 HMOs and low rates). Reality has finally caught up to them as the HMO’s that serve CALPERS must give rate increases to this loss leader in California. Chances are, these increases are not even enough, but no one wants to lose membership. The average increase is 9.7% according to BI with Kaiser (the HMO guru) raising rates by 11.7%. Beware of those massive employers who toot their own horns in BI. Sooner or later the bottom drops out, and most employers are not large enough to have their clout anyhow.

UNum is selling its reinsurance business, including Duncanson & Holt. D&H is the purveyor of many LTD contracts marketed by other insurance companies using products that are one step behind Unum’s latest.

AN ERISA showdown is likely in Maryland, where the state is attempting to make it against the law to sell reinsurance specific stop loss with attachment points of less than $10,000 for spec and aggregates less than 115%. Such a law will diminish the ability of small group plans to escape the overbearing state regulations (by going self-funded) which drive up the cost of insurance.

YOu may want to try adding a benefit to save money? S&S offers a benefit package which assists your employees in finding child and elder care. If employees are spending time on your phones or days away from work to arrange this care, this benefit could be of assistance. Plus it may help attract and retain employees in the labor short market.

S&S Benefits Consulting is a partnership of benefits professionals with over 50 years in the health and welfare business. We specialize in the group business and don’t try to sell you services where we have no expertise. If we can’t help you, chances are, we know who can.