S&S Benefits.....Opinion,
Hearsay & News Review
&S
Benefits Consulting, Inc. 219
Darien
,
Dundee
,
IL
60118
Phone: 847-428-5353,
Fax:847-428-9876
The
summer solstice is almost here. We hope you are enjoying the longer days and
warm weather.
Rumors
continue to swirl about the sale of PHCS. The latest has MultiPlan buying the
largest proprietary PPO network in the country. MultiPlan was purchased in April
by The Carlyle Group, a global private equity group. MulitPlan made a name for
itself and eventually became accepted by starting out primarily as a silent PPO
network.
A
Kaiser report states that the average person pays 35% of their medical costs out
of pocket, with the balance paid by insurance. Rx represents 43% of those
expenses while office visits account for 26% and dental expenses are 17% of the
out of pocket costs. The 5% of Americans with the highest spending account for
about 49% of total health expenditures and the old 20%/80% rule still applies
according to KFF. Total
U.S.
health expenditures are $2.16 trillion this year, with per person spending at
$7,110 and projected to hit $12,320 by 2015.
A
new Robert Wood Foundation report shows that among workers who were eligible for
employer sponsored coverage, three million fewer enrolled in the coverage in
2003 than in 1998. Although premium increases accounted for much of that drop,
the average premium share paid by employees remained at 18% from 1998 to 2003.
The
U.S. Supreme Court has upheld subrogation rights of insurers/fiduciaries of
health plans under ERISA to seek reimbursement from patients who have collected
from a third party. The case was Sereboff
v. Mid Atlantic Medical Services, Inc.
Aetna
has announced the launch of a business unit-Advantus- to provide products and
services to TPAs, insurance companies and regional health plans. Companies
acquired over the past two years by Aetna such as HMS HealthCare, PPOM,
Sloans
Lake
, Mountain Medical Affiliates, ProNet and Flora will become part of Advantus,
which will have operations in
Michigan
,
Colorado
,
Texas
,
Connecticut
and
Maine
.
Finally
a quote from someone who understands health costs. Deborah Chollet, an economist
at Mathmatica Policy Research is noted in the Milwaukee Journal Sentinel as
saying that health insurance will not be more affordable until hospitals and
doctors become more efficient, providing better care at lower cost. How unique
is it in today’s market to point to health care costs as being the cause of
the reflective costs of insurance? We
think it is very unique. Of course, personal responsibility for one’s own
health is also a source of costs of treatment.
More
news from the Watson survey: 72% of individuals have healthcare costs of less
than $1,500 per year. Twenty –four percent of individuals have costs ranging
from $1,500 to $9,999. Four percent of individuals have costs of over $10,000.
Claims of over $10,000 accounted for 49% of health care costs in 2004. Claims
from $1,500 to $9,999 accounted for 40% of costs and claims of less than $1,500
accounted for 11% of health care costs. Will this information burst the CDH
bubble? We doubt it.
The
Hartford
recently became the number one seller of new group short and long term
disability insurance according to the 2005 market share report issued by LIMRA
International.
A
new study by the Commonwealth Fund reveals that two out of five working age
Americans with incomes between $20K and $40K were uninsured for at least part of
the past year. Of the estimated 48 million working age uninsured Americans, 67%
were in families where at least one person was working full-time.