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

Why be like everyone else?

HOpe you had a Happy Halloween and that all your candy was your favorite! Hopefully you set your clock back and made it to work on time!

RIpped off on capitation fees? Check those renewals to see if your capitations and access fees are being trended as claims. Are caps really going up by 8-10%? Sure (sic). How about access fees? Are you getting your money’s worth for your caps? Is anybody analyzing this for you? We can help.

WElcome to the wonderful world of lawsuits. The trial lawyers are loving the fact that Charlie Norwood’s bill has passed through the House. Warming up to the matter are lawyers who have filed class action lawsuits against Humana and Aetna, among others. It’s only a matter of time before premium rates begin to reflect the attorney’s fees.

SUrveys are telling us that while the majority of Americans are in favor of being able to sue HMO’s, the same consumers are cognizant of the fact that the increase in lawsuits will lead to an increase in rates???? In the meantime, stock prices of HMO companies are tumbling.

COnsumers want the best possible healthcare in the world and they want it free…..or at least very inexpensive. When it comes to healthcare, no one wants to believe that the new Cadillac has a higher price tag than the 1987 Jeep.

HAs anybody analyzed your plan savings verses your plan access fees on your managed care program? How are you doing? What kind of discount is your plan getting? What is your plan utilization in terms of dollars and services in-network verses out-of-network? Are there more opportunites to save? Is case management kicking in soon enough on those large claims? We can help.

BUsiness Insurance has reported that 57% of workers do not roll over their 401(k) balances when moving on to another job. They take cash payments instead! However, that is down from 64% in 1993 according to a Hewitt study. The study does show that those with smaller amounts ($10,000 and less) are those that tend to take cash, while those with 401(k) amounts over $25,000 and up do tend to rollover. It appears that more education is needed for those changing jobs. But do employers really want to spend the time on employees who are going elsewhere?

LIncoln Re is reportedly ceased writing new HMO excess loss coverage. They were one of the largest reinsurers of HMOs. Reducing capacity in that market will also serve to drive up HMO rates.

A Health Confidence Survey released by the Employee Benefit Research Institute reveals that 64% of employees were "Extremely or very satisfied" with their traditional fee for service plan. The number drops to 49% for PPOs and 35% for HMOs. Remember, we have to take this with a grain of salt since EBRI also reports that among HMO enrollees, 54% report that they have never been in a managed care plan!!

IF you have a supplemental (also called voluntary or optional) life insurance program, don’t forget that the new Table I will apply to plans renewing on or after January 1, 2000. This could create a real problem with imputed income for those in plans whose age-based rates straddle the new Table I. Those most likely affected will be the higher paid persons on the plan. Those are also the employees most likely to buy this coverage.

ILlinois HMO enrollment grew by only 3.9% in 1998 covering 19.7% of the state’s population. Illinois maybe becoming a hotbed for HMO lawsuits with an Illinois Supreme Court ruling that allowed a lawsuit for malpractice on the part of an HMO to proceed.

In Maine, Tufts Health Plan said it will discontinue operations in April,2000 for 70,000 members due to an expected $30 Million loss this year.