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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 : jseiler@ssbenefits.net                                               http://www.ssbenefits.net/   November  2010 Issue

The Office of Personnel and Management has announced that the average premium for the Federal Employee Health Benefit Plan will be increasing by 7.2%. Six plans that are part of the coverage offering are leaving, including UHC which is no longer going to be offering coverage in 25 states for the FEHBP.

Walgreens has announced that it will be selling its Pharmacy Benefits Management subsidiary which it has owned since 1995. The sale price is said to be $500M to $1Billion and Walgreens is selling to focus more on its core business.

According to a Towers Watson Survey of 466 large and mid-size employers, 59% plan to implement significant to moderate health plan design changes with projected costs expected to rise by 8.2%.  Fifty-five percent expect to lose their grandfathered status in 2011, with 85% expecting to lose that status by 2013.

McDonald’s and 29 other firms have applied for and received waivers from the requirements of PPACA. The waivers are for one year and the companies have to reapply next year. Most of the firms filing for waivers had limited benefit plans for their employees and would have dropped that coverage if forced to meet the requirements of PPACA. Also, the United Agricultural Benefit Trust which offers coverage to 17,347 farm workers received a waiver.

Self-funded non-federal government programs previously were allowed to opt out of several laws that affected non-governmental plans. The allowed opt outs included the Newborns’ and Mothers’ Health Protection Act of 1996, the Mental Health Parity Act of 1996, the Women’s Health and Cancer Rights Act of 1998, the GINA Act of 2008, the Mental Health Parity and Addiction Equity Act of 2008 and Michelle’s Law of 2008. Under PPCA the HHS has decided that these plans would no longer be able to opt out of limitations on preexisting conditions exclusion periods, requirements for special enrollment periods and prohibitions on discrimination based on health status. Why any exemptions are allowed at all is confusing. Why should government bodies have the right to opt out of costly provisions forced on private industry?

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From 2007 to 2009, two top House Democrats accuse Aetna, Humana, UHC and Wellpoint of denying coverage to more than 651,000 people due to preexisting medical conditions, an option that is not allowed after 2014. Henry Waxman and Bart Stupak claim the four carriers denied 212,800 medical claims for conditions that predated enrollment in medical plans. These are the same two congressmen who called for hearings when AT&T and other large employers stated that PPACA would cost their companies’ benefit plans by eliminating the subsidy for Medicare Part D retirees. They quietly canceled the hearings after learning the law required these companies to book the losses immediately.

The U.S. Justice Department has alleged in a lawsuit that BCBS Michigan is discouraging competition by engaging in practices that raise hospital prices by using “most favored nation” clauses in at least 70 of 131 general acute care hospitals in the state. The state of Michigan has joined in the suit which claims the Blues practices violate the Sherman Act and the Michigan Antitrust Reform Act.