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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,

Email: ssbenefits@interaccess.com

Volume 1 Issue 11-Street Talk October 2,1999

WElcome to Autumn and short days! How do you think Wardís felt when they listed General American in their Top 50 Life and Health companies and a few days later liquidity issues forced a ratings downgrade, supervision by the MO insurance department and sale to Met Life? Talk is that Met canít find a buyer fast enough for the health business.

DId you know that if you are renewing for health coverage in January, you should have a good idea of what your renewal is now? Especially with any kind of open enrollment plan. Health is a big enough budget item that even if getting a final renewal three months in advance is not possible, you should have some budget numbers. If you need to learn more about developing those numbers, give us a call.

QUick items: A California court is allowing Medicare recipients to sue in state (rather than Federal)court for referral denials. California (in Jan. 2001) has become one of three states (Georgia and Texas the others) to give patients the right to sue HMOs. The California Medical Assn. is suing 8 HMOs (that cover half of the stateís enrollees) in the state to recover $100 M for docs whose bills were left unpaid after their IPAs went bankrupt. Alabamaís 11 HMOs lost $50.7M in 1998 according to a report in BI. Five of those HMOs were provider owned. Express Scripts has entered an agreement with PlanetRx.com to be the internet pharmacy for Expressí 36 million members. Watch for this IPO!

SO you like your broker, but he/she doesnít really know the group business? Canít do an analysis? The broker is your bossí friend? We can assist. Give us a call to learn how.

AEtna is selling itís interest in NYLCare of the Southwest and Gulf Coast to BC/BS of TX (IL) to help complete their buyout of Pru Health. This basically makes one wonder what Aetna bought in NYLCare to begin with. TX was really the cherry in the NYLCare deal to begin with.

TRial lawyers must be licking their chops and thanking Congress and statehouse members with big donations. The GOP is even looking at a bill that would allow lawsuits. We now have three states where HMOs can or will be able to be sued. More will follow. Who wins? The lawyers. What did Shakespeare say?Ö..

ILlinois passed a managed care reform bill that will add to administrative costs and allow more access to specialists starting in January, including an "any willing pharmacy" clause. Look for nice premium hikes.

CAnít figure out how to get out of your current HMO with no experience data? Call us for a solution! Due to rising costs in HMOs and an unwillingness to pay more, many firms of 75 lives and up are trying to switch to partially self-funded PPO plans. The trouble is getting good rates without experience. Stop loss carriers have been burned by guessing and many have stopped offering quotes. In the meantime, many HMOs and even some of the larger insurance carriers are not releasing experience data at the necessary 100 life level. We have a solution!

DId you file your Schedule A information for Form 5500? Some insurance companies and HMOís are not willingly providing the information you MUST file if your company has over 100 employees covered. The Feds donít care. Is your broker helping you?

GUarantee Life is being acquired by Jefferson-Pilot according to BI. Crainís reports that Accord Health Networkís (a coalition of 10 Chicago Catholic hospitals) viability is in "?" The original idea was to unify the 25 Catholic hospitals. Accord officials are denying the alliance will disintegrate.

EMployees are confused! The Employee Benefit Research Institute reports that among HMO enrollees, 54% report they have never been in a managed care plan! The figure jumps to 68% for PPO enrollees! However, just 6% of Americans in fee for service plans think they are in managed care.

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 donít try to sell you services where we have no expertise. If you need professional advice or an impartial analysis we are here to assist you. If we canít help you, chances are, we know who can.