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

Why be like everyone else?

Anthem Blue Cross/Blue Shield said it plans to assume the HMO members of Sloan’s Lake HMO in Colorado. Sloan’s at one time was considered one of the finest HMO’s in the country, but their Best rating has dropped to C++ as others moved into their market.

Aetna is now coming to the brokerage/consulting community to announce they are trying to right their wrongs and be more customer service oriented. There are plans to start releasing experience to groups of 150 and up. Aetna is also considering dropping its capitation system of reimbursement in California and other states according to press reports. It has already announced that change in Connecticut. We’ll see.

PHCS is pulling the plug on their EPO (POS) plan due to lack of membership. Apparently no renewals allowed after 2001 according to sources. Some carriers are pulling the plug on the POS product now.

A federal appeals court agreed with a lower court judge that Aetna did Not violate racketeering laws in its advertising and membership materials. In fighting the case, Aetna admitted that its advertising claims of being committed to "maintaining and improving quality care" were "mere puffery." The lawsuit was filed on behalf of nearly 6 million Aetna customers who were apparently foolish enough to believe the puffery.

A decade ago there were more than 80 separate BC/BS plans, but now there are only 47 as the Blues consolidate. Certain Blues plans are trying to establish themselves as national players, including the Illinois Blues (Health Care Service Corp. or HCSC), Wellpoint (BC of CA) and Anthem. HCSC is acquiring the New Mexico Blues plan to go along with Texas (beating out Anthem and Wellmark-Wellmark is the parent of the combined Iowa and South Dakota Blues). HCSC has announced an affiliation with the Blues in WA, OR, UT, ID in the northwest, which are otherwise known and The Regence Group (TRG). In the meantime, Cerulean Cos. (BC/BS of GA) will continue to merge with Wellpoint. We still find it fascinating that the BC plans continue to change their names so as not to be known as a BC plan? Maybe the Shield doesn’t have the corporate clout it used to, even if it does with unions?

PCS is being sold again. For being one the largest PBMs they seem to float from seller (Lilly paid $4.1B)) to seller (Rite Aid paid $1.5B) to generate cash. It has been announced that Advance Paradigm is buying PCS (for $1.0B) from Rite Aid.

There seems to be a lot of hoopla over "auctioning" health plans over the Internet that is really malarkey. After Hewitt’s big deal for some extremely large customers saved no more than a normal bid process would have (but they made it a big PR deal), UltraLink has supposedly saved American Airlines 2.2% through what was described as an electronic auction in the press. Read between the lines and you’ll find that someone e-mailed a few companies some specs and the bids were e-mailed back. A few phone calls were made and the numbers were refined. So that is worth a two-page press release? The only big news is that some companies have taken this long to learn to attach documents to their e-mail.

NCQA is extending their accreditation program to PPOs. The largely ignored statistical/quality association announced that 5 PPOs have agreed to participate. PHCS is the only national PPO on the list that was announced.

Isn’t it fun to find out when one of your insured employees passes away that they forgot to change the beneficiary to their new spouse after a divorce and remarriage. With open enrollment arriving for many plans in the near future it may be time to remind employees to update their beneficiary designations.

Two companies now have minimum premium products available to qualified groups with as few as 50 lives. If you want an insured product and cash flow minimum premium may be the vehicle for you. Other companies do have the product available for larger groups.

Just because your carrier doesn’t provide the information without you or your broker/consultant asking, doesn’t mean you don’t need to file it if you have over 100 employees. Check your records. When is the last time you filed your 5500 information? Where is that Schedule A information? Smaller plans with the Blues should be especially careful from our experience.