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

Why be like everyone else?

GroupWorks, the Internet broker in the north suburbs of Chicago is closing shop. The word we have is that the product was good, but there weren’t enough group people to make the ideas work.

Aetna is restructuring its small group business to provide less flexibility. HMO/PPO packages will not be offered. PPO will only be offered as a total replacement with a limited number of plan designs available. HMO can only be packaged with POS. Of course, in an earlier edition we disclosed Aetna’s desire to get out of the small group market and HMO markets and go back to paying claims on and ASO basis for large customers.

BC/BS is pulling the plug on its merger with the Regence Blues plans in Oregon, Washington, Utah and Idaho (4 million employees insured, unlimited potatoes). The claims systems were said to be part of the problem in the merger.

Word on the street is that Gallagher Benefit Administrators (the health side) will be changing claim systems on 1/1 from the outdated and inflexible EDS system to a new one. We’ve never seen such a conversion go smoothly.

First Health has completed its acquisition of the CCN network after the Justice department withdrew its request for information. Watch for the blood. A First Health person has already taken over CCN operations.

D&B reports that of 540 respondents to a survey, just 17% of small businesses offer retirement benefits (including 401(k) plans).

S&S Benefits has been working with a company that obtains substantial discounts on non-network (non-par) claims. We are amazed by the number of TPAs/Carriers that show little to no concern about this area or who work with substandard "negotiation" services. Many are more concerned with lining their pockets than doing the best job for their clients. Many are just completely unconcerned unless the claim reaches case management level. If you consider that on average, 15% of claims are non-network, this is serious cause for concern. If you are concerned about your TPA/Carrier, give us a call and we’ll fill you in the best we can.

The IRS has ruled (somewhat) on the deductibility of obesity treatment. If a weight-loss program is intended to treat a specific disease (such as heart disease and high blood pressure), it is deductible. The IRS inched closer to implying that obesity may be a disease, and if so, treatment such as special foods or prescription drugs may be deductible. But the word "may" gives them a backside cover for future rulings.

Nine of the top 30 selling drugs in 2000 were antidepressant or antipsychotic related drugs. The top seller was Prilosec, an antiulcerant. That says a lot for our society.

If your company has at least 1,000 uninsured employees and you would like to reduce your company payroll taxes while providing some pre-tax medical benefits to those lower paid employees who need it most, S&S Benefits may have a product that can fit both needs. Contact S&S Benefits for more information.

Watson surveyed 10,000 employees at 18 companies and found that 63% underestimate the value of their health benefits and 47% believe that better plans are available at the same cost while only 48% trust their employer to design a benefit with adequate coverage. We’d like to see their expressions after a quote (or more likely decline) for an individual policy. This country still suffers from a huge dichotomy between the reality of cost vs. benefit. Kaiser reports that 62% of 1,200 survey respondents give their plans an "A" or "B" while 39% say managed care plans do a "bad job" serving customers. But as we already know from prior survey’, must employees don’t even know if they are in a managed care plan.