PR Newswire -Jan. 30:
Nashville, Tenn., - HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, finds that California Insurance Commissioner John Garamendi will be seeking tighter regulation of Preferred Provider Organizations (PPOs), a form of health insurance product favored by consumers in recent years over more-restrictive HMOs. According to the latest issue of California Health Plan Analysis, this will include a requirement that the health plans provide the same common benefits as licensed HMOs in the state."PPOs have grown substantially in recent years," said Jane DuBose, HealthLeaders-InterStudy analyst. "Consumers like them because they don't require as many prior approvals for care as traditional HMOs do, and insurers often find that they have lower administrative costs. But regulators have caught on that the majority of the health care insurance business has moved into an area they have only limited influence over."In his remarks, Garamendi specifically targeted Blue Cross of California, a WellPoint subsidiary, and called it "unconscionable" that its profit margins on certain products have increased 15 to 24 percent in recent years. He also said that large premium rate hikes have contributed to the number of uninsured residents in California, which now total 6.5 million, or just over 20 percent of the non-elderly population, according to the California HealthCare Foundation.Garamendi is recommending PPOs be required to provide the same common benefits minimums as licensed HMOs provide. That includes prescription drug coverage. He's also calling for strengthening rate review of PPOs with an emphasis on scrutinizing administrative expenses.
The number of beneficiaries covered by high-deductible health insurance plans tied to health savings accounts has nearly tripled over the past 10 months to more than 3 million, according to new data compiled by America's Health Insurance Plans. Created as part of 2003's Medicare Modernization Act, HSAs allow contribution of pretax funds by individuals or their employers into tax-free savings accounts that may be used to pay for qualified medical expenses. The plans must be attached to so-called "catastrophic" coverage through compatible high-deductible health plans. AHIP doesn't expect to have a breakdown of the new enrollment data by market segment whether large group, small group, or individual for at least another month. However, Karen Ignagni, the group's president and chief executive officer, expressed in a conference call her sense that much of the increase is attributable to the participation of large group plans. Because regulations for the accounts weren't promulgated by the U.S. Treasury Department until August 2004, many large employers already had made their benefit decisions for 2005 and thus didn't offer the plans last year."The bottom line is that this shows the market for HSAs is definitely becoming broader, with companies offering HSAs in more markets and to a wider array of groups," Ignagni said. Ignagni also noted she expects considerable discussion in Congress this year on whether to increase maximum allowable contribution limits for the accounts from the current caps of $2,700 for self-only coverage and $5,450 for family coverage. Other potential changes to the plans may be allowing policyholders to roll over balances from flexible spending accounts; including chronic drug coverage as part of the carve-out of health-care expenses that aren't counted toward a member's deductible; and possibly expanding tax deductions or credits for those who purchase the accounts in the individual market. "Individuals who are not offered health insurance through their jobs, or who may not be employed in a full-time way for instance, consultants and contract employees don't have the same ability to take advantage of tax subsidies the way employers do," Ignagni said. "One of the things that has been circulated over the past couple of days is that the president is considering a level playing field, and we think that would definitely increase the ability of individuals to actually purchase coverage and protect themselves."
MEDICARE IS CHANGING. HEALTH NET MAKES IT SIMPLE.January 25, 2006As a valued partner, we want to keep you updated on our Medicare Part D activities.We are excited to announce that since enrollment to "Part D" began November 15, 270,000 members have chosen to receive their prescription benefits from Health Net, with 100,000 members from California alone. Bringing on more than a quarter million new members from 10 states for Part D's January 1 start date was one of Health Net's biggest efforts ever. A lot of Health Net associates came together to successfully transition to the new program.As with any project as monumental as this one, there were administrative and transitional issues that arose as soon as the project went live. Most were dealt with promptly and efficiently. To ensure that every Health Net member who walks into a pharmacy walks out with his or her medicine, we have undertaken several initiatives:
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We devised procedures for pharmacists to get coverage approved, even when eligibility information was unavailable or incomplete.
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We have nearly doubled the staffing levels in our Medicare call centers.
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We extended our call center hours of operation. We are now open 16 hours on weekdays - from 4 a.m. to 8 p.m. Pacific Time - and 12 hours on Saturdays - from 8 a.m. to 8 p.m. Pacific Time.
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We are in contact with CMS daily to ensure it is informed of our efforts.
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We are proactively calling all new Part D members to ensure they are receiving needed medications.
As the nation's fifth largest Medicare contractor, Health Net is focused on solving each member's issues as they arise, making sure no one is denied his or her essential medications, and providing improved service levels during this historic period. Thank you for your support during this transition. You can be confident that Health Net remains committed to meeting the needs of our Medicare members and your clients by offering plans that are simple and easy to understand and by providing quality customer service for everyone. If you have general questions, please call our Senior Products Broker Services department at 1-800-708-7646.
As an attempt to help decrease the amount of uninsured nationally and locally, Anthem changed its guidelines to break down earlier barriers and expand access to health insurance for the small group business market, especially defined as employers with less than 50 employees. This new guidelines make things easier the eligibility rules which no longer require 50 percent of total qualified employees to enroll. It also provides more options for small business employers to access health insurance. The purpose is to make health insurance more accessible to small business employers throughout the Midwest and this change applies to existing and new business.
"Relaxing our participation guidelines for small business employers is just one of the ways that Anthem Blue Cross and Blue Shield is representing its obligation to providing affordable health care to as many people as possible," said Keith Faller, President and CEO, Wellpoint Central Region. Wellpoint is the parent company of the Anthem plans. "Many small businesses that were previously unable to qualify for group health coverage will now have access to coverage, ultimately resulting in a reduction in the number of uninsured."
Like an up-and-coming number of companies, Countrywide Financial Corp. of Calabasas is phasing out its pension plan to save money, and employees hired since Jan. 1 won't be eligible for lifetime income in retirement.
But new countrywide executives still qualify for a special executive pension; one that will pay Chief Executive Angelo Mozilo up to $3 million a year for life. First American Financial Corp. of Santa Ana also has one plan for those in the cubicles and one for those in the executive suites. The workers saw their pension plan frozen in 2001. But a particular plan for executives will pay Chief Executive Parker S. Kennedy nearly $1 million a year for life if he remains with the company until age 65.
Major corporations throughout the country are abandoning their pensions, saying the benefits are too costly and less important, with the widespread adoption of individual withdrawal accounts. But many of these same companies are retaining special pension plans for top executives, saying they would lose the top brass to rivals without them."We view this type of program as a standard and necessary component in recruiting and retaining talented top executives," Kelly Dunmore, vice president of employee benefits at First American Financial, said in a statement. Others view it as a double standard.
KARVY Global Services Limited, the Business Process and Knowledge Process Outsourcing subsidiary of KARVY, the largest non-banking financial institution in India, officially launched its Transaction Processing Outsourcing (TPO) unit with the announcement of its first client in the healthcare industry.
KARVY Global Services' Transaction Processing Outsourcing (TPO) unit covers the entire spectrum of back office processing for insurance services ranging from policy administration to claims processing for life (including pensions and annuities) and non-life (property and casualty) policies. Services include policy administration services (endorsements, cancellations, renewals, and expirations), billing services (premiums, invoicing, payment plans, and reconciliation), recovery services (subrogation, premium and dues collection) as well as audit and reporting services.
Affiliate Healthcare Administrators is a privately-held licensed third-party health plan administrator that works with small to medium sized businesses to develop a comprehensive plan to fund, and cost-share with a company's employees, self-funded medical coverage program using high deductible insurance plans offered by major carriers. Affiliate Healthcare Administrators offers the Advantage PLUS plan based on the concept of paying for claims when they arise not if they occur, thereby offering employer's considerable savings over traditional health insurance plans. Affiliate Healthcare launched its trade three years ago in southern California, population base of 15 million, and has newly begun to develop into Texas and Louisiana. Its business has developed significantly since inception and today this is the administrator to over 100 businesses serving 3,500 employee and family members.
Affiliate Healthcare Administrators program is planned to help reduce healthcare costs to small and medium sized companies by an average of 30 percent, while maintaining and in many belongings improving remuneration. Affiliate Healthcare Administrators helps employers customize the Advantage PLUS plan, to purchase group health insurance with higher deductibles than they would typically buy and apply a portion of the premium savings to the plan benefits specific to the employer's design. Advantage PLUS is an innovative group health program that lowers healthcare costs and improves benefits offered to employees.
Blue Cross of California now offers Blue View Vision to small and large businesses throughout California. These Blue View Vision benefit procedure can be purchased with medical coverage or on a separate source and offer contact to great savings on eye exams, contact lenses, frames and accessories. Blue View and Blue View Plus are small group plans offered through affiliate BC Life & Health Insurance Company that provides affordable access to: - A national network of participating providers
- Value added savings of 15 percent to 40 percent beyond plan benefits on extra eyewear, non-prescription sunglasses and other popular accessories
- Flexible, easy to use benefits including comprehensive eye exams and fast delivery of eye wearAbility to combine vision and medical coverage in one consolidated bill.
- Large group has multiple plan options available but also provide the above features.
Vision benefits are essential to maintain overall health and wellness. - Offering vision coverage as part of a complete and smart benefits package is advantageous in attracting and retaining healthy and happy employees.
Blue Cross of California continually strives to find innovative approaches to improving the quality of health care and addressing the needs of our members and communities," said John Monahan, president, State Sponsored Business, Blue Cross of California. "We are honored to receive these distinguished awards that reflect our commitment to improving California's health care system through education, collaboration and utilization of technology."
Blue Cross of California is one of the state's largest health insurers and together with its California affiliate, BC Life & Health Insurance Company, the company serves more than 7.6 million medical members. Headquartered in Southern California, Blue Cross of California offers a flexible product portfolio with a broad range of options for small, medium and large groups, as well as individual plans for people without access to group coverage, seniors and consumers who are eligible for state sponsored programs. The Blue Cross and Blue Shield Association is comprised of 40 independent, locally operated Blue Cross and Blue Shield Plans that collectively provide healthcare coverage for more than 92 million - nearly one-third of all Americans.
Today, when people talk about broad California health care coverage, instead of using the term "major medical," they are more likely to refer to fee-for-service or managed care. These terms apply to different kinds of coverage or health plans. Moreover, you'll also hear about specific kinds of managed care plans: health maintenance organizations or HMOs, preferred provider organizations or PPOs, and point-of-service or POS plans.
While fee-for-service and managed care plans differ in important ways, in some ways they are similar. Both cover an array of medical, surgical, and hospital expenses. Most offer some coverage for prescription drugs, and some include coverage for dentists and other providers. But there are many important differences that will make one or the other form of coverage the right one for you.
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