Aim to Save Next Year on Health Care Costs

For most people with employer-sponsored health insurance, changes in benefits take effect in January.

Total health-plan costs per employee rose 6.3% in 2008 and are expected to rise by a similar amount in 2009, according to the Mercer National Survey of Employer-Sponsored Health Plans. Because of increased cost-sharing by employers, most workers also are paying a greater share of the costs out of their own pockets.

Next year, resolve to save money on medical expenditures by following four simple rules whenever possible:

1 Use in-network providers.
Most health plans either require you to use doctors and hospitals within their network (HMOs) or charge you more for going out of network. Staying inside the network when possible can save you hundreds or thousands of dollars.

When obtaining preauthorization or precertifications for surgery or other procedures, check to make sure that anesthesiologists, physical therapists and other care providers also are in-network, not just your physicians and surgeons.

2 Use the right provider.
Going to a hospital emergency room for nonemergencies like sniffles or scrapes because the doctor’s office is closed can set you back big time: Fees for such emergency-room visits can range from $300 to $500, while an urgent-care facility could charge $120 to $135, a primary-care office visit $65 to $75, and a retail clinic like those inside pharmacies, supermarkets and discount retailers could charge just $45 to $55, according to Cigna, a major insurer.

If your health plan has a nurse telephone or online hotline, use it to help determine which is the best course of action for a medical problem. Of course, for severe bleeding, shortness of breath, head injuries, chest pains, poisoning or other real emergencies, don’t hesitate to dial 911 and go to the nearest ER.

3 Prefer generics.
Most companies today use multitier drug plans that charge the least for mail-order generic prescription drugs and the most for brand-name or lifestyle drugs for which generic equivalents are available. Always ask your physician if a generic is suitable and available when he or she writes a prescription.

For instance, a commonly prescribed medicine such as the antidepressant Prozac could cost $154 a month at a retail pharmacy but $145 a month by mail order and as little as $4 a month if obtained as the generic fluoxetine hydrochloride.

Also, some commonly prescribed maintenance medications are available more cheaply in 90-day supplies from pharmacies at discount retailers, supermarkets and the like.

4 Use online tools.
These let you comparison shop for prescriptions, procedures and high-tech radiological services. A growing number of insurers are providing online tools that enable you to compare prices for drugs and procedures.

Aetna’s cost-transparency tool, for example, lets you compare the cost of PET scans, CT scans and MRIs in your area. The difference between free-standing and hospital-based testing centers can be as much as $200 to $300 a scan, says Jeffrey Kang, Cigna’s chief medical officer. You share in the savings if you’re in a high-deductible plan or pay co-insurance. But be certain the scanning facility is properly licensed and accredited by a group such as the American College of Radiology.

Google Health offers a place to store your personal medical information in one easy to locate place even if your insurance provider changes from year to year. This is a handy way to track your medical information online, and keep consistancy over a number of years even as your health care provider or insurance provider may change. Also if you move or travel for prolonged periods, it is a great way to have this information nearby rather than at the doctors office.

Consider puting healthy dependents and spouses on individual health insurance coverage or see if your spouse can get on group coverage through his or her employer. Often times employers only cover a portion of the premium for the employee, and the monthly premium for spouses and dependents can be signifigant. By putting children on individual coverage, you can exclued things like maternity coverage to help reduce costs. Also, generally medically underwritten individual health insurance is less expensive the guaranteed issue employer sponsored health plans.

The pressure is mounting on President-elect Barack Obama to do something about health care reform sooner rather than later. Senator Max Baucus last week unveiled his plan (see below) to reform health care, and Senator Ted Kennedy is expected to do the same in the near future. Outside the Capitol, The Business Roundtable, the National Federation of Independent Businesses, AARP and the Service Employees International Union are pressing, in a letter sent last week, Obama to make an overhaul of health care a priority in his Administration’s first 100 days. This timeframe would be a monumental challenge, given the nation’s economic woes.
Federal
Senator Baucus, Chairman of the Senate Finance Committee, released an 89-page blueprint for health care reform titled “Call to Action: Health Care Reform 2009.” The plan calls for several policies with which Aetna agrees, including an individual mandate, subsidies for low-income individuals, expanded health information technology, tax credits to small businesses, Medicaid and SCHIP expansion, a comparative effectiveness research institute, medical liability system reform and a strong focus on primary care, wellness, prevention, transparency and quality care. But some aspects of the plan are problematic: a “play or pay” employer mandate; a federal health insurance exchange (similar to the Massachusetts Connector); a competing public plan; and lowering Medicare Advantage payments. Aetna has been helping to inform the Senator’s health reform plan, through Aetna Chairman Ron Williams’ testimony before Congress in June, and through both formal and informal conversations. Senator Kennedy also plans to release a health reform proposal later in the year, and Aetna has been invited to participate in those conversations as well. Whether the two proposals can be forged into one legislative package by January remains to be seen, but it seems clear that each will support a major push for health care reform early in 2009.
States
ARIZONA: Proposition 101, a ballot measure billed as an attempt to amend the state constitution to protect the rights of Arizonans to make their own health care and health insurance choices, was defeated by fewer than 11,000 votes. Proponents argued the measure would prevent the government from enacting a single-payer health care system. However, the scope of the language helped fuel the argument that it would apply to the state’s Medicaid/SCHIP programs and private managed care plans as well. Legal experts opined that if the measure had passed, a strong case could be made that the state’s use of private plans to deliver Medicaid benefits limits consumers’ choice of providers. Likewise, commercial plans’ use of physician networks could have come under legal scrutiny.
MAINE: As expected, the “People’s Veto” measure has passed, repealing the newly enacted beer, wine and soda taxes that would have replaced the savings offset payment (SOP) used to provide subsidies for the state’s Dirigo Health plan. The legislature passed the beverage taxes to avoid contentious litigation around the SOP and to create an equitable, sustainable funding mechanism for Dirigo. Currently, the SOP is levied on health plans and TPAs according to a formula that has been challenged every year since its inception in 2003. The SOP for 2008 was reduced from $140 million to $48 million and is the subject of litigation again this year.
NEW YORK: In anticipation of the legislative special session set for November 18, Governor David Paterson has proposed increasing the covered lives assessment by $120 million this year and next, a move already defeated once in 2008 by the State Senate. The Governor also proposed shifting the funding source for mental-health parity small employer subsidies to the revenue stream raised by insurance taxes known as “HCRA” (the Health Care Reform Act). This shift would amount to $88 million this year and $91 million next year. The state set aside $100 million annually to subsidize small businesses when it passed the mental-health parity law. It is not clear what would happen to the additional $21 million for the two years. The Governor also reintroduced his proposal to increase the State Department of Insurance’s Section 332 assessment, which is a tax on all lines of insurance premiums. The Republican majority will continue to control the state Senate until January 2009 and remains committed to opposing new taxes.
PENNSYLVANIA: The House Insurance Committee held a three-hour roundtable discussion last week with Highmark, IBC, the insurer trade representative, providers, Capital Blue Cross and UPMC Health Plan of PA concerning the proposed Highmark-IBC consolidation. The contentious meeting pitted the insurance industry against Ken Melani of Highmark. Highmark dismissed the Department’s expert report on competition as an academic exercise completed during a different economic climate (this past September). This could open the consolidation to the same argument: the Blues projections were based on a different economic environment. The House Insurance Committee plans to meet again on November 19 to discuss what, if anything, it will recommend to the Insurance Commissioner. The House and the Senate Banking and Insurance Committees have until November 29 to submit comments to the Insurance Commissioner. It is not clear what position the House will take. The Senate (at least as a majority position) is prepared to recommend disapproval or conditional approval.
Resources
Transforming Health Care in America

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. Those companies include Aetna Health Inc., and Aetna Health Insurance Company.
© 2008 Aetna Inc.

Aetna has recently published their 1st quarter 2009 rates for Small Group business in California.  This spreadsheet is a handy tool to calculate the RAF and renewal rates for your group. Aetna ofter runs RAF promotions to try and win new business. .  Many brokers, benefits administrators, and insured companies find this tool very helpful when renewing their small business group health insurance.  What this tool allows you to do is to see rates at whatever RAF you would like.  When you open the tool you enter the desired RAF and then go to the tabs at the bottom and click on the appropriate rating area (San Diego is RA1 & Orange County is RA2) and it will show you the rates at this RAF. 

Remember that the Aetna Small Group rates are based on the Employer Zip code.  Hope this tool helps you out. Remember Aetna allows groups to write our regular HMO network alongside of our Value HMO network which is a HUGE benefit for your clients and prospects.

You can use the HealthInsurancePlus.com website to generate a quote on indvidual health insurance from Aetna or you can get a quote on small business group health insurance as well.

December 2008
Small Group New Business Submission “Cut-Off” Dates

CARRIEREFFECTIVEMUST BE AT
DATESWARNER PACIFIC
Aetna * 12/1Thursday12/4
12/15Friday12/19
Anthem Blue Cross12/1Friday12/5
12/15Friday12/12
Cal Choice 12/1Friday12/5
Cigna (AAQHC)Medical:12/1Thursday12/4
Dental HMO:12/1Wednesday11/19
Delta DentalHMO:12/1Friday11/14
PPO:12/1Monday11/24
Golden West 12/1Monday12/8
Health Net ** 12/1Friday12/5
12/15Friday12/12
Kaiser 12/1Friday12/5
KP Choice 12/1Friday12/5
PacifiCare 12/1Friday12/5
Principal 12/1Thursday11/20
12/15Thursday11/20
Safeguard 12/1Monday11/24
Sharp 12/1Wednesday12/3
U.S. Life (AIG) 12/1Tuesday11/11
VSP 12/1Tuesday11/25

* If the group has had immediate prior group coverage the effective date must coincide with prior
carrier’s termination date.
**A 15th of the month is only available if the groups current policy is on a 15th of the month cycle
Please remember:
It is important that all cases be submitted complete. Missing information causes enrollment delays. If there is anything we can do to help, let us know. Contact your Warner Pacific Dedicated Sales Team at 1-800-801-2300. We also arrange for new case pick ups (overnight service) from you or your client.
Please submit your cases to:
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Westlake Village, CA 91361-4026