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Anthem Discontinues Short Term Policy for Indiana

admin — Mon, 14 Mar 2011 17:43:35 +0000

Short Term Product Sales Discontinued in Indiana Effective April 1

“At Anthem Blue Cross and Blue Shield, we strive to provide the best coverage to our members, offering both stability and affordability through our individual health coverage plans. We have made the strategic decision to discontinue the sale of short-term individual health insurance policies in Indiana effective April 1, 2011, as current premium rates are insufficient to adequately cover claims and other costs. ”

This news is not all that surprising. There has been major concerns with the carriers staying in the Individual markets because of the health care reform. The short term policy has become an option for a lot of people because of the reduced cost.

As we move forward through 2011 and it will be interesting to see if any other companies will also pull out of the short term market. With the Medical Loss Ratio there is a real fear of carriers pulling out of the individual health market all together.

Indiana Medical Loss Ratio Explanation From Anthem

admin — Tue, 07 Dec 2010 17:19:42 +0000

The new Medical Loss Ratio will have a huge impact on health insurance companies. There is major concern in the industry that we could see some carriers pull of certain markets. The market that creates the most concern is the Individual market. This segment of insured represent a small portion of the overall block of business. Some companies will look at this block of business and ask themselves is it worth the risk. In the individual market a company might make money on one policy but then lose 300% on the next policy. In the past they have been able to pool the policies together to offset risk. This pooling is no longer an option for the carriers with the health care reform.

The Patient Protection and Affordable Care Act (or health care reform law) added a new provision to the Public Health Service Act that sets requirements for the minimum medical loss ratio. The medical loss ratio is the percentage of premiums that insurers spend on medical care (including claims and activities that improve health care quality), as opposed to the percentage spent on administrative expenses.Health insurance issuers offering insured group or individual coverage must meet the following minimums:

85% in the large group market

80% in the small group and individual market

Issuers who do not meet these minimums will be required to issue rebates.

The National Association of Insurance Commissioners (NAIC) was responsible for recommending to the U.S. Department of Health and Human Services which activities count as medical and quality improvement expenses, as well as how plans should calculate the medical loss ratio. The interim final regulations issued by Health and Human Services on November 22, 2010, adopted the NAIC’s model regulation in full but modified some of NAIC’s recommendations and added other provisions to the NAIC model.

Some key points from the interim final rules:

Medical loss ratio calculation would include premium used to pay medical claims and premium used for quality improvement activities. It would exclude federal and state taxes, and licensing and regulatory fees.

Issuers will need to report calendar-year premium, claims and other expenses for all insured group and individual health insurance coverage as an aggregate by legal entity state by state and by health insurance market (small group, large group, individual).

Reports must be submitted to Health and Human Services by June 1 of each year. Rebates must be paid by August 1 of each year.

The medical loss ratio provision does not apply to self-insured or ASO plans; it applies only to the issuer of insurance plans in the large and small group and individual markets.

Rebates will be provided to the enrollee (defined in the interim final rules as anyone covered by a group plan, as well as anyone covered by an individual policy, despite the fact that this term is not ordinarily used in the individual market).

Milliman Medical Index 2010

admin — Tue, 01 Jun 2010 15:04:01 +0000

The Milliman Medical Index has been released for 2010. This is a very good study of healthcare costs and the effects that they have. 2010 marks the 6^th year that the study has been performed. The top 100 leading insurers read this report to estimate future health insurance claims costs. You would think that our government officials would all take this study into consideration when they are making laws that effect healthcare.

The topics that are discussed in the Study:

Key Findings

The total medical cost for a typical family of four in 2009 was $16,771. In 2010 the study shows an increase of 7.8% to $18,074. Employers and Employee alike shared the increase in cost this year.

Employers cost at an average of $10,744 surpasses $10,000 for the very first time.

Geographic Differences in Healthcare Costs

The study shows that Miami, New York and Chicago continue to have costs at leasts 10% higher than the national average.

Dissecting HealthCare Costs

In this section the $18,074 is broken down into components of spending.

15% Rx+ 33% Physician +17% outpatient+ 31% inpatient +4% other

Employee’s Share of Healthcare Costs

In 2010 the employer is picking up $10,744 of the $18,074 of total healthcare cost to a family of four.

Economic Effects on Healthcare for People with Insurance

This section is addresses the effects of unemployment and health insurance. The study addresses the effects layoffs have on people who continue to be insured under the employer plan.

Cost Implications of Healthcare Reform on a Family of Four

The study states the cost implications are unclear.

Technical Appedix_Milliman Medical Index

This section discuses how the Index is formed.

2010 Milliman Medical Index

Breast Cancer Patient Protection Act

admin — Wed, 26 May 2010 18:17:20 +0000

Recently Wellpoint took some really bad press on the treatment of Breast Cancer. Some of that bad press was wrong. Anthem was accused of purposely rescinding policies of women diagnosed with breast cancer. This accusation was really way out of bounds. Wellpoint has paid for the treatment 10 of thousands of women who have suffered from Breast Cancer. So I think its appropriate that Anthem is implementing the key provisions of this new act.

WellPoint, Inc. (NYSE: WLP), the nation’s largest health insurer by medical membership, announced today it will unilaterally implement key provisions of the Breast Cancer Patient Protection Act introduced by U.S. Rep. Rosa DeLauro. These new provisions include more transparent benefit language including clear explanations of benefits to members with breast cancer, and the provisions standardize minimum recovery times in the hospital for women recovering from mastectomy.

The adoption of these provisions builds on WellPoint’s existing leadership in breast cancer treatment. While variability exists within clinical guidelines and state regulations, the vast majority of WellPoint’s members already receive the standard of care indicated in the legislation. However, WellPoint believes that applying this universal minimum standard will both benefit our members, as well as encourage others in the industry to follow and adopt this standard. Beginning July 1, 2010, WellPoint will standardize clinical guidelines for women recovering from mastectomy to offer a voluntary 48-hour minimum in-hospital stay.

“Women recovering from breast cancer surgery will decide, in consultation with their physicians, whether hospitalization for 48 hours is required,” said Sam Nussbaum, Chief Medical Officer, WellPoint. “We are committed to making medical coverage decisions for women with breast cancer that are in accord with the latest scientific evidence and clinical research. It’s important for us and our members that WellPoint continues to lead in this area,” he added.

“We continue to work with the American Cancer Society and academic thought leaders to gain real-world knowledge of breast cancer treatments to shape improvements in care for women with breast cancer,” said Nussbaum. “Our goal is to ensure that our members receive optimal care.”

WellPoint also champions effective member communication and transparency regarding breast cancer diagnosis and treatment options. More than 3,000 nurses and clinical associates work with members daily, to encourage detection of breast cancer at its earliest stages and to ensure that members are receiving the best breast cancer treatments available. Toward that end, WellPoint is taking steps to provide comprehensible, straight-forward explanations of benefits so that members more clearly understand their treatment options.

“WellPoint works to ensure that all of our members are getting best practice care,” said Dijuana Lewis, Chief Executive Officer of WellPoint’s Comprehensive Health Solutions business unit. “We are especially proud of our record in improving care for women with breast cancer in this country and believe these added measures will increase the quality of care that our members receive.”

Why Health Insurance Premiums Keep Increasing

admin — Wed, 10 Jun 2009 17:57:12 +0000

Anthem plans across the country are working to develop innovative products and programs that help address rising health care costs. Through pay for performance initiatives, consumer directed health plans and transparency initiatives; Anthem is providing access to the information needed to drive down health care costs.

While many people may believe that insurer profits are the driving force behind increasing health insurance premiums, research reveals very different reasons for the high cost of health insurance.

A May 2009 report titled “What’s Really Driving the Increase in Health Care Premiums?” addresses the issue. The report, issued by the WellPoint Institute of Health Care Knowledge, compiles research from sources such as PricewaterhouseCoopers, the Robert Wood Johnson Foundation, the Kaiser Family Foundation, the Bureau of Labor Statistics and the Congressional Budget Office.

According to the report, the “key drivers” of spiraling U.S. health care costs are:

Advances in medical technology and subsequent increases in utilization;
Price inflation for medical services that exceeds inflation in other sectors of the economy;
Cost-shifting from people who are uninsured and those receiving Medicare and Medicaid to the private sector;
High cost of regulatory compliance; and
Patient lifestyles, such as smoking, physical inactivity and obesity.

Citing PricewaterhouseCoopers research from 2008, the report found that only three cents of every health care premium dollar is spent on health insurer profit.

According to the Institute’s report, newer medical technologies tend to increase costs because they are generally more expensive than the older technologies they replace. While the availability of more advanced, superior technologies can yield better results for some patients, these technologies and diagnostic tests may be used inappropriately in some situations where existing, older technologies are more effective and accurate.

To view a copy of the full report, click here.