In this Issue:
As premimums rise, are even the insured scrimping on healthcare by skipping visits?
Self-Funding: The Effects of Leveraged Trend on Stoploss Policies
GR SelectCare Product Launches in AZ
New CMS Program to Provide Incentive Pay to PCPs
USL&H Fall Bonus Program

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Looking for an alternative to the BUCA's?  

 

AFMC's flexibility, multiple network plans and medical management solutions can fit the healthcare needs of your clients.  

 

Ask your AFMC Senior Sales Consultant for more information.

 

Call: 800-624-4277

Click: www.azfmc.com  

Email: [email protected]   

As premiums rise, are even the insured scrimping by skipping doctor's visits?

Americans are spending more money on insurance premiums, and they're spending less out of pocket on health services. The trend doesn't reflect patients getting more health coverage for their insurance money, experts say. It reflects patients, even those with insurance, avoiding spending cash on healthcare they think can be put off.  

 
"Patients are paying more, and they are getting less. It's a distortion of the economics of healthcare in our country," said Glen Stream, MD, president of the American Academy of Family Physicians. "And we see people for economic reasons deferring important screening procedures or coming in less often for chronic conditions such as diabetes."

The U.S. Bureau of Labor Statistics' annual report on consumer expenditures, released Sept. 27, found that the amount paid out of pocket for health insurance increased 2.6% in 2010. But medical services, a category that includes physician visits, went down 1.9%. On average, Americans spent $3,157 overall out of pocket, including $1,831 on insurance and $722 on medical services.

The gap between health insurance inflation and medical services costs was even greater in 2009 - an 8% gain to a 1.2% rise. But at the beginning of 2010, many experts believed that consumers would spend more on care not paid by insurance as the economy recovered from recession. As it turned out, even though the economy grew slightly, that didn't happen, experts said. Read more...

Arizona Foundation for Medical Care

the Advisor

E-newsletter for Brokers, Consultants and Agents

 

Fall 2011   

 

Self-Funding: The Effects of Leveraged Trend on Stoploss Policies

 

By: Cindy Lee Rottmann, President/CEO, Outsource Marketing Strategies 

 

Medical trend is the anticipated annual increase in medical claims from year to year. Trend will take into account a number of components that affect the average medical coverage and therefore will also influence stop loss rates.

 

Components of medical trend include:

 

          Plan Design           Utilization Patterns       Demographics

          Technology           Network                          Cost Shifting

 

These components are the reasons why medical trend is greater than inflation as reported and measured by the CPI (Consumer Price Index). Medical trend gets leveraged when parties responsible for medical claims do not maintain the same proportional share of the risk from year to year. Read more...

GR SelectCare Product Launches in Arizona

By: Mike Hoffman, Arizona Benefit Plans, Inc.

GR SelectCare is a private labeled fully insured look-alike program offered by Fidelity Security for Group Resources, Inc. and marketed statewide via Arizona Benefit Plans, Inc.

 

The program targets fully insured groups with as few as 10 employee lives that have limited or no claims experience. This allows employers a simple, painless transition from their fully-insured medical plan to a partially self-funded one. Additionally, existing self funded groups can elect the GR SelectCare model.

 

GR SelectCare:

  • Has 13 plan options.
  • Includes access to the Arizona Foundation for Medical Care's (AFMC) PPO, POS and EPO networks.
  • Allows for multiple plan options to be used by the same employer group.
  • Incorporates Labcard and One Call Medical.
  • Offers a choice of PBM (pharmacy benefit manager) selection.

GR SelectCare shares many fully insured characteristics, including standardized plan design options and all rates and specific deductible thresholds are set by Fidelity Security Life. As with other fully insured plans, individual questionnaires are necessary in most instances for final underwriting. A plan using more than one option will not have blended rates, but will rather have two (or more) sets of rates and factors to match the chosen plan designs. All quotes will be based on 4 tier pricing. Read more...

New CMS Program To Provide Incentive Pay to Primary Care Physicians

On September 28, CMS announced a new plan that will give extra Medicare payments to primary care physicians who provide better care coordination, The Hill's "Healthwatch" reports (Baker, "Healthwatch," The Hill, 9/28).

Program Details

The plan - known as the Comprehensive Primary Care Initiative - is part of the Center for Medicare and Medicaid Innovation, which was established by the federal health reform law to evaluate strategies to improve care and lower costs (Sanger-Katz, National Journal, 9/28). Read more...  

Have you looked at United Security Life and Health Insurance Company Lately?

United Security Logo

USL&H Fall Bonus Program - Earn up to $350 per application!  Click here for details!

 

United Security Life and Health Insurance Company (USL&H) is a regional insurance carrier whose core product line includes Individual Major Medical Plans. In Arizona specifically, there are five plans to choose from that offer a variety of deductibles and optional benefits that will suit the needs of many. USL&H offers a comprehensive ancillary product line which includes: a Disability Income Plan; Short Term Major Medical Plan; Cancer and Critical Illness Plans; simplified issue First Step Children's and an EZ-Life Whole Life Insurance Plan and a guarantee issue Accident Hospital Indemnity Plan.

Founded in 1973, USL&H is licensed to sell its products in Arizona, Arkansas, Illinois, Indiana and Missouri and Nebraska through a network of independent insurance agents. USL&H  utilizes the Arizona Foundation for Medical Care as part of their company network.

USL&H has named the Fisher House Foundation as its charitable partner for 2011. The company will be donating one dollar to the Fisher House Foundation for every new business policy that is written in 2011. Company employees will also participate in a variety of special fundraising events that will benefit the Fisher House.

For more information on United Security Life and Health Insurance Company please visit the company's Web site at www.uslandh.com.

Quick Links  

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Network Plan Definitions

POS Network Plan Description

Foundation COMP Flyer

Self-Funded Guide

Fully Insured Guide

AFMC Contact Information

Larry Dennis, RHU, AFMC Sales Consultant
direct: 602-417-2301 *
[email protected]  

 

Judi Hayer, AFMC Sales Consultant
direct: 602-417-2813 *
[email protected]


326 E. Coronado Rd.
Phoenix, AZ 85004

Phone: 800-624-4277  

www.azfmc.com