| Issue: # 61 | October 26, 2010 |
Dear
Things have finally settled down in the small group marketplace (1-50 employees). From April thru September 2010, many small businesses experienced uncertainty and volatility with rates. Despite the fact that the Division of Insurance supposedly "capped" rates, it was not communicated that the cap was on "base" rates only. Therefore, many small groups still had double digit renewals, well above the "cap". Lets hope the Commonwealth of Massachusetts focuses on real reform that addresses cost control, like the Massachusetts Cost Control bill, versus rejecting rates filed by the insurance carriers. Again, the rejection of rates by the Division of Insurance did nothing to lower the true cost to provide healthcare. In a recent newsletter we highlighted a new plan from Blue Cross that announced TIERED NETWORKS, which divided hospitals into categories. Co-payment and deductibles vary based on which hospital you choose to seek treatment. This newsletter introduces Harvard Pilgrims new plan, called the FOCUS NETWORK, which is available as of January 1, 2011.
Advantage Benefits Group,
|
| Harvard-Pilgrim
New plan targeted at Central Massachusetts
|
Eric Stoltz, former CEO of Fallon, has taken over the helm at Harvard-Pilgrim, to replace Charlie Baker. He is taking some of his ideas from Fallon with him! At Fallon, there are two networks: - Select: Larger network with approximately 8000 doctors and 58 hospitals.
- Direct: Smaller network with approximately 3300 doctors and 32 hospitals. The premiums for the Fallon Direct plan is 13% less then Fallon Select.
Harvard is now adding a limited network plan (similar to Fallon Direct) called Focus Network , targeting Central Massachusetts effective January 1st. Premiums are estimated to be 12% less than the traditional Harvard HMO network. The plan has two types of hospitals: - "Easy Access Hospitals": Most of the Central Massachusetts hospitals except UMASS.
- "Authorized access": Mainly UMASS and Partners in Boston.
This is a big move by Harvard Pilgrim to get membership in Central Massachusetts. We will automatically present our clients with quotes for this new product if you are in the Central Mass area! 
|
| Massachusetts Cost Control Bill
This actually helps control the cost of health insurance
|
The Massachusetts Cost Control Bill passed in August, addresses issues to help control the cost of health insurance. One item is to limit Open Enrollment for individuals to two defined months per year. This will prevent people from being able to buy insurance on demand, receive treatment, terminate coverage, and then re-enroll later when care is needed. This loophole only drives up the insurance carriers loss ratios, which is then passed on to the entire small group marketplace. In fact, we hope this is limited to one month per year, just like any group sponsored private plan.
Our next wish is that the Commonwealth will not require prescription coverage in order to meet Minimum Credible Coverage (MCC). Many small businesses would like to see Prescription Coverage as an option, not mandatory. It is estimated prescription coverage makes up about 10% of premiums.
As companies like Walmart, Target and Walgrens expand their Generic Drug Programs, you should remind employees to check these options out! The list of drugs grows daily, and you can purchase a 30 day supply for $4 or a 90 day mail order supply for $10. You do not need any health insurance at all to take advantage of these programs. Everybody is eligible, just bring. the prescription from the doctor to Walmart .
|
 |
|
|
