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Issue: # 63December 13, 2010 

78 pleasant 
Dear

On the health insurance front, the Division of Insurance finally approved the first quarter rates for 2011 filed by the insurance companies.  Let's hope this continues in 2011, as the    2nd and 3rd quarter 2010 "interim rate" fiasco did absolutely nothing to control the cost of health insurance, or reduce premiums.

Another thing to keep an eye on in 2011, is how the Commonwealth of Massachusetts will proceed with collecting fines from residents, who did not have health insurance.   Check out the recent Boston Herald story.   On this Monday morning, as you try to get started keep in mind that at your morning could be worse.  Ask the management of the Metrodome.  
metrodome
Metrodome, click here for video

If you have any questions email Bill or Vanessa.  We hope you find these newsletters helpful, please forward to anyone who may find this of interest, by using the forward link at the bottom of this e-mail.   Thank you for your referrals.

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Sincerely,


Bill Randell CLU,CHFC,        Vanessa Costa CLU,CHFC,
Advantage Benefits Group,
Massachusetts Cost Control Act
Limited and tiered networks?
We have discussed this act, passed last August, regarding how "open enrollment" for individuals has changed.   No longer will uninsureds be able to buy insurance 365 days per year, with no pre-existing conditions, and then cancel coverage.  There will now be only  two months per year for individuals to obtain health insurance without medical underwriting.   Unlike the "interim rate" situation, this will actually help control the cost of health insurance in Massachusetts.
 
In addition, the bill also requires that insurers offer a limited or tiered network plan with at least a 12% price differential from their standard HMO.  
  1. Fallon has a smaller Direct network versus the larger Select network.  
  2. Tufts is in compliance with their smaller network, ironically called Select.   
  3. Harvard-Pilgrim starts their limited Focus Network ,  in Central Massachusetts, without UMass, starting January 1, 2011. 
  4. Blue Cross is also in compliance with their tiered product.
     

There will be more emphasis on limited or tiered networks over the next couple years.   Employers and employees will need to make tough decisions as to what doctors and hospitals they will have access to, and whether or not a savings of approx. 12% in premiums will be worth introducing these types of plans. 

Preventive (Routine) vs. Diagnostic

Important terms to understand

Another key component of National Healthcare Reform is the elimination of co-payments for certain preventive services.    Here is a good story detailing the new rules effective September 23, 2010.   The hope is to encourage subscribers to visit their primary care physician annually. This could help to detect any potential problems early, before they become a major problem, thereby lowering the overall cost of healthcare.  
 
How a procedure is coded by your doctor's office, however, can make a very big difference in your wallet.  Routine adult physical exams, including related tests, will now cost nothing, if they are submitted as preventive.  On the other hand, if they are billed as diagnostic, co-payments will apply.
 
 
Health Insurance 2003-2009
How bad has it been?

 

We read this article in the National Underwriter.  

 

Here is the key line

 
"Premiums for employer-sponsored family health insurance increased an average of 41% across states from 2003 to 2009, according to a study by the Fund. That rate was 3 times faster than increases in median incomes, the study report points out."

 

Where has it been the worst?

"By 2009, premiums were highest in Alaska, Connecticut, Massachusetts, Vermont, Wisconsin and Wyoming, with family premiums in those states exceeding $14,000 a year, the report found."


Was the coverage better?

"At the same time, deductibles rose sharply in almost all states, increasing an average of 77% from 2003 to 2009 in large as well as small firms.   In addition, more workers paid deductibles-74% in 2009, compared to 52% in 2003."


In another story from NPR, "From 2001 to 2009, the median monthly premium for individual health plans soared by 76 percent, from $251 to $442."  Lets hope 2010-2015 is much different.