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Greetings!
Over the the past few months, we have introduced the concept of limited networks and/or hospital tiering. These are the products the insurance carriers are focusing on and marketing to employers. The Boston Globe had a great story last week detailing the success Blue Cross has had with the HCCS rider, which passes on extra costs if you utilize higher cost hospitals, and the Options plan, which tiers hospitals and doctors into three different co-payment levels. Better yet, the Worcester Telegram also ran a story and even quoted Vanessa.
It must be having an effect, as hospitals classified as "Expensive", which means higher costs to their patients, are starting to fight back. Check out Attleboro Sun Chronicle story titled Sturdy versus Blue Cross regarding their "Expensive" classification. 
As far as the Tufts-Harvard merger? No news....
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| Health Choice Cost Sharing
HCCS rider
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If you have Blue Cross now, at your next renewal, you can add this rider to your existing plan. This should lower rates by approximately 5.5%. You will, however, pay higher costs, if you have services at what Blue Cross defines as a higher cost hospital, which includes:
- Baystate Medical Center
- Berkshire Medical Center
- Brigham & Women's Hospital
- Cape Code Hospital
- Caritas St. Anne's
- Cooley Dickinson
- Dana-Farber Cancer Institute
- Fairview Hospital
- Harrington Memorial
- Massachusetts General Hospital
- NorthShore Medical Center (Salem & Union Campus)
- South Shore Medical
- Sturdy Memorial
- UMass (Worcester locations only)
The biggest difference with the HCCS rider is that hospitalizations/day surgeries in any of the above hospitals will cost you an extra $1,000 and MRI-CT-PET scans $450. Blue Cross has come out with a great video you may like to check out!
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2nd Quarter Rates, 2011
Rates have been approved rates
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If you renew between April - June (2nd quarter), the Mass. Division of Insurance has approved the submitted "base" rates from all carriers for the small group (less than 50 employees) marketplace. Although you may have read that the state's nine major carriers approved renewal rates ranging from 1.4% to 9.9%, this only refers to the "base" rate.
"Base rate" is only the starting point with the carriers. Once the 'base rate" has been approved, the insurance companies may adjust for certain factors, primarily demographic changes. This means that if your number of enrolled employees was 30 last year, and now due to layoffs, you are at 15 participants, you may see a double digit increase. Also, if the average age of the group spikes up, the insurance carriers may factor an additional load.
Eric Schultz has two great blogs explaining this in better detail, part 1 and part 2.
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