Busy Season for Health Insurers

Added : ( Wed Nov 24 1999 )

By PHIL GALEWITZ AP Business Writer

As the deadline fast approaches for most workers to choose their type of health insurance option for 2000, employees are finding a host of changes, some good, some bad.

Most are facing higher premiums and higher co-payments for prescription drugs and office visits. Premiums are rising on average about 8 percent for 2000 - the biggest increase since 1993.

On the positive side, many employees are seeing less bureaucracy, gaining more flexibility in choosing doctors, getting coverage for alternative treatments such as acupuncture and gaining Internet access to health information from their insurer. Also, some companies are providing report cards that grade various health plans on customer satisfaction and other categories.

Late fall for health insurers is akin to Christmastime for retailers. That because this is right now, during fall re-enrollment season, is the one time each year that companies usually allow their workers to switch health plans.

Consumer demand for more flexible health plans is one reason premiums are rising so fast. Another big factor is the escalating cost of prescription drugs, which at many plans is increasing by about 20 percent.

At the same time, however, many companies are so desperate to find employees that they are willing to absorb much of the premium increases themselves.

Many employees are benefiting as health maintenance organizations drop some restrictions.

The nation's largest health insurer, Aetna U.S. Healthcare, is adding an 'open access' type of HMO that lets members use specialists in the plan's network without first getting approval from their primary care doctor.

United HealthCare, the nation's second-largest managed care insurer, is doing one better: It is dropping all pre-authorization requirements and giving doctors the final say on all patient care matters.

HMO Illinois, owned by Blue Cross and Blue Shield of Illinois, is even letting its members for the first time choose a chiropractor as a primary care doctor. Until now, all HMOs required a medical doctor in that role.

Most employers are now offering workers a three-tiered prescription coverage plan. In this system, workers pay a nominal fee for generic drugs (usually about $5), a higher fee for the insurer's preferred brand-name drugs (usually $10 to $15) and an even higher fee for brand-name drugs that are not on insurers' approved lists ($25 or more).

Added flexibility, though, could end up costing employees more money through higher premiums.

"People want lots of freedom of choice, and that is more expensive," said Bill Sullivan the former president of Oxford Health Plans, which operates in New York, New Jersey and Connecticut. Oxford is one of several health insurers that provides discounts to members who visit acupuncturists, massage therapists and other alternative health providers.

Among other changes in the industry, Aetna has begun letting members enroll over the Internet. They can also check their benefits on Aetna's Web site and determine which doctors are in the plan's network. In addition, the company has its Intellihealth.com Web site, a source of health news and information on diseases.

Some employers are setting up programs to help workers choose the right plan.

Pitney Bowes, the Stamford, Conn.-based manufacturer of office equipment, is distributing a report card that grades HMOs on such things as their preventive-care performance and the size of their doctor networks.

"People are confused about all the material they get, and could not decipher the difference between plan A and plan B and wanted us to be more active in helping them make a selection," said David Hom, executive director of corporate benefits. Submitted by: Pressbox Add your press release for free.