Already struggling in a tough economy, many small employers are about to face another big hit: markedly higher increases in health-insurance premiums as they head into 2009.

For many of these companies, the steeper increases couldn’t come at a worse time, when the economy is weakening and credit is harder to come by.

“We can’t pass these costs on to our customers; the market just won’t bear it,” said Daniel Lance, who owns E.CAB, a St. Petersburg, Fla., firm that produces finishes and fixtures for elevator-cab interiors.

After no increase last year, E.CAB’s premiums jumped 75 percent to about $6,800 a month when its annual Blue Cross Blue Shield of Florida policy came up for renewal last month. Much of the jump was triggered by the hiring of a few older workers by the 25-employee firm, pushing it into a higher-cost actuarial bracket. E.CAB couldn’t get a better price from rival insurers.

Rather than pass the cost on to his employees, who aren’t required to contribute premiums for themselves though they do for family members, Mr. Lance said he’s forgoing new wood-cutting equipment he had planned to purchase. “I just felt it was a bad time to pass on costs,” he said. “The employees are having a tough enough time, too.”

As hard as it has been for businesses to absorb ever-higher health-care costs each year, the collective premiums they paid actually had climbed at a slower rate in recent years. But as small businesses begin to receive their annual renewal notices, employers and health-insurance brokers in the South, Midwest, and California report noticeably steeper rises. Some premium increases being quoted to employers are double those quoted just a few months ago.

In a nationwide survey of 30 insurance brokers released by Citigroup in November, more said insurers were raising premiums at a faster rate than those who reported slowing increases.

For-profit health insurers have seen profit margins shrink this year in the face of higher-than-expected medical costs and pricing missteps, not to mention membership declines as more businesses drop or cut back coverage. While companies with 500 or more employees might have leverage to negotiate, health insurers are “being much more rigid” with smaller firms, said Edward Kaplan, national practice leader at Segal Co., an employee benefits consultancy.

Adding to upward pressure on prices could be dozens of not-for-profit Blue Cross and Blue Shield plans, whose investment portfolios have taken a beating in the recent market turmoil.

C. Steven Tucker, a health insurance broker for small businesses in Illinois, said his clients received increases of 28 percent to 31 percent last month, compared to typical increases of 18 percent to 20 percent. In Florida, brokers say many plans hit with high increases are high-deductible plans eligible to be used with a health savings account.

A few years ago, health insurers tried to win business with the new health savings accounts by charging low premiums, but since the most popular ones pay 100 percent of costs after a $1,500 to $3,000 deductible, their costs have been higher than anticipated.

Dottie Jessup, who owns bicycle shops in Clearwater and Palm Harbor, Fla., with her husband, Tom, said they and their 25 employees, who share premium costs 50-50, couldn’t handle a 12.5 percent increase set to go into effect this month.

Instead, they went with their only other option: to raise one plan’s deductible to $2,500 from $2,000 and the other to $3,500 from $2,850, in exchange for just a slight premium increase.

“Our concern is that we’re getting to the point where we’re wondering where this is all heading, because you can only reduce benefits and contain costs so much,” she said.

Original Excerpt from the Wall Street Journal

Tags: 2009 healthcare costs, health-care premiums

Effective January 1, 2009, Prime Therapeutics will become the Medicare Prescription Drug Plan (PDP) pharmacy mail-order vendor for Blue Cross Blue Shield of Illinois plans, replacing Walgreens. Existing members who use the mail order program are being notified via letter of the change and efforts are underway to make the transition as seamless as possible.

Current clients of Illinois Health Agents can contact our office for personal assistance with the new mail order forms by phone at (630) 930-9364 or by email at info@ilhealthagents.com.

To capitalize on heightened consumer interest in higher deductible plans, Blue Cross and Blue Shield of Illinois is introducing a new deductible option to the BlueEdge Individual HSA (health savings account) plan. Along with the current deductible offerings of $1150, $1750, $2600 and $5000, a new deductible option of $3500 is being added beginning January 1, 2009.

The new $3500 deductible plan is available at both 80 percent and 100 percent coverage levels, with or without maternity benefits. Marketing of the $3500 deductible began November 15, 2008 with effective dates of January 1, 2009 or later.

Also, effective January 1, 2009, the deductible level for the $1100 plan increases to $1150, in keeping with the IRS HSA minimum deductible guidelines.

Tags: BlueEdge, Health Savings Accounts

Effective January 1, 2009, NorthShore University HealthSystem (formerly ENH), has acquired Rush North Shore Hospital in Skokie, Illinois. Rush North Shore Hospital, which will be renamed Skokie Hospital, will remain a participating hospital in our PPO, BlueChoice Select and HMO networks.

The Rush North Shore Hospital listing in the Provider Finder® section of the BCBSIL web site and in the HMO provider directories will reflect the following:

• Skokie Hospital – (formerly Rush North Shore Hospital)

Individual physicians affiliated with Rush North Shore Hospital can still be found via a name search within our online Provider Finder. However, in the interim, members may still need to search for the hospital using the former name.

How will this name change impact BCBSIL members?
BCBSIL has an agreement in place covering the new entity. Members who use Rush North Shore Hospital and its affiliated physicians will not be affected by the name change and can continue to receive treatment and services. There should be no disruption in claims processing.

Tags: bcbsil, Blue Cross Blue Shield of Illinois, BlueChoice Select network, Rush North Shore Hospital, Skokie Hospital

Effective January 1, 2009, the current Members First discount program will be replaced with the BlueExtras discount program. All BCBSIL members enrolled in individual health plans are eligible for the BlueExtras discount program.

BlueExtras offers discounts on value-added health care products and services that can enhance health and well-being – as another advantage of BCBSIL membership. There are no claims to file, no referrals or pre-authorizations, and no fees to participate.

For additional information about the products and services offered through BlueExtras, log into Blue Access® for Members (BAM) at www.bcbsil.com. Click on the My Coverage tab, and then the BlueExtras Discount Program link.

Tags: BCBS IL, Blue Cross Blue Shield of Illinois, BlueExtras Discount Program, Members First Discount Program

Advocate Health Care’s is acquiring Condell Medical Center effective December 1, 2008. The new name of the hospital will be Advocate Condell Medical Center. As of the December 1 acquisition date, the Advocate Condell Medical Center will return to the Blue Cross Blue Shield of Illinois PPO and HMO networks. Advocate does not participate in the BlueChoice Select network.

Information regarding the formation of the Advocate Condell PHO for the HMOI physician network will be forthcoming.

Tags: Advocate Health Care, BCBS IL, bcbsil, Blue Cross Blue Shield of Illinois, Condell Medical Center

Blue Cross and Blue Shield of Illinois, the state’s largest health insurer, soon will no longer administer claims and provide customer service to employees of Wal-Mart Stores Inc., the world’s largest retailer, losing the business to another Blue Cross plan in Arkansas.

Starting in January 2010, Illinois Blue Cross won’t be performing administrative functions, such as staffing customer-service call centers, for employees of Wal-Mart, the health plan confirmed. Wal-Mart employees in the state still should be able to access benefits through Illinois Blue Cross because the new contract is largely related to behind-the-scenes work, the insurer said.

Such administrative tasks will begin in 2010 to transition over to Arkansas Blue Cross and Blue Shield, Illinois Blue Cross said.

Illinois Blue Cross would not disclose the financial impact of this change. Bentonville, Ark.-based Wal-Mart has more than 1.4 million U.S. employees and is known for its clout in negotiating with its many vendors.

“The membership in our four states will still be captured as part of our market share,” Illinois Blue Cross spokesman Jack Segalsaid of its parent, Chicago-based Health Care Service Corp., which also operates three other Blue Cross plans in Oklahoma, Texas and New Mexico.

In its new role, Health Care Service’s four Blue Cross providers will “become what’s known as ‘host plans’ for Wal-Mart’s approximately 200,000 members that live in our four states,” Segal said. “As host plans, we’ll provide our [medical-care provider] networks and our discounts, continue to reimburse providers and continue to determine claims pricing.”

As a home plan, Illinois Blue Cross has 445,000 members at Wal-Mart.

Wal-Mart would not confirm the change in the contract or financial terms of its relationships with any of the Blue Cross plans that process its health care.

“We regularly assess the quality and costs of the health-care plans offered by our providers, including those plans owned by Health Care Service Corp., and we don’t have any changes to those plans to announce at this time,” said Greg Rossiter, spokesman for Wal-Mart.

But Illinois Blue Cross said, “Wal-Mart was looking to consolidate into a single platform, so Arkansas [Blue Cross] decided to take this on and become the single home plan or administrator.”

Until the transition, Illinois Blue Cross will continue to share administrative duties with the Arkansas Blue Cross plan and Blue Cross and Blue Shield of Alabama.

Health Care Service had $865 million in net income last year on $14.3 billion in premium revenue. The nation’s fourth-largest insurer, the Chicago company has 12.4 million members, including 7.4 million in Illinois.

Tags: bcbs, Blue Cross Blue Shield of Illinois, Health Care Service Corp, health insurance illinois, illinois health insurance, illinois insurance, Wal-Mart, Walmart

CHICAGO, Aug. 11 — Blue Cross and Blue Shield of Illinois (BCBSIL) announced today its intent not to pay for costs resulting from hospital-based preventable medical errors known as “serious hospital acquired conditions” and “never events” (errors in patient care that can and should be prevented). BCBSIL said it will work with hospitals in its networks to put this new approach into operation and ensure that members are held harmless financially when these events occur.

In addition, BCBSIL reiterated its longstanding commitment to collaborating with contracted network providers to prevent medical errors before they occur.

“Blue Cross’ goal for years has been to work to prevent medical errors, which often go undetected. To this end, Blue Cross has and will continue to collaborate with hospitals and physicians in our communities to promote quality and safety and prevent medical errors before they threaten patients’ health and add to the cost of care,” Scott Sarran, MD, BCBSIL’s chief medical officer, said.

For years, BCBSIL has participated in initiatives designed to prevent medical errors. In 2001, for example, BCBSIL began an outcomes-based reimbursement program that provides incentives to hospitals when they provide care without complications. Designed to enhance quality and safety, this approach can reduce employer groups’ claims costs if hospitals’ services do not meet established quality criteria.

In addition to payment methodologies, BCBSIL participates in a variety of initiatives designed to help prevent medical errors, including:

* — Rewarding BCBSIL PPO and HMO physicians who complete the American Board of Medical Specialties’ Patient Safety Improvement Program, which addresses a host of inpatient and outpatient safety issues;
* — Encouraging hospitals (through letters, personal meetings, Blue Cross’ “Hospital Profile” scoring, and public reporting) to comply with and make public information about their progress towards meeting The Leapfrog Group’s patient safety standards. The Leapfrog Group’s goal is to reduce preventable medical errors and improve the quality and affordability of health care;
* — Measuring and reporting diverse indicators of hospital quality and patient safety. For the past six years, the results from the BCBSIL profile have been sent to hospital CEOs, and receive the attention of senior management;
* — Annually collecting data from Illinois hospitals on their participation in state and national patient safety and quality improvement programs and their procedures for addressing “near misses;”
* — Making information about hospital quality and safety available to members via our Blue Star Hospital Report, which is available at http://www.bcbsil.com; and
* — Starting up and providing the first $1 million in funding for a statewide e-prescribing system, which is open to network physicians, health insurance carriers, pharmacies, technology providers, professional societies, and others. Since its inception in April 2007, participating physicians have written approximately 467,500 electronic prescriptions – 41,573 in June 2008 alone. Moreover, in June, the system, which is designed to help prevent medication errors, detected more than 4,500 potential negative drug interactions, of which nearly 19% resulted in a change or cancellation of the proposed prescription. In addition, in June, the system detected more than 700 potential allergic reactions. As a result, physicians changed or cancelled more than 8% of prescriptions.

Tags: bcbsil, Blue Cross Blue Shield, Blue Cross Blue Shield of Illinois, health care, health insurance, illinois health insurance

Effective July 13, 2008, Blue Cross Blue Shield of Illinois will no longer print and mail Explanation of Benefits (EOBs) that relate to all patient share zero liability claims. Zero liability claims are those claims that are covered and paid for by Blue Cross and Blue Shield of Illinois and do not require any additional payment by members. Zero liability claims can still be viewed and downloaded online through Blue Access® for Members at www.bcbsil.com/members.

In mid-December, 2008, Blue Cross Blue Shield of Illinois will begin to bundle all EOBs into one envelope on a weekly basis. However, any EOB accompanied by a check will be excluded from the bundling process and instead will be immediately mailed.

Tags: Blue Cross Blue Shield, EOB, green, health care, illinois insurance, insurance

(BestWire Services Via Acquire Media NewsEdge)
An increasing number of employers are participating in employee health and wellness programs in a bid to reduce health care costs due to chronic illnesses, officials from Blue Cross Blue Shield companies and the National Business Group on Health announced. The Blue Cross Blue Shield Association of America also released a new report finding that workplace education efforts can increase worker participation in wellness programs by 21% or more.

Joined by participating companies, the insurers were in the nation’s capital to lobby Congress on the benefits of wellness programs.

With chronic conditions such as heart disease, diabetes, obesity and smoking accounting for approximately 75% of health care costs, employers have a strong incentive to utilize workplace wellness programs, panelists said at the National Press Club. Blues’ representatives did not provide national statistics on how many companies and employees have joined such plans.

Dr. Douglas Woll, senior vice president and chief medical officer for the Blue Cross Network of Michigan, said the nonprofit insurer gave participating member companies an up-front 10% discount on health insurance premiums in exchange for enacting health and wellness programs. In less than two years, 575 employers with 75,000 employees have signed up, a figure that is growing by about 1,000 employees monthly.

Insurers began offering wellness, disease management programs and pharmacy benefit management services over the past decade because they learned that employers were willing to pay for them, according to Edward Kaplan, national health practice leader with the Segal Co., a New York-based employee benefits consulting firm. These programs also are helping insurers boost revenue in an environment where they?re struggling to grow membership, he said (BestWire, June 16, 2008).

While anecdotal and qualitative findings show increased participation by employers and employees, Blue Cross and Blue Shield of North Carolina Vice President and Chief Medical Officer Don Bradley said insurers have to show hard numbers verifying cost savings from wellness programs.

Otherwise, he said, “I’ll be polishing up my resume.”

Tags: Blue Cross Blue Shield, health insurance, wellness