Assurant Health removes waiting periods

Assurant Health has removed waiting periods for the treatment of tonsils, adenoids, hernias, bunions, hemorrhoids, and varicose veins have been removed from the contracts for new policies effective
November 1, 2008 and later.

Assurant expands rate guarantees to OneDeductible and SaveRight Plans

Assurant Health is expanding the 24 month and 36 month rate guarantee buy-up option on OneDeductible and SaveRight plans. The rate guarantee option locks in the premium rate for up to 36 months. The following OneDeductible and SaveRight deductible levels have an initial 12-month rate guarantee and now include the 24 or 36 month buy-up options:

OneDeductible: $2,100 individual deductible/$4,200 family deductible
$2,850 individual deductible/$5,700 family deductible

SaveRight: $2,200 individual deductible/$4,400 family deductible
$3,000 individual deductible/$6,000 family deductible

U.S. Government announces 2009 Medicare drug plan premiums

Seniors enrolled in Medicare’s drug benefit will pay average monthly premiums of $28 next year, government officials announced today.

That’s about $3 higher than the 2008 average premium, or a 12 percent increase.

“Average plan bids have increased at roughly the same rate as drug costs,” said Paul Spitalnic, an official with the federal Centers for Medicare & Medicaid Services.

Premiums are set by the private plans that offer drug benefits under Medicare and will vary depending on the plan and location.

The average increase affects nearly 25 million Medicare beneficiaries — 7.6 million in Medicare Advantage plans with comprehensive coverage and 17.4 million plans that cover only drugs.

While officials said the premium increase was well below projections, advocates noted that it exceeds the annual cost of living increase for Social Security, which remains under 3 percent.

The problem is “the government is failing to do anything about the runaway prices that Americans pay for drugs” because it won’t negotiate price discounts directly with drug companies, said Robert Hayes of the Medicare Rights Center.

The annual enrollment period for Medicare Part D begins Nov. 15 and extends through the end of the year. This is the only time of year that seniors can elect to change their plans.

For 2009, the annual deductible for Part D plans (the amount consumers pay before coverage kicks in) will be $295. Once you pay the deductible, your Medicare Part D plan will pay 75 percent of your drug costs up to $2,700.

Then, you enter the so-called “donut hole,” and you’re responsible for 100 percent of your drug costs up to $6,153.75. After that, the government will pay 100 percent of your drug bills.

In other words, you could end up paying $4,350 in 2009 out-of-pocket for drug expenses before Medicare will take over paying for all your drugs.

In Illinois, seniors with low incomes will want to make sure they consider applying for assistance that can help cover these extra expenses. For more information about Illinois Cares Rx, one of these programs, click here. To obtain this assistance, you have to work with a Medicare drug plan that partners with Illinois Cares Rx.

If you’re very low income, you probably qualify for a program known as Extra Help. For more information about Extra Help, click here. To qualify, you’ll have to apply and be approved by the Social Security Administration.

For help figuring out how Medicare Part D works, counselors are available at the organizations listed below.

Illinois Department of Aging Senior Help Line 1-800-252-8966

Illinois Senior Health Insurance Program 1-800-548-9034

AgeOptions, suburban Cook County 1-800-699-9043

Chicago Department of Senior Services 1-312-744-4016

Blue Cross Blue Shield of Illinois loses contract with Wal-Mart

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.

Resurrection Healthcare joins the Aetna Medicare network in Illinois

Aetna Medicare is happy to announce the addition of Resurrection Healthcare to our Aetna Golden Medicare (HMO) and Aetna Golden Choice (PPO) network! Resurrection Healthcare operates nine hospital facilities throughout the city of Chicago and suburban Cook County.

The Resurrection Health Care facilities include:

* Resurrection Medical Center

* Our Lady of Resurrection

* Holy Family

* St. Elizabeth

* St. Mary

* St Joseph

* Westlake

* West Suburban

For a complete list of Resurrection Healthcare programs and services, visit Reshealth.org

Blue Cross and Blue Shield of Illinois Announces Its Intent Not to Pay for Additional Costs Resulting From ‘Never Events’

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.

IRS releases 2009 maximum health savings account contributions

The Treasury Department and Internal Revenue Service recently released 2009 guidelines for maximum contribution levels for Health Savings Accounts (HSAs) and out-of-pocket spending limits for high deductible health plans (HDHPs) that must be used in conjunction with HSAs. The 2009 IRS requirements are:

Minimum Deductible: $1,150 single plan; $2,300 family plan
Maximum Out-of-Pocket: $5800 single plan; $11,600 family plan
Contribution Maximum: $3,000 single plan; $5950 family plan

New Annual Contribution Levels for HSAs

• The maximum annual HSA contribution for an eligible individual with self-only coverage is $3,000.

• For family coverage, the maximum annual HSA contribution is $5,950.

• Catch-up contribution for individuals who are 55 or older is increased to $1,000 for 2009 and all
years going forward.

• Individuals who are eligible individuals on the first day of the last month of the taxable year (December 1 for most taxpayers) are allowed to make the full annual contribution (plus catch up
contribution, if 55 or older by year end), regardless of the number of months the individual was an eligible individual in the year. For individuals who do not maintain eligibility for the 13-month
testing period following that date, both the HSA contribution and catch-up contribution should be prorated based on the number of months of the year a taxpayer was an eligible individual. New Amounts for Out-of-Pocket Spending on HSA-Compatible HDHPs

• The maximum annual out-of-pocket amount for HDHP self-coverage increases to $5,800. The maximum annual out-of-pocket amount for HDHP family coverage is twice that at $11,600. Minimum Deductible Amounts for HSA-Compatible HDHPs

• The minimum deductible for HDHPs increases to $1,150 for self-only coverage and $2,300 for family coverage. In addition, a fiscal year plan that satisfies the requirements for an HDHP on the first day of the first month of its fiscal year may apply that deductible for the entire fiscal year.

Evanston Northwestern, Rush North Shore finalize merger

North suburban hospital operator Evanston Northwestern Healthcare said it will acquire Rush North Shore Medical Center in Skokie, committing more than $160 million to the deal, according to a definitive agreement finalized today.

As part of the deal, which still needs approval of regulators including the Federal Trade Commission, Evanston Northwestern will retire Rush North Shore’s $54 million in debt and contribute $10 million to a community foundation. In addition, Evanston Northwestern will commit $100 million in capital over the next several years that includes establishing an electronic medical record system at the Skokie hospital.

“The merger will provide enormous benefits to the patients and families we serve for generations to come,” said James Frankenbach, president of Rush North Shore.

Evanston Northwestern operates hospitals in Evanston, Glenview and Highland Park. Rush North Shore is affiliated with Rush University Medical Center on the West Side and Rush-Copley Medical Center in Aurora through a so-called obligated group, which allows them to cooperate on financing needs. If Rush North Shore issues debt through the group, the other member hospitals would have to sign off on the spending plan.
But the obligated group these days is more focused on funding a huge renovation at Rush University Medical Center on Chicago’s West Side so Evanston Northwestern’s retirement of the Rush North Shore debt will help in the Rush University financing plan.

The Federal Trade Commission, which has taken issue with Evanston Northwestern’s acquisitions in the past, has not asked for additional information from the merging parties in this deal, Rush North Shore executives said.

Evanston Northwestern and Rush North Shore executives said they expect the deal to close by the end of the year.

Earlier this year, the FTC made official an earlier decision ordering Evanston Northwestern and Highland Park Hospital to contract separately with managed-care plans. Although Highland Park is owned by Evanston Northwestern, the FTC said that the two parties must allow health insurance companies to “negotiate separately again for those competing hospitals, thus reinjecting competition between them for the business of [managed-care organizations].”

Last year, the FTC affirmed a 2005 ruling by an administrative law judge that found Evanston Northwestern’s 2000 acquisition of Highland Park to be anti-competitive and in violation of federal law. The FTC did not order a divestiture of Highland Park but the agency and Evanston Northwestern came to an agreement .

The FTC alleged prices at Highland Park rose 50 percent or more in certain instances after the merger, compared with price increases of 4 percent to 6 percent in the several years preceding the combination.

Evanston Northwestern argued that its rate increases were catching up with poor managed-care contract negotiations in the past and that it invested more than $150 million in the facility.

Blue Cross Blue Shield of Illinois reducing EOB mailings

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.

Blagojevich alters insurance bill to cover autism therapy

By Monique Garcia | Chicago Tribune reporter

When Brianna Dicianni was diagnosed with autism two years ago, doctors said the girl would never learn to speak.

Undeterred, her family sought therapy, only to run into another roadblock: Because their insurance company didn’t cover treatment for autism, they would have to pay for the costly sessions out of pocket.

Brianna’s parents borrowed against their home, dipped into college savings for their three children and—$80,000 later—Brianna, now 5, can talk.

On Sunday, Gov. Rod Blagojevich moved to help families like the Diciannis, using his amendatory veto power to alter legislation so insurance companies would be required to cover diagnosis and various therapies for autistic children.

“The billion-dollar profits of insurance companies are being put before our children, and it’s wrong, it’s criminal,” said Brianna’s father, Peter Dicianni.

The legislation would force insurance companies to cover up to $36,000 a year in occupational, physical, speech and behavioral therapies in addition to psychiatric and psychological services. Children would be covered until they turned 21.

Proponents of the legislation said early treatment is vital to the development of children with autism. By undergoing therapy early in life, they are more likely to gain the communication and social skills needed to live independent lives.

“This is literally about whether a child can grow up and live a good and happy life, or whether a child will grow up and be in his own isolated world, unable to communicate,” Blagojevich said at a news conference announcing the legislation.

For Peter Dicianni, the governor’s action comes after more than a year of lobbying lawmakers and insurance companies to cover autism treatments. But hurdles still remain. Lawmakers in both chambers must approve the governor’s changes.