Court Upholds Balance Billing Regulations
The California Supreme Court handed down a unanimous ruling to uphold state regulations that prohibit emergency room doctors from billing patients directly for a payment that is higher than what the health plan pays. California Assn. of Health Plans CEO Christopher Ohman said that the court’s ruling in Prospect Medical Group vs. Northridge Medical Center “will help ensure consumers have the peace of mind they should have with health insurance. They will no longer face the threat of receiving bills from emergency room doctors who want more than the fair payment a health plan is willing to cover.” According to a 2007 study commissioned by CAHP, more than 1.76 million insured Californians who visited Emergency Rooms in the last two years received balance bills on top of their co-pays and deductibles. The average bill was $300, meaning Balance Billing is a $528 million burden on insured patients.
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Premiums for Employer Sponsored Coverage on the Rise
A report by the California HealthCare Foundation reveals that premiums for employer-sponsored coverage increased 8.3% in California in 2008 -- compared to a 3% increase in consumer prices generally. Premiums more than doubled since 2002.
Similar to national figures, single coverage premiums in California cost $4,906 annually, and family coverage cost $13,427. Among covered California workers, enrollment in a high-deductible health plan with a savings option remained unchanged at 4% while such enrollment doubled nationally from 4% to 8%. More than half of California firms provided coverage for same-sex domestic partners, which is more than double the national average. For more information, visit www.chcf.org/topics/healthinsurance/index.cfm?itemID=133543
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Snapshot of California’s Uninsured in 2008
Over the past 20 years, the percentage of uninsured Californians under 65 has continued to rise as employer-sponsored health insurance has declined. Between 1987 and 2007, employer-sponsored coverage declined almost 8%. Although Medicaid and individually purchased coverage partially offset that decline, more than 20% of Californians remain uninsured, according to a report by the California HealthCare Foundation.

The nationwide problem of the uninsured is more prominent in California, which has a lower percentage of people with employer-sponsored coverage and a higher proportion of uninsured. And because of California’s large population, the number of people without insurance — 6.6 million — is the highest of any state.
Some findings from this year’s snapshot include the following:
• Workers at private sector businesses are more likely to become uninsured, although workers in businesses with fewer than 10 employees are most at risk.
• More than a third of the uninsured have family incomes of more than $50,000 per year.
• 27% of families with incomes of $25,000 to $50,000 are uninsured.
• 70% of uninsured children are in families in which the head of the household has a year round, full-time job.
• Nearly 60% of the state’s uninsured are Latino.
The ranks of the uninsured are likely to grow in the coming year in light of economic conditions in California. For more information, visit www.chcf.org/topics/healthinsurance/index.cfm?itemID=133820
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Update on California Health Plans and Insurers
According to a report by the California HealthCare Foundation, private health insurance carriers form the backbone of California’s market-based healthcare system, providing coverage to 67% of its population. Health insurance carriers serve the privately insured as well as large portions of the publicly insured in Medi-Cal, Healthy Families, Medicare, and other public programs.
The following are key findings of the report:
1. Five insurers account for 76% of the $91.9 billion in health insurance revenue.
2. From 2003 to 2007, enrollment in Department of Managed Health Care (DMHC)-regulated plans averaged losses of nearly 1% per year, while enrollment in California Department of Insurance CDI-regulated plans grew 22% per year.
3. In 2007, revenue grew faster in CDI-regulated plans than in their DMHC-regulated counterparts, with Blue Shield revenues growing 58% (versus 3% under its DMHC entity) and Anthem Blue Cross growing at 20% (versus 2% under its DMHC-regulated company).
4. Medicare Advantage plans cover nearly a third of California’s Medicare beneficiaries.
5. Half of all Medi-Cal beneficiaries are enrolled in managed care plans.
To download the complete report, visit www.chcf.org.

Healthcare Spending Sees Big Jump During Governor’s Tenure
Healthcare spending in California increased 18% since Gov. Arnold Schwarzenegger (R) took office in 2003, according to a San Jose Mercury News analysis of state spending. Medi-Cal accounts for a big chunk of public health spending. It increased by $2.9 billion above what inflation and population growth would dictate from 2003 to 2008.
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Commissioner Settles With Anthem Blue Cross
California Insurance Commissioner Steve Poizner announced a settlement with Anthem Blue Cross over rescission of individual plans. The agreement calls for Anthem Blue Cross to do the following:
• Offer coverage to 2,300 members whose policies it rescinded.
• Reimburse the individuals for medical expenses they incurred after losing their coverage with the company, at a cost estimated at as much as $14 million.
• Pay a $1 million fine.
• Simplify its coverage application.
• Modify the way it sells and manages individual health insurance coverage in California.
In July 2008, Anthem Blue Cross reached a settlement with the California Department of Managed Healthcare that requires the insurer to offer coverage to about 1,700 former plan members whose policies had been canceled.

Worksite Marketing News

Voluntary Benefits Become an Important Part of Sales  
Voluntary benefits used to be seen as an extension of the core group portfolio, but the market has changed dramatically over the past few years, according to an Eastbridge report. “We believe that having a separate strategy for voluntary is critical for any company that wants to be a leader in the voluntary market,” says Gil Lowerre, president of Eastbridge. Today, companies plan for and track voluntary separately and have specific voluntary sales goals, says Bonnie Brazzell, vice president of Eastbridge. Brazzell says that another change is that group companies are now developing products specifically for the unique needs of the voluntary market. In the past, carriers have simply used their traditional group plans on an employee-pay-all basis. All of the changes are positive signs for these carriers and the industry as a whole. “We are seeing group and individual companies change to better meet the competition and the needs of the market,” says Lowerre. For more information, visit www.eastbridge.com.

Employees Don’t Understand Health Insurance Coverage For Cancer
Half of working Americans with health insurance don’t have a clear understanding of what cancer expenses their health plan covers. This is according to a recent online survey of 1,067 full-time employees conducted by Harris Interactive on behalf of Colonial Life. Tom Gilligan of Colonial Life points to a 2008 study by the American Cancer Society, which shows that Cancer costs the American public more than $219 billion a year and only 41% of these costs are covered by most major medical plans.
These include direct costs, such as hospital and doctors’ charges and medications. The remaining 59% of costs are indirect costs for lost wages, deductibles, travel expenses to and from treatment centers, child care, and lodging and meals.
“Group health insurance plans at work aren’t as comprehensive as they used to be...A growing number of employees may be interested in purchasing a personal cancer plan at work, particularly if cancer runs in their families, and paying for the policy themselves,” Gilligan says.  For more information, visit www.coloniallife.com.

Voluntary Benefits Awareness Program
Avant Benefits will conduct 50,000 hours of outbound telemarketing via a dedicated, US-based voluntary benefits call center. The calls will target every organization in the country with 50 to 100,000 or more employees, excluding non-performing business classes, such as real estate agencies and restaurants. Avant Benefits first schedules a meeting with a prospective customer. It then notifies pre-approved participating carriers, enrollment firms, and independent agents. All participants are offered the same opportunity, and the first to respond will receive the pre-scheduled meeting exclusively. The meeting is reconfirmed by Avant Benefits, at which time the prospect is given the name and title of the participating representative. Most independent agents pay a flat rate for each confirmed guaranteed meeting and retain all of the commission generated. Agents and brokers can sign up at www.avbap.com. Carriers and enrollment firms should contact Avant Benefits in Massapequa, N.Y., by emailing adam.post@avantbenefits.com or calling (800) 514-9039.