Minnesota's 4 leading insurers, Blue Cross Blue Shield of MN, HealthPartners, Medica, and Preferred One, are already gearing up for the additional benefit demands due to Health Care Reform. The bottom line is that the legislated changes will cost more, so the question is where does the insurer cut to keep premiums down. Sky rocketing health costs have been an issue for years, and now the consumer is going to have to make more choices and shoulder more costs. The biggest change will affect benefits in services that will no longer be covered, in pharmacy, and new network options, beginning with groups renewing 7-1-2010 and after. Here is a rough breakdown of some of the changes that all or some of the insurers are implementing:
New Benefit Exclusions: Acupuncture - HealthPartners, Medica & Preferred One Bariatric Surgery - HealthPartners, Medica, & Preferred One Ins Co
Infertility treatment- HealthPartners, Medica, and Preferred One
Orthognathic surgery - HealthPartners, Medica , & Preferred One
Out of Pocket Maximum Increases: Blue Cross, HealthPartners, Medica, & Preferred One. Out of Network-Out of Pocket Maximum: huge increases by all insurers
Prescription Drug Changes: Brand Name & Specialty Drug Copays Increase -Blue Cross, HealthPartners, Medica
Excluded Drugs for Coverage related to infertility, erectile dysfunction, allergy (antihistamines), Proton Pump Inhibitors, acid reflux & stomach ulcers - HealthPartners & Medica
Network Changes: "Perform"- a new option w/HealthPartners which excludes all Mayo Clinics & affiliates. Blue Cross has their "Accord" network which excludes the Mayo system for their Freedom plans.
Blue Cross has hinted that they will also be making covered service changes this fall. A likely guess is that they will also begin excluding coverage for acupuncture, bariatric surgery, and infertility treatment. These are considered elective services that are very costly, and should not be a burden for the majority of insured members. It's important to study your benefit changes with your renewals this year, and publish these changes for your employees to review so that there are no surprises. The good that comes with these changes is that it forces us to be better consumers. (We can't have our cake and eat it too!) Have a great summer...