Congress Said COVID-19 Tests Should Be Free — But Who’s Paying?

Hospitals around the country are afraid to send out hundreds of thousands of bills related to COVID-19 testing. That’s because Congress mandated there would be no copays and no out-of-pocket costs for patients. But many employers with self-funded health plans seem to believe they’re exempt from the rules.

The issue comes down to an interpretation of whether the new federal legislation applies to health plans offered by larger employers. Those companies, which usually have at least a few hundred employees, often use their own money to pay claims as a way to drive down costs. A survey by the Kaiser Family Foundation finds a majority of Americans with health coverage are in this type of plan. Read More: KHN

Blue Cross Blue Shield of Michigan to Return More Than $100 Million to Insured Customers and Members for Medical, Dental and Vision Premiums

Due to disruptions in previously anticipated health care services caused by the COVID-19 pandemic, Blue Cross Blue Shield of Michigan and Blue Care Network will be returning more than $100 million to many fully insured customers this year. The refunds are in addition to $494 million that BCBSM has invested in expanding the availability of no-cost benefits for members and to support health providers in response to COVID-19 – bringing the BCBSM enterprise’s commitment in response to the crisis to nearly $600 million. Read More: BCBSMI

Americans’ Health Care Costs Rise Again, Now $28k per Family

From BenefitsPro

Katie Kuehner-Hebert is reporting in BenefitsPro that the cost of health care for a typical American family of four receiving coverage from an employer-sponsored preferred provider plan will rise by just 4.5 percent this year. This is according to the 2018 Milliman Medical Index.

The article notes that the index also found that prescription drug trends are down for the third consecutive year. However, while employers are paying more, employees are paying a lot more. Over the long-term, Milliman had seen employees footing an increasingly higher percentage of the total. That trend continues in 2018, with employee expenses increasing by 5.9 percent, while employer expenses increased by only 3.5 percent.

Read more

Study: Market Power Drives up Hospital Prices

Hospital costs for those who are privately insured vary widely and are much higher than Medicare payment rates, a new study by the Center for Studying Health System Change (HSC) found.

Within the communities studied, hospital prices for privately-insured patients were found to be approximately one-and-a-half times the Medicare rates for inpatient care, and twice what Medicare pays for outpatient services.

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ACOs’ Coordinated Care Savings May Be Contagious

Accountable care organizations (ACOs) may actually be the unicorns we’ve been waiting for, spreading their cost-saving magic throughout the health system.

An early cost-sharing program in Massachusetts designed to cut costs for private Blue Cross Blue Shield patients also lowered costs for Medicare patients who were seen by the same providers, according to a study published Tuesday in the Journal of the American Medical Association.

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Consumer Driven Health Care Plans Can Help Reduce Health Care Spending and Make Positive Behavior Changes: HCSC

CHICAGO, June 13, 2012 /PRNewswire via COMTEX/ — Consumers enrolled in Consumer Driven Health Plans (CDHPs) are more likely to make sustainable, positive behavior change leading to significant health plan spend reductions year over year, according to data studied by Health Care Service Corporation (HCSC), operator of the Blue Cross and Blue Shield Plans in Illinois, Texas, Oklahoma and New Mexico. Members who migrated to CDHP plans – those that have a higher deductible, prompting consumers to be more directly involved with the selection and usage of health care services – reduced their health care spending significantly.

This study is unique because of its focus on tracking individual members who migrated from traditional health plan coverage to CDHP coverage in order to analyze their health care behavior and their health care spending habits both before and after the switch. The data also showed that changes in behavior, including increases in preventive care and use of generic prescriptions, helped contribute to a reduction in health care spending for both employers and members.

The CDHP program, BlueEdge(TM), is offered through the four Blue Cross and Blue Shield Plans, and includes Health Savings Account (HSA) and Health Reimbursement Account (HRA) options. BlueEdge enrollment surpassed 1.5 million members earlier this year, after experiencing double-digit percentage increases for six straight years.

Key results from the study indicate that, following migration from a traditional non-CDHP plan to a CDHP, on average, the CDHP members studied:

  • were four percent more likely to take advantage of preventive services.
  • reduced health care utilization by an aggregate of more than 12 percent.
  • were 10 percent more likely to fill their prescriptions with generics.
  • spent 24 percent less on inpatient hospital services and eight percent less on outpatient services.
  • had a 12 percent decrease in emergency room visits.
  • reduced combined medical and pharmacy spend by an aggregate of 11 percent

In addition, data showed that employers who offered only a CDHP saw even greater spend reductions – up to an aggregate of 14.4% over the three years following migration from a traditional plan to a CDHP.

“Our BlueEdge CDHP program gives consumers the flexibility and tools to help make positive decisions to reduce their healthcare spend, coupled with broad access to care, award-winning service, comprehensive incentives, wellness and care management programs, and a personalized, engaging health care experience,” said Thomas Meier, Vice President, product development, HCSC. “Our experience finds that CDHP members tend to be more engaged and informed in making better health care decisions.”

This is the second year that HCSC has done this analysis, this year studying more than five years of data for more than 265,000 members (with pharmacy data available on 121,000 of those members). HCSC continues to invest in more consumer focused approaches, adding more robust incentives and value-based insurance design products in 2013 to complement both traditional and CDHP plans.

“Our findings are significant because they indicate both real and potential health care spend reductions. Rather than comparing the utilization of different groups of consumers, we have focused on the utilization changes of members who migrated from traditional plans to CDHP. The fact that we are comparing the same members in both plans allows us to minimize inherent risk differentials,” said Guy McGinnis, Vice President, client analytics, HCSC.

About Health Care Service CorporationHealth Care Service Corporation, a Mutual Legal Reserve Company, is the country’s largest customer-owned health insurer and fourth largest health insurer overall, with more than 13 million members in its Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas. HCSC is an independent licensee of the Blue Cross and Blue Shield Association. For more information, please visit , visit our Facebook page or follow us at .

SOURCE Health Care Service Corporation


New 2011 Health Care Benefits Data: High Deductible Plans Demonstrate Savings

BOSTON & ARLINGTON, Va.–(BUSINESS WIRE)–HighRoads, the industry leader in employer health care regulation compliance, and the Corporate Executive Board (NYSE: EXBD) (CEB), a leading research and advisory services company, today announced the results of their first joint study on health care benefits plan design data. The combined study from The Lab®, HighRoads’ real-time employer benefits database, shows that employees can save an average of $187 a year in premium savings alone by using a high-deductible consumer-driven health plan (CDHP). Families can save an average of $204 a year by using a CDHP. While CDHP’s provide savings in premiums, and in over-all maximum out-of-pocket exposure, the savings may be too small and the deductible too high relative to traditional Preferred Provider Organization plans (PPOs) and Health Maintenance Organization plans (HMOs) to encourage a larger percentage of employees switching to CDHPs. As such, PPOs still remain the most popular health care plan offering.

“As employee benefits professionals devise their benefit plan designs for 2012, fresh data on average plan designs will provide them with the industry-standard metrics and trends they need to make informed decisions”

The Lab, which includes Fortune 500 benefits data from HighRoads, CEB’s Corporate Leadership Council, and Thomson Reuters Healthcare, is comprised of data from over 10,500 real medical plan designs and rates, representing over 30 million lives.

“The data available through this partnership provides employers with a wealth of information on health care plan designs,” said Ania Krasniewska, senior director, Corporate Executive Board. “Leveraging this robust benchmarking tool, organizations now have the ability to compare their health plans against the national landscape of employers to ensure a best practice approach as they prepare for the Fall open enrollment period.”

Based on a recent data snapshot which shows results for 2011, The Lab reveals the following trends:

1. PPO plans are still the most widely offered employer plans, despite heavy communications around consumerism strategies with high deductible CDHPs. PPOs represent 39% of employer plans. Health Maintenance Organization plans (HMOs) represent 27%. High deductible plans represent 17%.

2. Monthly employee premiums for traditional (non high deductible plans) are consistent across the board, with an average monthly, employee only, premium of $132.11. PPOs are $149.88 per month. HMOs are $132.73 per month. Exclusive Provider Organization plans (EPOs) are $111.36 per month.

3. Monthly employee premiums for CDHPs are much lower, with an average monthly, employee only, premium of $62.14.

4. CDHP plans, for most individual employees and families, offer a lower annual total out-of-pocket cost compared to PPOs. When adding the average out-of-pocket costs for annual premiums, in network deductibles, and health savings account (HSA) contributions (specifically for CDHP plans), the average total annual individual out-of-pocket cost is $2,128 for CDHP plans compared to PPOs which have an annual out-of-pocket cost of $2,315. For families, the average total annual out-of-pocket cost is $5,656 for CDHPs and $5,860 for PPOs.

“As employee benefits professionals devise their benefit plan designs for 2012, fresh data on average plan designs will provide them with the industry-standard metrics and trends they need to make informed decisions,” said Eric Parmenter, Vice President of Consulting, HighRoads. “Data from The Lab shows that employee education around the cost savings possible with CDHP may help many employees reduce their out-of-pocket health care expenses while offering them increased flexibility and control over their health care decisions.”

The recent study also showed average co-pays and coinsurance contributions for in-network primary care physicians and specialists, non-traditional services including chiropractor and physical therapists, and urgent care facilities. Average in-network co-pays are $19 per visit for primary care providers, $31 per visit for specialists, and $103 per visit for emergency room.

To request a complete copy of the report, please contact Petra Marino at

About The Lab

The Lab is the single largest benchmarking repository of health care benefit plan data in the U.S. It provides a number of health care benchmarks including statistics on alternative care, preventative care testing and screening, surgery, maternity, mental health, family planning, prescription drugs, vision and hearing care. Employers use The Lab data to compare their plans with other organizations by industry, geography, company size, plan and employee type.

About HighRoads

The world’s leading employers choose HighRoads to gain complete control over their health care costs and compliance. With HighRoads’ service, employers have online access to benefits plan information and pricing, competitive benefits benchmarks, and complete benefits supply chain management. The privately-held company is headquartered in Woburn, MA. For more information, visit

About the Corporate Executive Board

The Corporate Executive Board drives faster, more effective decision making among the world’s leading executives and business professionals. As the premier, network-based knowledge resource, The Corporate Executive Board provides customers with the authoritative and timely guidance needed to excel in their roles, take decisive action and improve company performance. Powered by an executive network that spans over 50 countries and represents approximately 85 percent of the world’s Fortune 500 companies, The Corporate Executive Board offers unique research insights along with an integrated suite of exclusive tools and resources that enable the world’s most successful organizations to deliver superior business outcomes. For more information, visit


Employers Stress Healthier Habits and Behavior Change in an Effort to Lower Health Care Costs

LINCOLNSHIRE, Ill., June 2, 2011 /PRNewswire/ — Employers are beginning to rely more on employees to stem the tide of rising health care costs, but the inability to motivate and change habits has prompted concern, according to Aon Hewitt, the global human resource consulting and outsourcing business of Aon Corporation (NYSE: AON).

Aon Hewitt surveyed 1,028 employers nationwide in its 2011 Health Care Survey and found that the top health care outcomes organizations would like to achieve this year are improving employee health habits (56 percent), lowering the health care cost trend (49 percent), decreasing worker health risk (44 percent), increasing participant awareness of health issues (37 percent) and enhancing participation in health improvement/disease management programs (37 percent).  This survey suggests that success may be difficult, as 56 percent of respondents say motivating participants to change unhealthy behaviors is the most significant challenge to accomplishing 2011 health care program goals.  This was followed by issues involving reluctance to change (26 percent), unpredictability of costs (23 percent), government regulations/compliance (22 percent) and managing the health of an aging workforce (21 percent).

In addition, this survey revealed that many companies offer disease management (70 percent), health and wellness improvement (64 percent) and behavioral health (60 percent) as key components to health care strategies.  In an acknowledgement that more needs to happen to achieve success, many organizations are looking to expand efforts during the next three to five years and implement strategies that focus on total well being to improve physical and mental health (60 percent), absence management (53 percent), and integrated safety and health improvement efforts (50 percent).

“Despite reform, organizations still face rising costs and worsening population health,” said John Zern, Americas Health & Benefits Practice leader with Aon Hewitt.  “It’s clear that traditional annual trend mitigation tactics alone won’t work.  As a result, leading employers are implementing a ‘house money, house rules’ environment, using a mix of incentives, penalties and targeted messaging to reward healthy behaviors.”

While some companies are budgeting for a medical trend increase during the next four years, many do not have a long-term increase built into their budgets as of yet.  Nearly one-third of respondents (30 percent) have budgeted an annual medical trend increase between 4 percent and 7 percent from 2011 – 2015, and 22 percent have budgeted an increase of more than 8 percent during that time.  Meanwhile, 42 percent have not built an annual long-term increase into their budget at this point.

“Employers are spending millions of dollars annually on health care, and yet many report they do not have a specific plan for how best to manage that investment,” notes Jim Winkler, Large Employer Segment leader in the Health & Benefits Practice with Aon Hewitt.  “Given the risks and opportunities presented by health care reform, it is imperative that employers develop a written strategy for controlling cost and improving health.”

Rewarding & Penalizing Participants

The Aon Hewitt survey also showed that 22 percent of employers will have programs in place by the end of 2011 to reward participants for achieving specific health outcomes, and 10 percent will have similar programs to penalize participants for exhibiting unhealthy behavior.  However, by 2016, 64 percent of organizations said they will add programs that reward for good health, while 46 percent said they will add programs that penalize for unhealthy outcomes.

Respondents currently offer incentives to employees for participation in key initiatives, such as biometric screenings (33 percent), health risk assessments (33 percent), wellness programs (31 percent) and tobacco cessation programs (27 percent).  Conversely, some employers are imposing a penalty for non-participation in biometric screenings (5 percent), health risk assessments (5 percent), wellness programs (2 percent) and tobacco cessation programs (6 percent).

Money serves as the primary incentive and penalty these employers use to promote employee participation in key programs, including health risk assessments (66 percent have a monetary incentive; 9 percent have a monetary penalty); biometric screenings (65 percent have a monetary incentive; 8 percent have a monetary penalty); disease/condition management (54 percent have a monetary incentive; 9 percent have a monetary penalty); and wellness programs (59 percent have a monetary incentive; 6 percent have a monetary penalty).

“In a challenging economy, organizations are using financial incentives, as a mix of rewards and penalties, to motivate behavior change,” said Jennifer Boehm, principal in the Aon Hewitt Health & Benefits Practice, and a project leader for the survey.  “However, leading employers also recognize that success requires more than just dollars; those organizations also focus on marketing health improvement services, eliminating barriers to needed care and measuring the impact of specific interventions.”

Additional Survey Data

  • One-third of organizations currently offer stress reduction programs and 35 percent offer nutrition programs to employees.
  • Slightly more than half (52 percent) of employers have initiatives targeted to employees with chronic conditions (e.g., asthma, diabetes, heart conditions).
  • Less than 20 percent of organizations have performance goals tied to wellness success or participation levels, while 49 percent plan to add this type of program in the next three to five years.
  • By 2016, 77 percent of employers plan to have targeted communications on their health care programs, based on workforce demographics.
  • By 2016, 61 percent of employers plan to use social media to reinforce smart health behaviors and actions with their plan participants.

About this Survey

Aon Hewitt surveyed more than 1,000 HR Professionals nationwide on their current and future health care plans and practices.  In the findings report, Aon Hewitt offers analysis on the trends and insights within the context of four dimensions of a successful health care strategy: optimizing plan design and funding, reducing expenses, engaging participants in managing health, and improving health and workforce productivity.  To download a copy of Aon Hewitt’s 2011 Health Care Survey Report, please visit

About Aon Hewitt

Aon Hewitt is the global leader in human resource consulting and outsourcing solutions.  The company partners with organizations to solve their most complex benefits, talent and related financial challenges, and improve business performance.  Aon Hewitt designs, implements, communicates and administers a wide range of human capital, retirement, investment management, health care, compensation and talent management strategies.  With more than 29,000 professionals in 90 countries, Aon Hewitt makes the world a better place to work for clients and their employees.  For more information on Aon Hewitt, please visit

Assurant Health Now Offers Payment Advocacy Services

Milwaukee, Wis., February 15, 2011—Assurant Health announced today that it will be offering a payment advocacy service to all its Assurant Health AccessSM customers who have more than $500 in out-of-pocket expenses related to their healthcare.  This service is available through Assurant Health’s agreement with Health Payment Advocates (HPA), a healthcare financial advocacy firm, at no additional cost to its customers.

The advocacy service helps Assurant Health Access customers understand their financial liability and assists them in managing and reducing their out-of-pocket medical expenses that exceed $500, regardless of the reason. Assurant Health Access is Assurant Health’s convenient, low-cost option for individuals who want coverage for routine medical care expenses, as well as cost sharing on many major expenses, without large deductibles.

When customers use the HPA services, experienced professionals will serve as their advocates with medical providers to find solutions acceptable to both parties. These potential resolutions can include discounts on the amount owed or enrolling the customer in a payment plan or charity care program.

“We are always looking for new ways to differentiate our offerings and provide additional services for customers,” said Scott Krienke, senior vice president, product and marketing at Assurant Health. “At a time when plan members are becoming responsible for an increasingly large share of their health care expenses, we feel it is important to provide them with tools and services to help manage those expenses.”

“We conducted a pilot of the HPA services across our entire book of business over the last year, and the results exceeded our expectations.  That’s why we’re now offering this service to individuals enrolled in our Assurant Health Access product to help them manage their exposure if they exceed coverage limits and have high out-of-pocket expenses.”

“We welcome the opportunity to continue and expand our relationship with Assurant Health,” said Terry Harris, president of HPA. “The recession, healthcare reform and continued cost-shifting have all caused hardships for many healthcare consumers.” 

About Assurant Health

Assurant Health has been in business since 1892 and is the brand name for products underwritten and issued by Time Insurance Company, John Alden Life Insurance Company and Union Security Insurance Company. Together, these three underwriting companies provide health insurance coverage to people nationwide. Each underwriting company is financially responsible for its own insurance products. Primary products include individual medical, small group and short-term health insurance products, as well as non-insurance products and consumer-choice products, such as Health Savings Accounts and Health Reimbursement Arrangements. Assurant Health is headquartered in Milwaukee, Wis., with operations offices in Minnesota, Idaho and Florida, as well as sales offices across the country. The Assurant Health website is

About Health Payment Advocates, LLC

Health Payment Advocates (HPA) is dedicated to helping plan members understand and minimize their healthcare related out-of-pocket expenses.   HPA works with the payer, TPA, broker and employer group community to provide significant administrative savings for the plan and administrator. For more information, please visit the firm’s web site at

CIGNA CDHP Study Shows How Americans Can Reduce Their Health Care Costs Without Compromising Care

When Americans engage in health-smart habits such as participating in health coaching and disease management programs, substituting generic medications for brand name drugs and avoiding unnecessary trips to the emergency room, their total medical costs went down 15 percent — an average $358 per person in the first year — according to a new multi-year study comparing the health care claims experience of 897,000 CIGNA customers in consumer driven health (CDH) plans, PPOs and HMOs.

The 2010 Fifth Annual CIGNA Choice Fund Experience Study findings show individuals covered by CIGNA Choice Fund CDH plans improve their costs without compromising care by becoming more engaged in improving their health and by becoming informed health care consumers:

  • Health coaching and disease management program participation: CIGNA CDH plan customers are up to 19 percent more likely to participate in the CIGNA Health Advisor® health coaching program compared to those enrolled in a traditional plan. Individuals with chronic illnesses covered by CDH plans are 21 percent more likely to participate in their plan’s disease management program.
  • Generic medications: CIGNA CDH plan participants who also have CIGNA Pharmacy Management benefits choose generic equivalent drugs 70 percent of the time.
  • Avoiding Unnecessary ER visits: The study also shows that CDH plan enrollees use the emergency room at a 13 percent lower rate than individuals who have HMO and PPO plans. When CIGNA Choice Fund customers visit an urgent care facility, their doctor’s office or convenience clinic instead of the ER, they saved an average of $800.
  • Informed choices: Customers enrolled in a CIGNA CDH plan are more likely to use online information and tools through; use of myCIGNA increases by 40 percent when customers are enrolled in a CDH plan. The study also shows CDH plan enrollees are five times more likely to complete a health assessment compared to those enrolled in a traditional plan.

One company that is realizing the benefits of CIGNA Choice Fund plans is Starwood Hotels & Resorts. According to Starwood Executive Vice President and Chief Human Resources Officer Jeff Cava:

“Starwood is demonstrating that by giving our associates affordable health plan choices supported with education and health advocacy resources to help them make better health care decisions, people will make good decisions about their health and wealth. Early on it has become clear that more Starwood associates are using their preventive benefits, increasingly choosing generic medications over costlier brand names and taking advantage of free preventive prescriptions through CIGNA Home Delivery Pharmacy. Moreover, our associates are literally “buying into” their plans — with 83 percent contributing their own pre-tax dollars to their health savings accounts.”

As with previous CIGNA studies, the Fifth Annual CIGNA Choice Fund Experience Study confirms that CDH plans reduce health care costs relative to other types of plans without compromising care or shifting costs to employees:

  • Immediate and sustainable cost savings: CIGNA CDH medical costs are 15 percent lower than traditional plans during the first year, cumulative cost savings rise to 18 percent in the second year, 21 percent in the third year, 24 percent in the fourth year, and 26 percent in the fifth year.
  • Higher levels of care: New CIGNA CDH customers had the same or better statistical compliance with 400 evidence-based medical best practice measures than their counterparts in traditional plans, and compliance among CIGNA CDH customers is 14 percent higher for those enrolled in CDH plans for multiple years. Moreover, CDH customers sought preventive care 8 to 10 percent more frequently than those enrolled in a traditional plan.
  • Less cost for those with chronic conditions: Medical cost trend was substantially less for CIGNA CDH customers with joint disease (21 percent less), diabetes (8 percent less) and hypertension (7 percent less), than for individuals with any of those diseases in traditional CIGNA health plans.
  • No cost-shift from employers to employees: CIGNA CDH customers with health reimbursement accounts paid out of their own pockets an average of $35 less per year compared to customers in traditional plans, demonstrating that savings can be achieved without cost shifting; also the percentage of total cost was the same for both men and women.

“Our studies have consistently shown individuals in CIGNA Choice Fund plans reduce their annual health care costs without compromising care, and now the data are rolling in showing why,” explains CIGNA Chief Medical Officer Jeffery Kang, M.D. “The evidence is clear. Given the right incentives, the right health improvement programs, useful cost and quality information, and easy-to-understand correspondence, individuals are making rational, wise and successful health care decisions.

“Perhaps because most individuals covered by CIGNA Choice Fund plans are receiving the same or better levels of care for lower cost, 83 percent of those surveyed report that they are “satisfied” or “very satisfied” with the service for their CDH plans – slightly higher than the 82 percent satisfaction rate across all of our health plans.”


CIGNA (NYSE:CI), a global health service company, is dedicated to helping people improve their health, well being and sense of security. CIGNA Corporation’s operating subsidiaries provide an integrated suite of medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance, through 60 million customer relationships with individuals in the U.S. and around the world. To learn more about CIGNA, visit