 |
| Sep 30, 2009 |
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CDHP adoption rate rose among big employers, despite the economy |
| Sep 16, 2009 |
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Employees like their health plans, despite gaps in understanding |
| Sep 10, 2009 |
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Obama proposes controversial employer mandate, public option |
| Sep 1, 2009 |
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Hospital cracks down on ER visits |
| Aug 20, 2009 |
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COBRA enrollment soars, reports Hewitt |
| Aug 11, 2009 |
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NY law seen as harbinger of more state health reform |
| Aug 4, 2009 |
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Near-term health trends familiar, irrespective of reform |
| Jul 21, 2009 |
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Employers lukewarm on public-plan option, survey shows |
| Jul 17, 2009 |
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House committee approves health reform bill |
| Jul 15, 2009 |
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Senate committee passes health reform bill |
| Jul 7, 2009 |
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‘Pay or play’ not as painful as originally thought |
| Jul 1, 2009 |
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Five costly conditions to watch |
| Jun 30, 2009 |
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Americans go online for health information |
| Jun 23, 2009 |
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Pennsylvania passes mini-COBRA law |
| Jun 16, 2009 |
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Health benefits taxation takes center stage |
| Jun 8, 2009 |
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Obama alters stance on health reform proposals |
| May 28, 2009 |
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Mail trail shows health insurers readying for reform |
| May 19, 2009 |
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Health care costs hit women harder |
| May 7, 2009 |
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To see a doctor, get in line |
| May 1, 2009 |
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Considering the exit ramp: Employers rethink offering health benefits |
| Apr 23, 2009 |
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Hard times tighten ‘use-it-or-loss-it’ bond to health benefits |
| Apr 13, 2009 |
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COBRA subsidy expected to be costly |
| Apr 6, 2009 |
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Workplace wellness bill reintroduced with greater support |
| Mar 24, 2009 |
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New COBRA model notices released |
| Mar 10, 2009 |
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Twelve ways to slash medical bills |
| Mar 1, 2009 |
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Self-insuring is a way for employers to get 'a whole lotta cannoli' |
| Feb 23, 2009 |
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Employers turn to eligibility audits, voluntary benefits to control health care costs |
| Feb 11, 2009 |
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Senate, House debate COBRA subsidy |
| Feb 3, 2009 |
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Dems optimistic on comprehensive health reform |
| Feb 1, 2009 |
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How's this for an incentive? You get to keep your health insurance |
| Jan 27, 2009 |
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Medicare reimbursement shakes things up |
| Jan 20, 2009 |
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Health benefit costs continue to rise, survey shows |
| Jan 13, 2009 |
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N.Y. proposes policy requiring employers to extend dependent coverage |
| Jan 1, 2009 |
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Health care reform to take center stage this year |
| Dec 16, 2008 |
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Employees cut back on health costs - for better or worse |
| Dec 1, 2008 |
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Moderating health care costs could signal trouble ahead |
| Nov 25, 2008 |
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Tobacco addiction costs employers $167.5 billion a year |
| Nov 18, 2008 |
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Benefits professionals favor drastically reworked employer-based systems in new administration |
| Nov 11, 2008 |
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Employers urged to flex muscle on health care reform |
| Nov 4, 2008 |
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Obesity epidemic remains a battle |
| Nov 1, 2008 |
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Evidence shows positive outcomes from greater investment in primary care |
| Oct 21, 2008 |
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Losing sight of wellness program goals |
| Oct 14, 2008 |
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DOL seeks comments on how health plans use genetic data |
| Oct 1, 2008 |
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More patients heading to the emergency room |
| Sep 23, 2008 |
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BFE: Up your FMLA ante with these helpful tips |
| Sep 15, 2008 |
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Companies combat high HMO premiums with aggressive strategies |
| Sep 8, 2008 |
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Steady support for wellness and disease management |
| Sep 1, 2008 |
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Chronic conditions afflict more than half of Americans |
| Aug 12, 2008 |
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HHS wants wellness program advice |
| Aug 1, 2008 |
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Attention all shoppers: How to be a smart PBM shopper |
| Jul 15, 2008 |
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Parties stand far apart on health care reform |
| Jul 10, 2008 |
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Benefits to protect— and add— during economic downturns |
| Jul 1, 2008 |
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Seven Self-Insurance Myths |
| Jun 24, 2008 |
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Growth of employer medical costs projected to accelerate |
| Jun 15, 2008 |
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Pushing the envelope: Zero tolerance on tobacco use |
| Jun 1, 2008 |
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A new direction for health care reform and HMOs |
| May 27, 2008 |
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What's next for health care reform? |
| May 20, 2008 |
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Ohio, W.Va. and Pa. say no to CDHPs, survey reports |
| May 6, 2008 |
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Health plan study shows performance varies region to region |
| May 1, 2008 |
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Benefits finance: Is a self-insured health plan right for your company? |
| Apr 29, 2008 |
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HHS Secretary Leavitt backs value-based health care |
| Apr 22, 2008 |
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Obesity costs employers $45 billion a year |
| Apr 10, 2008 |
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Want to reduce sick days by an average of 41%? The solution is easy. Just walk. |
| Apr 1, 2008 |
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Robust incentives may improve retention rates in wellness programs |
| Mar 25, 2008 |
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Mercer Report: Employers focus on generic and specialty drugs to reduce Rx costs |
| Mar 11, 2008 |
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How to make your PBM more accountable |
| Mar 6, 2008 |
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Americans alarmed by gaps in quality health care delivery |
| Feb 21, 2008 |
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PBMI launches career center for drug benefit industry |
| Feb 12, 2008 |
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Business group wants to reduce health disparities among minorities |
| Feb 5, 2008 |
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Using incentives for health risk appraisals |
| Jan 31, 2008 |
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Mid-size employer turns to "hybrid" CDHP model |
| Jan 15, 2008 |
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Employees take advantage of wellness resources - when they're available |
| Jan 8, 2008 |
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Consumers are in the dark on health insurance terminology |
| Jan 1, 2008 |
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Checking the label: Transparency, generics utilization key components to effective PBM relationship |
| Dec 18, 2007 |
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Group counters belief that benefits sky is falling |
| Dec 4, 2007 |
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Touting large-scale ideas for health reform |
| Nov 20, 2007 |
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Health benefit costs still outpace the rate of inflation |
| Nov 8, 2007 |
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Toolkit outlines best practices in health coverage for mothers, children and adolescents |
| Nov 1, 2007 |
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Communications, wellness prove challenging for HR |
| Oct 15, 2007 |
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HealthMarkets charged with misleading customers and denying required care |
| Oct 4, 2007 |
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Is your company prepared for a pandemic? |
| Sep 25, 2007 |
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Focus on health plan design paying off for employers |
| Sep 15, 2007 |
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iPhone puts consumers' health records in the palm of hand |
| Aug 23, 2007 |
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Health insurers are starting to focus on value-driven plans |
| Aug 9, 2007 |
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California to produce first PPO report card |
| Aug 1, 2007 |
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Chicago museum makes walking exhibit grounds cornerstone of successful, no-frills wellness program |
| Jul 24, 2007 |
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Health care costs top employer concerns |
| Jul 12, 2007 |
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Benefit professionals react to Moore's depiction of health care |
| Jul 1, 2007 |
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Creating wellness incentives that resonate with workers |
| Jun 21, 2007 |
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Health insurance inflation is slowing down |
| Jun 15, 2007 |
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On the contrary: Employers not looking to shift costs |
| Jun 1, 2007 |
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Can't we all just get along? Achieving successful benefits integration with multiple carriers |
| May 17, 2007 |
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Employers shift focus to prevention |
| May 17, 2005 |
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Employers shift focus to prevention |
| May 8, 2007 |
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Fortune 500 firms push for health reform |
| May 2, 2007 |
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Biotech drug costs skyrocket |
| Apr 26, 2007 |
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Experts help small firms with health plans |
| Apr 18, 2007 |
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Group says health premium jumps should be justified |
| Apr 5, 2007 |
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HMOs more cost-effective in California |
| Mar 20, 2007 |
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CVS buys Caremark |
| Mar 6, 2007 |
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Americans value e-health services |
| Feb 22, 2007 |
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Top-rated hospitals have lower mortality rates |
| Feb 5, 2007 |
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Participation in wellness programs grows |
| Jan 25, 2007 |
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Country reacts to Bush health care proposal |
| Jan 16, 2007 |
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FMLA ruling protects subsidiaries |
| Jan 10, 2007 |
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Latest CDH trend may be plan attrition |
| Jan 3, 2007 |
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Tool helps employers keep up with the "Joneses" |
| Dec 20, 2006 |
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Majority unaware of medical costs |
| Dec 13, 2006 |
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Bill makes HSAs more flexible |
| Dec 5, 2006 |
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Half of CDHP users would switch plans if possible |
| Dec 1, 2006 |
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Health inflation lower, but worries grow over "fraying benefits" |
| Nov 30, 2006 |
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NBGH launches free guide to preventive care |
| Nov 16, 2006 |
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Medical costs may show double-digit increase in 2007 |
| Nov 7, 2006 |
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Most workers do not use FSAs |
| Oct 25, 2006 |
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PBMs keeping up with Wal-Mart |
| Oct 17, 2006 |
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Consumers prefer generics to brand drugs |
| Oct 11, 2006 |
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Workers worried about future of health benefits |
| Oct 1, 2006 |
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Dental providers embark on new ways to offer benefits |
| Sep 20, 2006 |
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Questions remain about provider quality programs |
| Sep 15, 2006 |
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Cheaper Zocor throws generic market a curveball |
| Sep 6, 2006 |
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HSA assets surge over past six months |
| Sep 1, 2006 |
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Consumers get more tools to gauge medical costs, quality |
| Aug 31, 2006 |
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Workers motivated by richer benefits |
| Aug 24, 2006 |
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Bush compels price and quality transparency in health care |
| Aug 17, 2006 |
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Workers uneasy about pay, health care |
| Aug 9, 2006 |
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HMOs account for one quarter of insurance market |
| Aug 1, 2006 |
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Generics influx drags prescription drug trend to seven-year low |
| Jul 25, 2006 |
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Depression costs related to health care access |
| Jul 12, 2006 |
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Research shows effects of quality ratings for surgeons |
| Jul 6, 2006 |
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Employers portend scaling back retiree medical benefits |
| Jun 20, 2006 |
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Tips for CDHP roll-outs |
| Jun 15, 2006 |
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Ohioans recoup $6.5 million in health claims |
| Jun 8, 2006 |
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Not-so-great expectations for health costs |
| Jun 1, 2006 |
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Vermont latest state to pass health reform |
| May 30, 2006 |
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Study gauges health data gap |
| May 17, 2006 |
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Most employers do not offer DM, wellness, but they want to |
| May 10, 2006 |
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Declining employer-sponsored health plans documented |
| Apr 27, 2006 |
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Workers build muscle with incentives |
| Apr 25, 2006 |
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Change coverage to lower pregnancy cost |
| Apr 20, 2006 |
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Health experts face off on access vs. innovation |
| Apr 15, 2005 |
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Target draws bead on consumer-driven health care |
| Apr 11, 2006 |
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Female employers worry about skyrocketing health costs |
| Apr 5, 2006 |
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Mental health benefits add value, not cost |
| Mar 27, 2006 |
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Validate your health ROI to the CFO |
| Mar 21, 2006 |
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Variety of strategies needed to curb health costs |
| Mar 9, 2006 |
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Managers doubt CDH will make workers healthier |
| Mar 1, 2006 |
|
Health care to account for 20% of GDP by 2015 |
| Feb 23, 2006 |
|
Higher co-pay differentials increase generic fill rates |
| Feb 14, 2006 |
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Consumer advocates worry about health data privacy |
| Feb 7, 2006 |
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Cost and talent issues challenge benefit professionals |
| Jan 25, 2006 |
|
More than half of seniors stay away from Part D |
| Jan 15, 2006 |
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Mind the Meds: Top 10 pharmacy benefits management strategies for 2006 |
| Jan 2, 2006 |
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Put your health care eggs in many baskets |
| Dec 14, 2005 |
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CDH participants dissatisfied but frugal |
| Dec 8, 2005 |
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Health care banking gets the Blues |
| Dec 1, 2005 |
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Generic drugs offer employers untapped savings |
| Nov 29, 2005 |
|
Care management, cost-shifting reduce health costs |
| Nov 17, 2005 |
|
Pay-for-performance generates quality improvements |
| Nov 15, 2005 |
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Employers should examine full impact of obesity |
| Nov 3, 2005 |
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US CEOs more health care cost conscious |
| Nov 1, 2005 |
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Health cost relief takes center stage at BMF&E |
| Oct 25, 2005 |
|
Wal-Mart extends lower-cost health insurance |
| Oct 11, 2005 |
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Large companies find lower health care hikes since 1999 |
| Sep 21, 2005 |
|
Cost-shift trend is also costing brokers |
| Sep 15, 2005 |
|
Financial incentives touted as health care cost fix |
| Sep 8, 2005 |
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PBM mail-order pharmacies deliver cheaper drugs |
| Aug 31, 2005 |
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A spoonful of compliance helps health costs go down |
| Aug 18, 2005 |
|
AutoNation claims UnitedHealthcare overpaid by $10 million |
| Aug 16, 2005 |
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Consumers elevate HMOs over PPOs |
| Aug 9, 2005 |
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Medical cost containment depends on changing habits |
| Aug 2, 2005 |
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Employers could see relief in benefit costs |
| Jul 26, 2005 |
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PBMs scoop up specialty pharmacies |
| Jul 15, 2005 |
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Off and running: Self-funded employers may have head start in push for wellness |
| Jul 5, 2005 |
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Walgreens says drug costs rose 7.2% in 2004 |
| Jun 28, 2005 |
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More than half of employers concerned about wellness |
| Jan 21, 2005 |
|
Benefit managers offer best ways to ease health costs |
| Jun 14, 2005 |
|
UnitedHealth has a million in consumer-driven plans |
| Jun 9, 2005 |
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Uninsured worsen medical inflation for workers |
| Jun 1, 2005 |
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New study puts medical costs into focus |
| May 24, 2005 |
|
Disease management has become the norm |
| May 10, 2005 |
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Unions found to have better access to health insurance |
| May 4, 2005 |
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Employers don't lie down for higher premiums |
| Apr 28, 2005 |
|
Mandatory health insurance rejected in California |
| Apr 21, 2005 |
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GM says health costs partly to blame for first-quarter losses |
| Apr 12, 2005 |
|
Group launches program to buy health insurance in bulk |
| Apr 7, 2005 |
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Maryland considers bill that mandates benefits spending |
| Mar 25, 2005 |
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Many would sacrifice choice for lower health costs |
| Mar 15, 2005 |
|
State health mandates scrutinized |
| Feb 9, 2005 |
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Scandals may prompt more online insurance bidding |
| Jan 19, 2005 |
|
Employers should investigate disease management math crimes |
| Jan 12, 2005 |
|
Clients tackle medical inflation roots |
| Jan 8, 2005 |
|
Employees prefer work-based insurance |
| Dec 21, 2004 |
|
Automated Systems For Drugs Examined |
| Dec 14, 2004 |
|
Companies Rapidly Cutting Health Benefits |
| Dec 2, 2004 |
|
40 Percent in U.S. Use Prescription Drugs |
| Nov 1, 2004 |
|
Your New Health Plan |
| Sep 27, 2004 |
|
Health costs rising faster than incomes, study says |
| Sep 13, 2004 |
|
Employers slow shift of health care cost burden to workers |
| Aug 10, 2004 |
|
Health care costs employers more than paid leave |
| Jul 15, 2004 |
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Health insurers lost $85 billion to fraud last year |
| Jul 22, 2004 |
|
Health and productivity management intrigues firms |
| Jun 4, 2004 |
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Rising benefit costs hurt small businesses' financial health |
| Feb 28, 2004 |
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Strike-weary grocery workers eye new offer |
| Feb 28, 2004 |
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Experts ponder limitations of cost-sharing |
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Self-insuring is a way for employers to get 'a whole lotta cannoli'
I enjoy eating at an Italian buffet restaurant here in Kansas City. While I like the pasta and grilled veggies, my favorite part is the desserts. I enjoy having the ability to try a variety of desserts, instead of just one.
This is the way I view self-insured health plans. There's a great deal of flexibility, and I have to say, there's nothing better than having leniency with plan design.
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The definition of "lenient" reads as follows: "exerting a soothing or easing influence; relieving pain or stress."
According to latest survey by The Kaiser Family Foundation, over 158 million people are covered under health care plans, and 55% of them are in a self-insured plan. The tasty part of a self-insured plan is that ERISA provides pre-emption from state laws relating to employee benefit plans. Thus, you don't have to worry about state-mandated benefits, premium taxes, consumer protection regulations or state insurance laws.
Look out chocolate — more employers have found a stress-reduction alternative.
According to The Council for Affordable Health Insurance, there are more than 1,900 mandates dictating who and what health plans must cover. Maryland, for example, requires up to $100,000 in coverage for in-vitro fertilization. Various states require coverage for providers such as dieticians, naturopaths, denturists and massage therapists. Arkansas mandates covering athletic trainers. New Jersey even requires insurers to offer coverage to unmarried dependents up to age 30. Man, I hope my kids are out of the house way before then.
CAHI estimates that these mandates can boost the cost of a policy between 20% and 45%. That's a whole lotta cannoli, if you ask me.
Basically, a self-insured plan only needs to comply with ERISA-mandated benefits, which include continuation of coverage (COBRA), eligibility as defined by the Health Insurance Portability and Accountability Act (HIPAA), Women's Health and Cancer Rights Act (WHCRA), standard benefits relating to the Newborns' and Mother's Health Protection Act, The Mental Health Parity Act and the new Michelle's Law, which becomes effective in October.
Beyond that, self-insured plans have a great deal of flexibility. You can put a dollar cap on the amount paid on cancer or physical therapy, or limit the amount of visits on a specific treatment. You can exclude certain drugs on the plan or flat-out refuse to pay, say, more than $1,000 a year on anyone covered under the plan. Realistically, not many employers want to cap a treatment for cancer or put small limits on a health plan, but it certainly is legal under the ERISA umbrella.
This flexibility becomes an advantage with savings to the bottom-line, and it can help with high-turnover industries. Let's say you're in the restaurant industry, and you've been plagued with high turnover. You can first offer a plan that caps a smaller dollar limit, then after a year of service, move members into a plan with enhanced benefits. Thus, self-funding can help protect from the risk during the first year of employment.
Nice.
Eligibility definitions can be defined creatively, if necessary. In our plan, we outline eligibility to include a health risk assessment every year. If a member doesn't complete the assessment, then that person is no longer deemed eligible, and we drop him or her off the plan. It's a brave step toward creating a healthier workforce, besides telling everyone to eat less dessert.
You even have flexibility with contribution rates. For example, when we implemented our wellness program, we offered a lower contribution rate for nonsmoking families.
I recall a conversation I had with an employee's spouse, who was a smoker. She was rather upset that others on the plan paid less. She started quoting the state insurance regulations to me on the phone, pointing out that I had a lot more work to do, and my discount program was illegal. Her communication escalated to a record-breaking pitch when I explained that our plan was self-insured, and we were exempt from those rules. I offered the phone number to the Employee Benefits Security Administration and never heard from her again.
Not everyone, though, is a fan of self-insurance. State policymakers have a valid concern that employers may design health plans that prevent participants from receiving adequate care.
Say, for example, you decide to put a dollar limit on dialysis treatments. Those individuals who max out will most likely turn to public programs for necessary medical care. It's a bold approach to cost-shifting the burden to the state, and a tight economy has forced some employers to consider this bitter option.
Another advantage is the right to recovery and subrogation. The self-insured plan's reimbursement right exists even if state laws prohibit such an attachment.
The U.S. Supreme Court unanimously affirmed a self-insured health plan's right of reimbursement in its decision in Sereboff v. Mid Atlantic Medical Services, Inc. Thus, if a defendant is handing over a kettle of cash to a plaintiff, the health plan has the right to put its hand in the pot, too.
Of course, I'd strongly suggest considering the adverse publicity that could result if you decide to seek payments from accident victims. This could definitely lead to a sour stomach.
I really enjoy managing our plan with a variety of choices and protections. If you've not considered self-insurance as an option, you might take another look. Wouldn't the world be sweeter if the Italian buffet could pre-empt me from gaining weight? If only life could be so simple.
By Karrie Andes |
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