The H1N1 influenza is the wild card on the list of the year’s top stories in the health, disability and group benefits markets.
As of press time, the U.S. Centers for Disease Control and Prevention was reporting a decrease in flu activity, and the H1N1 flu had not caused the emergency room-swamping catastrophe of risk forecasters’ nightmares.
But insurers such as UnitedHealth Group Inc., Minnetonka, Minn., and Aetna Inc., Hartford, say the flu was one of the main reasons ratios of medical claims costs to premiums were higher in the third quarter of 2009 than in the third quarter of 2008.
And, as of press time, there were still a few more weeks left in the year for the flu to make a comeback.
Here is a rundown of some of the other big group benefits and individual health and disability stories of the year:
2. The Economy. Few group health plan sponsors that survived as going concerns dropped their plans in 2009, but layoffs reduced head counts.
A group that had 20 workers before the slump began might have 15 workers today, says Jim Shepherd, an associate vice president at AlphaStaff Group Inc., Fort Lauderdale, Fla., a human resource outsourcing firm.
“I think everyone’s nervous,” Shepherd says. “There’s so much uncertainty.”
Some groups are shrinking because employers are eliminating family coverage options, or asking workers to pay a higher percentage of the cost of covering spouses and dependent children, says Thomas Mangan, president of Corporate Synergies Inc., Mount Laurel, N.J.
3. The economy drove up claim costs. So far, the recession has had little effect on disability claims, but it has increased health and dental claims.
Employees who still have their jobs “are more worried about losing their benefits,” says Theresa McConeghey, dental products director at Principal Financial Group Inc., Des Moines, Iowa. “More members are going to the dentist. When these people do go, they’re getting more services done.”
In some cases, efforts to cut plan costs by passing more family coverage costs on to employees have backfired, by leaving employers with sicker pools of insureds, Mangan says.
Family coverage cost-sharing increases can lead to adverse selection problems, because workers will pay dearly to keep group coverage for family members with serious health problems, but they will buy other coverage, or go without coverage, for healthy, cheap-to-insure family members.
4. Layoffs and the temporary 65% COBRA benefits continuation subsidy program increased COBRA enrollment.
For a departing worker, the cost of COBRA coverage is usually 102% of the full cost of coverage. This year, the federal government is paying 65% of the cost for eligible involuntarily terminated workers, and the workers are paying just 35% of the premiums. Ceridian Corp., Minneapolis, a benefits administration firm, says the subsidy increased the COBRA take-up rate to 18%, from 12%, at its client employers.
The increase in COBRA enrollment contributed to higher third-quarter claims costs, insurers say.
But the subsidy program may have held down the average amount of claims per COBRA enrollee, because the pool of workers willing to pay 35% of the full cost of coverage is healthier than the pool of workers willing to pay 102% of the cost of coverage, Mangan says.
5. Individual health account plans continued to gain market share. About 4% of individuals in U.S. employer-sponsored group health plans are now in plans that offer health savings accounts or health reimbursement arrangements, up from 1% in 2005, according to the Employee Benefit Research Institute, Washington.
6. Researchers found that information technology might not be a magic wand for fixing the U.S. health care and health finance systems.
A team of researchers led by Ashish Jha says existing hospital electronic health record programs have done little to reduce the cost of care or improve quality. But the Jha team says health IT might pay off if it were being used better.