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Life Health > Health Insurance > Health Insurance

The Catch: Ideas

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Principal Financial Group Inc. is outfitting its dental insurance program with a classic health care cost containment feature: Access to second opinions.

Major medical plans have been urging consumers to get a second opinion before having major procedures for decades.

Principal, Des Moines, Iowa (NYSE:PFG), will now be giving dental plan enrollees the flexibility to seek additional opinions from two or more dentists before electing a dental procedure.

A plan member can use vouchers to pay for two more second opinions.

Principal also offers Web-based cost calculators


SeeChange Health, San Francisco, a division of Triveris L.L.C., Eatontown, N.J., is offering employers throughout the United States access to one of the new cost containment ideas: Value-based insurance design (VBID).

Managers of VBID programs try to use low or no co-payments and other personalized incentives to encourage patients to get the kinds of care that seem likely to lead to the most improvement in health and biggest reductions in overall care costs.

SeeChange already serves plans with about 1 million enrollees, and it is now making an “administrative services only” (ASO) personalized VBID health program available to self-insured employers in all 50 states.

An employer could tailor the program to fit its culture and choose, for example, whether to emphasize condition management programs or wellness programs, SeeChange says.


OptumHealth can’t just make the Patient Protection and Affordable Care Act of 2010 (PPACA) go away, but it is offering a stop-loss program that protects self-insured plan sponsors against problems stemming from the claims appeal process created by PPACA.

A stop-loss arrangement serves as a kind of reinsurance for a self-funded health plan. The arrangement protects the employer that sponsors the plan against the risk of catastrophic losses.

OptumHealth, a unit of UnitedHealth Group Inc., Minnetonka, Minn. (NYSE:UNH), is calling the amendment to its stop-loss contract an “extended liability endorsement.”

Twenty states have approved the amendment.

In those states, the amendment will be part of all new and renewal OptumHealth stop-loss contract that take effect on or after Jan. 1, 2012.

PPACA will create new independent review organization appeal rights for many plan members starting in 2012. Typical stop-loss contracts exclude protection against claims paid outside a set time period. The new endorsement can extend the paid date in the contract by up to 12 months, OptumHealth says.


Former Senate Majority Leader Tom Daschle will speak at a VBID conference Wednesday at the University of Michigan in Ann Arbor, Mich.

The conference is being organized by the university’s Center for Value-Based Insurance Design.


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