What's new in health insurance for 2005? For most people, that depends heavily on which plans their employer is sponsoring. And insurers are saying that businesses continue to favor plans that shift costs onto consumers. With federal workers also receiving more such options, pressures -- or incentives, if you prefer -- are growing for people to limit their medical expenses.
Sponsors "are coming to the realization that what perhaps has the best potential for controlling these costs is to engage their employees in understanding the actual cost of health care, in becoming better consumers, making better decisions about their health care consumption," said Jeff Lucht, an Aetna spokesman.
Several insurers allow members to call nurses at any time of the day or night -- a service that can bring the consumer peace of mind while reducing often unnecessary and always expensive trips to hospital emergency rooms. Insurers also encourage their members to fill out health risk appraisals that offer advice on reducing their odds of developing serious illness. Some firms endorse these assessments by paying their employees -- $50 is a common reward -- to take the tests.
Like other major insurers, Aetna offers Zip-code-specific cost estimates for common procedures. The in-network cost of a breast biopsy for an Aetna member in Gaithersburg, for example, is $1,904, compared with $2,747 if the procedure is done by an out-of-network provider. Likewise, the estimated cost of a knee or shoulder arthroscopy is $3,302 within the network vs. $7,702 from an unaffiliated practitioner. (Of course, an individual's policy controls whether Aetna would cover any portion of such charges.)
Another new wrinkle offered by Aetna is its "Aexcel" network of specialists. Offering care in such categories as cardiology, orthopedics, neurology, urology and obstetrics/gynecology, Aexcel "basically encourages members to select specialists that have demonstrated effectiveness in clinical performance and cost efficiency," Lucht said. The lower fees associated with this pool of specialists may appeal to people with high-deductible policies who are paying for their care partially from tax-favored health savings accounts, he said, "or even any plan where coinsurance is involved."
Federal workers can consider several high-deductible policies. Among them is one offered by the Mail Handlers Benefit Plan that offers no-fee preventive care, including annual physical exams, mammograms, cancer screenings and well-child office visits.
And for federal families whose kids get sick?
Beth Sammis, a United HealthCare spokeswoman, said one of her company's plans features "no co-pay for kids going to see their primary care physician" -- perhaps a good option for those parents who "feel like the physician's become part of your family."
-- Tom Graham
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