TriState | Fall | 2010 | Health Plan Analysis
New York health plans are under more pressure than ever to keep a lid on rates, but their requests for premium increases have been curtailed under the new prior approval law. As one alternative, carriers are trotting out innovative new plan designs to lower the cost for employers. Despite the challenging economy, MVP Health Care has entered the Buffalo market to compete with three entrenched insurance carriers. In New Jersey, Horizon Blue Cross Blue Shield has agreed in a settlement not to sell a controversial new plan design in the large-group market that caps its claims liability on out-of-network ambulatory surgical centers. For the Medicare segment, plan offerings have been streamlined in both the Medicare Advantage and Part D programs, while some operators are making bold moves in prescription drug offerings. On the healthcare reform front, TriState carriers are having to remove annual limitations on pharmacy benefits, which is in some cases resulting in small premium increases for employers. New York insurers have to live under a new law that prohibits them from establishing separate pricing tiers for specialty drugs in the regulated individual and small-group insurance segments. The TriState delves into the latest wellness trends, while some New York plans test a system of bundling medical payments.
