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Leader in Health Plan Cost Containment Cites Three Economy-Driven Reasons Why Self-Insured Health Plans Should Brace for Claim Increases and Fund Reserves Accordingly
Date:3/18/2009

elves and their dependents that might otherwise be postponed or ignored," he added.

"The third reason why claim costs for thousands of self-insured employers might be unexpectedly high is a COBRA provision in the new Federal Stimulus," Niehus said. "As part of the Stimulus, the Federal Government will provide a temporary 65% subsidy for COBRA continuation premiums for up to nine months for workers (and their families) who fall within certain income thresholds and who have been or will be involuntarily terminated on or after September 1, 2008 and before January 1, 2010. COBRA premiums are permitted to be set at 102% of plan costs and can be changed once a year," she added.

Niehus went on to explain that it is possible that average costs for COBRA participants can exceed the plan average, particularly if participants who elect COBRA coverage have significant medical concerns. In that event, the self-insured plan may have to subsidize COBRA members, resulting in increased costs.

Niehus urges plan sponsors to get sound actuarial advice in setting COBRA rates, and to consider all factors affecting average costs, including those listed above.

Putting the need to monitor costs in perspective, McSweeney offered the illustration of a company with 2,000 covered people, a15 percent increase in claim expense in 2009 and an underfunded reserve. "The additional expense could reach into in the millions of dollars," he explained.

"Today, the only 100 percent effective way to set or adjust claim budgets and reserve requirements is to analyze claims from a financial versus clinical perspective on a rolling, quarter-to-quarter basis, so you can catch a problem in its early stages," McSweeney concluded.

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SOURCE Healthcare Data Management, Inc.
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