A GROWING MARKETPLACE

Rocky Mountain Health Plans, headquartered in Grand Junction, Colo., offers four PPO options, two health savings accounts and two safety net alternatives in Colorado under the Solo brand. The deductibles for the PPO, Solo Select, range from a $500 to a $2,500 with $30 copayments for office visits in network. The first $500 are not subject to the deductible. After the deductible is met, the insurer covers 80% for in network services. An optional accident rider and prescription drug rider for brands are available; generics require a $10 copayment.

The HSAs, or Solo Smart Choice, offer a $2,800 deductible single plan and $5,600 for a family. Generics are covered 100% after the deductible is met. The safety net offerings are geared to those who only need catastrophic coverage, which Kevin Scanlon, director of sales for the insurer, says is the least popular offering. One of the safety net options invites individuals to contribute to a tax-advantaged savings account; contributions are tax-deductible and interest earned is tax-free.

The individual health plan is a PPO with four deductible levels ranging from $500 to $5,000 for single coverage. Members may purchase a no-deductible pharmacy benefit in place of the regular $500 deductible prescription drug benefit, as well as an office visit rider with copayments.

The HSA offers four deductible levels and two co-insurance options, 80/60 and 100/70.

"We are trying to create an array of plan options to meet a wide range of needs and risk and budget preferences," says Ted Zacharias, president of HumanaOne, based in Milwaukee. "Affordability is always a challenge, which is why we periodically address price points."

Both offerings have a built-in $300 first dollar preventive care benefit to encourage members to maintain good health, Zacharias says, along with a telephonic or online application process that connects prospective members to an underwriter immediately.

HumanaOne plans to expand its range of deductibles up to $10,000 for both types of plans for those who are comfortable with self-insuring, Zacharias says. A new rider with unlimited office visits also is expected this year.

LOWER-COST OPTIONS IN FLORIDA

Last summer, Blue Cross and Blue Shield of Florida (BCBSF), based in Jacksonville, extended its lower cost BlueOptions products from the small business market to individuals, ranging from a conventional PPO with deductibles and copayments to catastrophic coverage—the result of research by the insurer. The products also incorporate a targeted Hispanic market component in seven Florida counties.

"We have targeted plan solutions to meet diverse needs," says John Wagner, director of group and individual products. "Our lower-cost product, BlueOptions, has become the mainstay for affordable solutions."

Wagner says the most popular plan is the 50/50 family physician plan, which provides comprehensive coverage with copayments for family physician office and wellness visits and generic drugs. For other services, members pay 50% of the insurer's negotiated rate after a deductible is met.

BCBSF also has entered into the world of HSA-compatible plans with a 100% product. The deductibles and out-of-pocket maximums are at the same level so that once the deductible is met, a member no longer has any financial responsibility. The 100% product also is available with an HSA attached. "This 100% product is great for the uninsured; it's easy to use and reintroduces the uninsured to health insurance," Wagner says.

The catastrophic options—hospital/surgical plans—cover hospitalizations and outpatient surgeries for individuals under 65. A temporary product available to the same market bridges coverage between jobs or before an individual purchases permanent coverage.

To make life even easier for BlueOptions' PPO members and physicians, BCBSF has designed a real-time, card swipe technology, CareCalc, which shows if members have a deductible, if it has been met or if they still have part of the deductible left. Physician offices also can input CPT codes for a patient procedure and be notified of the amount the member owes.