All posts by Kelly Smith

Experimental Drugs: In Your Health Plan and Stop Loss Policy

Experimental drugs are a proposed treatment for an illness such as cancer that has been tested in a laboratory and has received approval from the FDA to begin treatment on people.[i]   They have many uses that are vital, and often times the circumstances are life and death.  Even so, they are not always covered under all insurance plans across the United States, due in part to the unknown efficacy and cost of the drugs.  If experimental drugs are covered under your plans it is essential to take note in what instances they are covered, specifically clinical trials or off label drug use.  Therefore, if you are choosing an underlying plan (HMO, PPO) or a stop loss policy (for self insured plans) for your employees it is important to know what is covered under each. Continue Reading >

Factors to Consider for Self Funding Your Health Plan

If you are considering a self-funded health plan for your company you are certainly not alone!    Many employers, both small and large are now exploring the option of self insuring their health plan for a variety of reasons with larger long term savings topping the list.   However, self funding isn’t right for everyone; therefore we will discuss some of the factors you’ll want to consider before making any changes to your health plan. Continue Reading >

Factors to Consider

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In 2011, the top 5 most expensive medical conditions treated in US hospitals were: Septicemia, Osteoarthritis, Complication of device, implant or graft, Liveborn, and Acute myocardial infarction

From 2010 to 2013, the number of claims that were individually $1 million or above rose by 1,000%

In 2017 approximately 18% of the American public will purchase insurance through exchanges, radically transforming the health insurance landscape.

In 2014, 98% of large firms (= 200 Workers) offer 1+ wellness programs to their employees.

The most costly 1% of patients account for 20% of national health expenditures – accruing average annual expenses of nearly $90,000 per person.

6% of firms offering fully-insured plans report they intend to self-insure because of Obamacare.

In 2014, PPO plans remained the most common plan type, enrolling 58% of covered workers.

In 2012, 93% of businesses with 5,000+ employees and 80% of companies with 1,000-4,999 employees were self-funded

Massachusetts has the third-highest prevalence of self-funded insurance in the small-group market (Fewer than 50 employees).

In 2013, the average deductible was $2,906 for individuals selecting plans from marketplaces. This compares with average deductibles of $1,135 for an individual with employer coverage.

In 2013, the average annual premiums for employer-sponsored health insurance are $5,884 for single coverage and $16,351 for family coverage, up 5% and 4% respectively from 2012.

From 2010 – 2013, cancer followed by chronic/end stage renal disease and leukemia accounted for the top 3 costliest illnesses.