Friday, October 21, 2016


The FEHBlog is visiting Storrs Connecticut for his 40th University of Connecticut reunion. UConn only offers two class reunions 40th and 50th because the classes are so large. 

The Federal Times offers Walt Francis's observations on the coming Federal Benefits Open Season. Federal News Radio provides an update on the rather tumultuous decisionmaking period for Federal Long Term Care Insurance Program enrollees.
As of Oct. 7, more than 96 percent of enrollees who responded to the OPM’s enrollee decision period, which ran from July 18 through Sept. 30, chose to accept the increase or take one of the special benefit reduction options, an agency spokesperson told Federal News Radio in an email.
Less than 4 percent of those who responded chose to discontinue their coverage or take the “paid-up” option, the spokesperson said.

Yesterday the FEHBlog ran across this interesting September 2015 OPM website providing a profile of federal civilian non-postal employees. 

Healthcare Dive reports on a recent Healthgrades report on clinical outcomes at U.S. hospitals.
A total of 22 states, including Delaware, New Mexico and Hawaii, as well as the District of Columbia did not have any hospitals that received either a 4- or a 5-star rating, Healthcare IT News reported. The states with the most hospitals in the top 50 list was California with eight hospitals, followed by Illinois and Michigan.
Among the top 50 hospitals were the Mayo Clinic in Phoenix, Saint Luke's Hospitals in Cedar Rapids and Baltimore-based Medstar Good Samaritan Hospital.
Finally, Drug Channels provides his annual analysis of the Kaiser/HRET 2016 Employer Health Benefits Survey. The FEHBlog appreciates Drug Channels insights but he was puzzled by observation that "Patients taking specialty drugs face economically-debilitating coinsurance—in some cases with no limit on out-of-pocket expenses."  Currrently, the ACA requires that all in-network coinsurance be subject to an annual limit.  The FEHBlog is not suggesting that Drug Channels has identified a non-issue but rather that the issue may be overstated.

1 comment:

Anonymous said...

It seems that FEHBLog should NOT be "puzzled by observation that "Patients taking specialty drugs face economically-debilitating coinsurance—in some cases with no limit on out-of-pocket expenses." Out of pocket limits for ACA and FEHB plans are only for COVERED expenses. The determination of drug coverage is usually stated separately in these plans and subject to detailed formularies and drug approval procedures for many drugs, with specialty drug coverage extremely restrictive. It is not sufficient for a plan member to use the in-network pharmacy; a member, who needs specific specialty drugs due to a life-threating condition, is at the mercy of the insurance company. If a drug the member needs is not approved, there is virtually no limit on what the member could pay, that is NOT "subject to an annual limit." It appears that Drug Channels has NOT overstated the issue.