Highmark requests some rate increases

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Health insurer Highmark Inc. intends to increase premiums on a dozen individual and guaranteed-issue plans, including a plan for children, according to paperwork filed with the state Department of Insurance.

The filings are requesting rate increases of about 9.5 percent for each of the plans, affecting about 60,000 policyholders and family members statewide, and about 38,770 in the western and central portions of the state.

The premium hikes, if they are approved by the insurance department, would go into effect on Jan. 1. Together, the rate hikes would bring in an extra $15.4 million, on top of what would have been collected next year if the premiums held steady.

Guaranteed-issue plans -- which are available to everyone, regardless of health history -- are subsidized. In other words, they are money-losers, with the projected premium revenues exceeded by the claims that are projected to be paid out.

Non-profit Blue Cross Blue Shield insurers, including Highmark, historically have been the only insurers in the state that offered coverage to people with preexisting medical conditions. Highmark says it will spend $56.5 million in 2013 "to help hold down the cost of premiums for members in these products."

"Highmark's proposed rate increases for each product are due to increases in health care costs for people in these programs driven primarily by higher hospital prices, an increase in physician and hospital costs and increased prescription drug costs," said Highmark spokesman Michael Weinstein.

Those higher hospital and medical costs are at least partly attributable to the contract extension recently struck between Highmark and UPMC, which gave Highmark customers access to UPMC doctors and hospitals through 2014, but required Highmark to pay higher prices in order to access the UPMC network.

Most of the plans referenced in the filings make note of benefits changes, including changes to incorporate "well-woman care" services to the list of covered preventive care benefits, and a new limit to the number of "physical medicine" visits a patient can make to the chiropractor or physical therapist without getting pre-authorization from the insurer.

The filings include rate increase requests for the following plans:

• Four "ClassicBlue" medical and hospitalization plans, affecting the central and western regions in the state. Highmark is seeking a rate increase of 9.4 or 9.5 percent for each of the plans. The ClassicBlue "Traditional" plan would cost an extra $84.30 a month; the ClassicBlue major medical plan, an extra $17.72 a month; the ClassicBlue hospitalization plan, an extra $45.75 a month, and the ClassicBlue comprehensive major medical in the state's central region, an extra $54.84, on average.

• Two high-deductible PPOs, in the western and central regions. Subscribers to either plan would see a 9.5 percent increase -- the central region plan would cost an extra $62.54 a month, and the Western Pennsylvania plan would cost an extra $72.51, on average.

• The KeystoneBlue for Kids HMO, which covers roughly 600 children in the western region, would see a 9.5 percent increase, or an extra $13.72 a month.

• The PreferredBlue Individual PPO would see a 9.5 percent increase, and would cost an extra $67.88 a month.

• The Keystone Health Plan West "conversion" plan, for those who have recently lost group plan employer benefits, would see a proposed 9.4 percent increase, or an extra $6.55 a month, on average.

• Three different "Special Care" plans for low-income subscribers also would be affected. Highmark is seeking a 9.5 percent increase on those Special Care plans, though the last time Highmark sought a similar increase on its Special Care plans, the increase was later halved, to 4.9 percent.

The Special Care customers account for the majority of those who will be affected by the price increases.

Highmark's last major batch of rate increase applications came in May, when the company asked for increases for 100,000 customers, effective Oct. 1.

businessnews - health

Bill Toland: btoland@post-gazette.com or 412-263-2625.


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