November 2019 Volume 21 Issue 11
Providing Current Information on

Health Insurance Industry Issues and Legislation

Catastrophic Claims on the Rise
The number of self-funded health plans reporting catastrophic claims continues to
trend upward. 64% of self-insured health plans reported at least one claim in excess
of $500,000 in 2019, up from 58% in 2018. 31% had at least one claim in excess of
$1,000,000 over the two year period according to a recent survey of self-funded health
plans. Aggressive hospital billing and spiraling specialty pharmacy costs are two major
reasons for the increases. Stop-loss coverage premium coverage varied significantly
among companies with self-funded plans for a variety of reasons including the
company's risk tolerance, employee demographics, variety of contracts and broker
commissions. The report offers a number of strategies for reducing companies' stoploss
premiums.
Sounding the Alarm on High-Cost Cases
The most expensive cases include those for certain infectious and parasitic
diseases, metabolic disorders; diseases of the nervous, circulatory, respiratory
digestive, and genitourinary systems; congenital abnormalities, pregnancy and
childbirth, and injuries from external causes. Early identification is the key to
controlling the cost of these most expensive cases. Once identified, they can be
case-disease managed to ensure that the patients receive the appropriate care and
get it as cost efficiently as possible.

We sound the alarm. Upon request, HHC Group automatically alerts its clients every
time we receive a claim containing one of the "Trigger Codes" for the 146 most
potentially expensive diseases and conditions. Our alerts include pertinent patient
and group information along with a list of the Trigger Codes on the claim with
explanations. There is no extra charge for this service. It is just one more way we
work to achieve our mission of enabling our self-insured clients to provide the care
their members/employees deserve while minimizing their healthcare spend.
Evolving Marijuana Laws What You Need to Know
Thirty-three states have now legalized the medical use of marijuana. Three, California,
Colorado and Washington have also legalized recreational marijuana use. For employers
with contracts with the federal government the rules are generally clear no marijuana
usage allowed. For employers without federal contracts, conflicting laws at the state
and federal level have created a confused legal environment. The issue is even more
complicated for employers having locations in more than one state. State courts and the
federal government are weighing in.
Preventing Cyber Attacks
From viruses to malware to ransom demands, cyber attacks are becoming more
common and more brazen every day. 53% of firms in the US reported attacks in 2019,
up from 38% in 2018. Alarmingly, a quarter of companies reported 4 or more attacks in
the last year. The mean cost for the attacks year to date was $119,000. Based on a recent
study, 72% of U.S. companies are cyber novices lacking oversight, strategies, resources
and processes to prevent and respond to a cyber incident. Attacks can be prevented or
detected early so damage to the bottom line can minimized.
Three Star Preferred Provider Program Additions
Biodesix
San Francisco, CA 94160

Mves Boardman, LLC
Cleveland, OH 44194

United Clinical Laboratory NJ
Fairfield, NJ 07004

First Care Toledo
Cincinnati, OH 45215

Thrive Counseling & Employment Service
Astoria, OR 18418

Dr. Kevin Logan
Indianapolis, IN 46256

Michigan Neurology & Spine CE
Detroit, MI 48277