Eclipse Insurance

Two of the region’s three dominant health insurers intend to raise premiums on average by double digits for next year, and the third wants a double-digit increase for plans not structured as health maintenance organizations.

The premium for one insurance plan could rise almost 36 percent.

The insurers cite rising costs of medical care and federal health care reforms.

The question is whether the state will let them.

Under a new state law, health insurers must submit their premiums to the state Insurance Department for approval before they take effect.

The state can reject or modify the increases if regulators feel they are not appropriate or justified.

The law also means insurers must disclose their rate plans much earlier than in past years.

Reaction from consumers and small businesses has been swift.

“There’s no question that there’s frustration and anger,” said Howard N. Silverstein, president and CEO of Choice Employee Benefits Group LLC, an insurance agency. “Everybody I’ve talked to cannot believe that some of the rate increases are as high as they are.”

Joe Milazzo, owner of Milazzo Renovations in Lancaster, already was paying $1,200 a month for individual coverage from Independent Health Association when he got a notice of an increase of roughly 15 percent.

“It’s craziness,” he said. “It’s getting to the point where health insurance payments are more than the mortgage payment.”

So he went to the Amherst Chamber of Commerce’s insurance broker and got almost the exact same plan from BlueCross BlueShield of Western New York for $1,351.72 — but every three months, because he is now in a group plan.

“We’re talking a lot of money in savings, for virtually the same plan. I still don’t believe it,” he said.

‘Entire industry changing’

In response, employers are expected to cut back on benefits and ratchet up the amount that employees and their families pay to share in the costs — through higher deductibles, co-pays and co-insurance.

“Our clients … have come to expect double digit increases the past few years,” said Colleen C. DiPirro, president and CEO of the Amherst Chamber, which helps small businesses get health insurance. “However, it doesn’t make it any easier for them to absorb the costs.”

“At the end of the day, I think the entire industry is changing and people are going to become more acclimated to paying more out of pocket and utilizing health insurance for major claims to keep them from financial ruin as a result of a health issue,” she said. “That is the only way we can insure the masses.”

The average requested increase across the board for BlueCross Blue-

Shield was 13 percent, according to information filed with the state Insurance Department, but the increases range from 3.9 percent on one HMO to 28 percent.

Increases would range from less than 10 percent for 30 percent of members to 10 percent to 15 percent for 45 percent, and more than 15 percent for more than 22 percent of those covered.

Independent Health’s rates would rise 10 percent overall, but the increases would range from 7.4 percent on an HMO to 35.8 percent for its small-group high-deductible health plan, where the deductible is not changing. For 1 percent of the company’s small group subscribers, increases would exceed 21 percent.

Univera Healthcare wants to raise rates by 5.4 percent for its Transitions, direct-pay HMO and point-of-sale plan, and 11 percent for all of its other products.

The insurers noted that the premiums and estimated ranges apply only to their base policies, before taking into account individual “riders” that modify coverage for group plans. Also, they are not final until approved.

Independent Health submitted a 1,200-page rate filing July 29, one of the first to do so, and responded to questions once with another 600 pages.

“It’s a ridiculous process,” said Dr. Michael Cropp, the insurer’s CEO.

Univera spokesman Peter Kates said the company submitted its information in August but has not heard back from the state.

Comments reveal rage

HealthNow, the parent of BlueCross BlueShield, filed rates Sept. 1 and has talked to state regulators. But “we don’t have any insights” about how the state will rule, said Stephen T. Swift, the insurer’s chief financial officer.

“They’re very, very stretched,” Swift said. “I’m optimistic the state will approve these rates as filed, but I can’t say we have any indication.”

Comments from the public to the state Insurance Department are being posted, with names blacked out, on the department’s Web site.

“This is preposterous!!!!” wrote a woman who co-owns a business with her husband. Independent Health had notified them of an 11.8 percent increase. “Who on earth can afford this? … The cost of health insurance now is an almost unmanageable burden. This new increase would put us out of business.”

“In these economic times to propose an average 14 percent increase in health care is absurd,” wrote another person who appears to be an insurance agent. “I am not looking forward to meeting my clients and trying to explain these incredible increases while their expenses rise and wages fall.”

“I am writing to express my disgust,” wrote another small business owner, who claimed to have received notice of a 37 percent rate increase.

A dental health care professional wrote: “I wish my income increased as much as my health insurance premiums have.”

As they do each year, the insurers defended their increases as necessary to account for the ever-increasing costs of providing care for their members. Companies routinely cite the high costs of and growing consumer demand for new diagnostic technology and hospital treatments, such as colonoscopies, heart surgeries, radiation and chemotherapies, and intensive services for patients during emergency room visits.

They also point to the high cost and use of sophisticated drugs, especially brand-name and specialty prescription drugs or injectable medications for some of the most serious medical conditions.

“Each year, medical inflation and a continuing increase in the use of medical goods and services combine to drive health care costs higher,” Univera wrote in its own letter. “To cover these increasing costs, we must modify premium rates.”

Consolidation among providers also has reduced competition to some degree, allowing prices to creep up. And the local insurers are quick to note that their administrative costs are much lower than the national average and especially for-profit health plans.

“Obviously our push is to drive those rates as low as possible,” HealthNow’s Swift said. “We know our customers’ concerns as far as affordability and access.”

But they also have treaded in waters that even the White House has deemed inappropriate, by blaming the federal health care reforms. Obama administration officials have warned the industry and its national trade group not to justify rate hikes by citing the reforms.

Notices called “deficient’

So far, requirements for full coverage of preventive care with no co-pays on screenings, the elimination of annual and lifetime limits and coverage for young adult dependents up to age 26 are the only reform provisions that have taken effect.

“Independent Health has evaluated the cost of our members’ health services and benefit changes, including those mandated in conjunction with health care reform,” the carrier wrote in a letter to small employer groups. “As such, we have determined that we must adjust our premiums for 2011.”

Late last month, after the due date for the filings, the Insurance Department issued a statement criticizing many of these notices to employers as “deficient, if not misleading, and in violation of the new prior approval law.” That law was designed to allow insured consumers an opportunity to understand any rate increase and to comment or ask questions about it.

“These type of misleading notices have the effect of confusing members and masking the underlying reasons that a rate adjustment is being requested,” the Insurance Department wrote in its letter to insurance companies, directing them to provide consumers and employers with details.