National Health Access Citizens Health Care Working Group

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National Health AccessCitizens Health Care
Working Group
May 12, 2005
Presented by Kenneth L. Sperling CIGNA HealthCare
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Background

• The HR Policy Association
• Represents the senior HR leadership of Fortune
  500 companies
• Over 240 member companies cross-section of
  American industry
• Entry into health care at 2003 annual meeting
  formed Health Care Policy Roundtable
• Identified the uninsured as principal focus

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Health Care Policy Roundtable

• J. Randall MacDonaldIBM Corporation, Chairman,
  Health Care Policy Roundtable
• Timothy HughesCox Enterprises, Inc., Chairman,
  Public Policy Directions
• Greg LeeSears Roebuck Co., Chairman,
  Affordable Health Care Solutions Coalition
• John ButlerTextron Inc., Chairman, Regional
  Health Care Quality Reform Initiatives
• Sid BanwartCaterpillar, Inc., Chairman, Direct
  Pharmaceutical Purchasing Coalition

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Charter Coalition Members

• Initial population 1.3 million
• Employees, independent contractors, pre-65
  retirees
• 3 million including dependents

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Affordable Health Care Solutions Coalition

• Concept
• Address the issue of the working uninsured by
  aggregating large groups of employees not
  receiving a health care benefit subsidy from a
  broad cross-section of American industry
• Create more viable individual health care market
• Promote dissemination of provider efficiency and
  effectiveness data
• Focus on uninsured populations in large
  corporations, specifically
• Full-time, part-time, temps without coverage
• Contract workers, independent agents, consultants
• Pre-Medicare retirees

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Affordable Health Care Solutions Coalition

• Goals
• Fully insured
• No required direct employer subsidy
• Guaranteed issue (i.e., no medical questions or
  underwriting)
• National solution
• Range of options and price points significantly
  better than current individual health insurance
  market, including comprehensive major medical
  coverage
• Provider cost and quality transparency

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National Health Access Offering for Fall 2005
Level VI
Major Medical1,100 Deductible (HSA)1
Level V
Major Medical2,000 Deductible (HSA)1
Level IV
Scheduled Inpatient Outpatient Benefits
Scheduled Outpatient Benefit
Level III
Level II
Wellness Benefit
Discounted Network
Level I
Guarantee Issue (with waiting periods) Guarantee
d Issue (no waiting periods)
1Depending on location, individual products may
be offered that do include individual underwriting
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States with Major Medical Offerings
Current configuration leads to Major Medical
options in 32 states representing 87 of the
eligible population
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Challenges

• Adverse selection concerns on major medical
  coverage led to a fragmented state-by-state
  solution
• Could not cover franchisees or small employers
• Need to build front-end infrastructure for
  eligibility, enrollment, billing, and service
• Lack of industry consensus on provider quality
  measurement and reporting