RE-ENROLLMENT TIME FOR WORKERS' HEALTH INSURANCE; PREMIUMS, CO-PAYMENTS RISING.

Byline: Phil Galewitz Associated Press 

Retailers have Christmas. Beach resorts have summer. Allergy drug makers have ragweed season.

For health insurers, the busiest time of year is right now during fall re-enrollment season, the one time each year that companies usually allow their workers to switch health plans.

As the deadline for making changes to their health insurance approaches, employees are finding a host of changes, some good and some bad.

Most are facing higher premiums and higher co-payments for prescription drugs and office visits.

On the positive side, they're gaining more flexibility in choosing doctors, getting coverage for alternative therapies such as acupuncture and gaining Internet access to useful health information from their insurers. Additionally, some companies are providing report cards on health plans based on consumer satisfaction and other measures.

Consumer demand for more flexible health plans is one reason why premiums are rising on average about 8 percent for 2000, the biggest increase since 1993. Another big factor is the escalating cost of prescription drugs, which at many plans is increasing by about 20 percent.

Helping to mitigate some of the cost increases for workers is the nation's low unemployment rate. With many companies facing difficulty finding workers, they are more willing to absorb much of the premium increases themselves, benefits experts say.

Workers required to use health maintenance organizations are also benefiting as the plans drop some restrictions.

The nation's largest health insurer, Aetna U.S. Healthcare, is adding an open-access type of health maintenance organization that lets members use specialists in the plan's network without first getting approval from their primary care doctors.

United HealthCare, the nation's second-largest managed care insurer, is doing one better: It's dropping all pre-authorization requirements and letting doctors make the final decisions on all patient care matters.

HMO Illinois, owned by Blue Cross and Blue Shield of Illinois, is even letting its members for the first time choose a chiropractor as a primary care doctor. Until now, all HMOs require a medical doctor for the role in coordinating patient care.

Added flexibility, though, could end up costing employees more money through higher premiums.

``People want lots of freedom of choice and that is more expensive,'' said Bill Sullivan, former president of Oxford Healthcare Plans, which operates in New York and Connecticut. Oxford is one of several health insurers that provide discounts to members who visit acupuncturists, massage therapists and other alternative health providers.

To assist the enrollment process, Aetna has begun letting members enroll over the Internet. Aetna also lets consumers check benefits on its Web site and determine which doctors are in the plan's network. Further, the company has its Intellihealth.com Web site that serves as a reference for information on various diseases and health news.

Trying to balance the need to control drug costs and give workers coverage for the broadest array of medicines, most employers are now offering workers a three-tiered prescription coverage plan. In this system, workers pay a nominal fee for generic drugs (usually about $5), a higher fee for the insurer's preferred brand-name drugs (usually $10 to $15) and an even higher fee for brand-name drugs not on insurers' approved lists ($25 or more).

While health plans are expanding options, some employers are setting up programs to assist workers in choosing the plan right for them.

At Stamford, Conn.-based Pitney Bowes, which manufacturers mailing and shipping systems, the company has begun distributing a report card that grades HMOs. The evaluation is based on the plan's performance in providing preventive care, the size of its doctor networks and its accreditation status from a national watchdog group.

``People are confused about all the material they get and could not decipher the difference between plan A and plan B, and (they) wanted us to be more active in helping them make a selection,'' said David Hom, executive director of corporate benefits.

The changes at Bolton Corp., a Raleigh, N.C.-based commercial construction company, are typical of what is happening around the nation. Bolton is dropping its two current health plans in favor of a new one. While Bolton pays the full cost of its 450 employees' premiums, about half the workers with families face prices about 12 percent higher for their dependents' health care coverage.

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Chart: HEALTH PREMIUMS ON THE RISE

Associated Press