Printer Friendly

COMMUNITY RATING HAS SUCCESSFUL HISTORY WITH PENNSYLVANIA BLUES

 CAMP HILL, Pa., Jan. 20 /PRNewswire/ -- "Community rating," a key element in most recent state and national health care reform proposals, has helped 1.8 million Pennsylvanians to purchase health care coverage through the state's Blue Cross and Blue Shield Plans.
 The community rating system, which is practiced in only 11 other states, has helped rank Pennsylvania as the fourth-lowest among all states in percentage of uninsured population.
 Community rating is available to small businesses and individuals who directly purchase health insurance coverage for themselves and/or their families. It places many persons or groups together and calculates the premiums for each member based on the entire group, or a "community" rate. Under this system, a member with above-average health care spending pays no more than a member with average spending, with the risk spread among all members of a category.
 Included in Blue Cross and Blue Shield community rated programs for individuals and small businesses is an "open enrollment" policy enabling applicants to purchase coverage regardless of their personal situation. This open enrollment provision is in direct contrast with most commercial for-profit insurance companies and HMOs which use extensive criteria to exclude applicants who they deem as "undesirable risks" to insure. Employment status, medical history, claims experience and occupational hazards among individual applicants are ignored in the Blue Cross/Blue Shield open enrollment program, allowing individuals with a pre-existing condition to be covered after a one-year waiting period. Without these programs, according to a Blue Cross and Blue Shield official, nearly two-thirds of the 1.8 million community rated subscribers would likely be uninsured.
 "We know that 1.1 million of our community rated subscribers are under age 65 and have few other health insurance options," said Douglas Smith, director, Corporate Affairs of Pennsylvania Blue Shield. "Being the only insurer offering programs to individuals with an open enrollment policy, we're very aware of the impact those programs make on Pennsylvania's uninsured rate, and in making health care more accessible and affordable to everybody."
 Substantial discounts of 35 percent and more accepted by participating hospitals and doctors contribute to the success of Blue Cross and Blue Shield's programs.
 Also, Blue Cross and Blue Shield's programs feature premiums that reflect the actual cost of providing benefits. In 1990, a quarter million Pennsylvanians under age 65 with individual Blue Cross and Blue Shield coverage paid $260 million in premiums, but received nearly $300 million in benefits.
 Community rated programs, unavailable in most states, have become a popular addition to many reform proposals being debated nationally. "We have been and remain committed to these programs, and welcome the efforts toward nationwide replication, including the proposals from President Clinton," said Smith. "Our community rated products have been recognized nationally, demonstrating exceptional quality and value for the premium dollar spent on them."
 In August 1990, Consumer Reports ranked hospital-surgical policies sold by Capital Blue Cross and Pennsylvania Blue Shield first among more than 50 policies reviewed. That year, Blue Cross and Blue Shield Plans in Pennsylvania enrolled 239,036 individual, direct pay subscribers under age 65. An additional 699,810 individual subscribers were enrolled in a direct pay Medicare supplemental or "Medigap" program.
 "Community rating has to be included in any serious health care reform proposal," said Smith. "Anyone interested in seeing program results has to look no further than Pennsylvania, where 1.8 million people enjoy excellent community rated coverage through Blue Cross and Blue Shield."
 Pennsylvania's Blue Cross and Blue Shield system includes Blue Cross of Northeastern Pennsylvania, Blue Cross of Western Pennsylvania, Capital Blue Cross, Independence Blue Cross and Pennsylvania Blue Shield.
 /delval/
 -0- 1/20/93
 /CONTACT: Brian Herrmann of Pennsylvania Blue Shield, 717-763-3319/


CO: Pennsylvania Blue Shield ST: Pennsylvania IN: INS SU:

LJ -- PH017 -- 6936 01/20/93 13:39 EST
COPYRIGHT 1993 PR Newswire Association LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:PR Newswire
Date:Jan 20, 1993
Words:631
Previous Article:NAVISTAR AND UAW REACH TENTATIVE AGREEMENT
Next Article:BOEING GIVES WSU $7 MILLION TO BENEFIT ENGINEERING, EDUCATION; LARGEST GIFT IN WSU HISTORY
Topics:


Related Articles
BLUE CROSS AND BLUE SHIELD OFFER FREE LAMAZE CLASSES
BLUE CROSS OFFERS TESTIMONY AT ALTOONA HEALTH CARE HEARING
U.S. REP. KLINK COMMENDS BLUE CROSS IN HEALTH CARE REFORM PROCEEDINGS
BLUE CROSS OF WESTERN PENNSYLVANIA PROVIDES INITIAL REACTION TO THE PRESIDENT'S HEALTH CARE REFORM PROPOSAL
UNITED CONCORDIA COMPANIES, INC., NEW BLUE SHIELD SUBSIDIARY, TO ADMINISTER INSURER'S DENTAL BUSINESS
BLUE CROSS, BLUE SHIELD TO HOLD MEDIGAP RATES, WILL ALSO INTRODUCE NEW MEDICARE HMO IN 1995
CAPITAL BLUE CROSS AND PENNSYLVANIA BLUE SHIELD HOLD THE LINE ON SECURITY 65 AND SPECIAL CARE RATES
HEALTH CARE COVERAGE EXPANDED FOR UNINSURED CHILDREN
UPMC Strengthens Ties With Blue Cross: Finalizes Investment In Medicare Product
Highmark to Delay New Payment Method for Specialty Physicians.

Terms of use | Copyright © 2016 Farlex, Inc. | Feedback | For webmasters