Health insurance companies planning to participate in health-insurance exchanges set to debut in 2014 may need to adjust their offerings to do so.
That’s according to a study published in late May in the journal Health Affairs. The study showed that companies such as Minnesota-based UnitedHealth Group Inc., which employs more than 3,000 people in Orange County, and WellPoint Inc. of Indianapolis, will have to improve benefits in some of their individual plans to meet requirements that they cover at least 60% of a person’s care.
The health exchanges that are coming on line in 2014 were created by federal healthcare reform. The exchanges, which will be run by the government, will be called bronze, silver, gold or platinum, depending on types of coverage.
Under the exchanges, annual out-of-pocket costs will be capped, and limits on lifetime benefits will be eliminated.
The study found that about 51% of people who have individual plans have average deductibles of $3,881, or five times the average for employer group plans, study author Jon Gabel told Bloomberg.
“Deductibles will have to be lowered,” Gabel said. “The out-of-pocket limits may have to be lower. They will have to offer maternity [and mental health] benefits.”
Robert Zirkelbach, a spokesperson for Washington, D.C.-based industry group America’s Health Insurance Plans, said that people with policies that don’t meet the exchange requirements would have to “buy up” in 2014.
“Any time new benefits are added to a policy that adds to the cost of coverage,” Zirkelbach said.
The Commonwealth Fund, a New York-based nonprofit that supports expanded health insurance coverage, paid for the research.
Breast Implants
“Serious lessons” are to be learned from a scandal that led to the demise of a European rival of Irvine-based drug and medical cosmetic maker Allergan Inc., according to a United Kingdom government review released last month.
The British health ministry commissioned the review after it was discovered that for up to 10 years, 47,000 British women and hundreds of thousands worldwide had received substandard breast implants made by Poly Implant Prothese, a now-defunct French manufacturer.
The Medicines and Healthcare Products Regulatory Agency followed sound scientific advice as it did its investigation, but it should do more to obtain evidence from a wider range of sources, including detailed clinician data, reviewers said.
Allergan has moved to boost sales of its breast implants in the wake of Poly Implant Prothese’s closure.
It started an advertising campaign earlier this year in European women’s magazines urging consumers to opt for quality in their choice of breast implants.
“It’s a risk—it’s bold, it’s never been done before,” Douglas Ingram, president of Allergan’s Europe, Africa and Middle East region, told the Financial Times in London.
European OK
Laguna Hills-based medical device startup Vessix Vascular Inc. won European regulatory clearance for its V2 Renal Denervation device for treating high blood pressure.
Renal denervation is catheter-based and uses radiofrequency energy to disrupt renal-sympathetic nerves whose hyperactivity leads to uncontrolled high blood pressure.
The clearance enables Vessix to market its system throughout the European Union.
Figures provided by Vessix show that there are more than 12 million people worldwide whose blood pressure remains uncontrolled despite taking three or more anti-hypertensive drugs.
That represents a global market opportunity for renal denervation that could ultimately grow to $30 billion, according to the company.
Vessix was founded in 2003. Backers include NeoMed Management AS of Sweden; Paris-based Edmond de Rothschild Investment Partners and OrbiMed Advisors LLC of New York.
InstaMed Gets $14M
InstaMed Inc., a Philadelphia-based healthcare information technology company with an office in Newport Beach, raised $14 million in capital from undisclosed investors.
InstaMed processes payments for healthcare services through a network that connects providers, insurers and patients.
It processes payments for more than 200,000 providers nationwide.
Proceeds from the funding will be used in building up the company’s network infrastructure and operations, and to support new growth of the payer segment on its network.
InstaMed’s cofounder and chief technical officer, Chris Seib, lives in OC.
