Blue Cross And Blue Shield: Experiences Of Weak Plans And The Role Of Effective State Oversight
A study of the Blue Cross & Blue Shield plans to: (1) determine the extent of financial weakness among the Blue plans; (2) identify factors that contribute to plans' weak financial conditions; & (3) determine the measures taken by the plans, the Blue Cross & Blue Shield Association (BC & BSA), & states to address plan weaknesses. Also describes the oversight & other roles played by the BC & BSA & discusses the implications of health care reform on Blues plans. Charts & tables.
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actual claims experience adjust premium rates affiliate Appendix Association officials Blue Cross Blue Shield Association Blues plans board of directors BP Cl BP commercial insurers community rating Corporation coverage requirements Cross and Blue Differences Among Blues District of Columbia enrollment financial performance financial problems financially troubled plan formula health care reform health insurance health maintenance organization health status individual plans insolvency Insurance Industry insurance regulators Inter-plan Investigations Hearings Leslie G license agreement Massachusetts member plans million minimum surplus requirement NAIC NAIC's National Capital Area not-for-profit oversight roles percent plan boards plan CEO plan's plans and commercial preferred provider organization protect the value rate-setting and coverage Regulation of Blues regulatory requirements Required Required review of first-time risk-based Senate Permanent Subcommittee solvency staff statement Washington Subcommittee on Investigations termination trademark license U.S. Senate Permanent Virginia Plan weak financial condition West Virginia X X X X X X
Page 36 - L P P P P P P L P P P P P m m p L L P Differences Among Bines Plans (Table notes on next page) Plan name Medical Service Corp. of Eastern Washington Pierce County Medical Bureau (WA) Mountain State BC/BS (WV) BC/BS United of Wisconsin BC/BS of Wyoming
Page 50 - Association now requires that each Plan's subsidiary activity be regulated the same as all commercial health Insurers In Its state. See comment 3. See comment 4. See comment 5. Comments of the Blue Cross and Bine Shield Association Ms. Leslie G.
Page 52 - truly outstanding results In Its marketing of managed care and Its financial performance. These are not uncommon examples among the Plans. This year. Blue Cross and Blue Shield Plans had over 24 million subscribers enrolled In managed care programs around the country. The Plans collectively are far and away the largest managed care providers
Page 51 - payment and continued coverage are guaranteed. He believe actions In these and other areas stand as proof of Blue Cross and Blue Shield Plans' continuing accountability to their subscribers. THE ROLE OF STATE REGULATION Your report Is commendable for recognizing that state regulators also share responsibility for assuring strong and stable Plans. This
Page 34 - Differences Among Blues Plans Our study found that Blues plans differ considerably in organization, operations, and regulation. For example, plans operate within different legal contexts. As of May 1993, 54 plans were regulated pursuant to special enabling statutes, 14 as mutual insurers, and 2 as not-for-profit stock insurers (see column 1 of table
Page 54 - Although not incorrect, your statement that no Plan paid more than 1 percent of its net subscription revenue In dues to the Association could be misleading. In fact, in 1992 no Plan paid more than 0.181 percent of net subscription revenue in dues and the weighted average for all Plans was 0.089 percent. Page 54 GAO/HEHS-94-71
Page 51 - will be tolerated. Acting on such an Incorrect assumption would be a Mistake. Since 1991. when the Association first established a specific surplus level below which a Plan would be terminated without any further considerations, no Plan has been allowed to fall short. In two recent cases where Plans appeared In
Page 33 - is an Ohio-based insurance corporation formed in 1986 to provide property/casualty and general liability insurance to plans and to reinsure a portion of the coverage written by BCS Insurance. It is owned by the Association, BCS Financial, and more than 40 Blues plans. Its 1992 gross revenues were $4.6 million. Appendix
Page 41 - (continued) Table IV.1 : State Regulatory Requirements for Blues Plans (as of 12/31/91) RATE-SETTING MA NY NY NY NY NY NY CT Ml NJ NH SD VA VT WV CO PA PA PA PA PA Rl TN TN AZ ID ID MD ME MN NC NE NM Plan Boston Buffalo New York City Rochester BC Rochester BS Syracuse