"The Big Picture" Newsletter

July/August 2009 Issue

SOUTH CAROLINA EDITION

CIGNA Introduces Individual Plans in South Carolina

CIGNA HealthCare has introduced new plans for Individuals in South Carolina with July 15, 2009 effective dates. The plans offer many of the benefits that have traditionally only been available to larger employers such as access to a 24-hour health information line and tools to help people understand their own personal health risks and take action to prevent a serious health event.

Individuals and their families will have access to a network of more than 500,000 quality health professionals and facilities throughout the country. In South Carolina, this includes more than 15,000 doctors and more than 90 hospitals.

In South Carolina, there are three Health Savings plans and four Open Access plans available for individuals and families. The Health Savings Plans are high-deductible health plans used in combination with a tax-advantaged Health Savings Account (HSA) to pay for certain medical expenses (now or in the future) that may not be covered by the health plan. The new plans include a broad range of benefit levels which enables you, the broker, to find the plan that is right for your customer.

For more information, contact Nancy Melton at nancy.melton@cigna.com.

Legislative Update

Governor Mark Sanford (R) has been the nation’s most vocal critic of federal stimulus money and refused to accept nearly $700 million in stimulus money for education and law enforcement unless state legislators reduced an equivalent amount of debt. The legislature passed a budget which included language directing the Governor to accept the federal money, the Governor vetoed the measure and legislature overrode the veto. Governor Sanford recently filed a federal lawsuit challenging the General Assembly's authority to force him to accept the money. In addition, two state actions were filed one by the South Carolina Association of School Administrators and the other by two students which are before the South Carolina Supreme Court.

On May 21, the South Carolina legislature adjourned the 2009 regular legislative session. Legislators are expected to return on June 16 for a limited session to address gubernatorial vetoes and conference committee reports. The following is a report of bills of interest:

Legislation that became law

S.B. 390 (Mental Health Parity) expands current mental health parity laws to include substance abuse disorder and requires coverage to be equal to medical and surgical benefits for other mental health benefits. Legislation which will carry over to the 2010 legislative session

S.B. 202 (DOI “Technical” Bill) requires HMOs to offer conversion policies in the result of termination due to insolvency. In addition, the House amended S.B. 202 to increase the maximum coinsurance differential for in-network and out-of-network health care services from 20 to 30 percent. The coinsurance percentage for in-network and out-of-network covered health care services or supplies provided by dentists may not exceed a maximum difference of five percent. The Senate did not concur with the House amendments.

S.B. 416 (Dependent Coverage) amends the definition of dependent to include: 1) a spouse: 2) an unmarried child under 25 years of age: 3) an unmarried child incapable of self support due to mental disability or physical handicap; and 4) an unmarried child who has served on active duty in the National Guard or the United States armed services or reserves. This bill passed the Senate and but remains in the House Committee on Labor, Commerce, and Industry.

S.B. 455 (Health Net) establishes the South Carolina HealthNet Program. The program, promoted by Director of Insurance Scott Richardson, requires small group insurers and any health group cooperatives to offer HealthNet plans. Policies are exempt from state mandates and guaranteed issue without regard to health status. S.B. 455 passed the Senate but awaits consideration by the House Committee on Labor, Commerce, and Industry.

S.B. 613 (Clinical Trials Mandate) requires coverage for certain approved cancer clinical trials. This bill remains in the Senate Medical Affairs Committee. S.B. 467 (Alcohol Exclusion) repeals the optional alcohol exclusion from medical expense policies.

S.B. 467 remains in the Senate Banking and Insurance Committee.

H.B. 3063 (PBM Registration) requires registration of a pharmacy benefit managers and provides oversight. This bill remains in the House Committee on Labor, Commerce, and Industry.

H.B. 3584 (Premium Subsidies) increases the cigarette tax with revenues directed to health insurance premium subsidies. The bill passed the House and was reported favorably by the Senate Finance Committee. A Senate committee amendment places the majority of the new revenues in a healthcare trust fund without designating use of the revenues.

H.B. 3371 (Provider Contracting) extends in-network payments to providers whose contracts have terminated if insured is in the middle of course of treatment. In addition, the bill establishes requirements on a provider when a contract is terminated or nonrenewed as a result of the provider failing to meet credentialing requirements. This bill remains in the House Labor Commerce and Industry.

H.B. 3376 (Provider reimbursement) prohibits insurers from limiting or conditioning a service or reimbursement rendered by a health care provider unless the limit or condition also applies to all health care providers. This bill remains in the House Committee on Labor, Commerce, and Industry.

 

LOCAL SPOTLIGHT

Where We Are

250 Commonwealth Drive
Greenville, SC 29615

Who to Contact

Michael Foresman
864.987.1394
Michael.Foresman@cigna.com

Experienced Local Leadership

Charles C. Pitts, President and General Manager – CIGNA HealthCare of the Carolinas
Charles Pitts has over 20 years experience in the health care industry. Prior to joining CIGNA in 2006, Charles led the development and growth of multiple health plans for UnitedHealthcare. His responsibilities included financial, operational and leadership performance of health plans in North Carolina, South Carolina, Alabama, Louisiana and Mississippi. Charles earned his Bachelor of Arts degree from Washington and Lee University, and his MBA in Finance from the University of Alabama. He currently resides in Charlotte, North Carolina.