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UPMC gets ready for individual health plans

Tuesday, April 16, 2013, 12:01 a.m.
 

Health insurers are gearing up to compete for millions of potential customers who could begin shopping for an individual health plan later this year.

And one strategy to win new business from individual health-insurance buyers could be by offering new and unique products, experts said.

UPMC Health Plan, the health insurance arm of hospital system UPMC, said on Monday that it will introduce a wellness-program option next month for its Individual Advantage plans. It will include financial rewards for participating.

While fairly common in employer-sponsored health plans, wellness programs are still rare among individual plans. But those programs and other new options could become more widespread.

Health insurers will need to differentiate themselves in what's expected to be a highly competitive market for customers who are required under the Affordable Care Act to buy their own coverage because they don't get it from an employer, said James McTiernan, a health care consultant with Triad Gallagher. “I suspect it's a very smart thing as they prepare for health reform,” he said.

Insurers “are going to be competing vigorously” in the online marketplace being set up in Pennsylvania by the Health and Human Services Department, he said.

More than 2 million Pennsylvanians could use the new marketplace to buy insurance, according to an estimate from the state Insurance Department.

UPMC Health Plan said it isn't offering the individual wellness program — which it is calling Goals Plan — in anticipation of the online marketplace opening for enrollment on Oct. 1.

“We believe there is a large segment of the individual market which is interested in health and wellness,” said John Mills, the health plan's senior director of consumer products. “We are currently evaluating the marketplace and navigating the regulations surrounding health care reform to develop comprehensive product offerings for 2014.”

Goals Plan participants can earn $400 a year, which can be used to offset out-of-pocket medical expenses, through more than 150 activities, such as health screenings, general physical exams, online health risk assessments, and online sessions on physical activity, nutrition, and weight loss.

Susan Pisano, vice president of communication for America's Health Insurance Plans, a Washington trade group, said health insurers are focusing more energy on the individual market, she said, “and there will continue to be an increase” under the Affordable Care Act.

Highmark Inc., the state's largest health insurer with a wide offering of individual health plans, offers six free programs to its individual members including nutrition, weight loss, and stress management, spokeswoman Denise Hughes said. But it doesn't induce participation with money, she said. Kristin Ash, another Highmark spokeswoman, said the insurer “plans to have an array of products” in the new individual marketplace, but they remain under development.

Aetna Inc. declined to comment on its plans for new options under the online marketplace.

Cigna Corp., which provides plans for employer groups in Western Pennsylvania, doesn't sell individual plans in the state.

Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or anixon@tribweb.com.

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