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WESTERN PA. Highmark insurance seeks rate changes



Published: Wed, September 25, 2002 @ 12:00 a.m.



Lawrence County subscribers will see the cost of their basic coverage triple.

By HAROLD GWIN

VINDICATOR SHARON BUREAU

SHARON, Pa. -- Mercer County subscribers to Security Blue Medicare HMO insurance won't see their rates change much next year, but their peers in Lawrence County can expect some hefty increases.

Mercer and Crawford County senior citizens buying the supplemental insurance package have seen their rates rise sharply over the past two years, but Vanessa Paris, spokeswoman for Highmark Blue Cross/Blue Shield, which puts out the package, said that won't happen in 2003.

There are about 5,000 Mercer County subscribers and 1,100 Crawford County subscribers who are paying $99 a month for the basic package -- it includes basic health care and routine vision and hearing insurance -- and $134 per month for the standard package, which covers everything in the basic package plus $150 per quarter in prescription drug coverage.

Paris said Highmark is proposing to keep the basic rate the same for 2003 and raise the standard rate to $139 per month.

The rates must be approved by the federal Centers of Medicare and Medicaid Services.

Mercer and Crawford have been rated as rural communities by CMMS, but adjacent Lawrence County is rated as an urban area, linked to Allegheny County, which has resulted in lower rates over the years.

Rates there are slated to take significant jumps in 2003 but will still be lower than in Mercer County, Paris said.

The basic package will rise from $12 to $36 per month while the standard package will rise from $65 to $97 per month. The standard package in Lawrence County carries a $350-per-quarter prescription drug coverage plan.

Cites rising cost of care

The company said increases are necessary to offset the growing cost of medical care, which is outpacing federal reimbursement for Medicare coverage.

Lawrence has about 4,600 subscribers.

Mercer County subscribers are limited to the basic and standard options but those in Lawrence have two other packages available.

They can get the deluxe package, which includes the standard option plus chiropractic, podiatry, dental and limited out-of-service area coverage at $73 per month.

They also can select a new direct package, which includes the standard package plus open access to network specialists without referral and limited out-of-service area benefits for $90 per month.

Paris said some new charges implemented for Mercer and Crawford subscribers at the beginning of this year were eliminated in June.

Those were a $100 copayment for inpatient hospitalizations and a $25 copayment for any outpatient surgery.

Paris said drug copayments will remain the same next year at $12 for a 34-day supply of a generic drug and $20 for a brand-name drug for the same period.

gwin@vindy.com




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