Gaining traction: health insurance premiums priced to lifestyles

[Nords]

How'd you like to have your health insurance premiums linked to your lifestyle?

Or, for you military veterans, how'd you like to have your TRICARE premiums linked to a physical-fitness score?

Sweat More, Pay Less

[Darryl]

Last year my megacorp had me take an HRA (health risk appraisal) and call a health coach to discuss the results and set a health goal in order to obtain $500 in matching HSA money. This year DW also needs to participate it not only affects the match but our weekly premiums (not participating will cost us another $500 a year if we take up smoking it will cost an additional $500 per year) the coaching this year is not a one time shot there will be multiple phone calls and if we stop communicating the premiums go up $10 per week.

[bssc]

Certifying that we are non-smokers or smokers going to quit gets us a $15 a check credit.

[ziggy29]

I think most employers start with carrots when considering an implementation of this scheme, but will transition to sticks over a 2-3 year period. In other words, instead of incentives to "do the right things" with your health, they'll change to penalties for not doing it.

But I think most of them are concerned about morale issues and legal hassles if they go too far into the realm of punishing certain health conditions, especially in the era of the ADA and other legislation. So most likely, I think they'll tie incentives and penalties not to good health itself, but for taking steps toward achieving it -- at least initially. I suspect most people who are (say) 100 pounds overweight, even, would be given the benefit of the doubt if they enrolled in some weight-loss programs or other get-in-shape initiative, and might have to show results in future years to qualify again.

My megacorp is going to start providing carrots in the form of increased contribution to our HSA or HCA this year for participating in wellness initiatives and for completing a health assessment. Don't know how much in total, but we can get up to $225 if we both complete the assessments. One has to wonder if, in the future, doing all these things will be required for getting the base match and not doing it could result in takeaways.

[youbet]

Megacorp gave us a lower monthly premium if we had an annual physical exam. No metrics were turned in to Megacorp by doc. I think they just assumed that if you had an issue, seeing your doc would at least give him/her the opportunity to get on your case to improve your situation.

I think it's great to have corporate culture support positive lifestyle changes, but there would be a dangerous slippery slope if performance metrics were reported and acted on in any meaningful way. If penalties become too severe, our courts will become burdened with cases involving ideal weight formulas, safe levels of alcohol consumption, tobacco use (is an occassional cigar OK?), and all that.

If you're going to have significant penalities for non-compliance, determining which behavioral metrics to measure, how to measure them, the absolute values that trigger penalities, length of warning periods, etc., etc., will be a real picnic to figure out. Especially, if any metric has a disparate impact on one sex or a particular ethnic group.

[Gotadimple]

Originally Posted by youbet

Megacorp gave us a lower monthly premium if we had an annual physical exam. No metrics were turned in to Megacorp by doc. I think they just assumed that if you had an issue, seeing your doc would at least give him/her the opportunity to get on your case to improve your situation.

I think it's great to have corporate culture support positive lifestyle changes, but there would be a dangerous slippery slope if performance metrics were reported and acted on in any meaningful way. If penalties become too severe, our courts will become burdened with cases involving ideal weight formulas, safe levels of alcohol consumption, tobacco use (is an occassional cigar OK?), and all that.

If you're going to have significant penalities for non-compliance, determining which behavioral metrics to measure, how to measure them, the absolute values that trigger penalities, length of warning periods, etc., etc., will be a real picnic to figure out. Especially, if any metric has a disparate impact on one sex or a particular ethnic group.

All good points, however, federal law (HIPAA) prohibits employers from seeing personal health information that can be tied directly to an individual. Some states prohibit employers from seeing any claims data with a diagnosis that would directly identified an AIDS-related disease.

Many megacorps know that focus on good health habits results in lower medical utilization, therefore, lower premiums AND less absenteeism. So from the big picture, it is in the employer's best interest to attract and retain a healthy work force, and sharing some of the savings with employees is one way to encourage healthy behaviors, or at least, encourage thinking about it.

My employer? Mega-corp health insurer.

-- Rita

[youbet]

Originally Posted by Gotadimple

All good points, however, federal law (HIPAA) prohibits employers from seeing personal health information that can be tied directly to an individual. -- Rita

ou

We're on the same page........ I think you misread my post. I said "No metrics were turned in to Megacorp by doc."

[cute fuzzy bunny]

My wifes group health seemed to offer a carrot by introducing the "health appraisal" along with regular weekly talks with a health counselor. Doing so netted a $50 per pay period deduction of the insurance costs. Unfortunately my wifes asthma and my cholesterol would put us both in counselor hell, where the counselor decides how often we need to talk to them, can chide us freely about our genetic conditions that are untreatable without medication, and decide if we dont call often enough to qualify.

Then they took the carrot away by raising the cost of the health insurance by $50 a pay period to negate any advantage.

Still not too bad though. $340 a month for family coverage @ $5 an office visit, free labs and $5 for 100 day supplies of meds.

[ziggy29]

Originally Posted by cute fuzzy bunny

Then they took the carrot away by raising the cost of the health insurance by $50 a pay period to negate any advantage.

Sounds exactly like what I meant about starting out with carrots that eventually become sticks.

[cute fuzzy bunny]

Theres no free lunch.

With one hand someone will say that theres an opportunity to fix high health care costs by shifting the burden to less healthy or potentially less healthy, then someone else will notice that theres a revenue opportunity.

Nice move to get people off the socialized medical bandwagon for a few more high insurance company profit years...

[lazygood4nothinbum]

Originally Posted by Nords

How'd you like to have your health insurance premiums linked to your lifestyle?

lucky me, they already are. i got penalized for body mass index because i'm bulked up by working out and healthy eating.

[lets-retire]

Originally Posted by lazygood4nothinbum

lucky me, they already are. i got penalized for body mass index because i'm bulked up by working out and healthy eating.

You gotta love when the insurance industry use essentially a height/weight chart (which have been found to be unreliable at best) to determine if your overweight.

[ziggy29]

Originally Posted by lets-retire

You gotta love when the insurance industry use essentially a height/weight chart (which have been found to be unreliable at best) to determine if your overweight.

BMI sucks, at least as it's most commonly calculated (from a table). It should not ever be calculated from a height/weight table.

I remember hearing Jack LaLanne talking about it once. He gave an example of someone who was muscular, active and fit in their 20s who might be the "right" weight. Over a couple of decades he doesn't put on much weight but becomes more and more sedentary. The man is proud because he hasn't gained weight and thinks he's as fit as ever. The problem is, despite being the same weight, most likely fat has replaced muscle. His BMI is considerably higher even though the charts don't spot it.

To the extent BMI is ever used, it should be from professional measurement with appropriate equipment. Using it just by looking up height and weight is quackery. By most charts, professional bodybuilders might be obese because of all the muscle mass they pack on their frame.

[lets-retire]

Ziggy-- Here is a quote directly from the CDC's web site "Body Mass Index (BMI) is a number calculated from a person’s weight and height." The problem with BMI, like you said, is it does not take into consideration the composition of a persons body. With that said, a person who is 6' tall and weighs 210 will always have the same BMI, no matter their body composition, so it can be taken directly from a height/weight chart. If the BMI is calculated correctly, all bodybuilders will be overweight.

Shortly before exiting the military there was a push to use BMI to determine if someone was within standards. In the beginning stages I would go in for my annual weigh in and, of course be overweight. I would then have to go to the fitness guru's and listen to the same mandatory story about how being overweight is bad. They would also take more accurate measurments to determine my fat content. They would normally laugh when I would walk in and tell them why I was there. The level of seriousness also declined dramatically when I had to lift my shirt and they would see the six pack.

The BMI Formula is: (Weight/Height in inches Squared)*703=BMI

[Khan]

Originally Posted by ziggy29

BMI sucks, at least as it's most commonly calculated (from a table). It should not ever be calculated from a height/weight table.

I remember hearing Jack LaLanne talking about it once. He gave an example of someone who was muscular, active and fit in their 20s who might be the "right" weight. Over a couple of decades he doesn't put on much weight but becomes more and more sedentary. The man is proud because he hasn't gained weight and thinks he's as fit as ever. The problem is, despite being the same weight, most likely fat has replaced muscle. His BMI is considerably higher even though the charts don't spot it.

To the extent BMI is ever used, it should be from professional measurement with appropriate equipment. Using it just by looking up height and weight is quackery. By most charts, professional bodybuilders might be obese because of all the muscle mass they pack on their frame.

"Your waistline is your lifeline."
-Jack LaLanne

[cute fuzzy bunny]

Originally Posted by lets-retire

You gotta love when the insurance industry use essentially a height/weight chart (which have been found to be unreliable at best) to determine if your overweight.

My doctor told me to lose some weight.

I told him I'm going to take a shot at getting taller.

[ziggy29]

Originally Posted by cute fuzzy bunny

My doctor told me to lose some weight.

I told him I'm going to take a shot at getting taller.

I'm not overweight, I'm undertall.

[cute fuzzy bunny]

Well I figured getting taller has a stronger chance of happening than losing weight. I simply tackled the most plausible solution to the problem.