1. Happy Thanksgiving!
The Thanksgiving season allows us to reflect on the year and give thanks for the many
liberties and benefits we have as Americans and to those individuals who impact our daily
lives. I am blessed and have a lot to be thankful for, including the business and friendship
relationship we share.
Wishing you and your family a Safe and Blessed Thanksgiving Holiday!
Mike
In the spirit of Thanksgiving, I'd like to share a few special quotes I enjoyed, and felt you may
too............
"As we express our gratitude, we must never forget that the highest appreciation is not to utter
words, but to live by them". - JF Kennedy
"Let us remember that, as much has been given us, much will be expected from us, and that
true homage comes from the heart as lips, and shows itself in deeds". - Theodore Roosevelt
"May your stuffing be tasty, may your turkey be plump, and your potatoes and gravy have nary
a lump. Your yams be delicious, your pies take the prize, and your Thanksgiving dinner stay
off of your thighs!"- Unknown
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

2. Market Trends, Surveys and Strategies
Workplace Wellness Programs to Reduce Workers' Compensation
Costs
Silos in Human Health Management! In years past employers would engage risk managers to
control workers compensation costs and human resource managers to control health plan
costs. When addressing today's complex workforce, a combined effort creating an integrated
approach to controlling costs would be much more effective.
This is particularly important due to: our aging workforce, which now averages 46 years old:
our population working into their 60's and early 70's increasing medical care costs; increase in
stress related illnesses; obesity rates at an all-time high; and approximately 90 percent of
Americans living with some chronic condition, such as diabetes, hypertension, asthma and
thyroid disorders. These non-work related health issues directly increase the risk of work-
related injuries. For a good read on the subject from Business Insurance Magazine click here.
Public Sector News
Consumer Driven Health Plan Effectiveness - Case Study: State of
Indiana
Last month's newsletter featured a study by the Manhattan Institute (Cadillac Coverage - The
High Cost of Public Employee Health Benefits) which reviewed some of the success's the
State of Indiana had as a result of implementing a Consumer Driven Health Plan (CDHP). A
case study was conducted on the State's progress by Mercer in May, 2010.
The State implemented a CDHP plan in 2006, along with two existing PPO programs that were
merged into one plus an HMO. In 2007, a second CDHP was added and the HMO was
eliminated. Mercer's report validated sources of savings and overall experience of the two
CDHP plans compared to the remaining PPO. The CDHPs have achieved significantly lower
cost than the PPO. The CDHPs will account for 90 percent of all participants in 2012.
The following experience was noted in the Mercer study:
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

3. The total average cost for the PPO was $12,317 compared to $5,462 for CDHP1 and
$9,444 for CDHP2.
The two CDHPs had combined savings of 10.7% per year and were projected to save
$17-23 million for the state in 2010.
Additionally, state employees and their families enrolled in the CDHPs were projected to
save $7 to $8 million in 2010.
Both CDHPs had lower than average age populations, but a higher average family size
compared to the PPO.
The actuarial values of the CDHP plans were somewhat lower than the PPO plans,
meaning that employees would pay more out-of-pocket than if they enrolled in the
PPO. But, the CDHPs were not significantly lower in value.
Individuals who moved to either CDHP option had reduced utilization and intensity of
services.
There was no evidence participants in the CDHPs were avoiding care. Sources of
savings came from better use of healthcare resources and more cost conscious
decision making. Both CDHP plans had better outcomes when compared to the PPO
for emergency room visits, outpatient visits, physician office visits, generic dispensing
rate, hospital admissions and average length of stay in the hospital. To receive the full
study click here.
Containing Health Care Costs - Proven Strategies For Success In The
Public Sector
The Government Finance Officers Association (GFOA), with a grant from Colonial Life,
conducted independent research to identify the most innovative and effective strategies local
governments can employ to meet the dual goals of containing costs and managing the quality
of employee health-care benefits. The study identified six primary targets:
1. Change the level of benefit provided. Modify the number of benefits offered and who
they are offered to.
2. Manage participants' choice of providers. Direct, or even limit, health plan participants'
choices to lower cost providers.
3. Share cost with employees. Structure the health plan so that employees bear an
increasing part of the burden of benefit costs. Increase premiums, co-pays or
deductibles.
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

4. 4. Reduce use of health care services by employees. Address incentives and actual need
for health care services. Consider offering Consumer Driven Health Plans. Add
Worksite Wellness Initiatives.
5. Right-source health benefit services. Identify a strong network of service providers.
6. Maximize the value received for the health care dollar. Consider the benefit received
per dollar spent on health benefits.
To review the full report including implementation strategies, click here.
Legislative Updates and Impacts
Supreme Court To Hear PPACA Challenges
On November 14, 2011, the United States Supreme Court announced that it will hear
arguments relating to various constitutional challenges to the Patient Protection and Affordable
Care Act (PPACA). A decision will be issued before its term ends in June 2012.
The Court has agreed to review four questions that were raised in various lower court
challenges to PPACA:
Individual Mandates - Did Congress exceed its authority under the Commerce Clause of
the Constitution in requiring that individuals maintain minimum essential coverage
beginning in 2014 or pay a tax assessment?
Severability - if the individual mandate provision is nullified as unconstitutional, is it
severable from the rest of the legislation, or will some or all of the PPACA provisions be
nullified?
Anti-Injunction Act: Are private individuals and states procedurally barred from
challenging the constitutionality of the individual mandate by the Anti-Injunction Act,
which prohibits legal challenges to taxes until after the tax is collected?
Medicaid: Did Congress exceed its constitutional authority in expanding the Medicaid
program?
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

5. Compliance Date Delayed for Summary of Benefits and Coverage
(SBC)
On August 22, 2011, the Departments of Health and Human Services and Labor and Treasury
issued proposed regulations for the SBC. The proposed regulations included guidance on
providing and preparing the SBC as well as a proposed template for the SBC. The regulations
were not final.
On November 7, 2011, the Department of Labor (DOL) issued a set of Frequently Asked
Questions that addresses when plans and issuers must start providing the SBC. The proposed
regulations called for providing the SBC by March 23, 2012. However, in the FAQ, the DOL
delays the compliance date. It now states plans and issuers can wait to start providing the
SBC until after the final regulations are released. Thus, the March 23, 2012 deadline no longer
applies.
More information on the SBC requirement, including the proposed regulation is available at
www.dol.gov/ebsa/healthreform/index.html.
Insurance Carriers and Healthcare Providers In The News
Aetna HealthFund - Seventh Annual Study
Aetna conducted its seventh annual study of their CDHP block of business. The study, the
longest running of its kind, included more than 2 million Aetna members and compared
participants with traditional PPO plans versus those plans with high deductibles including
Health Savings Accounts (HSA) and Health Reimbursement Arrangements (HRA).
The study showed that members of consumer-directed plans accessed more preventive care
and screenings than people with traditional PPO plans. In addition, members were more
engaged as a consumer of health care, did not forgo care but instead continued to get the care
that they needed. When compared to PPO members CDHP members were twice as likely to
go online for: cost of care information, health information and benefits information.
The study showed employers with complete replacement models saved more than those
offering the plan as an option. Also noted, members spent 12 percent more on preventive
care, diabetics in CDHPs accessed screenings at higher rate than diabetic members in PPO
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

6. plans. Members also visited the emergency room for non-urgent care less than members
in PPO plans and they used prescription drugs to treat chronic conditions as necessary.
The results also showed that HSAs continue to demonstrate more dramatic savings than
HRAs. Several other key findings showed employers offering plans that required increased
member responsibility exhibited the best total cost trends. Specifically plans with a deductible
of at least $1,500 for individuals experienced approximately 4 percent lower total cost trend
than plans with deductibles that were less than $1,000. A new finding this year showed that
plans with coinsurance experienced trends as much as 5% higher than those with lower
coinsurance.
Maximum savings came from well-designed plans offering incentives for CDHP participation,
plan education and worksite wellness engagement. For details on the study, click here.
Human Resource Center
Spousal Waivers and Exclusions on the Rise
As employers are faced with greater challenges to control benefit costs, they are rewriting their
benefit philosophies, adopting consumer centric plan designs, developing higher cost share
models and reviewing who their plans cover. At open enrollment time, employees are "doing
the math" to determine which plan options best fit their family's needs. Dual income families
take that a step further and determine which employer offers the best deal.
Harsh as it might seem, employers are being forced to reconsider eligibility guidelines and
contribution sharing which might currently make their plan "the plan of choice" and attract not
only employee participants, but their dependents, even if other coverage is available to them.
As a result, there is a strong trend to implement "spousal carve-out" or "spousal exclusion
policies." They usually follow one of three formats:
Working spouse pay a premium surcharge if working elswhere and has coverage
available there.
A requirement that the spouse purchase health coverage through his employer's plan
before also purchasing it through the other plan - making it secondary.
An outright exclusion from coverage under the employer's plan if similar coverage is
available from the spouse's employer.
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

7. A recent Towers Watson survey report of 600 employers found that in 2010 nearly 20% used
spousal surcharges or waivers when other coverage was available for a spouse and another
15% intended to add the provision by the end of 2012. For a deeper read offered by HR
Magazine including legal questions and employee reactions click here.
What is your Health Insurance IQ?
According to a national survey conducted in September and October of 2011 by Kelton
Research and sponsored by eHealthInsurance fewer than six in ten (55%) consumers can
confidently say what a "deductible" is and even fewer are able to define or explain the terms
"premium" (41%), "HMO" (34%), "coinsurance" (25%) or "copay" (61%).
The confusion goes deep into their personal coverage not knowing if services are
covered. While 80%+ know doctor visits and prescription drugs are covered, about 60-70% do
not know if their plans cover diagnostic services, overnight hospital stays, immunizations or
maternity care.
The survey also notes the majority of Americans are confused or consider themselves
uninformed about Health Care Reform Legislation passed in 2010 (Patient Protection and
Affordable Care Act). In fact, many feel the guaranteed issue and removal of pre-existing
clause provisions are already in effect, when in fact it won't actually take place until 2014.
Health Care Reform will not change Health IQ's overnight. Members have to become more
engaged in the process as consumers, from cost to quality.
Note" eHealthInsurance announced the release of its new book, Individual Health Insurance
For Dummies, Health Care Reform Special Edition produced in cooperation with For Dummies,
a branded imprint of Wiley. Congratulations to them for their efforts.
Hospital Selection
A Thomson Reuters Healthcare Survey shows how a member's income, education and age
can be influenced by hospital ratings. If their hospital received a bad rating, nearly 75% would
change hospitals rather than stay put. If specialty care is needed, slightly more than half would
seek out the best-rated facility rather than go to their community hospital. If a serious illness is
involved, nearly 60% would rely on ratings rather than community location in seeking care. To
see the full study, click here
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

8. Wellness Initiatives
November is Diabetes Awareness Month
If you currently do not offer screening, coaching or any other tools to assist employees in need,
www.diabetes.org has the resources for those recently diagnosed. This includes treatments,
strategies and support as well as suggestions and guidelines for those who wish to prevent or
delay the onset of Type 2 Diabetes. For more information view the November Horton
Health Initiatives Newsletter, click here.
Wellness & Safety Checklist
If you want to give your safety and health program a check-up, take a few minutes to complete
the attached survey. There are no right or wrong answers - the survey is designed to help you
quickly identify areas where improvements can be made.
Horton Webinars & Seminars (Reminders)
Click here for the latest Webinar & Workshop schedule through January 2012.
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com