California's Health Net moves into upstate New York

CNY Business Journal (1996+), Oct 27, 2006 by Erbstoesser, Greg

SYRACUSE - California-based managed-health-plan provider Health Net, Inc. (NYSE: HNT) is expanding its presence in upstate New York, offering several Medicare Advantage health plans to retirees and businesses.

Health Net, headquartered near Los Angeles, will offer Private-Fee-For-Services (PFFS) Medicare alternative plans to Medicare recipients in Onondaga and Broome counties and 46 others across New York State beginning in 2007, according to Donald Tarr, the insurance company's Central New York territory account executive.

Health Net notes there are more than one million Medicare recipients, 65 years old and older or disabled, in upstate New York - with 49 percent of the recipients who are covered solely by Medicare Parts A&B and do not have any supplemental Medicare Advantage coverage to cover out-ofpocket deductibles and co-insurance.

"Here's an option for when you retire, for the employer who wants to offer his retirees a health-insurance plan," whether the employer contributes to any premium costs, or leaves the payments to the retiree, Tarr explains. "They can set it up the way they want."

"This works for the healthy and not-so-healthy," Taff says.

Tarr notes the Health Net plans allow participants to see any doctor, specialist, or hospital that accepts Medicare and the plan's payments.

The private insurance plans offered have different benefit provisions and premium schedules.

One plan offers a no-monthly-premium policy, in which the participant pays only the $93.50 monthly Medicare Part B premium, Tarr explains. The policy has a $3,100 maximum yearly out-of-pocket expense.

A second, no-additional-premium-plan offered by Health Net is available in Clinton, Columbia, Delaware, Green, and Otsego counties where the monthly premium is $25, Tarr says, because of the individual Medicare reimbursement rates assigned to those counties.

Health Net also offers a third-option plan in which the recipient pays a $95 monthly premium in addition to his or her Medicare Part B monthly premium. However, the yearly, out-of-pocket maximum is $1,000, Tarr points out.

Benefits, co-payments, and out-of-pocket expenses also vary between plans, although Tarr notes that while participants are enrolled in a private healthinsurance plan, they still will receive the benefits offered by Medicare.

Downstate is not included in the Health Net PFFS healthinsurance coverage plans.

The company also offers three separate, Medicare Part D prescription-drug plans nationwide.

Tarr says the company will begin an extensive advertising campaign about its PFFS plans, and it will host numerous informational seminars across the state in advance of the annual enrollment period for individuals on Medicare that begins on Nov. 15 and ends on Dec. 31.

Enrolling groups in the health-insurance plans for groups, however, can be done throughout the year, Tarr explains.

Advertising will include television, radio, and print advertisements as well as direct-mail, he says.

The plans will be sold through brokers, financial advisors, and independent agents in the state, he says.

Tarr, formerly an agent with the Mang Insurance Agency, Inc. in Vestal, is one of three regional-company representatives who are overseeing Health Net's introduction Upstate.

Tarr's territory in Central New York, stretches south to north from Broome to Jefferson counties, and west to east from Elmira to Oneonta, he says.

Health Net is offering its PFFS health and prescription-drug plan through its subsidiary, Health Net Insurance of New York, Inc.

Other insurance companies offering PFFS plans in the state in 2007 are: Advantage Freedom, Sterling Life Insurance Co., Humana Insurance Company of New York, Independent Health, Today's Option, and WellCare, according to the U.S. Health and Human Services' Medicare Web site.

Health Net is one of the largest publicly traded healthinsurance companies in the United States. It says it is the fourth-largest Medicare health-insurance provider in the country. The company reported revenue of $11.9 billion and net income of nearly $230 million in 2005.

In addition to upstate New York, Health Net also is offering similar PFFS plans in California, Connecticut, Hawaii, New Mexico, Texas, and Washington, as well as a special-needs plan in Arizona in 2007.

For more information online, go to: www.medicare.gov and www.healthnet.com.