11. Last week, the high court heard arguments in a case about whether the ERISA law allows individual benefit plan members to file those kinds of suits. 12. Most California doctors are in groups that receive a lump sum from health plans for each plan member. 13. Now, to my surprise, the company is going out of business and the money is being distributed to the plan members. 14. Republican leaders in the House and insurance company lobbyists have argued that the right to sue the companies would increase costs for health plan members. 15. The action is a tribute to the recovery program being implemented by Harvard Pilgrim executives and the confidence that receivership has given plan members in its viability. 16. The combination comes at a time when competition for plan members has heated up in New York. 17. The disparities should ring alarms among plan members. 18. The employee or health plan member has a lower co-payment on these products, an incentive to choose them. 19. The hospital is paid a set monthly amount for each health plan member, whether or not the person requires hospital care. 20. The PBMs create lists of preferred drugs for plan members, typically the least expensive drugs, and cover more of the cost of those medications. |