Humana Employees Pave Way
for “Consumer-centric” Benefits

Health care consumerism took on a new dimension this summer when Humana employees throughout the country began using benefits tailored to meet their individual needs.

This is part of an innovative, technologyaided concept that enables Humana’s 12,000 employee-members to choose a health plan in a very different manner than ever before — with highly individualized benefits packages created from a wide range of options.

During Humana’s recent open-enrollment period, employees used Web tools to contrast and compare plans based on both their own past utilization patterns and their projected health needs. At the heart of the concept is a decision-support “health plan Wizard” that helps employees evaluate, compare and select benefit options based on need and individual health concerns. Employees can make decisions on such benefit elements as office-visit copayments, deductibles, coinsurance percentages and maximum annual out-of-pocket limits, among others.

In addition, the health plan Wizard incorporates 70 distinct episodes of care, ranging from pregnancy to treatment for a chronic pulmonary or heart condition, so members can compare related out-of-pocket costs for certain conditions and services.

A similar pharmacy Wizard tool lets members compare pharmacy costs to determine out-ofpocket costs under different benefit scenarios. “It really allows them to select a plan based on what’s most important to them,” said Carolyn Karibo-Livingston, a process manager in Humana product development. “This recent open-enrollment period was different from anything we’ve done before in terms of the number of options and tools available to enable our employee-members to make the best possible decision to meet their needs.” The plan-design tools were made available to Humana employees in all locations, and employee-members began using the new benefits in mid-summer.

HumanaAccess MasterCard®

Humana employee-members who selected a Flexible Spending Account (FSA) and/or Personal Care Account (PCA) are able to access funds “stored” in those accounts at the point of care using the new HumanaAccess MasterCard® card. The card, which began showing up in physicians’ and other health care providers’ offices this summer, is designed to make life easier for both members and network physicians.

Representing the most recent development in Humana’s commitment to continual product innovation, the HumanaAccess MasterCard card combines medical- identification information with stored-value card functionality into a single card. The stored-value portion of the card works just like a regular credit card. Members on these plans deduct copayments for office visits or other out-of-pocket expenses directly from their account.

The card also contains all current medicalbenefits information: subscriber and group name, copayment amounts, claims address and all relevant phone numbers. If the member has activated the card and has funds available to cover the expense, payment is as simple as swiping the card through a MasterCard machine. When members use this card, there is no longer any need for physician offices to collect payments by check or cash, which streamlines office checkout and alleviates bookkeeping and patient-account functions. Processing instructions have been sent to each practice’s or provider’s office.* Humana plans to make the card available to other commercial members in 2004.

Most important, Humana memberemployees using the new benefit designs will be far more educated than ever before — about not only how they use health care, but also what it costs. As such, patients are likely to be engaged in more health care/health plan decision-making than in the past and likely will seek their doctor’s advice on the most cost-effective treatment approaches. “Since Humana associates can now estimate what their [service] usage is and what it costs, their whole approach to health care and benefits changes,” said Livingston, who learned firsthand after recently designing her own coverage. “Now that we are acting in the capacity of a consumer, the tendency is to buy and use services very differently than we’ve done in the past.”

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