Bulletin Board

Question: When was the first Triple-Option Plan created? What are the legislations supporting Triple-Option plans?

Answer: Triple option and Point of Service (POS) sometimes get used interchangeably, but they technically have different meanings. 
Triple Option plans simply have three tiers of benefits throughout their
benefit structure. They could be PPO or HMO. They originated from the PPO setting, and historically involved flat copays at one level with a more restricted network, % copays and a small deductible with a comprehensive network, and then even higher % coinsurance and larger deductible with non par providers. As PPO plans, they needed no enabling legislation. They originated as a PPO competitive response to HMOs in the mid 1980s. They  declined in popularity in the past 5 years or more as cost sharing concerns caused greater elimination of flat copays. Currently the trend is more for a triple option just for a specific benefit, such as prescription (generic/preferred/brand) or more recently for hospital benefits. These are often referred to as tiered networks or tiered benefits.

Point of Service plans are HMO plans with a least two levels of benefits
(one being non-par). In states that provided enabling POS legislation, the
entire policy was provided through the HMO. Many states did not provide
enabling legislation for this. Instead, in many states, the POS benefit is
provided through two simultaneous policies: an HMO policy and a traditional insurance policy that covers the non-par care. The employer pays a premium for both policies. A POS plan with three levels of benefits would be a triple option plan as well. POS plans were introduced around 1990.

Thank you for publishing the picture of Illinois's 1st HMO license.  I'm
the guy in the middle holding the certificate - I was also the person
who wrote the application for license and was Roosevelt Health Plan's
1st Executive Director.  By the way, Roosevelt morphed into Chicago
Health Plan which was acquired by United Healthcare. so, in a way it is
still in business. You can find out more about me at
www.brianhellerphd.com

THIS IS A GREAT IDEA!!!!  You would not believe how many HR directors call us wanting to know what a staff model versus an open panel plan is in our Warren surveys?  These are the ones hiring people in the industry and they know nothing of the history of the industry or the very significant contributions made by Elwood, Enthoven, Warren and others.
William J. DeMarco,
President, DeMarco and Associates Inc

Just had a chance to poke through here... good stuff! Thanks for
pulling this all together in one spot! Sander
(Alexander C. Domaszewicz)
Mercer Human Resource Consulting

Interesting concept...I enjoyed the few minutes I spent "touring". I
was particularly amazed at the large # of defunct plans.
Vince Kuraitis,
Principal, Better Health Technologies, LLC

Is this the next step in health care's e-volution?  MCOL is launching a
new public Web site that is a virtual museum of historical managed care data.  The site, http://www.managedcaremuseum.com , offers such information as time lines, a library of narrative history, a gallery of images, a 20th century archives database and -- TEHB's favorite -- a "Hall of Defunct Plans." A simple search function can tell you what happened, for example, to such health plans as Qual-Med, Healthsource and Foundation Health, as well as lesser-known ghosts of the past managed care era.  And, as MCOL President Clive Riddle says, for this museum "admission will always be free of charge."  Appeared in "Heard on the Street" Today in E-Health Business, April 19, 2005, Atlantic Information Services

Want to add a comment to our Bulletin Board? Use our Call for Content
form, and enter your comments you'd like to share with the Museum