Pittsburgh

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With Medicare's open enrollment period now closed - and the formal UPMC-Highmark breakup less than four weeks away - attention is shifting to employees in the Pittsburgh-region who may have only days left to decide on their commercial group health plan for 2015.

'If employees have a choice, many times it's a choice they've never had to make before and they're not comfortable making it,' said John Seltzer, a Mt. Lebanon-based insurance broker. 'And if they don't have a choice, they may be losing access to providers that they've had in the past.'

The strongest indicator of how many consumers will stay with Pittsburgh insurer Highmark or opt for access to Pittsburgh-based health care provider UPMC either through its UPMC Health Plan or one of the national insurers may come from small employers who can't afford to offer multiple plans.

'From our standpoint, we don't have a clear winner,' said Steven Shivak, president of SMC Business Councils in Churchill, which represents some 450 businesses who typically have fewer than 50 full-time equivalent employees.

'Neither group was necessarily a winner in moving business to them and away from the other guy. Each side was able to keep a sizeable chunk and lost a sizeable chunk.'

The commercial insurance market is larger than that for Medicare and packs a bigger dollar punch. Although last summer's consent decree agreements will allow Highmark members to continue seeing their UPMC physician past 2015, there is no ongoing agreement beyond 2015 for commercial members similar to what Medicare beneficiaries enjoy.

So, with the largest number of renewals occurring this time of year, the stakes could hardly be higher.

Nearly all employers by now would have settled on what plans they would offer their workers for 2015. A survey by the Pittsburgh Business Group on Health earlier this fall showed that Highmark remains the biggest player in the local health insurance market with 47 percent of PBGH employers saying they will offer it, but that's down from 64 percent in 2014.

Next closest is Aetna, with 24 percent of employers offering their plan, doubling the percentage from 2014; followed by UPMC Health Plan at 13 percent, compared with 14 percent in 2014; Cigna and United Healthcare, 6 percent; and Coventry/​HealthAmerica at 4 percent. Only 4 percent said they were considering shifting employees to private exchanges.

Also, 37 percent of the responding PBGH members planned to either change or augment their insurance plan offerings for next year, with most of those adding a second option to Highmark.

'Highmark has come back with some very high [rate] increases and that has turned some employers off,' said Pittsburgh Business Group on Health Executive Director Jessica Brooks, 'and I think employees have changed their mind about staying with them.'

Mrs. Brooks and Mr. Shivak both said their members and clients have noted the national insurers - Cigna, Aetna, United Healthcare and Coventry/​HealthAmerica - are making attractive offers.

'We are definitely seeing some people looking more at the national carriers,' Mr. Shivak said. 'We're seeing those rates are more competitive than in previous years. And, for some companies, the issue of not knowing what's going to happen with Highmark and UPMC next week or the week after - they're just going with one of the national carriers so their employees will be covered.'

Anthony Benevento, Highmark's senior vice president of Pennsylvania markets, said Monday the insurer has added 15,000 members this fall, with employee renewals in the mid-80 percent range, 'which is not far off our prior year.' He also said it is seeing a 60-80 percent renewal rate with companies offering multiple plans.

'We are very pleased' with Highmark's retention numbers, he said. 'We are well above our expectations.' Highmark has 1.2 million commercial members in Western Pennsylvania, spokesman Aaron Billger said.

UPMC Health Plan officials are also upbeat, as spokeswoman Gina Pferdehirt said they expect 'in excess of 50,000 new commercial members in January, and most of those are employers who are offering UPMC Health Plan to their employees.'

Among the national insurers, Cigna spokeswoman Amy Turkington Szable said that company has about 55,000 medical plan customers in this region 'and is experiencing double-digit growth in Western Pennsylvania for 2015, supported by a very strong performance in Pittsburgh for Jan. 1 enrollment.'

Aetna spokesman Walter Cherniak, meanwhile, said the insurer, which also owns Coventry/​HealthAmerica is expecting to get a combined 28,000 new middle market and small group members and 'it is too soon to tell' for national accounts.

Regional numbers for United Healthcare were not available.

Steve Twedt: stwedt@post-gazette.com or 412-263-1963.