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![handle is hein.gao/gaobadxtk0001 and id is 1 raw text is:
DOCUMENT RESUME
00687 - [A1051694]
(The Need for More Civil Service Commission Supervi.iion To
Control Health Insurance Costs for Federal Employees]. March 15,
1977. 15 pp.
Testimcny before the House Committee on Post Office and Civil
service: Compennatior and Employee Benefits Subccmsittee; by
Gregory J. Ahart, Di-ector, Human Resources Div.
7nssue Area: Person-el Management and Compensation (300).
Contzkct: Human lesources Div.
Budqev Function: General Government: Central Personnel
Management (805).
Organization Concerned: Civil Service Commission; Blue Cross
Association; Aetna Tife Insurance Co.
Congressional Relevance: House Committee on Post Office and
Civil Service: Compensaticn and Employee Benefits
Subcommittee.
Efforts hre needed to control health insurance costs
for rede,'l employees. G&O reviewed the operations of 10 Blue
cross and 10 Blne Shield health plans and 2 Aetna Life Insurance
paying offices to determine how Affectively they were :ompl7ing
with the contracts betwean the carriers and the Civil. Service
Commission (CSC) and with the cost contzol policies developed by
the Blua Cross and Blue Shield national offices and by Aetna's
home office. GAO also evaluatod the effectiveness of the CSC's
efforts for assuring that the carriers complied with
cost-con!.rol policies. GAO projected that 13.5% of all claims
paid during 1975 at 19 of the 20 Blue cross and Blue Shield
plans were questionable. A number of variations were disclosed
in benefit payments and cost-control systems. Evaluation of
Aetna's Indemnity Benefit Plan found 68 questionable claims out
of 569 reviewed ahd sop.) contractual discrepancies in the plan
itself. Tbe CSC should deal more aggressively with the carriers
of this health insurance both in the negotiation of its
contracts and in its revlews of the carriers' benefit paym-at
activities. If not, legislation should be developed which would:
require the CSC to include specific cost-control and/or
incentive provisions in carrier contracts; give the CSL the
specific authority to audit the carriers; and provide the CSC
with some flexibility in contracting for the Blue Cross/Blue
Shield service benefit plan. (QM)](ViewImageLocal?handle=hein.gao/gaobadxtk0001&div=1&collection=&method=preview&ext=.png&size=3)