Wednesday, May 26, 2010

BCBSNC to update member discount programs

Blue Cross Blue Shield of North Carolina (BCBSNC) has implemented the following changes to their Blue365 discounts and vision discount programs:
• Blue365 will no longer include discounts for Curves and Kronos.
• Discounts for conventional/traditional LASIK and LASIK with IntraLase are no longer available.
• Discounts are still available for LASIK with custom/wavefront and LASIK with both custom and IntraLase though the fixed pricing rates for these procedures has increased slightly.

For more information on the discounts currently available through BCBSNC, log onto BCBSNC’s Member Services page via

UHC prescription drug list updates effective July 1

Effective July 1, 2010, the new United Healthcare (UHC) Prescription Drug List (PDL) updates will take place. Members taking select maintenance medications impacted by a change will receive a letter in June. Lower cost alternatives will be listed along with a web address where they can find a more detailed reasoning for these changes. UHC will also communicate the updates to physicians and pharmacies.

Click to access the updated Advantage Prescription Drug List. For more information, please contact your Senn Dunn account manager or your UHC representative.

Please note not all PDL updates apply to all groups depending on state regulations, Riders and SPDs.

Tuesday, May 25, 2010

NextCare urgent care centers no longer in BCBSNC network

Effective May 13, 2010, NextCare Urgent Care Centers will no longer participate in the BCBSNC network.

Members may continue to use NextCare centers but benefits will be paid according to the members’ out-of-network benefits. Members can find in-network urgent care centers by using the provider search on the BCBSNC website.

We will continue to keep you updated on any changes in network status. As always, please feel free to contact us with any questions or concerns that arise.

Monday, May 24, 2010

BCBSNC to implement prior certification and restricted access drug changes

Effective July 1, 2010, Blue Cross and Blue Shield of North Carolina (BCBSNC) is implementing changes to their prior review/certification and restricted access drug lists.

The changes include:
The following injectable drugs, covered under BCBSNC medical benefits, will now require prior review by BCBSNC and written certification from a prescribing physician:
• Synagis® (palivizumab), used to prevent respiratory syncytial virus (RSV) prophylaxis in infants and children at risk
• Actemra® injections (tocilizumab), used to treat rheumatoid arthritis
• Stelara® injections (ustekinumab), used to treat psoriasis

The following angiotensin receptor blockers (ARBs), used most often for hypertension and covered under BCBSNC pharmacy benefits, are being added to the restricted-access drug list and will also require written certification from a prescribing physician:
• Atacand®, Atacand-HCT®, Avapro®, Avalide®, Benicar®, Benicar-HCT®, Teveten®, and Teveten-HCT®

The above ARBs will also move from Tier 2 to Tier 3, effective July 1, 2010. If the non-preferred ARB is authorized for them, members will pay a Tier 3 copayment.

Communication to Members and Providers
BCBSNC will mail letters to impacted members in late May. Click to access the Sample Member Letters. BCBSNC providers were notified of these changes in April.

Please note that most infants and very young children who receive Synagis® for one RSV season will not require it for a second season. Using past claims to identify patients who may require RSV prophylaxis for the upcoming RSV season will not be effective. For this reason, BCBSNC will not send letters to affected patients’ or patients’ caregivers.

Members with questions regarding these changes can contact their Senn Dunn Account Manager or call BCBSNC Customer Service at the toll-free number listed on their ID card.

Early retiree reinsurance program application not yet available

Although the Early Retiree Reinsurance Program will go into effect on claims incurred after June 1, applications are not expected to be made available from Health and Human Services (HHS) until mid- to late June. While details on the application process have not been released, HHS has confirmed that it expects more requests for reimbursements than the allocated $5 billion in funding can cover.

The Department has also confirmed that there will be a period of time between when the application is released and when they will begin accepting claims data submissions. As payments will be processed in the order claims are received, it is imperative that plan sponsors be prepared to respond quickly and thoroughly if they plan to participate in this program.

HHS released an interim final rule on the program in the beginning of May providing guidance on eligibility requirements. For more information, click to access the Early Retiree Reinsurance Program Interim Final Rule.

Friday, May 21, 2010

Tax-free treatment of health benefits for children under age 27 effective immediately

On April 27, the IRS issued Notice 2010-38, providing guidance on the tax exclusion for medical care reimbursement of adult children. These changes are a result of the recently enacted health reform legislation, collectively referred to in the notice as the Affordable Care Act.

The notice states that employers with cafeteria plans may permit employees to immediately make pre-tax salary reduction contributions to provide coverage for children under age 27, even if the cafeteria plan has not yet been amended with such a provision. Plan sponsors have until December 31, 2010 to amend cafeteria plan language to incorporate this change.

This immediate expansion will allow plan sponsors that wish to extend coverage to adult dependents now to do so without having to withhold additional federal taxes from employees to cover the value of the benefits if the amounts were deemed taxable income.

General Guidance from IRS Notice 2010-38
• The IRS will permit employers to amend their cafeteria plans retroactively to allow pre-tax salary reductions for adult children as long as the plan is amended by the end of 2010.
• The tax exclusion applies to employer-provided health coverage for an employee’s child who is not age 27 or older at any time during the calendar year.
• Employers may rely on an employee’s representation as to the child’s date of birth.
• For purposes of the tax exclusion, an adult child is defined as son/daughter, stepson/stepdaughter, adopted child or eligible foster child.
• Both married and unmarried adult children are eligible; however, the child’s spouse and/or children are ineligible.
• Plan participants who add an adult child dependent can increase their current year medical flexible spending account (FSA) elections due to current rules which allow election changes for change in status events.
• The tax exclusion expansion applies to plans that define eligibility based on Section 105(b), including medical FSAs and health reimbursement arrangements (HRAs).

Sunday, May 16, 2010

Interim final rule released on provision extending dependent coverage to age 26

On May 10, the Internal Revenue Service (IRS), Department of Labor (DOL) and Department of Health and Human Services (HHS) released an interim final rule on the dependent child coverage extension requirement in the Patient Protection and Affordable Care Act (PPACA).

The regulations were published in the Federal Register May 13, 2010 and are effective for plan years beginning on or after September 23, 2010.

Specifications of the Rule
• The following factors may not be used in defining “dependent” for purposes of eligibility under age 26: financial dependency, residency, student status, employment, eligibility for other coverage, or any combination of these factors
• Plans and insurers are not required to cover the children or spouse of an adult child
• Plans cannot vary benefits or cost based on the age of the child, except with respect to children who are age 26 or older
• Plans can charge more for each individual added to the plan as long as the charge is uniform and does not vary based on the dependent’s age
• Plans are required to provide newly eligible children a special 30-day enrollment period and must provide written notice of the opportunity to enroll
• Notice of this enrollment right may be provided to an employee on behalf of the employee’s child and can be provided with other enrollment materials
• Coverage for children enrolling under the special enrollment rules must take effect no later than the first day of the plan year for which the requirement is effective
• The mandate to cover dependent children up to age 26 must be extended to qualified beneficiaries under COBRA coverage as well
• If state laws impose stricter requirements than those imposed by the PPACA, the state laws are not preempted

Guidelines specific to grandfathered plans
• Grandfathered health plans may exclude an adult child for plan years beginning before 2014 if the adult child is eligible to enroll in an employer-sponsored health plan other than a group health plan of a parent
• For plan years beginning after 2014, a grandfathered health plan may not exclude an adult child, even if they have access to other employer-sponsored coverage

Areas needing further guidance
• The regulations do not include a definition of a “child” (such as the tax exclusion guidance in Notice 2010-38, which defines a “child” as son, daughter, stepchild, adopted child or foster child)
• It is unclear whether a child under age 26 who is receiving COBRA coverage under a former employer’s plan or a spouse’s employer’s plan must be given an enrollment opportunity under a grandfathered plan prior to plan years beginning in 2014

For more information, click to access the following Fact Sheet and FAQs from the US Department of Labor.

Monday, May 10, 2010

Senn Dunn to host expert Mark Hall in health reform seminar for employers

Join us for an employer-specific health reform seminar featuring Mark Hall, a premier expert on the current health reform legislation. As a professor of law and public health at Wake Forest University, he is considered one of the nation's leading scholars in the areas of health care law and policy and has recently provided interviews for multiple media outlets, including NBC Nightly News, New York Times, News and Observer, and The Business Journal of the Greater Triad Area.

Covered topics will include:
• A glimpse at health care cost drivers and how we got where we are today
• An in-depth look at the Exchanges; how they will work and what they mean for employers
• An overview of the key regulations affecting employers in 2014
• Q&A session with Mark Hall and a panel of industry specialists

Understanding Health Reform: Employer Impact

Choose from two sessions on Friday, June 11th:
9:00 – 11:00 AM
1:00 – 3:00 PM

Embassy Suites
204 Centreport Drive
Greensboro, NC 27409

Please RSVP by Friday, May 21st to Susan Shanahan at
To view a printer-friendly version of this invitation, CLICK HERE.

Friday, May 7, 2010

Health reform mandates reasonable break time for nursing mothers

The Patient Protection and Affordable Care Act (PPACA) signed into law on March 23, 2010, amends the Fair Labor Standards Act (FLSA) to require employers to provide unpaid break time for nursing mothers to express breast milk.

Section 4207, known as “Reasonable Break Time for Nursing Mothers”, is effective immediately and requires that employers provide reasonable break time whenever a nursing mother has a need to express milk for one year following a child’s birth. This provision applies to all employers covered by the FLSA.

Guidance has not yet been released as to the definition of “reasonable break time” or set limits on the number of breaks per day; however, the provision is modeled after Oregon’s current state law which allows nursing mothers 30 minutes of break time for every four hours worked.

Other requirements of the provision include:
• Employers with less that 50 employees may be exempt from this law if the requirements impose an “undue hardship” on their business by causing significant expense or difficulty to comply
• Employers must provide a location which is shielded from view and free from intrusion for mothers to express milk, other than a bathroom
• Employers must follow their state law requirements if the state law currently has greater protections for nursing mothers than the new federal law

Although this amendment to the FLSA became effective on March 23, 2010, it could be several months before the Department of Labor (DOL) issues further guidance and clarification. Employers should be aware of the break requirements and make a good faith attempt to adhere to the current guidelines.

Thursday, May 6, 2010

OTC infants’ and children’s liquid products recalled, including Tylenol and Motrin

On April 30, McNeil Consumer Healthcare announced the voluntary recall of specified over-the-counter (OTC) infants’ and children’s liquid products, including Benadryl®, Motrin®, Tylenol® and Zyrtec®. No adverse medical events have been associated with this recall but parents and caregivers are advised to discontinue use and properly dispose of these products as a precautionary measure.

The recall was issued in response to recently identified manufacturing deficiencies which may affect a drug’s quality, purity or potency. Products may contain inappropriate concentrations of active ingredients, inactive ingredients that fail to meet testing requirements, or tiny particles.

Recalled products include all unexpired lots of the following:
• Children’s Benadryl Allergy Liquids in Bottles
• Children’s Motrin Suspensions
• Motrin Infants’ Drops
• Tylenol Infants’ Drops
• Children’s Tylenol Suspensions
• Children’s Tylenol Plus Suspensions
• Children’s Zyrtec Liquids in Bottles

For additional recall information, including consumer contact information and product National Drug Code numbers, click to access the McNeil Product Recall or the FDA Press Release.

Wednesday, May 5, 2010

HHS releases interim final rule on early retiree reinsurance program

The Secretary of Health and Human Services (HHS) released an interim final rule Monday that implements the Early Retiree Reinsurance Program established by the Patient Protection and Affordable Care Act (PPACA). The interim final rule will become effective on June 1, 2010, following a 30-day public comment period.

The interim final rule establishes specific eligibility rules and guidelines for applying for and using the available claim reimbursements provided by this program. Click to access the Early Retiree Reinsurance Program Interim Final Rule.

As required by PPACA, the program will:
• provide reimbursements to participating employer-based plans, including multiemployer, fully-insured and self-funded plans
• reimburse the employer-based plan 80% for certain health claims between $15,000 and $90,000 for covered retirees age 55 to 64 and their spouses, surviving spouses and dependents
• expire January 1, 2014 or when the $5 billion allocation to the program has been exhausted, if earlier

The new HHS ruling provides guidance, including the following:
• the reimbursement process will be similar to the process used for the Medicare Part D Retiree Drug Subsidy (RDS)
• eligible employers must have programs and procedures in place to help control costs for individuals with "chronic and high-cost conditions" such as diabetes or cancer
• premium cost is not included in the calculation of claims eligible for reimbursement
• plan sponsors must have written agreements with the insurance carrier or employer-based plan to ensure that necessary information will be provided to HHS upon request
• plan sponsors must have policies and procedures in place to reduce fraud, waste and abuse
• employers applying for reimbursement must project reimbursements for the next two years and explain to HHS how reimbursements will be used
• employers must use reimbursements to lower plan costs