Wednesday, December 21, 2011

Webinar on data breaches and breach notification

Senn Dunn invites you to participate in an Assurex Global webinar on January 19 from 12:00 to 1:30 PM EST.

Reserve your seat now at:
https://www1.gotomeeting.com/register/805070560

Human Resources and Benefit Administrators need to know what a Data Breach is and what actions must be taken to avoid fines and civil actions. This seminar will explain what a Data Breach is and what actions the organization must take under HIPAA and state breach laws. Learn what data elements are included, what notifications must be made, to whom and when the notifications must be made. The most common sources for data breaches will also be presented.

Learn what HR and the IT Department can do minimize the chance of a Data Breach. Most breach laws require that written Policies and Procedures are in place so that your organization can execute the appropriate actions if a breach occurs. Common sense and somewhat more complex safeguards will be discussed that, if in place, will greatly limit your risk to Data Breaches.

Please note: times for AG webinars vary and are listed for the Eastern time zone.

Presented by:
Mark Hoaglund, Principal HIPAA Consultant, Benefit Comply, LLC
Mark Hoaglund is the principal HIPAA consultant for Benefit Comply, LLC.  Previously Mark provided HIPAA support and consulting to employers and insurance organizations though his affiliation with HIPAAanswers, and has helped more than 200 companies with their HIPAA compliance needs. Before becoming a HIPAA Compliance Specialist, Mark worked in the technology area for Fortune 500 companies including Pillsbury and Honeywell as a Senior Manager and Project Manager. He has extensive experience with Data Security and Security Management. Mark held lead positions in application development, application support, and computer operations.

Monday, December 19, 2011

HHS will allow states to determine essential health benefits

HHS announced Friday that they will give states broad latitude to define the minimum benefits that many health insurance policies will be required to offer under the 2010 healthcare law. 

Under the Department’s intended approach, HHS says, states would have the flexibility to select an existing health plan to set the “benchmark” for the items and services included in the essential health benefits package. States would choose one of the following health insurance plans as a benchmark:
  • One of the three largest small group plans in the state;
  • One of the three largest state employee health plans;
  • One of the three largest federal employee health plan options;
  • The largest HMO plan offered in the state’s commercial market.
The benefits and services included in the health insurance plan selected by the state would be the essential health benefits package. Plans could modify coverage within a benefit category so long as they do not reduce the value of coverage.

Consistent with the law, states must ensure the essential health benefits package covers items and services in at least 10 categories of care, including preventive care, emergency services, maternity care, hospital and physician services, and prescription drugs.

According to the New York Times, Friday's decision "would allow significant variations in benefits from state to state, much like the current differences in state Medicaid programs and the Children's Health Insurance Program."

For more information, please see the HHS News Release.

Thursday, December 15, 2011

UnitedHealthcare airs new online UHC.TV

UnitedHealthcare announced that it has launched UHC.TV, a new online television network designed to deliver health- and wellness-related information to all Americans. Network features include:
  • Sidewalk Talk - With the "average Joe or Jane" directly from the sidewalks across America to help clarify health care myths and truths.
  • Laugh Rx - A variety of comedians talk about serious life matters in a light-hearted, humorous manner.
For more information, please view the press release from UHC. 

Friday, December 9, 2011

BCBSNC to transition IT infrastructure services to Fujitsu America

On Thursday, BCBSNC announced it signed an agreement with Fujitsu America, Inc. (FAI), a global technology services company, under which FAI will purchase the BCBSNC data center, located in Research Triangle Park, and provide a variety of IS support services to BCBSNC.

 Please see the press release for more information.

Thursday, December 8, 2011

Carolina Advanced Health grand opening

Carolina Advanced Health, the new primary care physician practice from BCBSNC and UNC Health Care, is open for business as of Wednesday. The new medical practice is a collaborative approach aimed at enhancing efficiency and quality of care by coordinating a patient’s health care under one roof. By doing this, the practice hopes to improve health and quality standards and reduce complications among patients--both of which are expected to reduce medical costs.

Please see the press release below and this short video for more information. Visit http://www.carolinaadvancedhealth.org for more detailed information about the practice.

Eligible Member Mailings Begin in January
Carolina Advanced Health treats eligible BCBSNC customers who are over 18, are covered by a participating BCBSNC health plan and living with any of the following chronic illnesses: coronary artery disease, hypertension, hyperlipidemia (high cholesterol), diabetes, chronic obstructive pulmonary disease (COPD), chronic heart failure and asthma. 

Beginning in January, BCBSNC will send letters to identified members to invite them to become a patient of the practice. These members will be identified by living near the practice and having one or more of the above conditions. Individual and fully-insured group members will be included in the mailings. At this time, self-funded groups will not be included.

The member mailings will continue on a monthly basis to ensure the number of new incoming patients aligns with the practice’s capacity to manage the care appropriately.
  BCBSNC will provide more information about the member mailings before they begin.

If a BCBSNC member is interested in using Carolina Advanced Health before receiving a letter, they may call the customer service number on the back of their ID card to see if they are eligible.

Friday, December 2, 2011

BCBSNC contracts with new pharmacy benefit manager

As part of BCBSNC's effort to reduce costs as a company and for customers, BCBSNC has contracted with a new pharmacy benefits management vendor. Pending regulatory approval, Prime Therapeutics will administer pharmacy benefits for commercial customers whose pharmacy benefits are handled by BCBSNC. This change is effective April 1, 2012. BCBSNC has stated this change will result in lower pharmacy costs for customers and will provide more flexibility regarding services and programs.

Please see the FAQs for more information.

Thursday, December 1, 2011

UHC mails annual compliance notice to subscribers

UnitedHealthcare (UHC) announced it has mailed the Annual Rights and Resource Disclosure notice to fully insured subscribers this week to meet annual notification requirements from health plan accreditation groups, such as the National Committee for Quality Assurance, and various federal and state mandates.

The 2011 Rights and Resource Disclosure postcard notices were mailed on Nov. 29 to fully insured subscribers with UnitedHealthcare, Oxford, UHC West, Neighborhood Health Partnership (NHP), UnitedHealthcare Plan of the River Valley and legacy MAMSI life and health benefit plans.

The postcards provide an overview of the type of information included in the Annual Rights and Resource Disclosure and direct members to view their compliance documents in full at http://www.uhcrights.com/ or to elect a printed copy, if preferred. View a sample of the 2011 Annual Rights and Resource Disclosure.

Wednesday, November 23, 2011

Delayed compliance date for summary of benefits and coverage

The Patient Protection and Affordable Care Act (PPACA) adds to the list of necessary health plan disclosures by requiring plans and issuers to distribute a summary of benefits and coverage (SBC) to applicants and enrollees. The SBC is intended to be a relatively short document that provides important plan information in plain language so that health consumers can better understand their coverage options. This disclosure requirement applies to both grandfathered and non-grandfathered plans.

On Aug. 22, 2011, the Departments of Health and Human Services, Labor and Treasury (Departments) issued proposed regulations for the SBC. The proposed regulations include guidance on providing and preparing the SBC as well as a proposed template for the SBC. The SBC regulations are not final. The Departments have indicated that they will likely make changes to the SBC regulations before they are finalized.

On Nov. 17, 2011, the Department of Labor (DOL) delayed the compliance date for providing the SBC. The DOL provides that plans and issuers can wait to start providing the SBC until after the final regulations are released. Thus, the March 23, 2012 deadline no longer applies.

It is uncertain when the final SBC regulations will be released. However, according to the DOL, plans and issuers will be given sufficient time after the final regulations are released to get ready for complying with the new requirements.

This delay is significant because it gives plans and issuers more time to develop the SBC. Also, because plans and issuers can wait until final regulations are released to complete the SBC, they will not need to prepare the SBC based on the proposed regulations only to have to update it later for the final guidance.

Reminder: large employers must include cost of benefits on 2012 W-2 forms

The Affordable Care Act provides that employers are required to report the cost of employer-provided health care coverage on the Form W-2. Notice 2010-69, issued last fall, made this requirement optional for all employers for the 2011 Forms W-2 (generally furnished to employees in January 2012). The IRS provided further relief for smaller employers (those filing fewer than 250 W-2 forms) by making this requirement optional for them at least for 2012 (i.e., for 2012 Forms W-2 that generally would be furnished to employees in January 2013) and continuing this optional treatment for smaller employers until further guidance is issued.

For employers filing 250 W-2s or more, this requirement applies for your 2012 W-2 forms.  Notice 2011-28 provides guidance on how to report, what coverage to include and how to determine the cost of the coverage.  Your payroll vendor should be sending you a request over the next few weeks (if not before) to request information on your health plan costs that will need to be included on your 2012 W-2 forms.

Monday, November 21, 2011

Webinar on surviving a DOL ERISA audit

Senn Dunn invites you to participate in an Assurex Global webinar on December 15 from 3:00 to 4:30 PM EST.

Reserve your seat now at:
https://www1.gotomeeting.com/register/507841800

The Employee Benefits Security Administration (EBSA), a division of the DOL, conducts thousands of employee benefit plan audits each year. Approximately 75% of the audits result in at least one violation. If your plan is chosen for an audit, the DOL will send you a letter requesting applicable plan documents. The document request often includes dozens of different elements that must be provided to the DOL. There will also usually be an “on-site” review by the investigator that might require interviews with key employees and/or plan fiduciaries.

This session will review the type of information the DOL will look for in the case of an audit. Even if your plan is never subject to a DOL audit, this review will help plan sponsors understand the kinds of compliance related issues that matter to the DOL and help focus efforts and resources on important compliance issues.

Please note: times for AG webinars vary and are listed for the Eastern time zone.

Presented by:
Jennifer Lunski, Esq., Compliance Officer, Woodruff-Sawyer & Co.
Jennifer brings a unique perspective as an attorney with experience both investigating employee benefit plans in the Department of Labor (DOL), and as a Benefits Consultant to HR practitioners. She was recently awarded by Business Insurance as a 2010 Woman to Watch in the industry. Prior to joining Woodruff-Sawyer & Co., Jennifer was a senior investigator for nine years with the DOL in San Francisco. A published expert in PPACA, ERISA, COBRA, FMLA and HIPAA rules and regulations, she has investigated a broad spectrum of company employee benefit plans. Jennifer has also conducted numerous trainings on ERISA, COBRA and HIPAA to DOL employees, the Department of Justice, and to employers that sponsor ERISA-covered plans. Jennifer was awarded her juris doctorate from Southwestern University School of Law and is a member of the California Bar.

Bob Radecki, President, Benefit Comply, LLC
Bob Radecki has more than 25 years’ experience in the HR and employee benefits industry helping employers deal with difficult benefit and compliance matters. Previously, Bob founded and served as President of A.E. Roberts Company, a nationally recognized compliance consulting and training firm. He has served as the principal HIPAA consultant to a number of health insurance companies, and is recognized as a leading expert on a variety of benefit compliance issues including COBRA, FMLA, Health Reform and more. Bob has been the featured speaker at numerous industry events and conferences, and has published a number of articles concerning various compliance issues.

After registering you will receive a confirmation email containing information about joining the Webinar.

Tuesday, November 15, 2011

BCBSNC launches new EOB format

On Monday, BCBSNC launched a redesigned Explanation of Benefits (EOB) document. The new EOB includes information required by Health Care Reform as well as additional information to help our members better understand how their claims were processed.

The redesigned EOB is available for all members of fully-insured and ASO group plans, individual plans for members under the age of 65 and the State Health Plan.

Benefits of the New Design
In addition to adding required information, BCBSNC has reorganized the information and space and reworded to make the language more clear and concise. BCBSNC also reduced the amount of paper used for printing EOBs by more than 15 percent.

Members can also now receive their EOB in Spanish. Members who prefer to receive communications in Spanish can call customer service and request their EOBs in Spanish. Once the request is entered in the membership system, all future EOBs will be in Spanish.

Member Communications and Tools
When members receive the new EOB for the first time, they will also receive an insert to introduce the new EOB. The insert explains what the EOB is and includes a list of words from the EOB defined in plain language for better understanding. There is also a quick reference code on the insert that takes members to an interactive version of the EOB where they can learn more about the different sections of the document.

Wednesday, November 9, 2011

BCBSNC member postcard mailings begin this week

This week, BCBSNC will begin mailing an informational postcard entitled “How Your Insurance Works” to approximately 510,000 subscribers. “How Your Insurance Works” directs customers to an online web resource where they can learn about BCBSNC and their rights as a member. Topics include:

• Your Rights and Responsibilities
• Preventive Care and Why It’s Important
• How To Obtain A Copy of Our Privacy Notice
• Protecting Your Well-Being
• The Appeals Process
• Official Notice of Mastectomy Benefits
• What Is Utilization Management
• Recent Accomplishments and Improvements
• Contact Information
• How To Get Information In Spanish

The postcard is being sent to Blue Advantage, Blue Options HSA for individuals and fully-insured Blue Options and Blue Care group subscribers. Self-funded groups will not receive the mailing this year. Self-funded employers may access the postcard at the following URL, www.bcbsnc.com/guide, or www.bcbsnc.com/guia for the Spanish version. This website contains all the information a self-funded group may want to share via a downloadable PDF.

The postcard replaces the previous “Guide to a Healthier You” publication. To reduce the cost of this annual mailing, the new version is a two-sided mailer rather than a multi-page, full color booklet.

Monday, November 7, 2011

BCBSNC ends specialty care vendor contract

On December 31, 2011, BCBSNC will end their contract with Accordant for their specialty care program. BCBSNC has found that they can provide the same quality care as Accordant at a lower cost and provide greater integration with BCBSNC health improvement programs.

Approximately 2,500 members participate in the specialty care program today and the transition of the case manager relationship is important. Here’s what you need to know about the transition for members currently working with Accordant:

• Group administrators of groups 51+ with impacted members will receive a letter regarding the change. It will be posted on the secure Employer Portal for small groups this week.
• Members will be called between November 28 and Dec 2 and invited to transition to a BCBSNC case manager and/or a specialty pharmacy coach.
• All case information will be transitioned to the new BCBSNC case manager.
• Members who receive care through a Medicare plan are not impacted by this change.

BCBSNC understands the importance of the relationship members may have with their Accordant nurse and is sensitive to the difficulties surrounding this change. BCBSNC is taking great care to make sure that the member continues to receive excellent care management.

Thursday, November 3, 2011

BCBSNC announces PPACA comparative effectiveness research fees to take effect

Under the Affordable Care Act of 2010 (ACA), health insurance issuers and sponsors of self-funded group health plans will be assessed an annual fee to fund comparative effectiveness research. The fee is imposed beginning in 2012 and ending in 2019. Revenue from this fee will fund research to determine the effectiveness of various forms of medical treatment.

In the first year, the amount of the assessment is $1 times the average number of covered lives under the plan for policy years ending on or after September 30, 2012. This means a group with an effective date beginning on or after October 2, 2011 would be subject to this fee. The fee increases to $2 per participant in 2013. In the years following 2013, the fee will be an amount indexed to national health expenditures thereafter.

Blue Cross and Blue Shield of North Carolina (BCBSNC) will comply with this requirement of ACA.
Here’s what you need to know about the requirements:
• BCBSNC will charge the fee to fully-insured groups with an effective date beginning after October 2, 2011.
• Policyholders with individual medical coverage will be assessed this fee beginning on January 1, 2012. It will be built into their 2012 rates.
• ASO groups are responsible for paying the fee directly.

For More Information on Comparative Effectiveness Research
Please see the frequently asked questions below for additional information on comparative effectiveness research and our implementation of these requirements. These websites are also good resources for more information.

BCBSNC Spotlight on Comparative Effectiveness Research: http://www.bcbsnc.com/assets/hcr/pdfs/spotlight_cer.pdf
Medicare Physician Compare Website: http://www.medicare.gov/find-a-doctor/provider-search.aspx
RAND Analysis of Comparative Effectiveness Research: http://www.randcompare.org/analysis-of-options/analysis-of-comparative-effectiveness
Kaiser Family Foundation Comparative Effectiveness Research: http://www.kff.org/healthreform/upload/7946.pdf
Agency for Healthcare Research and Quality: http://www.effectivehealthcare.ahrq.gov/index.cfm/what-is-comparative-effectiveness-research1/
BCBSA TEC: http://www.bcbs.com/blueresources/tec/

Monday, October 31, 2011

Webinar on employee benefit plan discrimination testing

Senn Dunn invites you to participate in an Assurex Global webinar on November 17 from 1:00 to 2:30 PM EST.

Reserve your seat now at:
https://www1.gotomeeting.com/register/943383672

Employers who sponsor health and welfare plans for their employees are subject to a number of discrimination rules and tests. Depending on the type of benefits offered, as many as 11 different rules and tests could apply to a particular employer:

• Three (3) Section 125 Discrimination Tests
• Four (4) Section 129 Dependent Care Account Tests
• Two (2) Section 105(h) Health Plan Tests
• Two (2) Section 79 Life Insurance Tests

Furthermore, the IRS is expected to soon release the new non-discrimination rules similar to the §105(h) which will apply to fully-insured health plans.

This session will help employers understand what tests and discrimination rules apply to their particular situation and review the basics of each test.

Please note: times for AG webinars vary and are listed for the Eastern time zone.

Presented by:Fritz Hewelt, Principal Consultant, Benefit Comply, LLC
Fred W. (“Fritz”) Hewelt brings over thirty years of experience to his clients, assisting them with a broad range of issues related to the evaluation and remediation of employee benefit and human resource compliance challenges. Fritz has also assisted numerous clients with welfare benefit plan due diligence in merger and acquisition situations. Fritz holds a BS in Business Administration from Elmhurst College, Elmhurst, Illinois. He also has earned designation as a Chartered Life Underwriter (CLU), a Certified Employee Benefits Specialist (CEBS) and a Fellow, Life Management Institute (FLMI).


Friday, October 21, 2011

BCBSNC to mail employers survey for medical loss ratio reporting

The Patient Protection and Affordable Care Act (ACA) requires health insurance issuers to submit a medical loss ratio (MLR) report to the Department of Health and Human Services annually beginning June 2012, and requires the insurer to issue rebates if the MLR is less than the applicable percentage established in the ACA. ACA requires a minimum MLR of 80% for individual and small group plans and a minimum of 85% for large group plans.

BCBSNC currently classifies plans based on number of eligible employees. Plans with eligible employees of up to 50 are classified as small groups, consistent with state law. Per recent federal guidance, BCBSNC must determine group size when calculating MLR by averaging the total number of all employees employed on any business day during the preceding calendar year. This includes each full-time, part-time and seasonal employee that receives a W-2 and excludes temporary employees and consultants with compensation reported on a 1099. This creates a need to collect group size information for MLR reporting purposes which differs from information BCBSNC collects for rating purposes.

Currently, BCBSNC does not collect data on ineligible employees, such as part-time or seasonal workers. To obtain this information, BCBSNC will send mailings to employers with 10 to 50 employees on their group plans, beginning on October 28th.

The instruction letter requests that the employer log into a website to complete the short survey. Or, the employer can complete the survey at the bottom of the letter and fax the letter back to BCBSNC.

Monday, October 17, 2011

HHS will not implement CLASS Act of PPACA legislation

On Friday, HHS Secretary Kathleen Sebelius released her recommendation to halt implementation of the CLASS Act, the long-term care insurance plan included in the health reform legislation passed in March of 2010.  Sebelius stated that the program was said to have design and financial problems and that it could not be implemented in time to launch next year as intended.

The CLASS Act was designed to be an optional, government-backed, long-term care insurance program that required a five-year vesting period before subscribers could collect benefits.

For more information, refer to the Memo from Secretary Sebelius or the HHS Report Analyzing CLASS Act Implementation Options.

UnitedHealthcare's new Prescription Drug List (PDL), effective January 1st

UnitedHealthcare (UHC) has released its PDL and benefits coverage updates for their Advantage and Traditional PDLs, which will be effective January 1, 2012.

To see the PDL changes, refer to the Advantage PDL and Benefit Plan Updates Summary.

Members taking select maintenance medications impacted by a change will receive a letter in December; lower cost alternatives may be listed. For certain changes, UHC will also be communicating with physicians and pharmacies.

Friday, October 7, 2011

BCBSNC & UNC Health Care release details on new medical practice for members with chronic conditions

On October 6th, BCBSNC and UNC Health Care announced that Dr. Thomas K. Warcup will serve as the medical director for Carolina Advanced Health.  Carolina Advanced Health is a first-of-its kind practice that will provide care for over 5,000 BCBSNC members with chronic conditions.  The practice will be located at the Quadrangle Office Park in Chapel Hill and is set to open in late 2011.

For more information, please see the Press Release and FAQ from BCBSNC.

Wednesday, October 5, 2011

Webinar Update on HIPAA Privacy for Employer Sponsored Health Plans

Senn Dunn invites you to participate in an Assurex Global webinar on October 27th from 12:00 to 1:30 PM EST.

Reserve your seat now at:
https://www1.gotomeeting.com/register/722168401

HHS has proposed changes to the HIPAA privacy rules that could have a significant impact on employers who maintain electronic employee related information. The proposed rules expand the HIPAA disclosure accounting requirements and create a new “access report”.

HHS has also stepped up enforcement of HIPAA, as required by HITECH. Now is a good time for employers to take stock of their current HIPAA policies and procedures, and learn about the impact the proposed changes may have on their plans.


Presented by:  Mark Hoaglund, Principal HIPAA Consultant, Benefit Comply, LLC
Mark Hoaglund is the principal HIPAA consultant for Benefit Comply, LLC. Previously Mark provided HIPAA support and consulting to employers and insurance organizations though his affiliation with HIPAAanswers, and has helped more than 200 companies with their HIPAA compliance needs. Before becoming a HIPAA Compliance Specialist, Mark worked in the technology area for Fortune 500 companies including Pillsbury and Honeywell as a Senior Manager and Project Manager. He has extensive experience with Data Security and Security Management. Mark held lead positions in application development, application support, and computer operations.

After registering you will receive a confirmation email containing information about joining the Webinar.

Thursday, September 1, 2011

UnitedHealthcare Prescription Drug List (PDL) and pharmacy benefit updates effective January 1st, webinar available

UnitedHealthcare (UHC) has released its PDL and benefits coverage updates for their Advantage and Traditional PDLs, which will be effective January 1, 2012.

You can view your plan's PDL by clicking on the links below:
Advantage PDL Update for Self-Funded Plans
Traditional PDL Update for Self-Funded Plans
Advantage PDL Update for Fully Insured Plans
Traditional PDL Update for Fully Insured Plans

To learn more, you can register for the webinar(s) below on the updates planned for both the Advantage and Traditional PDLs.
Registration for the webinar for Fully Insured plans: Wednesday September 7, 2011 at 12pm EST
Registration for the webinar for Self-Funded plans: Wednesday September 7, 2011 at 2pm EST

Members taking select maintenance medications impacted by a change will receive a letter in December; lower cost alternatives may be listed.  For certain changes, UHC will also be communicating with physicians and pharmacies.


Monday, August 29, 2011

Webinar on wellness compliance issues

Senn Dunn invites you to participate in an Assurex Global webinar on September 29 from 2:00 to 3:30 PM EST.
Reserve your seat now at:
https://www1.gotomeeting.com/register/416065889
 
Employer sponsored wellness plans come in many different shapes and sizes. Many wellness initiatives raise significant compliance concerns for employers. This session will discuss a variety of wellness related compliance issues including:

• When is a wellness program considered a “health plan” and what does that mean to the employer?
• HIPAA wellness non-discrimination rules
• Other compliance issues such as HIPAA privacy and tax consequences of some wellness-related incentives

Please note: times for AG webinars vary and are listed for the Eastern time zone.

Presented by: Bob Radecki, President, Benefit Comply, LLC
Bob Radecki has more than 25 years experience in the HR and employee benefits industry helping employers deal with difficult benefit and compliance matters. Previously, Bob founded and served as President of A.E. Roberts Company, a nationally recognized compliance consulting and training firm. He has served as the principal HIPAA consultant to a number of health insurance companies, and is recognized as a leading expert on a variety of benefit compliance issues including COBRA, FMLA, Health Reform and more. Bob has been the featured speaker at numerous industry events and conferences, and has published a number of articles concerning various compliance issues.

After registering you will receive a confirmation email containing information about joining the Webinar.

Friday, August 19, 2011

HHS announces proposed rules for uniform benefit summaries

On Wednesday August 17th, HHS released a Notice of Proposed Rulemaking for uniform benefit summaries as required by the Affordable Care Act (ACA).  HHS has adopted the format proposed by the NAIC for the standardized Summary of Benefits and Coverage.  Accoding to ACA, the Summary of Benefits and Coverage must include the following four components:
  • A four-page Benefit Summary (double sided)

  • Medical Scenarios called "Coverage Examples" for maternity, breast cancer treatment and managing diabetes

  • A standard glossary of medical and insurance terms

  • A phone number and website where individuals can get additional information including documents such as Certificates, Summary Plan Descriptions (SPDs) and policies

The new standardized summaries must be provided beginning with individuals enrolling in a medical plan on or after March 23, 2012.  This provision applies to individual and employer-sponsored medical plans, regardless of grandfathered status or funding.  For fully-insured plans, the insurer is responsible for producing and distributing the summaries.  For self-insured plans, the employer is responsible.

People enrolled in a health plan must be notified of any significant changes to the terms of coverage reflected in the Summary of Benefits and Coverage at least 60 days prior to the effective date of the change. This timing applies only to changes that become effective during the plan or policy year but not to changes at renewal (the start of the new plan or policy year).

Summaries are required to be provided both before and after enrollment and may be delived in paper and/or electronic format.  The penalty for willful non-compliance is up to $1,000 per enrollee.

For more information, please view Cigna's Informed on Reform briefing on this topic.

Tuesday, August 16, 2011

Health reform law headed for Supreme Court following split Appeals Court rulings

On Friday August 12th, the three-judge panel of the US Court of Appeals for the 11th Circuit ruled by a 2-1 vote that the individual mandate in the Affordable Care Act is unconstitional.  This decision comes on the heels of the 6th Circuit Court's ruling on June 29th, which found the individual mandate constitutional and a valid exercise of power under the Commerce Clause of the US Constitution.

As the courts are now split on this issue, it will most likely be headed to the Supreme Court, perhaps as early as next session.  President Obama says he is confident the Supreme Court will uphold the individual mandate as long as the justices follow existing laws and precedents.  However, there is some speculation that the Obama administration will attempt to delay a Supreme Court ruling on the case until after the 2012 election.

Tuesday, August 2, 2011

BCBSNC launches new treatment cost estimator

Blue Cross and Blue Shield of North Carolina launched a new Treatment Cost Estimator designed to help  members make informed health care decisions by providing data on the costs of elective procedures. The tool, found on mybcbsnc.com, replaces the previous cost estimation tool and adds cost information to the provider search tool.

The tool provides average costs for 59 common elective procedures. BCBSNC believes this information will help members become informed consumers and take an active role when they have choices to make about their health care. Additional information and more medical procedures will be added to the tool later this year.

Frequently Asked Questions
The following questions and answers can be used to help your clients understand and use the new Treatment Cost Estimator:

What is the Treatment Cost Estimator tool?
The new Treatment Cost Estimator is a web-based tool that provides members with information about the relative cost of 59 elective procedures. This tool gives our customers an estimated range of what a procedure may cost and provides them with information about how the cost may vary based on the physician/hospital they choose.

Can the tool be used for all BCBSNC plans?
Cost comparison information is not available to members on the following plans:
  • Medicare Advantage (Blue Medicare)
  • Medicare Supplement
  • FEP
  • Dental-only
What data is used to calculate the cost estimations?
Blue Cross and Blue Shield of North Carolina has joined other Blue plans across the country in providing new cost range information for various types of treatments and procedures based on network claims data.

The costs listed in the tool represent a range of the average treatment costs at a particular hospital. This tool calculates costs using a methodology which is broken into two components:
  • There are several steps involved in generating costs of a procedure at a particular facility. First, we collect claims data and categorize the information into cases of care. Cases of care represent a collection of services such as the doctors’ charges, the hospital charges, lab tests, etc. related to a particular procedure. Second, the cases are reviewed to remove any outliers/exceptions that may skew the averages. Third, cost bands/ranges are created for each procedure based on these averages.
  • Each office visit is assigned a code to specifically identify the procedure/service that is being provided. Costs are assigned to each procedure code; along with a standard rate based on the location (Zip Code) of the where the service takes place. This cost value is displayed within the application.
Is the tool intended to provide medical advice and exact payment information?
The cost information provided is intended to be used as a reference tool for our members’ convenience and is not a substitute for medical advice from or treatment by a medical professional for specific medical conditions.

Estimates are not intended to be an exact calculation of claim payment and do not contain all health benefit plan terms, conditions, limitations and exclusions that may apply to a member’s coverage. Also, estimates are not a guarantee of payment or prior approval for a particular service.

Members should not avoid getting health care nor should they make health care decisions based on the cost estimates displayed on this website. Only patients and their doctors can decide which medical decision is best for them.

Why is there such a wide variation in price for a certain procedure?
Doctors’ and hospitals’ rates may vary based on differences in selected treatment plans based on individual needs. This information is intended to be used as a reference tool for our members’ convenience and discussion with their doctors.

Why is BCBSNC introducing the tool?
Health plan designs increasingly require consumers to make informed decisions about their health care, and consumers do not always have the information to determine what they will be required to pay or why. The goal of introducing this type of tool is to support members as they consult with their physician and make decisions about where to seek the health services they need.

How do I use the new tool?
Blue Cross and Blue Shield of North Carolina members need to log into Member Services online at http://www.mybcbsnc.com/ to get treatment cost information. Once logged in with their Member ID and secure password, members can use our doctor or facility search to see cost ranges associated with specific practices or facilities.

Members may also use the Treatment Cost Estimator in Member Services to see the general cost range for 59 elective procedures, without selecting a specific physician or hospital.

For doctor or facility searches:
  1. http://www.mybcbsnc.com/ and click on Find a Doctor at the top right of the web page.
  2. Complete the fields to search for a doctor or facility.
  3. Select a type of facility to choose a type of treatment or procedure.
  4. Select your treatment from the category menu under “Get Treatment Cost Estimates.”
  5. Click “Search” and look for the cost range information on the right side. You may open or close the search field area after the results are visible.
For general treatment costs:
  1. http://www.mybcbsnc.com/
  2. Make sure the first three letters of your Member prefix are correct in the first field
  3. Enter your ZIP code.
  4. Select a type of treatment or procedure from the drop down menu.
  5. Click “Search” for results. You may open or close the search field area after the results are visible.
How does the functionality change the tool I have been using?
In the provider search tool, in addition to obtaining name, location and distance to a provider, you will also be able to access relative cost information which represents the allowed amount for the service. You can use this information to get a general cost comparison depending on the physician or hospital you choose.

Will my provider have access to the information?
The tool is available to all BCBSNC members who are registered on Member Services. BCBSNC has notified all impacted providers regarding this information. Please feel free to share the information with your physician if you have questions and would like to discuss options for where you should have treatment.

Does the cost displayed include all services related to my treatment?
The treatment costs you see represent a collection of services such as the doctors’ charges, the hospital charges, lab tests, etc. related to a particular procedure. The cost generally includes all services related to your treatment; however, some follow-up care may not be included depending on your treatment plan.

Can I use the tool even if BCBSNC is not my primary insurer?
The purpose of this tool is to provide cost comparison information between facilities. The relative value may not be as high if BCBSNC is not the primary insurer.

How often is the tool updated?
The tool is updated every 6 months in April and October. Additional procedures will be added to the tool by the end of the year.

Monday, August 1, 2011

HHS releases new guidelines for women's preventive services

Based on the July 2011 Institute of Medicine (IOM) report, Clinical Preventive Services for Women: Closing the Gap, HHS released new required health plan coverage guidelines for women's preventive services effective August 1, 2011. Accordingly, non-grandfathered plans and issuers are required to provide coverage without cost sharing consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012.

This requirement is part of a broad expansion of coverage for preventive services under the Affordable Care Act (ACA). 

Preventive services to be covered include well woman visits, screenings for gestational diabetes, HPV testing, contraceptive methods and counseling, breastfeeding support and supplies, among other services.  For more details on the new guidelines, refer to the Women’s Preventive Services: Required Health Plan Coverage Guidelines page of healthcare.gov.

Friday, July 29, 2011

Medco sending letters to 286,000 BCBSNC members next week

Medco, on behalf of BCBSNC, will send letters to approximately 286,000 members who are currently taking three or more maintenance medications. The letters are scheduled to go out next week. This mailing is an extension of the Therapeutic Resource Center program.

The letters are tailored to address a member’s specific health condition(s). Medco will send letters to members with diabetes, cardiovascular disease, pulmonary disease, cancer, neurological and/or psychological disorders, women’s health issues and general health conditions. Letters to members under the age of 18 will be sent to a parent or guardian.

The letters are further customized based on where the member is in the management of their condition. For example, Medco will send letters to members who are newly diagnosed with a condition, changing therapy for an existing condition, addressing multiple conditions or working to maintain their health.

Medco will not send letters to members in groups that have asked to be excluded from Therapeutic Resource Center initiatives. The Therapeutic Resource Center is a group of pharmacists and benefit specialists employed by Medco who contact members meeting certain criteria and provide prescription drug advice. The goals of this program are to improve medical adherence and reduce costs by encouraging generic and mail order utilization.

BCBSNC has provided sample letters in the following documents.  The first document contains four letters, each for a different stage of care, for members with cardiovascular disease. The second document is a sample of a letter that would be sent to the parent or guardian of a member under the age of 18.

Webinar on health reform: exchange regulations and 2012 implementation issues

Senn Dunn invites you to participate in an Assurex Global webinar on August 25 from 12:00 to 1:30 PM EST.
Reserve your seat now at:
https://www1.gotomeeting.com/register/656512945

There is so much change going on related to health reform that we will be doing a health reform update webinar at least once every few months. Already since our last Health Reform Update webinar in March 2011, a number of things have changed, including the repeal of the free choice voucher rule, and another delay in the release of the uniform benefit statement. The IRS has also provided some initial hints on how full-time employees will be defined. A number of important regulations are due to be released in 2011. This session will cover any new rules released and also prepare employers for upcoming heath reform implementation issues.

Some of the topics expected to be covered in this session include:

• Exchange regulations
• 2012 health reform implementation issues such as the uniform benefit statement and preparing for changes to Section 125 plans

Please note: times for AG webinars vary and are listed for the Eastern time zone.

Presented by: Bob Radecki, President, Benefit Comply, LLC
Bob Radecki has more than 25 years experience in the HR and employee benefits industry helping employers deal with difficult benefit and compliance matters. Previously, Bob founded and served as President of A.E. Roberts Company, a nationally recognized compliance consulting and training firm. He has served as the principal HIPAA consultant to a number of health insurance companies, and is recognized as a leading expert on a variety of benefit compliance issues including COBRA, FMLA, Health Reform and more. Bob has been the featured speaker at numerous industry events and conferences, and has published a number of articles concerning various compliance issues.

After registering you will receive a confirmation email containing information about joining the Webinar.

Wednesday, July 27, 2011

Several popular prescription drugs to be available as generics

(CNN Health report, 7/26/2011) According to the mail-order pharmacy Medco, at least 22 prescribed medications may be available as generics in the next year.

When drug companies develop a drug, the FDA usually grants them exclusive rights to market that drug for a set period of time. When those rights expire, other companies can make the exact same drug. Since there is competition, the generics are cheaper. The FDA says the regulations are “designed to promote a balance between new drug innovation and generic drug competition.”

The major drugs on the list for next year include:
Lipitor, a popular cholesterol drug, goes generic in November.
Solodyn, used to treat bacterial infections, November.
Zyprexa, which treats schizophrenia, October.
Lexapro, used to treat depression, March
Provigil, which treats sleep problems, April
Plavix, an antiplatelet drug which can prevent blood clots, May.
Singulair, an Asthma drug, August 2012.

Many of these drugs currently run between $100 and $400 for a 30-day supply.  There’s no clear indication how much cheaper the generic versions of the drugs will be, but for comparison the well-known depression drug Prozac, which became generic 10 years ago, now sells for less than $16 dollars for a one-month supply.

Monday, July 25, 2011

UHC to make PBM change effective January 1, 2013

On July 21, Medco announced an agreement to merge with Express Scripts. At the same time, Medco announced that it will not renew its contract to provide pharmacy benefits administration services to UnitedHealthcare (UHC) customers. The contract ends December 31, 2012 and includes a transition period thereafter.

As such, UHC has announced that they will be prepared to transition services currently handled by Medco to UnitedHealth Group's in-house pharmacy benefits manager (PBM), Prescription Solutions by OptumRx, when the Medco contract ends.  This change will not occur for more than a year, and until that time it is business as usual for UnitedHealthcare members, who should continue to use their pharmacy benefits as they have been.

UHC is confident about all this change will offer UHC customers.  OptumRx has made significant investments in its infrastructure and technology to expand its capacity and strengthen its operations for continued growth.  We will continue to keep you informed as any updates on this transition are announced.

Friday, July 22, 2011

Some UNC hospitals will only require copays for BCBSNC members

Effective August 1, 2011, services received by eligible BCBSNC members at certain independent UNC clinics will be treated as a single office visit with only one applicable copayment due at the time of service for members enrolled in a copayment product. Individual and group UW, ASO, State Health Plan, Federal Employee Program, and Inter-Plan Home members will be eligible for this upfront cost-savings at these specific UNC Hospitals clinics.

BCBSNC members with appointments on or after August 1 at any of the newly designated independent clinics will receive a letter from UNC Hospitals explaining that they can expect to pay an estimated out-of-pocket amount upfront, for clinic services, that is equal to the amount of their copayment, if applicable.

Highly specialized care and services received at UNC clinics, such as oncology/cancer care, transplant services, MRIs, CT scans, etc., will be subject to the member’s applicable deductible and coinsurance amounts.

For more information, refer to the FAQ.

Tuesday, July 19, 2011

Webinar on benefit issues during FMLA leave

Senn Dunn invites you to participate in an Assurex Global webinar on July 28 from 3:00 to 4:00 PM EST.
Reserve your seat now at:
https://www1.gotomeeting.com/register/755894896

Employers face significant risk if benefits are not properly handled for employees taking FMLA leave. This session will discuss in detail the employer’s obligations, employee communication requirements, and other rules specific to employee benefits during and after FMLA leave. This session is designed for employers with at least 50 employees who are subject to FMLA.

Topics will include:
• Benefit reinstatement rules
• What to do if an employee does not return from FMLA
• When do you offer COBRA?

Presented by: Bob Radecki, President, Benefit Comply, LLC
Bob Radecki has more than 25 years experience in the HR and employee benefits industry helping employers deal with difficult benefit and compliance matters. Previously, Bob founded and served as President of A.E. Roberts Company, a nationally recognized compliance consulting and training firm. He has served as the principal HIPAA consultant to a number of health insurance companies, and is recognized as a leading expert on a variety of benefit compliance issues including COBRA, FMLA, Health Reform and more. Bob has been the featured speaker at numerous industry events and conferences, and has published a number of articles concerning various compliance issues.

Monday, July 18, 2011

BCBSNC releases details on 2011 flu shot program

BCBSNC announced that its flu shot program for 2011 will be administered as in past years, with the following changes:
  • BCBSNC will send an email about worksite clinics to groups of 51+
  • The email will include a link to the online Clinic Request Form
  • BCBSNC will send a follow-up email to those groups that have not yet signed up for a clinic
Like Last Year:
  • Groups with immunization/preventive care benefits that pay at 100 percent prior to meeting a deductible who meet certain criteria can work with BCBSNC to arrange a free flu shot clinic at their worksite(s).
  • Members who currently have a copayment plan and receive a flu shot either at an on-site Maxim clinic, pharmacy, Minute Clinic, or any applicable non-physician practitioner will be covered without a copay required. This is similar to the BCBSNC benefit for immunizations, where as long as a claim for a physician's visit is not filed, then the administration of the shot is available at no additional member cost.
  • Flu shots will be available from doctor’s offices, at worksite flu shot clinics, or by in-network pharmacists who are certified to provide certain immunizations, including the flu vaccine and participating in the BCBSNC network.
  • ASO groups will be responsible for paying for the cost of flu shots. Groups that participate in a Maxim worksite flu clinic can take advantage of the $25 per-shot fee that BCBSNC has negotiated with Maxim for covered BCBSNC members.
  • BCBSNC members can find information at www.bcbsnc.com/flu. Employer groups can find information, including tips, posters and FAQs documents, on the employer website.
  • If participating urgent care centers or convenience care centers submit member flu shot claims to BCBSNC and the member has 100 percent immunization/preventive care benefits, BCBSNC will pay for shots administered by these participating providers. Some members may pay a copayment, or deductible, depending on the location and their specific benefits.
  • Maxim requires 25 vaccinations per clinic. Groups that fall below this minimum will be charged for the shots that fall short of 25.
  • Any group that can meet the minimum requirement for vaccinations can participate, but BCBSNC is only actively promoting clinics to groups of 51+, since it is unlikely that smaller groups will meet this requirement. Groups can request flu shot clinics by using the online request form found at www.bcbsnc.com/fluclinic. This form is easier for the group and will allow Maxim to provide faster turnarounds to get clinics scheduled.
  • H1N1 is now included as part of the standard flu vaccination.

Wednesday, July 6, 2011

Blue Options HSA online changes effective July 18th

Beginning July 18, 2011, BCBSNC is making changes to the way that members view and access information about their Health Savings Account (HSA) online.

If plan participants are enrolled in a Blue Options HSA account and their fund administrator is ACS/BNY Mellon, subscribers in that plan will notice the following changes:

• Beginning July 18th, subscribers who log into BCBSNC’s Member Services (http://www.mybcbsnc.com/) will notice that the “My HSA Account” link is being replaced with a “Manage My HSA” link. This link will direct subscribers to http://www.hsamember.com/, a site hosted by ACS/BNY Mellon, the HSA fund administrator.
• Subscribers who are accessing http://www.hsamember.com/ for the first time will need to complete the e-registration process with ACS/BNY Mellon. Then, to access their HSA account information at any time, they simply log into their new hsamember.com account. (This account and log-in process is separate from their BCBSNC Member Services account.)
• With http://www.hsamember.com/, BCBSNC members will have more of their HSA information at their fingertips.
• “My HSA Account” pages will no longer be available on http://www.bcbsnc.com/. Members will be able to access similar information, and more, from the http://www.hsamember.com/ website.

For more information, click to access the Employer FAQs on this topic.

Tuesday, July 5, 2011

BCBSNC to cover sleeve gastrectomies

Beginning July 1, 2011, BCBSNC will cover the sleeve gastrectomy procedure for qualified members who meet the criteria outlined in their medical policy titled “Surgery for Morbid Obesity.” You can search the medical policy on http://www.bcbsnc.com/.

What is a sleeve gastrectomy?
A sleeve gastrectomy is an alternative approach to a standard gastrectomy that can be performed on its own or in combination with other procedures. In this procedure, a portion of the stomach is removed, leaving a stomach remnant shaped like a tube or sleeve. Additionally, the pyloric sphincter is preserved, resulting in a more normal transit of food from the stomach to the duodenum and avoiding some of the complications seen with other gastrectomy procedures. A sleeve gastrectomy procedure is relatively simple to perform, and can be done through an open or laparoscopic technique.

Who might undergo this procedure?
As stated in the medical policy, a member must have a body mass index greater than 40 or over 35 along with one or more co-morbid conditions. Also, the surgery must be part of a comprehensive pre-surgical, surgical and post-surgical program. Some surgeons have proposed this as the first in a two-stage procedure for very high-risk patients.

Why has BCBSNC decided to cover this procedure?
Previously, this procedure was considered investigational. Now, long-term follow-up data (up to six years after surgery) and comparative studies are available. The research shows resulting extensive weight loss. Weight loss following a sleeve gastrectomy may improve a patient’s overall medical status and, as a result, reduce the risk of a subsequent, more extensive procedure. It should be noted that as with other surgical weight-loss procedures, weight gain often recurs over time.

Monday, June 27, 2011

BCBSNC launches redesigned member services website

Today BCBSNC launched their redesigned Member Services website, intended to make it easier for members to understand their health care coverage, manage their benefits and reduce their overall health care costs. Members can still access Member Services from bcbsnc.com, or they can access it directly at mybcbsnc.com.

The website contains several new features, such as:
• A personalized dashboard with quick access to the information members care about most
• Improved claims information such as a summary of recent claims on the home page, a simplified claims search and downloadable claims data
• A streamlined design for easier site navigation

Along with the new additions, the Member Services site will still feature a provider search, the wellness programs members already know, and much more. In the coming months, BCBSNC will add even more new features to Member Services.

For more information, please view the short video on this page highlighting the enhancements of the redesigned site.

Friday, June 24, 2011

HHS announces availability of $10 million in wellness grant funds

On June 23rd, the U.S. Department of Health and Human Services (HHS) announced the availability of $10 million in Affordable Care Act funds to establish and evaluate comprehensive workplace health promotion programs. According to the press release, the initiative is aimed at improving workplace environments so that they support healthy lifestyles and reduce risk factors for chronic diseases like heart disease, cancer, stroke, and diabetes.

Organizations interested in submitting proposals for grant funds for their workplace can find more information at http://www.fbo.gov/, specifically at the Comprehensive Health Programs to Address Physical Activity, Nutrition and Tobacco Use in the Workplace page.  The application deadline is August 8, 2011. 

Wednesday, June 22, 2011

Enhancements to CIGNA's benefit plan options & administration effective July 1, 2011

CIGNA is making the following enhancements to their benefit plans as of July 1, 2011.

National Radiology Network Management
CIGNA has engaged MedSolutions, Inc., to provide MRI, CT and PET scans at competitive rates through its national network of radiology centers and to review and manage non-emergency MRI, CT and PET scans for all CIGNA administered plans in the United States effective July 1, 2011. This is an exclusive contracting arrangement. We will be implementing the change to MedSolutions from all other radiology network vendors in a staged approach through the end of this year. CIGNA’s new national agreement with MedSolutions is designed to provide savings to our clients and a consistent experience for your plan participants.

Informed Choice Outreach Program
MedSolutions administers a patient support and outreach program called Informed Choice. The goal of the program is to educate patients undergoing an MRI, CT or PET scan about their options for geographically convenient and cost-effective facilities as they and their doctors choose where to have the tests done.

After a physician contacts MedSolutions for precertification of coverage of an MRI, CT or PET scan, a specially trained representative may contact the individual by phone and provide information about conveniently located credentialed participating facilities (hospitals or free-standing facilities) and offer appointment options. MedSolutions representatives can also provide cost comparison information, so that individuals are aware of the financial impact of their choices.

MedSolutions can assist in scheduling an appointment at the individual’s facility of choice and complete the referral for the services that have been authorized for coverage. In addition, if the individual has additional questions about benefits, account-based balances (e.g., HRA or HSA), or other plan details the MedSolutions representative can connect directly with CIGNA’s customer service team.

This proactive outreach occurs only when true opportunities for choice exist, such as when the ordering physician has requested a higher cost radiology center or hospital for services and other participating credentialed centers offer the same services at a lower cost.

Nuclear Cardiology Services Review and Precertification
Also effective July 1, 2011, MedSolutions will provide expert clinical review of nuclear cardiology services to ensure compliance with our clinical guidelines. The MedSolutions program is designed to promote appropriate care for patients planning to begin a nuclear cardiology treatment plan

Precertification of all outpatient, non-emergency cardiac nuclear studies will be required effective July 1, 2011 and it is the responsibility of the referring in-network health professional to obtain this precertification. Health care professionals contracted with CIGNA have been notified of this new precertification requirement.

Precertification of Outpatient Services
CIGNA requires network providers to obtain pre-certification for many outpatient services (e.g., radiology, surgery). Beginning July 1, 2011, CIGNA is changing its participating provider appeal process with respect to reimbursement for services that have not been pre-certified when required. Reimbursement will not be approved on appeal unless the health care professional can demonstrate that:

1. The services were provided in an emergency or urgent care situation; or
2. Extenuating circumstances prevented pre-certification (e.g., natural disaster, incorrect insurance information).

CIGNA’s agreements with health care professionals and facilities prohibit billing patients for charges for covered services that are administratively denied due to failure to obtain pre-certification where required. CIGNA has notified participating health care professionals of this change and is providing additional information to them in order to make this change seamless.

Introduction to UHC's Quicken Health Expense Tracker

For those that utilize UnitedHealthcare (UHC) for health benefits, be sure to take advantage of the Quicken Health Expense Tracker.  This free online tool can help you:
  • See what you need to pay and why
  • Spot billing errors and resolve them quickly
  • Track your deductible and out-of-pocket expenses
  • Understand what you need to do next
  • Easily pay your health care bills onine
You can sign up for the Quicken Health Expense Tracker online at http://www.myuhc.com/.  Once you've signed up, your medical expense history will be automatically downloaded from UnitedHealthcare and organized for you.

Thursday, June 16, 2011

Which companies will be impacted by health reform penalties in 2014?

In an effort to help employers understand whether the employer penalties will impact their business in 2014, the Kaiser Family Foundation has created a health reform penalty flow chart to simplify this information as much as possible.  This flow chart assumes health reform will continue to be implemented as the legislation is currently written.  Feel free to contact a member of your Senn Dunn team if you have any questions.

UnitedHealthcare rolls out enhanced member services

UnitedHealthcare (UHC) has implemented a new service model, which was first rolled out to some markets, including North Carolina, on May 1, 2011. Formerly known as Health Advisor, the new service focuses on increasing member's knowledge of their benefits and provides end-to-end inquiry resolution with the primary goal of serving as a member advocate.  For more information, see the Service Model Flyer.

Friday, June 3, 2011

Employers must amend cafeteria plans to comply with restrictions on reimbursement for OTC drugs

As a reminder, cafeteria plans that contain an FSA which provides for reimbursement of over-the-counter medicines or drugs must be amended to restrict such reimbursement to prescribed drugs or insulin by June 30, 2011. Although the new law applies to drugs purchased after December 31, 2010, an employer may amend its cafeteria plan to conform to the new law no later than June 30, 2011. The amendment must be retroactive to January 1, 2011. See IRS Notice 2010-59 for more details.

Wednesday, June 1, 2011

Webinar on common employer compliance mistakes and how to avoid them

Senn Dunn Insurance invites you to participate in an Assurex Global webinar on June 30, 2011 from 3:00 to 4:00 PM EST.
Reserve your seat now at:
https://www1.gotomeeting.com/register/748991633

This session will cover common employee benefit compliance mistakes made by employers, and provide practical suggestions on how to avoid or correct them. The issues covered include areas that create real legal, financial, and regulatory risks to employers. Specific mistakes discussed will include:
• Improper handling of benefits during an employee’s FMLA leave
• Confusion between Section 125 status change rules and HIPAA special enrollment requirements
• Failure to file timely 5500s for short plan years
• Lack of a proper Section 125 plan document for premium only plans
• Common COBRA mistakes including improper delivery of the initial general notice

The topics in this webinar are applicable to employers who sponsor both fully-insured and self-funded plans, however, some of the issues covered apply only to certain size employers (e.g. the 5500 rules apply only to welfare plans with at least 100 participants, while the Section 125 plan document requirements apply to any size employer).

Please note: times for AG webinars vary and are listed for the Eastern time zone.

Presented by:
Bob Radecki, President, Benefit Comply, LLC
Bob Radecki has more than 25 years experience in the HR and employee benefits industry helping employers deal with difficult benefit and compliance matters. Previously, Bob founded and served as President of A.E. Roberts Company, a nationally recognized compliance consulting and training firm. He has served as the principal HIPAA consultant to a number of health insurance companies, and is recognized as a leading expert on a variety of benefit compliance issues including COBRA, FMLA, Health Reform and more. Bob has been the featured speaker at numerous industry events and conferences, and has published a number of articles concerning various compliance issues.

Tuesday, May 31, 2011

HSA limits announced for 2012

On May 16, 2011, the IRS released the inflation-adjusted health savings account (HSA) contribution limits for individual and family HSAs.  The amounts are being raised for 2012, whereas the 2011 rates were unchanged from 2010.  The new annual limits will be $3,100 for individual accounts and $6,250 for family accounts (previously $3,050 and $6,150 in 2011).

The minimum deductibles for qualified high deductible health plans (HDHP) have remained unchanged for 2012, although the maximum out-of-pocket amounts have increased from $5,950 to $6,050 for individual coverage and from $11,900 to $12,100 for family coverage.

Thursday, May 26, 2011

New specialty pharmacy network effective July 1, 2011 for BCBSNC members

Beginning July 1, 2011, new specialty pharmacy networks will be available for commercial BCBSNC members.  These networks are intended for members with complex chronic conditions such as multiple sclerosis, cancer and rheumatoid arthritis.  These members have unique challenges that often require special administration and are very costly.

By establishing new specialty networks, BCBSNC's goal is that members can work with specialized experts to receive high quality care, while managing costs.  For more information, please view BCSBNC's online presentation (brainshark) on this topic.  You can also refer to the FAQs, Member Letter for fully insured groups, and Member Letter for CuraScript customers of self-funded groups.

Wednesday, May 25, 2011

End-of-Life documents and resources for North Carolinians

This is just a reminder that there are important end-of-life documents, such as a health care power of attorney, that your employees and their family members should be sure they have executed and updated as necessary.

These forms are available at the North Carolina Department of the Secretary of State Advance Health Care Directive Registry.  More information can also be found at the North Carolina Medical Society's Patient Information page.

Wednesday, May 11, 2011

Upcoming seminar on ERISA for employers

Join us for an employer seminar presented by Nimesh Patel, Assistant Vice President & Senior Counsel with Unum.

Topics covered will include:
• Key foundational ERISA concepts
• ERISA plan components
• ERISA exemptions
• Basic participant, beneficiary, and claimant rights under ERISA
• Disclosure requirements under ERISA
• Process involved in making a benefit determination

Choose from two sessions (Greensboro or Raleigh):
June 7th, 11:30 am - 1:45 pm (lunch provided)
3625 North Elm Street, Greensboro NC 27455

June 8th, 8:30 am - 10:45 am (breakfast provided)
4505 Falls of Neuse Road, Raleigh NC 27609

Space is limited - RSVP to Susan Shanahan by Wednesday, June 1st at sshanahan@senndunn.com or 336.272.7161.

This program has been pre-approved for 2 general recertification credit hours toward PHR, SPHR and GPHR recertification through the HR Certification Institute.

Thursday, May 5, 2011

BCBSNC customer service hours extended for members to 9:00 PM

Recently, BCBSNC extended customer service hours for their call centers for English-speaking insured/underwritten (individual and group) and ASO group members. The new hours for these call centers are 8 a.m. to 9 p.m., Monday through Friday, EST. The toll-free numbers for these call centers are:

• Insured/Underwritten Group Members: 1-877-258-3334
• ASO Group Members: 1-877-275-9787
• Individual Members: 1-888-206-4697

Other Call Center Hours
Please note that the service hours for some of their other customer call centers are NOT changing at this time. Those call centers and their hours of availability are:

• Customer Service for Spanish-speaking Members: 8 a.m. to 6 p.m., Monday through Friday, EST
• State Health Plan Customer Service: 8 a.m. to 6 p.m., Monday through Friday, EST
• North Carolina Health Choice Customer Service: 8 a.m. to 5 p.m., Monday through Friday, EST
• Medicare Supplemental, Blue Medicare Rx, and Medicare Advantage Customer Service: 8 a.m. to 8 p.m., Monday through Sunday, EST (closed on Thanksgiving Day and Christmas Day)
• Federal Employee Program Customer Service: 8 a.m. to 4:30 p.m., Monday through Thursday, and 8 a.m. to 3 p.m., Friday, EST
• Group Service Advisor (formerly known as Employer Service Line) Customer Service: 8 a.m. to 6 p.m., Monday through Friday, EST
• Web Support (available via phone or live Web chat) Customer Service: 8 a.m. to 6 p.m., Monday through Friday, EST
• Dental Blue and Dental Blue Select Customer Service: 8 a.m. to 6 p.m., Monday through Friday, EST
• Agent Contact Center for Group and Individual Markets: 8 a.m. to 5 p.m., Monday through Friday, EST

UHC provides assistance to tornado victims in southern states

Effective immediately, UnitedHealthcare plan participants affected by the tornados in Alabama, Mississippi, Tennessee, Georgia and Virginia will have access to the following services until at least May 13, 2011.

Counseling Services: OptumHealth's toll-free help line number, 866-342-6892, will be open 24 hours a day, seven days a week, for as long as necessary. The service is free of charge and open to anyone. Staffed by experienced master's-level behavioral health specialists from the company's OptumHealth business, the free help line offers assistance to callers seeking help in dealing with stress, anxiety and the grieving process. Callers may also receive referrals to community resources to help them with specific concerns, including financial and legal matters.

Early Prescription Refills: Individuals who have been displaced or do not have access to their medications, who call and identify that they have been affected by the tornados, will be able to have prescription medications filled if they have refills remaining on file at a participating retail or mail-order pharmacy. Note, this includes plan participants enrolled in all fully insured commercial products, Medicare Advantage, Medicare Supplement or Medicare Part D offerings insured through UnitedHealthcare. For mail-order delivery service to affected areas or any other questions related to their prescriptions, people are encouraged to call the pharmacy number on the back of their medical ID card, or speak directly to a pharmacist about their situation.

In addition, for certain counties covered by a FEMA Declaration of Emergency, additional measures are available. The following counties are covered by a FEMA declaration:
• Alabama: All Counties
• Mississippi Counties: Chickasaw, Choctaw, Clarke, Greene, Hinds, Jasper, Kemper, Lafayette, Monroe, Neshoba, Webster
• Tennessee Counties: Bradley, Greene, Hamilton, Washington
• Georgia Counties: Bartow, Catoosa, Coweta, Dade, Floyd, Greene, Lamar, Meriwether, Monroe, Morgan, Pickens, Polk, Rabun, Spalding, Troup, Walker
• No counties in Virginia have been covered by a FEMA Declaration at this time.

Plan participants residing in impacted counties who have been displaced from their place of residence or whose network medical facility is not accessible, and require assistance or special accommodations, can call customer care at the number located on the back of their medical ID card for assistance.
• This includes plan participants enrolled in all fully insured commercial products residing in FEMA impacted counties. To access out of network providers, plan participants must call customer care at the number located on the back of their medical ID card for assistance.
• Plan participants enrolled in Medicare Advantage or Medicare Supplement plans residing in counties in Alabama, Georgia, Mississippi, Tennessee and Virginia where a FEMA or state emergency declaration has been declared should call customer care at the number located on the back of their medical ID card for assistance or special accommodations in accessing services.

These special support services are effective immediately and will remain active until at least May 13, 2011.