Friday, February 25, 2011

BCBSNC maintenance medication mailing to select current members

On February 28, BCBSNC will send a letter to 177,100 current members who filled a maintenance prescription during the last three months of 2010. It discusses the use of generics and how to find them on, 90-day supplies of medications and the importance of taking medications as prescribed by your provider. The letter is intended to help these members make the most of their pharmacy benefits.

State and federal legislative activity impacting North Carolina

The following update on pending state and federal legislation was provided by BCBSNC in an effort to keep North Carolinians informed on relevant changes to health care and health insurance.

State Issues
The Senate approved HB 2 – Protect Health Care Freedom. The bill would block the federal requirement that people purchase health insurance or face a penalty. The measure would also require the attorney general to defend the challenge in court. The Senate made a change to the bill so it will need to go back to the House for approval.

The Senate Insurance Committee held its first hearing on SB 33 – Medical Liability Reforms by Senate Insurance Chairman Apodaca (R). The bill would make changes to the state’s medical malpractice statutes including:
• Providing limited protection from liability for providing emergency medical care
• Authorizing the bifurcation of trials on issues of liability and damages in certain actions
• Limiting the amount of non-economic damages to $250,000
• Authorizing the periodic payment of future economic damages in lieu of a lump sum payment
• Modifying appeal bonds in medical malpractice actions

Supporters and opponents spoke about the bill. The committee did not vote on the bill, but a vote is expected this week.

House Insurance Chairman Dockham (R) filed HB 115 – North Carolina Health Benefit Exchange Act. The bill would establish a health benefit exchange in North Carolina as required by federal law. The bill is based on the National Association of Insurance Commissioner’s model exchange act and includes governance and funding provisions from the state’s high-risk pool statute. The exchange would be governed by an eleven-member board with oversight by the Commissioner of Insurance. HB 115 provides for a market-based approach with the exchange accepting health plans that meet the federal requirements. Current high-risk pool funding would be diverted to the exchange in 2014 to support its operations. The bill was referred to the House Health Committee with a re-referral to the House Appropriations Committee.

Rep. Verla Insko (D) introduced a competing bill to establish a health benefit exchange in North Carolina. HB 126 – North Carolina Health Benefit Exchange Act tracks recommendations made by an Institute of Medicine work group on exchanges. HB 126 would create an eight-person independent board to govern the exchange. Insurers would be prohibited from serving on the board, and the exchange would have the discretion to limit the number and types of health plans offered in the exchange. The exchange and the Department of Insurance would also have unlimited authority to assess insurers to pay for exchange operations. HB 126 has not been referred to committee.

Chairman Dockham also introduced HB 138 – Amend Health Insurance Risk Pool Statutes. HB 138 would make changes to the high-risk pool. The changes include:
• Allowing the pool to use state money for premium subsidies for people up to 300% of the federal poverty level
• Reducing the minimum premium cap from 150% of the standard rate to 125%
• Eliminating the requirement that an individual exhaust COBRA coverage to be eligible for the pool
• Reducing the exclusion for paying for pre-existing conditions to the first six months of pool coverage

The changes would become effective October 1, 2011. The bill has not been referred to committee.

Rep. Stam (R) introduced HB 139 – Limit Contributions by State Vendors. The bill would prohibit a vendor from contributing more than $500 to a candidate for the following elected positions: governor, lieutenant governor, secretary of state, auditor, treasurer, superintendent of public instruction, attorney general, commissioner of agriculture, commissioner of labor, and commissioner of insurance. A vendor is defined as any individual with a contract greater than $25,000 with any of the above mentioned positions. HB 139 has not been assigned to a committee.

Federal Issues
Early Saturday morning, the House completed its work on a continuing resolution to fund the federal government through the end of the 2011 fiscal year (September 30). The final vote came after an agreement was reached to allow limited debate on 125 remaining amendments, down from the original 585 filed. The House voted to approve the following Republican amendments that would halt funding and implementation of the Patient Protection and Affordable Care Act (PPACA):
• An amendment by Labor-HHS-Education Appropriations Subcommittee Chair Denny Rehberg (R-MT) that would prohibit using funding in the bill to implement PPACA
• An amendment by Steve King (R-IA) to prohibit any funds from being used to implement any provision of PPACA
• An amendment by Steve King (R-IA) to prohibit any funds from being used to pay the salary of employees of any federal department or agency with respect to implementing any provision of PPACA
• An amendment by Jo Ann Emerson (R-MO) to prohibit any funds from being used by the Internal Revenue Service to enforce PPACA individual mandate

It is unlikely the Senate would approve such restrictions to PPACA implementation. This could lead to contentious negotiations among House and Senate leaders and the White House over final approval of the spending bill. Congress is in recess this week in observance of President’s Day so lawmakers will have just four days to reach a deal before the March 4 expiration date of the current spending plan. Congress will likely pass one or more short-term extensions of the current continuing resolution to avoid a government shutdown.

Meanwhile, the continuing resolution is the first such measure in history to include spending cuts, approximately $58 billion overall and $17.5 billion (11 percent) from the Departments of Health and Human Services (HHS) and Labor compared to 2010 fiscal year spending. The bill would put overall discretionary spending at roughly $36 billion less than President Obama’s 2011 fiscal year budget request submitted last year.

Among healthcare-related cuts, the continuing resolution would reduce the Centers for Medicare & Medicaid Services operating budget by $340 million and cut $56.5 million from Medicare contracting reform initiatives. It would also reduce discretionary spending on several programs that received funding in PPACA, including Community Health Centers, the National Health Service Corps (an initiative that funds, among other things, primary care physician development) and the Maternal and Child Health Block Grant.

In addition, the continuing resolution would prohibit funding to implement the 1099 tax reporting requirement in PPACA. It would also cut unobligated stimulus funding authorized by the American Recovery and Reinvestment Act, contributing $2 billion in savings.

NC Hearing Aid Mandate Effective January 1, 2011

This past fall, the North Carolina legislature passed an act requiring health benefit plans and the State Health Plan to cover hearing aids and replacement hearing aids for covered individuals under the age of 22. The act was effective for plans with January 1, 2011 and beyond effective dates.

All group medical plans are impacted. Hearing aid coverage will be standard for all fully-insured plans, including MEWAs and the State Health Plan, as well as for self insured groups.

BCBSNC Benefit Design Changes
BCBSNC modified their benefit plans to include the following hearing aid coverage:
• One hearing aid per hearing-impaired ear up to $2,500 per hearing aid every 36 months for covered members under the age of 22 years.
• Benefits include initial hearing aid evaluation, fitting and adjustments and supplies including ear molds.
• This is a 36-month benefit, not a three-year benefit, meaning hearing aids for the left and right ears could have a different 36-month coverage period.
• These benefits will display in the member guide but not in the benefit highlight.

Benefit changes made to comply with state mandates will not impact your group's grandfathered status.

Thursday, February 17, 2011

UnitedHealth Premium Physician Designation Refresh Effective March 30

Each year, all eligible network physicians in UnitedHealth Premium® designated specialties are evaluated to determine if they meet national standards for quality and local market benchmarks for cost efficiency. These updates are intended to continually enhance the UnitedHealth Premium program to promote access to quality and affordable health care.

Enhancements to the 2011 Premium program include:
• A more robust methodology and higher quality standards.
• The addition of seven new markets in Texas, New York, Minnesota, North Dakota, South Dakota and Western Wisconsin.
• Removal of Cardiovascular Surgery as a designated specialty.

These changes will be effective on Wednesday, March 30 on® and in other provider directories.

What Is the Impact of These Changes?
In some markets, these changes to the methodology will result in a slight increase in the number of designated physicians. Some markets will see a small decrease in the number of designated physicians and an even smaller number of markets will see a more dramatic decrease in the number of designated physicians.

There are some UnitedHealthcare medical plan designs like UnitedHealthcare EDGE and Tiered Benefits that enable members to pay lower copay and lower coinsurance percentages when they use a two-star quality and cost efficiency designated specialist. Because the designation status of an individual physician may have changed, it is important for any member who is seeking services from 2-star quality and cost efficiency designated specialists to confirm the designation status of their provider prior to the date of service by visiting or calling the Customer Care number on the back of their health plan ID card.

To minimize the impact of these changes to members, there will be a 90-day claims grace period for fully insured customers which will honor current two-star designations for claims payments. Self-funded customers may also request the 90-day claims grace period, if desired. UHC understands that patients may want to switch care from physicians who are no longer designated. In the past, UHC has allowed a 30-day grace period to facilitate the transition of care. This timeline has been extended to 90 days to reflect the greater number of patients who may be affected in certain markets.

Member Notification
UHC will be mailing a postcard notification to fully insured EDGE and Tiered Benefit subscribers informing them of the designation update later this month. A poster (color and black/white options) and email template are available for you to download below to help inform employees about this important update.
Member postcard notification
Member poster color option
Member poster black and white option
Member email

For the full news release from UHC, click to view the UHC Special Edition.

Monday, February 14, 2011

UnitedHealthcare to offer new podcast series on health and wellness

UnitedHealthcare (UHC) has added eight new podcasts to its current podcast series. Members can listen to health and wellness information at their convenience, 24 hours a day, seven days a week. Each podcast has chapters so you can choose to listen to the whole presentation or just the section that is most important to you.

The new podcasts include:
• Healthy Dining In and Out: Learn about healthy eating strategies, ways to cook healthy at home and tips for making healthier choices when eating out.
• Managing Stress: Identify sources of stress, discuss solutions for dealing with stress and practice problem-solving techniques.
• Overcoming Exercise Barriers: Identify and discuss ways to overcome exercise barriers. Discuss personal challenges while making exercise a priority. Review helpful tips to increase activity.
• Move to Lose: Understand the benefits of physical activity and review common exercise myths. Understand the role of physical activity in weight loss; identify moderate intensity activities; and learn how to plan your exercise routine.
• Planning Ahead for Healthy Eating: Discuss how planning ahead helps you make healthier choices. Discuss healthy meal planning and snacks, and review how to read nutrition labels.
• Healthy Habits: Identify common triggers that lead to unhealthy behaviors and review strategies for healthier habits. Discuss ways to make home and work healthy environments for adoption of healthy habits.
• Staying Positive: Discuss motivation techniques and positive self-talk. Look at progress, set new goals and review components of success.
• On Your Way to a Healthy Weight: Understand the benefits of weight loss and determine a healthy weight range. Review portion sizes and learn everyday ways to move more. Discuss the importance of tracking and setting realistic and achievable goals.

Current podcasts include:
• Women's Health: Learn about top women’s health concerns, such as heart, breast and brain health; osteoporosis; menopause; diet and exercise; and managing stress.
• Men's Health: Learn about top men’s health concerns, such as heart, prostate and brain health; diet and exercise; and managing stress.
• Back Health: Learn how to keep your back strong, how to address the causes of back pain and what to do when back pain strikes.

Members can access the podcasts by visiting Click to access the Member Flyer and Dr. Oz Video Clip Calendar.

Monday, February 7, 2011

BCBSNC launches interactive website

Today BCBSNC launched, a new way for North Carolinians to share their perspectives and participate in a two-way conversation with each other and BCBSNC. The website is intended to help BCBSNC listen to customers, learn from their insights and use the input for business improvements whenever possible.

Each week, North Carolinians who actively participate on the site can win prizes like gift cards to top retailers or tickets to North Carolina sporting events. This week’s prize is a $50 online gift card to Dick’s Sporting Goods.

How do I participate on the site?
• Just go to and complete the simple registration process.
• Share your opinions about health care, health insurance and other health-related topics by answering the poll questions or providing comments to the questions or the blog.

Participation earns you entries for prizes in the following ways:
• You'll earn one entry into the weekly promotion for each question on the site you answer. You can only answer each question once, so be sure to come back each week for new questions to answer (and new prizes).
• Then share the site with your friends and family, so they can join in the discussion too. You can do this through email or social networks, including Facebook and Twitter. For each friend that clicks on the link, you’ll earn 5 entries.
• Plus, you’ll earn 10 entries into the drawing for each friend who registers from your referral.
• The more you share, the more entries you will earn!

Who can participate?
Participants must be North Carolina residents and 18 years of age or older. Employees of BCBSNC, BCBSNC affiliates, or BCBSNC’s third party vendors involved with Blue Asks You NC are not eligible to win.

Friday, February 4, 2011

BCBSNC to send contract amendment mailing to groups this week

Beginning this week, BCBSNC will send letters to 6,641 fully-insured groups regarding an amendment to their contracts as a result of recent regulatory changes. These changes provide that upon a group’s request for a retroactive termination, BCBSNC will make any necessary premium adjustments, and the group will be responsible for returning premiums to affected members. Click to view a sample letter.

Groups receiving letters had renewal dates in October, November or December of last year. This change has been included in contracts for groups renewing January 1, 2011 or later.

Tuesday, February 1, 2011

Webinar on dependent eligibility audits

Senn Dunn Insurance invites you to participate in an Assurex Global webinar on February 24, 2011 from 1:00 - 2:00 PM Eastern.
Reserve your seat now at:

Employers are increasingly considering dependent eligibility audits as a way to reduce employee benefits costs. While the idea is simple, the actual process must be handled properly to avoid legal problems and negative employee relations issues. This session will discuss important compliance and operation issues for any employer considering an eligibility audit.

Presenter: Mark W. Major, J.D., Consultant, Benefit Comply, LLC
Mark has practiced as an employee benefits attorney for more than twenty-five years in private practice as well as being in-house ERISA counsel for corporations in the cable, telecommunications, and oil & gas industries. Mark was also a U.S. compliance team leader for a worldwide human resources consulting firm where he serviced employers of all sizes. Working closely with officers, managers and staff across human resources, labor, finance, trust investment and corporate development departments, as well as dealing with numerous vendors from the consulting side has given Mark a unique and broad perspective on the legal challenges faced by sponsors of employee benefits programs.

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