Wednesday, March 30, 2011

IRS issues further guidance on W-2 reporting, now optional for small employers in 2012

The Internal Revenue Service today issued interim guidance to employers on informational reporting on each employee’s annual Form W-2 of the cost of the health insurance coverage they sponsor for employees. The IRS emphasized that this new reporting to employees is for their information only, to inform them of the cost of their health coverage, and does not cause excludable employer-provided health coverage to become taxable; employer-provided health coverage continues to be excludable from an employee’s income, and is not taxable.

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). In today’s guidance, 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.

Using a question-and-answer format, Notice 2011-28 also provides guidance for employers that are subject to this requirement for the 2012 Forms W-2 and those that choose to voluntarily comply with it for either 2011 or 2012. The notice includes information on how to report, what coverage to include and how to determine the cost of the coverage.

For more information, please refer to Notice 2011-28 on

Monday, March 21, 2011

BCBSNC announces pharmacy benefit change for Allegra and Allegra-D

In early March, Allegra (fexofenadine) and Allegra-D (fexofenadine/pseudoephedrine) became available as OTC (over-the-counter) medications.

Members may be able to continue to receive Allegra and Allegra-D under their pharmacy benefit in pharmacies until current supplies run out. BCBSNC does not cover OTC medications, so the new OTC Allegra products will not be covered under their prescription drug benefits. Prescription fexofenadine liquid may remain on the market for certain uses in pediatric patients.

Tuesday, March 15, 2011

BCBSNC's HealthNAV mobile app comes to Droid

BCBSNC's thriving mobile app HealthNAV comes to the Android market just as the smartphone platform becomes the U.S. market leader. Following the successful launch of the app for iPhone and iPad devices in October, the release of HealthNAV for Android allows BCBSNC to provide convenient health information for even more customers.

Please see the Press Release for more information.

Monday, March 14, 2011

BCBSNC implements changes to prior review for certain prescription drugs

Effective April 1, 2011, Blue Cross and Blue Shield of North Carolina (BCBSNC) is implementing changes to their prior review/certification requirements for certain prescription drugs.

Members who have filled a prescription for oxandrolone (Oxandrin®), oxymetholone (Anadrol-50®), or doxepin (Silenor®) within the last three months will receive letters from BCBSNC this week.

For more information, please view the sample member letters, Samle Letter Doxepin and Sample Letter Androgen-Steroids.

Thursday, March 10, 2011

UHC survey mailed to fully insured customers to collect data for medical loss ratio provision

Provisions of the Affordable Care Act (ACA) calling for a specific medical loss ratio (MLR) for the small and large group markets require UnitedHealthcare (UHC) to survey customers to get data on the total number of employees to help determine the applicable MLR.

Beginning March 7, 2011, a mailing will go to all fully insured customers requesting “the average number of employees as employed by the employer’s company during the preceding calendar year,” using the federal definition. The survey, which can be done online with a secure access code, asks for the employee count by month for all 12 months.

For each MLR reporting year, a health insurance issuer must provide a rebate to the employer and each enrollee if the issuer’s MLR does not meet or exceed the minimum MLR percentage established in the law:
• 80 percent for individual and small group markets.
• 85 percent for the large group market.

The regulation defines small group as 1 to 100 and large group as 101+.

Customers will have 30 days from receipt of the mailing in which to respond to the survey. For those without online access, a form that can be faxed in response will be included with the mailing.

This data will be used to appropriately segment the group into the large or small group market according to federal guidelines and could have ramifications for rebate potential in 2012.

Going forward, this data must be gathered and reported annually in order to comply with the ACA regulation and provide any applicable rebates in a timely manner.

Monday, March 7, 2011

UnitedHealthcare to update Prescription Drug List effective July 1, 2011

UnitedHealthcare (UHC) will update their Prescription Drug List (PDL) and benefit coverage effective July 1, 2011 as follows:
Fully Insured Customers
Advantage PDL Updates
Traditional PDL Updates

Self-Funded Customers
Advantage PDL Updates
Traditional PDL Updates

Learn More at the Webcast
UHC customers are invited to attend a presentation of the pharmacy benefit strategies for July 1, 2011 updates planned for both the Advantage and Traditional PDLs. You will have the opportunity to ask questions and discuss the updates that impact you.

Date: Wednesday, March 16, 2011
Fully Insured Customer
12 pm EST
Broker Registration for Webcast

Self-Funded Customer
2 pm EST
Consultant Registration for Webcast

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

Thursday, March 3, 2011

Webinar on health care reform

Senn Dunn Insurance invites you to participate in an Assurex Global webinar on March 31, 2011 from 1:00-2:00 PM Eastern.
Reserve your seat now at:

By April the new Congress will have proposed and possibly already passed changes to existing health reform legislation. Regulatory agencies are also expected to release additional guidance early in 2011. This session will focus on changes and new rules released since the last Assurex Global health reform webinar, delivered 4th quarter 2010.

Specific issues covered in this webinar include: 
• Differences in state vs. federal tax treatment of dependent coverage
• The status of the new 1099 reporting rule
• Calculating the value of plans to be reported on the W-2
• Overview of the new 4-page benefit summary plans are required to provide beginning in 2012
• How coverage for less common dependents (e.g. step-children, grandchildren, etc.) is affected by the ACA
• Waiver of lifetime and annual maximum requirements for mini-med plans and health reimbursement arrangements (HRAs)
• The impact of recent court cases on health reform requirements for employer sponsored health plans
• The delay in the application of 105(h) rules to fully-insured health plans
• Other late breaking health reform compliance issues

Presenter: 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, March 1, 2011

BCBSNC 2010 financial results show stable finances & customer base

In 2010, BCBSNC continued to see stability in its financial performance and customer base despite a difficult economy. BCBSNC had a net income ratio (profit margin) of 3.2 percent for 2010, equating to just 3.2 cents for each dollar of revenue. That was up from 2.1 percent in 2009 and below the company’s target range of 3.5 to 4.5 percent.

BCBSNC spent over 86 cents per premium dollar on the medical care of its customers. Most of the remainder of the premium dollar went toward customer service and information technology.

For more information, refer to the BCBSNC press release.