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.