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:

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,, or 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:
Medicare Physician Compare Website:
RAND Analysis of Comparative Effectiveness Research:
Kaiser Family Foundation Comparative Effectiveness Research:
Agency for Healthcare Research and Quality: