Tuesday, January 31, 2012

BCBSNC to require prior review as of April 1, 2012 for facet joint denervation

Effective April 1, 2012, facet joint denervation will require prior review/certification by BCBSNC in order to be covered. The member’s physician must provide written certification that the member has met specific clinical criteria as outlined in BCBSNC’s medical policy for this procedure.

BCBSNC providers were notified of this change on January 1, 2012 via multiple channels, including www.bcbsnc.com/providers, e-mails to physicians who commonly perform these procedures, and personal outreach to physician practice managers, Medical Group Managers, NC Medical Society leadership, NC Hospital Association, and Blue Link.  
BCBSNC will publish an article about this change on www.bcbsnc.com/employers soon. 

Monday, January 30, 2012

Catalyst Rx details process for generic Lipitor roll-out

While Lipitor became available in generic form on November 30, 2011, the price has not significantly dropped as there is currently only one manufacturer of generic Lipitor.  The new generic Lipitor, atorvastatin, has a total cost only slightly below brand-name Lipitor.

To provide a low net-cost solution to this new expensive generic product Catalyst Rx has engaged the following strategy:
  • Catalyst Rx has contracted directly with the Lipitor manufacturer, Pfizer, for an additional discount at the point-of-sale which will be passed directly to the plan immediately.  This additional discount is almost $50 per 30-day supply.
  • Catalyst Rx is going to block generic Lipitor (atorvastatin) for six months until there are additional manufacturers producing atorvastatin and at that time the price will drop significantly.
  • In the interim, Catalyst is going to move brand-name Lipitor to generic status (Tier 1) so members on brand-name Lipitor will pay the generic copay of the lower costing product.
  • Members currently on Lipitor will be notified via the attached letter which is scheduled to be mailed on November 4th.
  • Once the 6 months manufacturing exclusivity for atorvastatin is over (June 2012) brand-name Lipitor will move to non-preferred status (Tier 3).
One of the exciting aspects of this low net-cost strategy is that there will be no member disruption at all.  Members will not need new prescriptions because our pharmacy partners will be notified as well.  In June of 2012, when the block is removed for atorvastatin, members will automatically move to a generic version that at that time will be produced by multiple generic manufacturers.

IRS releases new notice on W-2 reporting requirements

On Jan. 4, 2012, the IRS issued Notice 2012-9, providing further details on the W-2 Reporting Requirement of the Patient Protection and Affordable Care Act (PPACA). UnitedHealthcare (UHC) has provided a helpful summary of this updated provision:

Reporting Requirements
Employers that are required to file fewer than 250 W-2 forms in 2011 will not be required to report the cost of health coverage under the Patient Protection and Affordable Care Act. This transition relief will continue until further guidance is issued. Any additional guidance will not apply to any calendar year beginning within six months of the date the guidance is issued.

Employers are not required to report the cost of health benefit coverage on any W-2 forms furnished to employees prior to January 2013.

It's important to note that only covered employees that elect the coverage and pay the premiums or contribution amounts will receive cost of coverage information on their W-2 forms. For example, if a husband and wife work for the same company and are covered under the same health benefit plan, and the husband signed up for the plan and pays the premiums, he is considered the covered employee. Only the husband, in this case, would have the cost of coverage reported on his W-2. The wife is considered a beneficiary or dependent on the plan and would not have the cost of coverage on her W-2.

Cost of coverage is reported on W-2 forms for 2012 in box 12, using code DD.

Calculating Cost of Coverage
The cost of coverage generally includes both the portion of the cost paid by the employer and the portion of the cost paid by the employee, regardless of whether the employee paid for that cost through pre-tax or after-tax contributions.

Coverage that Does Not Need to be Reported
Notice 2012-9 confirms that applicable employer-sponsored coverage does not include:
  • Coverage for excepted benefits under the Health Insurance Portability and Accountability Act (HIPAA) (such as long-term care, accident, disability income, liability and supplemental liability insurance, automobile medical payments, and workers' compensation insurance)
  • Coverage for a specific disease or illness or hospital indemnity insurance
  • Coverage provided by the federal government, state government or agency of the government under a plan that is maintained primarily for members of the military and their families
  • Coverage under a self-funded plan that is not subject to any federal continuation requirements Consolidated Omnibus Budget Reconciliation Act (COBRA), Public Health Services Act (PHSA) continuation, Federal Employee Health Benefits Program (FEHBP) continuation, such as a group health benefit plan sponsored by a church
  • Coverage under a health reimbursement account (HRA)
  • Contributions to a health savings account (HSA) or Archer medical savings account (MSA)
  • Salary reduction contributions to a health flexible spending account (FSA) unless the amount of the FSA benefit exceeds the salary reduction election. In this case, the reportable cost would include the amount that exceeds the salary reduction election.
  • Coverage under a "stand-alone" dental or vision plan if the plan satisfies the requirements for being excepted benefits for purposes of HIPAA
  • Coverage for employee assistance program (EAP), wellness program, or on-site medical clinic, if that employer does not charge a premium for this type of coverage under COBRA

Tuesday, January 24, 2012

Webinar on benefit issues related to same-sex marriage and domestic partner coverage

Senn Dunn invites you to participate in an Assurex Global webinar on February 23 from 1:00 to 2:30 PM EST.

Reserve your seat now at:

The issues surrounding employee benefit coverage for domestic partners and same‐sex couples are becoming more complex as various states change their laws regarding these relationships. State rules impact employer plans differently depending on whether the plan is fully insured or self‐funded, but even self‐funded plans have issues that must be considered. Furthermore, employers must also understand how the coverage they choose to provide is treated by both federal and state tax laws. This session will review the current status of state legislation in this area, including state tax laws, and how they impact the employer benefit eligibility strategies.

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.

Friday, January 20, 2012

Guidance on health FSA cap of $2500

The health reform law (PPACA) imposes an annual limit of $2,500 on employee salary reduction contributions to Health Flexible Spending Accounts (FSAs).  PPACA states that this provision is effective beginning January 1, 2013 and the amount will be indexed annually for inflation. 

For calendar year plans, this provision will have no effect on your plan until the 1/1/2013 renewal period. However, because this is a calendar year cap and not a plan year cap, employers with 2/1/2012 through 12/1/2012 fiscal plan years should consider this as they plan for their 2012 renewal--some employers may find it simpler to institute the $2,500 cap at this renewal.  Final guidance has not been issued on the cap, and it is possible that the cap will be delayed or increased.

For more detailed information on this provision and options for complying with this regulation, refer to this news alert from ProBenefits.

Wednesday, January 18, 2012

BCBSNC ends Ceridian contract for COBRA services, communication begins

BCBSNC has announced that their contract with current COBRA administrator, Ceridian, will end on May 11, 2012. BCBSNC will start sending notifications to affected groups this week. The mailing will include this letter and FAQ.

Here’s what you need to remember about this change:
  • BCBSNC will administer COBRA for their underwritten health and dental groups beginning with 3/1/2012 effective dates.
  • Currently, all ASO groups must contract with a vendor of their choice for COBRA services. This will continue.
  • Groups that have products where membership and billing information is housed in other systems (i.e., ACS or in the case of groups with carved out products), would have to enter into a contract with a COBRA vendor to handle those non-BCBSNC products.
  • Dental Blue Select groups through ACS can contract with ACS for COBRA Administration services.
By providing COBRA services internally, BCBSNC hopes to reduce administrative costs and simplify the process for our group administrators. This chart illustrates the current process with Ceridian and the future process as BCBSNC begins handling the process internally.

Tuesday, January 10, 2012

North Carolina, Kansas City BCBS plans collaborate

Blue Cross and Blue Shield of North Carolina (BCBSNC) and Blue Cross and Blue Shield of Kansas City (BCBSKC) announced today that they will collaborate in an initiative that will position the companies to meet the new market demands required by a fast-changing health insurance landscape.

This joint effort will be undertaken by Topaz Shared Services, LLC (Topaz); BCBSNC and BCBSKC will be its initial members.  Topaz will provide services such as claims processing, enrollment and billing for the individual and small-group markets.

Refer to the press release for more information.

Carolina Advanced Health invites members to join practice

Carolina Advanced Health began inviting eligible members to become patients of the new practice early last week. Eligible members will be identified by being over 18, living near the practice and having one or more of the following conditions: coronary artery disease, hypertension, hyperlipidemia (high cholesterol), diabetes, chronic obstructive pulmonary disease (COPD), chronic heart failure and asthma.

Individual, fully-insured group and State Health Plan members will be included in the mailings and will receive an invitation letter and an informational brochure on the practice.

Also, employers with identified members will receive an email to make them aware of the practice and the invitation process.

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.  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.

Reminder: small employer tax credit available

As part of the Affordable Care Act (ACA), the IRS has made available a tax credit for small employer health insurance premiums.  This credit was first available in 2010 and will continue to be available in this format through 2013.  To claim the credit, employers must file Form 8941 and meet the eligibility criteria.

The following new documents are posted on IRS. gov:
For more information on this tax credit, please see our previous posts, Does my business qualify for the small employer tax credit? and IRS issues final guidance on small employer tax credit.

Tuesday, January 3, 2012

BCBSNC provides details on class action settlement

Please see the Summary Notice to Class Members regarding BCBSNC members who may be affected by the recent class action settlement.

This settlement may apply to members that meet the following criteria:
  • BCBSNC PPO member (Blue Advantage or Blue Options) – from November 1, 2002 through December 31, 2008
  • The plan was not covered by the Employment Retirement Income Security Act (“ERISA”)
  • During any benefit period, you reached your benefit period maximum or lifetime maximum under the terms of your PPO contract with BCBSNC
  • You were charged by an in-network provider more than the allowed amount for covered services after reaching your benefit period or lifetime maximum 
For additional information, you may contact Class Counsel at BlueCrossNCClass@marcusauerbach.com or write to the following address:

Hamm v. Blue Cross and Blue Shield of North Carolina
c/o Strategic Claims Services
600 N. Jackson Street, Suite 3
Media, PA 19063

UHC explains impact of changes to internal appeals process for 2012

UnitedHealthcare (UHC) published the following information in their recent news alert regarding the impact of PPACA's required changes to internal appeals processes.

Changes to Internal Appeals Processes for 2012
Members of non-grandfathered health plans with effective dates on or after Sept. 23, 2010 (and grandfathered health plans that voluntarily adopted the appeals provisions of the Affordable Care Act), will see some additional information on their adverse benefit determinations (ABDs), including explanations of benefits (EOBs), beginning Jan. 1, 2012. Specifically, ABDs will contain the following additional information (if they did not already do so):
  • Language translation assistance in designated counties; and,
  • The availability, on request, of treatment and diagnosis code information.
Members should refer to their benefit plan documents, including amendments and notices, regarding the internal appeal and external review rights available under their plan.

The Departments of Health and Human Services, Labor and Treasury (the Agencies) issued interim final rules (IFR), and subsequent Technical Releases and an Amendment to the IFR that details the new requirements. As referenced above, here are the changes that will occur to ABDs beginning Jan. 1, 2012:

Language Translation Disclosure Requirements
There now is a single threshold with respect to whether members are informed of language assistance services to provide ABDs and other notices in a "culturally and linguistically appropriate" (CLA) manner. Instead of being based on the employer's eligible population (for group business) and county census data (for individual plans), the threshold for both is set at 10 percent or more of the population in the member's county, based on 2010 census data.

The Agencies have identified the states and counties that currently meet the 10 percent threshold in one or more of four languages: Spanish, Chinese, Tagalog and Navajo. Sample one-sentence statements in the relevant non-English language have been provided by the Agencies to be used for ABDs sent to a member residing in a threshold county beginning Jan. 1, 2012.

Member service centers will assist members in using oral translation services, and will provide written notices in the non-English language upon request.

Treatment and Diagnosis Codes
Health plans must also notify members of the opportunity to request diagnosis and treatment codes, and their meanings, in ABDs. This notice regarding diagnosis and treatment code information will begin appearing on Jan. 1, 2012. (Note: Some UnitedHealthcare systems were enhanced before the previous July 1, 2011 IFR deadline to include treatment and diagnosis codes in ABDs, and those systems will continue to display this information in ABDs).

The IFR Amendment clarifies that any request for diagnosis and treatment code information may not be (and is not) considered a request for an internal appeal or external review.

BCBSNC online employer chat available to group administrators

BCBSNC announced that their new online chat feature is now available to group administrators that perform member maintenance online.  Here are some things you should know:

When is Employer Chat available?
Employer Chat is available from 8:00 am to 6:00 pm, Monday through Friday.

How does a group administrator log in?
The employer can log in to the employer portal at www.bcbsnc.com, click on “Manage Members” and then “Member Maintenance”.  There will be a button to “Chat with a Group Advisor”.

What are the benefits of using Employer Chat?
With little to no wait time involved, employers are able to receive fast responses to their billing, enrollment and claims related questions.