Friday, February 24, 2012

Webinar on calculating individual subsidies and employer penalties under ACA

Senn Dunn invites you to participate in an Assurex Global webinar on March 22 from 2:00 to 3:30 PM EST.

Reserve your seat now at:

As employers begin to understand the general health reform rules contained in the Affordable Care Act (ACA) they are recognizing the need for a greater understanding of the specific details based on the employer’s particular employee demographics and plans. This webinar will explain how to calculate the subsidies for individuals and how to estimate potential employer penalties based on the employers specific situation.

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

Tuesday, February 21, 2012

BCBSNC launches redesigned Spanish website

BCBSNC has recently redesigned their Spanish website,

The redesigned website is a place where Spanish-speaking customers can:
  • Read about BCBSNC and the work we are doing in the community.
  • Access information about our plans and products.
  • Review information about the health care system in the United States.
  • Get tips to stay healthy.
  • Receive information about our value added services for members.
In addition, subscribers can download visual job aids to help them navigate the member site at These guides are intended to help Spanish-speaking members:
  • Register to use the English member site
  • Understand the ID card
  • Find the health assessment
  • Find a doctor
  • Understand the appeal form

BCBSNC Prime Therapeutics Transition Details

As a reminder, Prime Therapeutics LLC (Prime) will begin administering pharmacy benefits for commercial BCBSNC customers, effective April 1, 2012.  BCBSNC will begin providing information about this transition to employers next week, both via email and on  For more information on the transition to Prime, please view BCBSNC's online presentation or the FAQs on this topic.

Monday, February 20, 2012

Final regulations published on Summary of Benefits and Coverage (SBC) requirements

On February 14th, agencies released final regulations regarding the health reform requirement to provide health plan information in a uniform format, now known as an SBC.  PPACA had originally set the applicability date of this requirement as March 23, 2012, though the final regulations have delayed this date.  The SBC must now be provided beginning with the first open enrollment period that begins on or after September 23, 2012.

As a part of these regulations, the SBC template has been finalized, along with a sample completed SBC, instructions, sample language, coverage examples, and a uniform glossary.  These materials are available on the DOL website and HHS website.

We will update you with details on the proposed implementation of this provision as carriers set forth their plans for SBC creation and distribution.

Wednesday, February 15, 2012

Reminder: BCBSNC members to receive new ID cards due to PBM change

As a reminder, BCBSNC will begin using a new pharmacy benefits manager (PBM) effective April 1, 2012.  Prime Therapeutics will be replacing Medco in an effort to secure better pharmacy discount pricing for BCBSNC members.

Members should expect to receive a welcome packet during the month of March.  The new packet will include new ID cards, recent changes for the member guide and information on navigating the pharmacy section of the BCBSNC website.  The new ID cards will simply replace Medco information with Prime information.

If you have any further questions on this change, please refer to our previous post, BCBSNC contracts with new pharmacy benefit manager, and the BCBSNC FAQ on this topic.

Friday, February 10, 2012

Summary of Benefits and Coverage (SBC) guidance released

Earlier this week, HHS released advance copies of the final regulations and guidance on the Summary of Benefits and Coverage (SBC) requirements.  According to EBIA Weekly, these final regulations are expected to be published in the Federal Register on February 14, 2012; however, a model template and instructions are currently avaiable on the Employee Benefits Security Administration website.  As part of the Affordable Care Act (ACA), the SBC requirements apply to group health plans with enrollment periods on or after September 23, 2012. 

The DOL also released a Technical Release providing guidance on automatic enrollment, employer shared responsibility and waiting periods.

Tuesday, February 7, 2012

BCBSNC announces redesigned member services site

BCBSNC has sent out a detailed press release on the company's redesigned Member Services website.  The new site is intended to provide more in-depth health care cost and quality data to help members be more informed consumers.

Aetna groups to receive letter requesting employee counts

On February 3, Aetna mailed letters to all plan sponsors with 200 or fewer enrolled employees, requesting their total average employee (TAE) count for 2011. Aetna will use this information to place the plan sponsor in the correct pool (Large Group or Small Group) for calculation of medical loss ratios (MLRs) for the 2012 experience year.

This mailing is similar to the letter Aetna sent to customers of this size in 2011 to collect 2010 total average employee count, to support the process for the 2011 experience year. Plan sponsors will have the option to respond through an online portal (which can be accessed through, or mail back a paper response. Aetna is requesting responses by March 31.

Wednesday, February 1, 2012

Self-funded BCBSNC groups to receive ASA amendments

This week, self-funded employer groups with BCBSNC will receive an administrative service agreement (ASA) amendment from their BCBSNC client managers. The upcoming pharmacy benefit manager transition from Medco to Prime Therapeutics on April 1 requires a 60-day notice period and new language in the ASA.

Details on the ACA's Basic Health Plan

The Basic Health Plan is a lesser-known program created by the Affordable Care Act (ACA), which is a state-run program that will be offered to those that fall between 133% and 200% of the federal poverty line.

To find out more, refer to BCBSNC's Spotlight Basic Health Plan.

BCBSNC prescription drug prior review and restricted access changes effective March 1

Blue Cross and Blue Shield of North Carolina (BCBSNC) is expanding its utilization management programs for members with pharmacy benefits with us effective March 1, 2012.  These programs include prior review and restricted access programs.  (Restricted access means members must try a preferred drug before they can receive coverage for a non-preferred drug.)

Changes Affecting ALL users of certain drugs:

Prior review will be required for:
  • Egrifta® (Tesamorelin) – used to reduce excess abdominal fat in HIV-infected patients with lipodystrophy
  • Growth hormones, which will continue to require prior review, will now also be added to the restricted access list
  • Omnitrope® is the preferred drug and must be tried before any other drug is approved.  The following drugs are non-preferred:  Genotropin®, Humatrope®, HumatroPen®, Norditropin Nordiflex®, Norditropin Flexpro®, Nutropin®, Nutropin AQ®, Nutropin AQ Nuspin®, Saizen®, Serostim®, Tev-Tropin® and Zorbitive®.
Changes Affecting NEW users of certain drugs:
  • Renin inhibitors will be added to the restricted access list for new users only. Members must first try a preferred drug before the non-preferred drugs will be approved:  
    • Preferred renin inhibitors: losartan or losartan/HCTZ (Cozaar® or Hyzaar®), (valsartan/amlodipine or valsartan/amlodipine/HCTZ (Exforge® or Exforge HCT®), telmisartan or telmisartan/HCTZ.(Micardis ® or Micardis HCT®), valsartan or valsartan/HCTZ (Diovan® or Diovan HCT®).
    • Non-preferred renin inhibitors: Tekturna®, Tekturna HCT®, Valturna®, Tekamlo™ and Amturnide™.
  • Multiple Sclerosis drugs, which will continue to require prior review, will now also be added to the restricted access list for new users only:
    • Betaseron® or Rebif® are the preferred drugs and must be tried before any other drug is approved.  The following drugs are non-preferred: Extavia® and Avonex®.
Additional Resources
In early February, BCBSNC will send this letter to 206 members who currently take Egrifta, Genotropin, Humatrope, HumatroPen, Norditropin Nordiflex, Norditropin Flexpro, Nutropin, Nutropin AQ, Nutropin AQ Nuspin, Saizen, Serostim, Tev-Tropin or Zorbitive.