The health care reform rollout continues. Last week, the Obama administration unveiled new regulations addressing insurance appeals procedures.

The provisions of the rules state that new health plans – self-funded as well as fully insured – must offer an internal appeals process with clear instructions on how individals can start the procedure. If the internal appeal is denied, an individual can request an external review, the outcome of which is binding. These and other appeals provisions do not apply to “grandfathered” plans.

For most MedBen clients, the new regulations vary little from their current appeals process. Fully-insured groups in Ohio and all self-funded public employer plans in Ohio and Kentucky already have similar protections in place. Moreover, our experience working with various external review entities should allow us to seamlessly adapt to other state’s procedurals. As such, this will not be a difficult transition for MedBen or its fully-insured clients in Indiana and West Virginia, or its self-funded private employers in any state.

MedBen University is currently touring the Midwest, speaking to business professionals on the topic, “Health Care Reform: What Employers Need to Know". These free presentations examine the immediate and long-term effects of reform, and offer timely advice to help employers stay on top of the latest federal rules.

Following presentations last week in Columbus, OH and Indianapolis, IN, we will host a seminar in Louisville, KY on Wednesday, July 28. MedBen Vice President of Compliance Caroline Fraker will be the featured speaker. To attend this event, please contact Bonnie Morton at bmorton@medben.com or (800) 423-3151, Ext. 398 by July 26. HR professionals who attend can earn two PHR, SPHR or GPHR recertification credit hours.

Please note that the seminar in Nashville, TN, originally scheduled for Tuesday, July 27, has been postponed until later this year, most likely sometime in October. If you are interested in attending this event, please contact Bonnie Morton and she will inform you when the new date is available.

MedBen will also soon announce an additional health reform seminar in Cincinnati, OH in late August. Details regarding this event will be posted on this blog soon.

MedBen is writing checks to self-funded clients totaling more than $976,000 for quarterly pharmacy rebates this week.

And while it may seem routine for MedBen clients, it is far from the norm in the pharmacy benefit management world. In fact, many pharmacy benefit managers (PBMs) withhold some or all of pharmacy rebates. Other third party administrators offer “discounts” from administrative fees in exchange for the right to keep rebates.

“It is best for the self-funded employer to demand all rebates,” said Kurt Harden, Senior Vice President for MedBen. “While the rebate amounts may fluctuate, it is highly unlikely that the discounted administrative fee will be a better deal than the rebate checks.”

“We have new clients who are surprised when they receive their rebate check,” Harden continued. “Some are surprised because they never received one from their previous carrier or administrator, while others are surprised at the amount on the check because their previous administrator or pharmacy benefit manager kept a portion of the rebates.”

MedBen also advises employers to demand all of the generic discount since another common practice is for PBMs to keep a portion of the discount. “Groups should be seeing generic discounts in the range of 75% off of Average Wholesale Price,” said Harden. “Many PBMs keep as much as 20% of the generic discount.”

MedBen was one of the first third party administrators in the country to offer clients a 100% transparent and pass-through pharmacy benefit program.

Have COBRA subsidies come to the end of the road? Judging by recent activity in Congress, it looks increasingly likely.

Employer subsidies covering 65% of COBRA premiums for termed workers ended on May 31 (individuals who were eligible on or before that date will continue to receive financial assistance for up to 15 months). On Wednesday, the Senate passed a bill to extend unemployment benefits until November for individuals who have been out of work for six or more months. A provision in the bill that would similarly extend COBRA subsidies was removed from the bill last month, and little has been heard from either house of Congress on the matter since.

MedBen continues to work with its COBRA clients to ensure that current regulations are being met and subsidies are paid properly. To learn more about our COBRA administrative services, please contact Vice President of Sales and Marketing Brian Fargus at 888-627-8683.

MedBen has compiled a series of useful documents with current information about various health care reform provisions. These downloadable documents are now available on the Plan Design section of this blog. This section is password-protected and accessible only to registered MedBen clients and consultants.

Documents authorized users can access include:

1. Updated Overview of the health care reform laws and regulations (dated June 29, 2010)
2. United States Preventive Services Task Force – “A” and “B” Rated Clinical Preventive Services List
3. Age 26 Dependent Model Notice
4. Lifetime Limits Model Notice
5. Patient Protection Model Notice
6. IRS Small Business Tax Credit Guidance
7. IRS Small Business Tax Credit FAQs

To create a login name and password, click here. Please note that registry requests must be approved by MedBen before you can access the Plan Design section.

The stigma against generic prescription drugs continues to wane as consumers become more educated about their similarities to brand name medications and cost-saving advantages. Employee Benefits News cites a CVS Caremark report that found the generic dispensing rate rose from 65.1% in 2008 to 68.2% last year, despite a lack of significant drug introductions during that period.

Such information is especially noteworthy as it allows employers to save money without shifting costs to employees. Greater acceptance of generics through patient education and doctor outreach help to slow prescription plan premium growth, which in recent years has seen annual double-digit cost increases.

MedBen offers an especially useful tool for employers who want encourage their prescription plan members to be “smart shoppers". Our RxEOB website, available to clients using Pharmacy Data Management (PDMI) as their PBM, allows members to easily compare their current medication prices with equivalent generic drugs. To visit RxEOB, simply go to www.medben.com and click on “Online Client Services”, select “MedBen Access”, log in and click on “My Rx”.

NPR has compiled a list of “Seven Things You Missed In The New Health Law”. The number one item: free coverage for preventive care. Earlier this week, the White House issued new rules requiring health insurers to cover at 100% such services as breast cancer screenings, cholesterol blood tests, and routine vaccinations, as well as stop-smoking and obesity counseling, plus several dozen more. While “grandfathering” will allow existing health plans to retain their current prevention coverage levels (including co-pays and deductibles, if applicable), any future changes to those plans could nullify that option.

In addition to free prevention, slipped-through-the-cracks reform provisions noted in the NPR article include a nonprofit institute that will examine various medical treatments to determine which ones work best, financial assistance to early retirees, an expansion of Medicaid… and so on.

Obviously, tracking all these health care reforms can be daunting (or exasperating – take your pick). But fortunately, you don’t have to go it alone – MedBen continues to offer employer seminars throughout the Midwest this summer. For more information about upcoming events, contact Bonnie Morton at (800) 423-3151, Ext. 398 or bmorton@medben.com.

As part of the Ohio Budget Bill passed in July 2009, Ohio law now requires insurance companies, health insuring corporations and public employee benefit plans to offer their insureds and participants the opportunity to continue health care coverage for their dependents until the dependent turns age 28. This new law is effective for plans and policies issued or renewed on or after July 1, 2010. The Ohio Age 28 Dependent Continuation law provides additional coverage beyond that provided by the federal Health Care Reform laws which require coverage of dependents up to age 26. Be aware, however, that the two laws are different in scope and application when it comes to continuing dependent coverage.

More information regarding the Ohio Age 28 Continuation law can be found on this Frequently Asked Questions sheet.

If your group has multiple plans administered by MedBen, it’s more convenient than ever to monitor your combined activity. MedBen Plan members can now access medical, dental, FSA and HRA information using a single user name and password.

When plan members log in to MedBen Access to check medical/dental claims status and benefits information, they will now find an “FSA/HRA Online Inquiry” option (visible only to groups offering MedBen FSAs/HRAs) under the “MY PLAN” section located on the left side of the screen. By selecting this option, users are automatically taken to the MedBen FSA/HRA Online System, where they can see their FSA/HRA balances, claims submissions and payments. So there’s no longer any need to log in to two separate websites!

Please note that plan members who still wish to log in directly to the MedBen FSA/HRA Online System can do so by going to the Online Client Services area of MedBen.com and selecting “FSA/HRA Employee Online System". Login requires a separate User ID and PIN.

MedBen plan members with questions regarding either MedBen Access or the MedBen FSA/HRA Online System can use the “Contact Us” links on the respective sites or call MedBen Customer Service at (800) 686-8425.

Human Resources Specialists have another important reason to attend one of the health care reform seminars MedBen University (MBU) is conducting this summer. MedBen has requested and received pre-approval from the HR Certification Institute, so HR professionals who attend a “Health Care Reform: What Employers Need to Know” presentation can earn 2.00 (General) recertification credit hours. Eligible HR certifications include:

• Professional in Human Resources (PHR®)
• Senior Professional in Human Resources (SPHR®)
• Global Professional in Human Resources (GPHR®)

HR professionals who attend a health care reform seminar and wish to submit the program on their recertification application form will receive a program ID number at the completion of the event. For general information about HR certification or recertification, please visit the HR Certification Institute website at www.hrci.org.

Of course, even if you are not earning credits, you’re invited to attend an MBU event… either way, you’ll find it a worthwhile experience! Upcoming health care reform seminars include:

Columbus, Ohio – Tuesday, July 20, 2010
Hilton Columbus at Easton, 3900 Chagrin Drive

Indianapolis, Indiana – Thursday, July 22, 2010
Crowne Plaza at Historic Union Station, 123 West Louisiana Street

Nashville, Tennessee – Tuesday, July 27, 2010
Radisson Hotel at Opryland, 2401 Music Valley Drive

Louisville, Kentucky – Wednesday, July 28, 2010
The Seelbach Hilton, 500 Fourth Street

All seminars begin at 9:00 a.m. for registration and a continental breakfast, with the presentation taking place from 9:30 a.m. to 11:30 a.m. If your group’s health plan administrator is interested in attending any of these events, please contact Bonnie Morton at (800) 423-3151, Ext. 398 or bmorton@medben.com. Please register no later than two business days before the specific event.

With relatively little fanfare, several provisions of the health care reform bill took effect on July 1:

• High-risk insurance pools are now available nationwide, either from the federal government or one of 30 states that offer their own programs. Offered as a stopgap solution until the introduction of insurance enchanges in 2014, people who have been uninsured for at least six months can purchase coverage through a high-risk pool at rates comparable to standard individual coverage available in their state of residence.
• A new government website (healthcare.gov) has been created for individuals who lack health coverage. By providing some basic information (neither name nor income is requested), the site generates a list of user options, including private health care plans as well as the aforementioned high risk pool plans and other state and federal programs. The site also instructs users in how future regulations will affect these options.
• Tanning salons have the dubious distinction of being the first businesses to help pay for the $940 billion cost of health care reform. A 10% tax on indoor tanning establishments – and, by extension, indoor tanners – is expected to raise $2.7 billion in the next 10 years. Exempt from the tax: health clubs that offer tanning beds as a secondary service, and spray-on tan machines.

MedBen Vice President of Compliance and Chief Privacy Officer Caroline Fraker recently spoke about health care reform to area business members at a luncheon sponsored by the Licking County (OH) Chamber of Commerce luncheon. The event was covered by The Newark Advocate.

In her presentation to representatives from 50 local companies, Fraker noted that reforms may have the greatest impact on smaller employers. “Smaller businesses tend to go with fully insured plans, and the impact will be increased premiums and, potentially, employers can’t afford to provide employer-based coverage,” she said.

Fraker also observed that “grandfathering” rules allowing employer plans to keep some of their current plan benefits may be difficult to work with in the long run: “You have to maintain these rules forever to remain grandfathered. Whenever you change, you lose it.”

You can read the full Advocate article here.

MedBen will continue to offer FREE health care reform seminars throughout the Midwest this summer, including July presentations in Columbus OH, Indianapolis IN, Nashville TN, and Louisville KY. Information about these seminars is available at the MedBen website.

A 21% cut in Medicare physician reimbursements has once again been put on hold. President Obama signed a bill on June 25 postponing the rate reduction for six more months, instead giving doctors a pay bump of 2.2%.

The oft-delayed reimbursement cut – this was the ninth such postponement in eight years – actually did impact Medicare payments for several days. Medicare held 50 million claims it received past the June 1 effective date in anticipation of a postponement, but finally began paying the claims at the reduced rate on June 18. Now that the President has approved the legislation, physicians may resubmit the claims to receive the outstanding balance at an additional processing cost of 30 cents per claim – meaning the extra time to okay the “delay” may run upwards of $15 million.

Consulting firm Hewitt Associates has released The Road Ahead: Under Construction With Increasing Tolls, a report highlighting both short- and long-term trends of employer-sponsored health plans. Based on a survey of nearly 600 employer plans representing over 10 million covered lives, The Road Ahead examines health plan strategy, planning and design as well as cost trends.

Hewitt uses the titular road analogy to describe how employers view their health care benefit strategy over the next three to five years. Most organizations (80%) claim that they are taking a long-term, or “Superhighway", approach, by focusing on solutions that promote better health and preventive care.

The report properly notes that the Superhighway approach requires ongoing attention to health care tactics and business strategy to be anything more than an aspirational goal. And as it happens, MedBen is well-versed in assisting employers to map out a long-term course and prepare for potential hazards. Call us at 888-627-8683 and we’ll be happy to help you plan for your group’s “road ahead".

You can download the entire report here (you will need to fill out a short form first, including your e-mail address).

While the future of COBRA subsidies remains uncertain – employer contributions to new COBRA recipients ended on May 31, and while Congress has made efforts to continue the subsidy, no bill appears near passage – the need to properly administer COBRA benefits remains unchanged. But with subsidy extensions coming in fits and starts, an already tricky process has become even more complicated.

In a recent article about the murky future of subsidies, Employee Benefits News observes that multiple changes to COBRA has made administration more difficult. Specifically, it cites the extension in March “which determined that a person who experienced a reduction in hours between September 1, 2008 and May 31, 2010, followed by an involuntary termination or if they quit as a result of the reduction, on or after March 2, 2010, would be eligible for the premium subsidy". And failure to comply to such provisions in a timely manner can result in costly financial penalties that can accrue on a daily basis.

From the introduction of employer subsidies in March 2009 to its present-day status, MedBen has remained on top of COBRA’s continuing twists and turns. And we regularly modify our administrative services to ensure that they address any and all legislative changes. For further information about MedBen COBRA administration, please contact Vice President of Sales and Marketing Brian Fargus at 888-627-8683.

Going in for a check-up soon? A posting in the EverythingHealth blog provides a handy reminder that doctors do a better job of diagnosing when you share detailed information about your medical history – even the stuff you may think insignificant, or perhaps a tad embarassing. Written by an Internal Medicine physician, “Eight Secrets You Should Tell Your Doctor” include:

1. All of the medicines you take, including herbs and over the counter.
2. Your smoking, drinking and drug habits.
3. If you can’t afford your prescriptions.
4. How much you really exercise.
5. Any sexual dysfunction you may have.
6. Changes in your bowel movements.
7. Extreme stress you are experiencing.
8. If you’re seeing another doctor.

Some of these “secrets” are understandably more awkward than others. But knowing the full story helps your doctor do his or her job much more effectively – and to your benefit.

Care to visit MedBen without having to get up from the comfort of your chair? We’ve recently updated our Virtual Tour on MedBen.com so you can take a look around our home office day or night, from anywhere there’s an Internet connection. It’s a convenient way to learn about our services and meet some of the people who are dedicated to providing our clients with peace of mind.

The MedBen Virtual Tour takes only a few minutes, so we invite you to stop by anytime. And if you want to know more about something you run across while touring, feel free to drop us a line at marketing@medben.com.

Good news on the personal wellness front: a study of Northern California health insurance participants found that hospital admissions for heart attacks dropped 24% between 1999 and 2008.

The New England Journal of Medicine observes that this dramatic decrease coincided with a greater emphasis on preventive care as well as such public health efforts as smoking bans. Lower target levels for blood pressure and cholesterol, plus improved incentives to meet thoses goals, apparently also proved beneficial.

MedBen offers employers a worksite wellness program that uses a disease and prevention based approach to encourage healthier lifestyles for every member and provides customized counseling for those suffering from heart disease and other chronic conditions. To learn more about MedBen Worksite Wellness, please contact your MedBen broker or Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.

Since April, MedBen has been meeting with employers throughout the Midwest to speak on the topic, “Health Reform: What Employers Need to Know". In July, we will embark on a special four-state tour to discuss the immediate and long-term effects of health care reform on employers and employees. Vice President of Compliance Caroline Fraker, who has handled regulatory compliance, contractual and risk management issues for MedBen since 1992, will appear as the featured speaker at these free seminars. Presentation locations and dates include:

Columbus, Ohio – Tuesday, July 20, 2010
Hilton Columbus at Easton, 3900 Chagrin Drive

Indianapolis, Indiana – Thursday, July 22, 2010
Crowne Plaza at Historic Union Station, 123 West Louisiana Street

Nashville, Tennessee – Tuesday, July 27, 2010
Radisson Hotel at Opryland, 2401 Music Valley Drive

Louisville, Kentucky – Wednesday, July 28, 2010
The Seelbach Hilton, 500 Fourth Street

All seminars begin at 9:00 a.m. for registration and a continental breakfast, with the presentation taking place from 9:30 a.m. to 11:30 a.m. If your group’s health plan administrator is interested in attending any of these events, please contact Bonnie Morton at (800) 423-3151, Ext. 398 or bmorton@medben.com. Please register no later than two business days before the specific event.

The Deloitte Center for Health Solutions has released an interesting study that offers a snapshot of consumer attitudes following the passage of health care reform legislation. Conducted in May 2010, “Post Health Care Reform Perceptions: Consumer Pulse Survey” found overall satisfaction with respondents’ current health care coverage and concerns about the changes that may result from the Patient Protection and Affordable Care Act.

Among the overall perceptions in the survey:

• 36% of all adults surveyed think they will be “better off” as a result of reform; 43% think that they will be “worse off”. The “better off” percentage is higher for the unemployed, lower for those covered by Medicare and individual insurance.
• 67% think that “in the long-term the reform bill will increase access to health insurance coverage for most of the uninsured".
• 77% think that “the cost of the reform bill will be higher than expected".
• 56% think that “some hospitals and medical practices will close” and 55% think that they will have to wait longer to see their doctor.
• Adults surveyed anticipate increases in the following: Taxes (76%); hospital and physician prices (66%); health insurance costs, including premiums and out-of pocket expenses (65%) and the cost of medications (54%).

You can review other findings and download the survey results here.