MedBen Worksite Wellness encourages plan members to live healthier lives. The program monitors member health histories, and when guidance is warranted, RN Health Consultants work one-on-one with individuals to help them make smarter lifestyle decisions.
Sometimes, coaching requires multiple communications before the plan member chooses to takes action. But in many instances, just the simple recognition that someone is looking out for their well-being can make a difference, as a worksite wellness nurse coach shared with MedBen (the plan member’s name was kept confidential):
“A wellness coach completed an initial call with a 60-year-old employee identified with four health conditions: cholesterol, coronary artery disease, diabetes and hypertension. Their discussion included suggestions for modifying her diet and exercise to improve overall health, and also stressed the importance of completing an eye exam to identify and problems associated with diabetes that could lead to loss of vision.
“At the completion of the call, the employee thanked the nurse for her concern. She admitted that the had not been taking care of herself like she should have been, and said the call reminded her that she should do more to improve her health.”
Acknowledgement of the need to make personal changes is the first step toward a healthier individual. And with MedBen Worksite Wellness, the RN Health Consultants will follow up with the plan member to monitor progress and provide the appropriate “push” whenever needed. For the employer, it adds up to a more productive workforce and lower health care costs.
For additional information about MedBen Worksite Wellness, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
At MedBen, one of our foremost duties is helping employers strike a suitable balance between their employees’ premiums and deductible and out-of-pocket costs. Key to this is giving plan members sufficient incentive to be fiscally responsible about their medical spending without burdening them with overly high payments.
Achieving said balance requires the ability to recognize individual needs – financial as well as medical. But as The New York Times reports, some of the health plans offered under Obamacare have come up short in this regard:
“For months, the Obama administration has heralded the low premiums of medical insurance policies on sale in the insurance exchanges created by the new health law. But as consumers dig into the details, they are finding that the deductibles and other out-of-pocket costs are often much higher than what is typical in employer-sponsored health plans.
“Brian H. Snoddy, 35, of Palmyra, Va., said his wife and two children had a policy with a $330 premium and a $2,500 deductible, but it is being canceled. For new plans with comparable coverage on the federal exchange, he said, ‘the deductibles are way higher, $5,000 or $6,000.’
For visits to a medical specialist, many plans on the federal exchange require co-payments of $50 to $75 or more.”
With the regulatory freedom available through self-funding, employers can ensure that their health plan provides comprehensive coverage while avoiding excessive deductibles and out-of-pocket costs. And with MedBen’s decades of expertise in managing group benefits, we can help you put together a plan that’s right for your employees – and save you money in the process.
For more information about MedBen self-funded solutions, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
To help clients determine the value of health care coverage to be reported on their employees’ W-2 Forms, this year MedBen will offer two different reporting information options: A basic eligibility report or a full W-2 report.
Full W-2 report – If you prefer that MedBen do the necessary math for you, you can receive a completed report for a $500 fee. If you select this service, we will provide a worksheet that lists each employee as well as his or her calculated coverage value for W-2 input.
If MedBen is NOT your COBRA administrator, you will need to send your group service representative a copy of your applicable 2013 COBRA premiums. And if your COBRA rates changed mid-year, please submit both sets of rates.
Should you desire one of these reports, simply send a request to your GSR. Please allow three business days from the date of your request to receive the basic eligibility report, and five days for the full W-2 report.
MedBen clients who have any additional questions regarding this service may contact Cara Delcher, Vice President of Risk Management and Quality Systems, at firstname.lastname@example.org or Morgan Antle, Group Underwriter and Quality Coordinator, at email@example.com.
Health care cost increases for self-funded employers managed by MedBen are coming in well under national and regional trends – and in some cases, are even decreasing.
According to Columbus Business First Mercer survey found that benefits costs for employer-based health care plans rose nationwide by an average of 2.1% this year. The stats weren’t quite as positive in Columbus and Central Ohio, where employers reported a 4.8% upward bump for 2013.
Now, compared to the double-digit cost jumps employers experienced in the past decade, these increases are relatively small. But they still look pretty huge when weighed against the cost trends of MedBen clients in Central Ohio and surrounding areas.
For example, in Zanesville and Muskingum County, where MedBen manages benefits for over 7,500 members, medical costs this year went up only 0.7% on average during the same period in 2012. Moreover, pharmacy costs – which typically see higher increases than medical costs – increased just a mere 0.3% among our clients.
The numbers for the 9,000 MedBen-managed members in Newark and Licking County are even more impressive. Not one of our self-funded groups in this area saw health care costs go up on a per employee or per member basis in 2013.
Overall, MedBen’s Licking County client costs went down by 16% when compared to the same period last year. In health care, that is a big deal.
Grown-ups and kids alike may wince at thoughts of “the needle”, but for most people getting a flu shot is definitely worth a moment or two of discomfort. The influenza vaccine protects against multiple viruses that will be most common during the upcoming season.
A flu vaccine is made to protect against three major flu viruses – H1N1, H3N2, and the B virus. When you receive a flu shot, antibodies develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine.
Physicians recommend that you get a flu shot every year because the viruses are constantly changing. Studies conducted over different seasons and across vaccine types have shown that the body’s immunity to influenza viruses declines over time.
Flu vaccines are offered in many locations: doctor’s offices, clinics, health departments and pharmacies, as well as by many employers. If you don’t get a flu shot from your family doctor, it’s a good idea to let him or her know during your next wellness exam. And if your fear of “the needle” is too strong, talk to your doctor about using a nasal spray flu vaccine instead.
Happy Thanksgiving from the staff of MedBen! We hope that you and your family have a safe and relaxing holiday.
To observe the holiday, MedBen will be closed on Thursday, November 28 and Friday, November 29. We will reopen at 8:00 a.m. on Monday, December 2.
Hopefully, questions about your health care plan won’t arise during the holiday weekend. But should you be in need of claims or benefit information, MedBen Access is available to help you around the clock, 365 days a year.
In case you haven’t visited MedBen Access in a while, getting there is simple. Just go to the MedBen.com home page and click on the “MedBen Access” link. Once you’ve logged in you can use the website to view individual claims data, note a change in participant status, order ID cards, and perform a variety of administration functions. Plan members can check the status of a health claim, review benefit coverage or see cumulative deductibles, to name just a few of the site’s features.
If your group uses Pharmacy Data Management, Inc. (PDMI) as its pharmacy benefits manager, you can also take advantage of the services available on MedBen Access by clicking the “My Rx” link. Plan administrators can review member utilization and cost of drugs by brand/generic and retail/mail order, while members can get detailed medication information and compare prices of brand name drugs with their generic equivalents, among other things.
Should you need to check FSA or HRA account balances, the site’s “FSA/HRA Online Inquiry” link will get you the information you need. You can even check your compliance with recommended wellness exams by visiting the “iHealth Information” page.
Again, our best wishes for a happy holiday!
Formulary updates for prescription plans administered by Pharmacy Data Management, Inc. (PDMI) are now available at MedBen.com – simply click on “Plan Sponsors” (for employers) or “Plan Members” (for insureds) and select “Prescription Formularies” from the “Form” drop-down menu.
The new formularies become effective January 1, 2014. If you still need a 2013 formulary, they will be available on the website until the end of December. As always, plan administrators with questions can contact their Group Service Representative, while plan members can call MedBen Customer Service at (800) 686-8425.
Self-funded groups use either the Focus formulary or the Outcomes formulary. Focus offers the most cost-effective drug options, while Outcomes offers broader choice while still delivering significant cost savings. All fully-insured groups use the Focus formulary.
To determine if your group is fully insured or self-funded, check your MedBen ID card. If your account # is less than 10,000, your plan is fully insured; if it is more than 10,000, your plan is self-funded.
Can you believe we’re less than six weeks away from 2014? For flexible spending account (FSA) plan members, the end of the year often means a mad scramble to use up remaining funds from their accounts… though a recent rule may change that.
Last month, the Obama administration announced that FSA plan members can carry over to the following year up to $500 of unused funds. However, the employer determines how much money can be rolled over, or can choose to retain the full forfeiture.
If you can’t carry funds over (or your employer doesn’t offer a grace period to spend remaining dollars), all is not lost. First of all, you can still squeeze in a dental or vision exam before year’s end and use your FSA dollars toward copays and coinsurance, as well as such necessities as contact lenses and eyeglass frames.
Second, a trip to your local drug store can help you deplete your funds. Stock up on bandages and gauze pads, saline solution, rubbing alcohol and other health-related odds and ends. If you need a list of what items qualify for reimbursement under an FSA, visit MedBen.com, click on “Plan Members” and select “IRS-Eligible Expenses” from the “Additional Resources” drop-down menu.
Finally, you can use FSA funds to purchase aspirin, ibuprofen and some other over-the-counter medications, so long as you have a prescription. So should you happen to visit your family doctor between now and December 31, it may not be a bad idea to request one!
MedBen Worksite Wellness can help to take up where a physician leaves off. Because most family doctors have packed schedules, it leaves them precious little time for discussion following an examination – and in the case of a chronic condition like diabetes or hypertension, questions inevitably come to a patient’s mind after leaving the doctor’s office.
A worksite wellness nurse coach recently shared with MedBen a perfect example of how one-on-one coaching complemented a doctor’s care. The plan member’s name was kept confidential:
During an examination for an ear infection, the doctor noticed that the patient’s blood pressure was higher than normal. At a follow-up appointment two weeks later, the doctor diagnosed the patient with hypertension and started her on medication.
Following the initial exam, an RN Health Consultant contacted the patient to discuss her high blood pressure and address the patient’s questions about her condition. The RN also scheduled a second session to take place after the follow-up appointment.
During the second session, the patient said that she wanted more information on how to control her hypertension. The nurse provided education on diet and exercise, mailed information about the condition, and provided a phone number for a local exercise and weight management program. The patient thanked her for following up and was very appreciative for all of the information provided.
Even with a wealth of health information available on the Internet, there’s no substitute for professional consultation. With MedBen Worksite Wellness, patients get the best of both worlds – a physician-first approach to personal care for chronic conditions backed by a team of RN specialists ready to address questions and concerns. To learn more, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Earlier this year, MedBen celebrated its 75th anniversary. A key to our longevity is the unwavering support of businesses in Licking County, Ohio – where our business was founded in 1938, and where we’re proud to still call home today.
MedBen currently manages about 9,000 members through self-funded health plans in Licking County. For decades, our neighbors have trusted us to help them provide comprehensive employee health care benefits while saving them money. So it pleases us to report we’re succeeding on both counts.
A recent review of Licking County client data found that not a single self-funded group managed by MedBen saw health care costs go up on a per employee or per member basis in 2013 – and indeed, many saw their costs go down. In fact, when health care costs are rising by between 10% and 12% per year from a medical trend perspective, our Licking County clients’ costs dropped by 16% when compared to the same period last year.
Of course, while Licking County holds a special place for us, our goal is to ensure that every one of our clients save money year after year, regardless of location. To achieve that goal, MedBen works very hard to advise and help clients manage all aspects of their health plans, from large claims to cutting-edge wellness programs and an industry-leading pharmacy program.
To see how MedBen is saving employers money in Licking County and throughout the Midwest, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
As hard as it is to focus on anything other than health care reform, another change in the law requires the attention of self-funded employers and their brokers before year’s end. In January 2013, the Department of Health and Human Services released new HIPAA/HITECH rules governing protected health information (PHI). Now, in addition to the Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”) and the Health Information Technology for Economic and Clinical Health Act (“HITECH”), we must also comply with the requirements of the final modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules as issued on January 25, 2013, often referred to as the “Omnibus Rule”.
One of the requirements of the Omnibus Rule requires the business associates of self-funded health plans to update their business associate agreements with the plan through the plan sponsor. Under HIPAA, HITECH, and now the new Omnibus Rules, self-funded health plans are considered Covered Entities and the service providers, vendors and brokers that perform services for those plans are considered business associates.
In addition to entering into a revised Business Associate Agreement (BAA) with MedBen, employers sponsoring self-funded plans will want to enter into Business Associate Agreements with their brokers and agents. These revised agreements detail the new responsibilities of business associates and are required for any entity that acquires, uses or discloses the plan’s PHI. In addition to the BAA requirement, all business associates are responsible for meeting the revised Omnibus Rules breach notification requirements and updating their privacy policies and procedures to meet new standards. The Omnibus Rule includes major changes in both penalties and enforcement actions, with penalties for non-compliance increased up to $1.5 million in a calendar year.
Last week, we highlighted several end-of-year reminders to MedBen HRA clients. Below, we do the same for clients that offer flexible spending account (FSA) plans:
Enrollment Deadlines: Per IRS regulations, enrollment in the 2014 FSA Plan must be completed prior to the beginning of the plan year (January 1, 2014). The regulations further state that in no event may the new election be effective prior to the first day of the month beginning after the enrollment form is completed and returned to the Administrator.
Health Care Reform and Your FSA: Employer Contributions to a health FSA could have an impact on the “exempted benefits” status under HIPAA, COBRA, and the Affordable Care Act. Many federal group health plan mandates do not apply to health FSAs that provide only “excepted benefits.”
MedBen is pleased to be the premier sponsor of the 2013 Granville Turkey Trot (GTT). This 5K fun run/walk, which takes place on the morning of Thursday, November 28, is Licking County, Ohio’s biggest single-day fundraising event. Over 2,000 Turkey Trotters, fans and volunteers are exected to attend!
The GTT benefits the Food Pantry Network, which is dedicated to acquiring, storing, and distributing nutritious food to the financially deprived and otherwise needy members of Licking County. Event organizers hope to raise $65,000 to help feed hungry people in the community.
If you’d like to help – and, in the process, burn off a few calories before settling down for Thanksgiving dinner – you can sign up as a participant online. Adults are $30 and children (6 - 13) are $10 if you pre-register – a $5 discount off race-day registration. Plus, pre-registration guarantees that you will receive the popular Turkey Trot t-shirt.
Or you can register as a “virtual runner” without leaving the comfort of your (or your in-law’s) home. You can donate any amount you want and support the Food Pantry. (Did you know that a dollar buys 25 pounds of food, or 25 boxes of cereal, or even more than 25 cans of vegetables and fruit?)
GTT organizers are also looking for volunteers to help register participants, hand out water, and so forth. Anyone interested in contributing a few hours of their time to this worthy cause is encouraged to sign up online.
Thanks to everyone who takes part in this fun event!
Last month, MedBen mailed important information about the re-enrollment process to clients that offer health reimbursement arrangement (HRA) plans. As a reminder, we highlight some of that information below:
Enrollment Deadlines: In order to ensure a plan member’s HRA benefits are loaded in our system by January 1, 2014, all HRA re-enrollment information must be received in our office no later than Friday, December 20, 2013.
Health Care Reform and Your HRA: Is your health plan carrier including your HRA language in your Summary of Benefits and Coverage (SBC), as required by the Affordable Care Act? HRAs are considered group health plans under federal government regulations, and therefore are subject to the SBC rules. The government’s preferred method for the SBC is to combine all related group health plan information onto one SBC.
If MedBen administers your health plan, your SBC will include your HRA plan language. But if we do not, please check with your carrier to ensure your HRA plan language is included in the SBC. If your health plan carrier is not able to or willing to include the language into your SBC, please let us know and we can help you create an SBC for the HRA plan to meet the ACA requirement.
Plan Changes: If you would like to make changes to your HRA plan (contribution amounts, eligible expenses, reimbursement methods, etc.), please contact MedBen as soon as possible to ensure that changes are implemented in a timely manner. These changes will be handled in the date order that they are received, so please communicate these to us as soon as possible.
Please keep in mind that stand-alone HRA plans are no longer permitted beginning January 1, 2014. Clients who currently have a stand-alone HRA plan should contact MedBen Director of Administrative Services Sharon A. Mills at firstname.lastname@example.org, so she can offer other options for your HRA plan design.
Cost trends may rise and fall, but MedBen stays focused on one thing: saving employers money.
PricewaterhouseCoopers’ Health Research Institute (HRI) recently projected a medical cost trend of 6.5% for 2014, continuing several years of lower-than-anticipated spending increases. That, in turn, follows an extended period of double-digit cost jumps.
So what accounts for the slow growth? Well, the recession certainly factors into it, as do new ways of providing patient care outside the traditional delivery models. Plus, a greater emphasis on high-deductible health plans has spurred employees to be more conscious of the cost of care.
HRI also sites “aggressive and creative steps by employers” as a reason for the reduced trend – and it’s in this area that Medben has been of particular assistance.
At MedBen, our goal is to give clients what they need to realize maximum savings potential on health care costs, regardless of current financial conditions. Through intelligent reporting, 100% paid pharmacy rebates and other customer-centered solutions, we do even the lowest trend one better.
One solution that has repeatedly produced provable client savings is our advanced claims surveillance system. Using over 80,000 financial and clinical algorithms, this system thoroughly reviews claims for cost reduction opportunities.
In the first three quarters of 2013, MedBen clients have saved, on average, 41% on flagged claims. That translates to an average cost savings of $9.90 per employee per month. And that’s savings on top of plan provisions, provider discounts, medical management and other cost controls.
To learn about savings solutions that improve on the national trend, contact MedBen Vice President of Sales & Marketing Brian Fargus at email@example.com.
Diabetes has become a global epidemic, with one out of every nine adults currently affected. Moreover, about one-third of people who already have the disease are unaware of it.
When the pancreas produces insufficient amounts of insulin (type 2 diabetes) or none at all (type 1), excess glucose in the blood can severely damage other organs. There is no known way to prevent or reverse type 1 diabetes, but proper diet and exercise can significantly reduce your risk of developing type 2.
If you have been diagnosed with type 2 diabetes, MedBen Worksite Wellness can help. An RN Health Consultant will contact you to offer customized counseling. Should you choose to use the service, you will get individualized, confidential disease monitoring on a scheduled basis. You’ll also be given educational materials and other resources.
Because diabetics often visit many specialists in addition to the family doctor, daily management of the disease can feel overwhelming. Our RN Health Consultants can provide an additional avenue of support when you need it most. And through weight loss and lifestyle coaching, you can potentially reverse your type 2 diabetes to the point where medication is longer required.
Great news for individuals with a health flexible spending account: The “use-it-or-lose-it” rule is being scrapped. On October 31, the IRS announced that, effective immediately, up to $500 of unused funds in a health FSA can be carried over to the following year at the discretion of the employer.
Prior to the rule change, any funds left unused at the end of the year would be forfeited, unless the employer offered a grace period. Now the employer has the option of allowing the carryover or the grace period, but not both.
According to The Wall Street Journal, the Obama administration made the change because the $2,500 employee contribution limit imposed on health FSAs under the Affordable Care Act essentially eliminated the reason behind the earlier rule – that people would use the pretax accounts to shelter large amounts of money.
The carryover rule does not affect the $2,500 contribution limit.
Employees who contribute to a health FSA can use the funds to pay for deductibles, copays, prescriptions and a variety of other medical expenses. A complete list is of eligible expenses is available at MedBen.com.
MedBen clients with questions regarding this change are welcome to contact Director of Administrative Services Sharon A. Mills at firstname.lastname@example.org.
Among the things MedBen has learned from offering a worksite wellness program is the beneficial effect of individual wellness coaching. Through one-on-one interaction with plan members who have certain specific diseases or risk factors, our team of RN Health Consultants have helped them to make crucial lifestyle changes.
A nurse coach with our wellness program recently shared this wellness episode with us (keeping the plan member’s name confidential), which demonstrates how positive reinforcement aided a woman with serious health issues:
Two years ago, a 48-year-old employee with hypertension and high cholesterol was contacted by an RN Health Consultant to offer individualized coaching. Repeated follow-up calls were scheduled, during which the RN monitored her progress and provided counseling and education.
On the most recent call, the employee told the RN that she had lost over 50 pounds through diet and exercise. Her doctor cut her blood pressue medication in half and she no longer takes cholesterol medication.
As the nurse notes, the specialized wellness coaching worked because it was done in combination with the plan member regularly seeing her family doctor. By offering a source of information and support while encouraging a “physician-first” relationship, worksite wellness can help plan members manage their condition or remedy it altogether. And healthier employees translates to a more productive workforce.
To learn more about how MedBen Worksite Wellness is benefiting employees and employers alike, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
Coming hot on the heels of President Obama’s health plan promise kerfuffle is a possible break on reinsurance fees… and more proof that it pays to self-fund.
According to BenefitsPro, the Department of Health and Human Services announced earlier this week that certain self-funded groups will be exempted from paying reinsurance fees in 2015 and 2016. The modification followed complaints by employers that the fees – imposed to offset high-cost individuals covered by the new health marketplaces – are burdensome.
At this point, it’s unclear as to which employers will be exempted. Additionally, all self-funded employers will still be required to pay the $63-per-plan-member fee for the program, which begins in 2014.
So why should a fully-insured group consider making the switch to self-funding when a porton of the fee still looms? Because health insurance companies also have to pay the reinsurance fee, and based on the HHS announcement, will not receive any exemption. That means insurers will either have to eat the fee or pass it on through employer premiums – and one guess as to which option most will choose.
With a self-funded plan, an employer has greater flexibility to offset such fees with changes to plan design. And with MedBen serving as your third party administrator, added saving solutions are available through such features as claims cost containment, 100% pharmacy plan discounts and rebates, and worksite wellness services.
Self-funding offers the advantage of less regulatory oversight than fully-insured coverage. But should the government impose added fees, MedBen can help your group minimize their impact. To learn more, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
“If you like your health plan, you will be able to keep your health plan.”
So President Obama promised Americans in 2009, a year prior to the passage of the Affordable Care Act. And it’s an assurance he has made repeated times since then.
But as NBC reports, the Obama administration has been aware for some time that the majority of people with individual health insurance would likely lose their current coverage. Because most policies supposedly protected under the law’s “grandfathering” rules have changed their design since 2010, they no longer meet the mimimum benefit requirements under the law.
As far back as July 2010, health care reform regulations noted that “40 to 67 percent” of customers – or even more – would not be able to keep their policy. For individuals, it means buying new plans with mandated benefits they may not want or need, and at significantly higher premiums (though the administration is quick to point out that subsidies may cover some of the difference).
Nor are fully-insured employer plans immune. The same mandatory benefit additions that have caused costs on individual insurance to spike will similarly affect group coverage. Plus, the requirement necessitates that insurers reduce their coverage options, resulting in less plan flexibiity.
Fortunately, MedBen has a simple answer for employers: Self-funded coverage.
By having greater freedom from state and federal regulations, self-funded groups avoid some of the mandates that artifically inflate health care costs. Plus you maintain the flexibility that allows you to design a plan that works best for your employees
Best of all, self-funding benefits your bottom line, because you keep any money that doesn’t go toward paying claims. And with MedBen variety of self-funding solutions, even groups with as few as 25 employees can enjoy the savings advantages.
To see how self-funding with MedBen can help your group avoid the regulatory traps and save you money, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.