Two separate – and opposing – federal appellate court rulings issued yesterday regarding subsidies available to individuals enrolled in health insurance exchanges could have long-term implications for another major provision of the Affordable Care Act, reports Andrea Davis of Employee Benefit News:
“Employers, meanwhile, are still waiting on the Internal Revenue Service to finalize employer reporting rules and forms for the ACA’s pay-or-play mandate, set to kick in next year. ‘If this drags on into the fall, where there is some uncertainty as to which exchanges do or do not trigger a penalty, combined with the delay in the employer reporting forms, I could easily see the government saying: ‘Let’s hold off another year [with the employer mandate] until this all gets settled,’’ says Paul Hamburger, co-chair of Proskauer’s employee benefits, executive compensation and ERISA litigation practice center in Washington, D.C.
“’It’s a fundamental decision the government needs to make – whether the employer mandate applies or doesn’t apply,’ says Brian Pinheiro, chair of the employee benefits and executive compensation group with law firm Ballard Spahr. ‘I don’t think there’s anything for employers to do, other than wait and see what everybody agrees the law is. If the D.C. Circuit opinion holds, then the employers that are in states that have federal exchanges basically don’t have any employer mandate – there’s no pay or play rules for [those] employers, which is huge.’”
July 31st is not only the anniversary of the creation of the federal Department of Health, Education and Welfare, it is also the date that the Department’s successor – Health and Human Services – set as the PCORI Fee filing date under the Affordable Care Act.
No later than July 31, 2014, all self-funded employer health plan sponsors are required to file and pay their Patient-Centered Outcomes Research Institute (PCORI) fee. All self-funded plan sponsors are required to pay a fee based on the average number of covered lives under their eligible plans – including employees, retirees, spouses and dependents. Self-funded plans subject to the requirements include self-funded medical benefit plans, including most non-ERISA self-funded plans and retiree-only plans. Other self-funded plans subject to the fee include self-funded HRAs and FSAs which are not integrated with a plan sponsor’s self-funded major-medical plan. Dental-only, vision-only, EAP, disease management, and wellness plans are exempt.
All plan sponsors must use the IRS Form 720 dated April, 2014 to record and remit the amount due. Those plan sponsors paying for the first time owe $1.00 per covered life; those paying for the second time owe $2.00 per covered life.
If you’re a MedBen client who needs more information about how to count covered lives under your plan or how to prepare and remit your payment, don’t hesitate to contact Vice President of Compliance Caroline Fraker at firstname.lastname@example.org.
By the way, if you’re interested in learning a little more about how your PCORI fees will be used, read this blog post from the Institute’s Executive Director.
On July 17, 2014, the Tri-Agencies (United States Departments of Labor, Health and Human Services and the Treasury) released a Frequently Asked Question notice pertaining to the recent U.S. Supreme Court ruling in Burwell vs. Hobby Lobby. As you recall, the Supreme Court ruled that Hobby Lobby, as a closely-held company, was allowed to pick and choose which contraceptive coverage its employee health benefit plan covered based on its deeply-rooted religious beliefs.
The FAQ released by the Tri-Agencies is probably only the first of its interpretive guidance on this issue. It provides only an inference that closely-held companies may select which contraceptive coverages they cover under the preventive services mandate of the Affordable Care Act. Rather, the guidance is a reminder to ERISA plans about how plan changes which reduce benefits coverage must be handled under ERISA. In fact, the FAQ doesn’t mention religious beliefs at all or how those might be tied to gaining an exemption from the contraceptive mandate. You can read the FAQ and the Tri-Agencies’ answer at the Department of Labor website.
As always, MedBen clients who have any questions regarding the ACA or its requirements should feel free to contact Vice President of Compliance Caroline Fraker at email@example.com.
A company that offers a worksite wellness program expects more for its efforts than the warm feeling that comes from doing its part to help plan members stay healthy. Understandably, it wants to see a tangible (read: monetary) return on its investment. But how does an employer go about quantifying the cost savings?
With MedBen Worksite Wellness, clients get actionable reporting that not only demonstrates the overall progress of their program, but shows in pure dollars-and-cents whether or not the plan is benefiting the business financially as well. We measure the success of our programs based on multiple criteria, including:
These reporting factors are tracked using Verisk Sightlines, an advanced data analytics platform that helps clients make informed health care decisions. This secure online service enables users to personally scrub claims and mine member data, so clients can identify trends and see exactly where their health care dollars are going – and why.
To learn more about how MedBen can help your business implement a worksite wellness program that improves member health and saves you money, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
The extensive media coverage of the recent Supreme Court ruling on contraceptive coverage – not to mention, the resultant political outcry – has somewhat overshadowed the reality that the decision affects only a small percentage of businesses. And for those majority of employers that are still legally obligated to cover the cost of birth control for their female plan members, many believe the added expense is worth it, according to one expert.
“There are so many incentives for companies to cover contraception,” says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a research and policy organization that focuses on reproductive health, in an interview with NPR. He observes that insurers and self-funded employers benefit from the cost savings inherent in paying for birth control in full, as the coverage cost is much less than maternity and delivery.
Even before the passage of the Affordable Care Act, 85% of companies with more than 200 workers – and 63% of employers overall – provided birth control coverage, according to the Kaiser Family Foundation’s 2010 annual employer health benefits survey. The health care reform law did prohibit employers from choosing which specific contraceptive methods they would cover, however.
As the Washington Post notes in a Q&A, “FDA-approved methods of birth control are considered preventive care, and the health law requires nearly all health plans sold on the individual and group markets to cover preventive care without any out-of-pocket cost to consumers. The Supreme Court decision didn’t change that.”
A new report suggests that women who get their annual wellness examinations from their family doctors receive a broader range of services, compared to those who get preventive tests from their obstetrician/gynecologists (OB/GYNs).
“I think [primary care providers] and OB/GYNs can play an important role in clinical preventive services,” said study co-author Dr. Mona Saraiya of the Centers for Disease Control and Prevention. “I think it’s important to be aware where there might be deficits.”
According to Reuters Health, the analysis of medical records from between 2007 and 2010 found that women who saw OB/GYNs were more likely to get screened for cervical and breast cancers, Chlamydia and osteoporosis, compared to those who went to primary care doctors. But those who went to primary care doctors were more likely to get screened for colon cancer, high cholesterol and diabetes and to be counseled about diet, exercise and obesity.
The researchers write that “women of reproductive age who see OB/GYNs only for preventive care may not be receiving the full spectrum of recommended screening and counseling.”
Under Affordable Care Act rules, health care plans must cover the costs of recommended wellness tests, but not necessarily the cost of the office visit itself. However, many plans will cover the full cost of a woman’s annual exams at both her primary care physician and her OB/GYN.
Females who prefer to receive specific well woman tests from multiple doctors should review their summary plan document or speak to their plan administrator to determine how the exams are covered. MedBen clients are welcome to also contact a MedBen Customer Service Representative at (800) 686-8425 or visit MedBen Access.
The Supreme Court made its ruling about employers and birth control coverage last week, but that hardly means the matter has been put to rest.
The New York Times reports that two Senate Democrats have introduced legislation to override the Supreme Court decision. The bill, written with input from the Obama administration, would require for-profit corporations like Hobby Lobby Stores to provide and pay for contraceptive coverage, along with other preventive health services, under the Affordable Care Act.
The bill states that an employer “shall not deny coverage of a specific health care item or service” where coverage is required under any provision of federal law. However, it does preserve the earlier exemption for churches and non-profit religious organizations that object to the coverage mandate.
House Democrats are also expected to draft a bill, but it would stand little chance of passage in the Republican-run House.
The Supreme Court ruling has also prompted a response from a trade group representing third party administrators.
According to Business Insurance, the Self-Insurance Institute of America wrote a letter Monday to the U.S. Health and Human Services, Treasury and Labor departments stating that the accommodation for religiously inclined for-profit employers places an additional financial burden on TPAs. Under ACA rules, TPAs must cover contraceptives on behalf on their self-funded groups that have religious objections to the requirement.
And even some employers that ostensively benefit from the high court’s decision don’t think it goes far enough. In two separate set court cases, 50 for-profit and 59 non-profit groups are challenging the very existence of the contraceptive coverage requirements.
According to MedCity News, most of the entities involved in the lawsuits charge that the birth control mandate violates their rights under the Religious Freedom Restoration Act. While most would not have to provide such coverage, the process by which they can opt out, which involves filling out a form and sending it to their insurance company or TPA, still goes against their religious beliefs by making them “complicit” in providing something they consider sinful.
Suffice to say, we haven’t heard the last of this story…
“Offering health benefits is critical to employee recruitment and retention,” says Bruce Elliott, manager of compensation and benefits for the Society for Human Resource Management (SHRM). As such, most companies desire to offer a competitive health and wellness package that appeal to job seekers. The key is finding the right balance between providing employees with great benefits and staying within a realistic financial margin.
According to SHRM’s 2014 Employee Benefits report, 95% of companies currently offer prescription drug coverage and dental insurance. Additionally, 79% of companies provide wellness resources and information to employees while 63% offer actual wellness programs.
As health benefit costs increase, it can be a struggle to continue providing comprehensive coverage for employees that can double as a recruitment tool, while still respecting the bottom line. But at MedBen, we are dedicated to helping employers strike the proper balance.
MedBen works closely with clients to tailor a benefits package that fits their direct needs. But we also offer advice regarding those benefits that appeal most to both current and prospective employees. And of course, we help employers locate cost-cutting opportunities while still maintaining what’s important to plan members.
Likewise, MedBen is a huge supporter of growing wellness programs and providing wellness resources to employees. Such programs help to reduce claims costs by keeping employees healthy.
MedBen understand that having good benefits for your employees is not just important to your employees of current, but those of the future. To learn more how a solid benefits package can put your business at a strategic advantage, contact Vice President of Sales and Marketing Brian Fargus at email@example.com
Under health care reform, large health plans are now required to obtain a Health Plan Identifier (“HPID”) number no later than November 5, 2014. Just as with previous HIPAA plan size determinations, large health plans are those with more than $5 million in annual receipts. All other health plans (those considered “small” with $5 million or less in annual receipts) have until November 5, 2015 to obtain a HPID.
Both the HIPAA and the Affordable Care Act (ACA) statutes require covered entities or their business associates to conduct certain plan related transactions electronically. Beginning on November 7, 2016, all covered entities must use a HPID to identify a health plan in any HIPAA standard transaction in which the covered entity is identifying a health plan as part of the transaction.
MedBen is reviewing the registration portal developed by the Centers for Medicare & Medicaid Services (CMS) for health plans to obtain HPIDs. Once we have completed this review, we will communicate this information to our health plan clients.
More information regarding this requirement is available on the CMS HPID website. This site has an abundance of information on the regulatory requirements pertaining to the registration, along with demonstration videos on the steps necessary to complete the registration process for a health plan.
The MedBen Compliance Department has prepared a document containing additional background information about health plan requirements pertaining to HPIDs. Clients that would like a PDF copy are welcome to contact MedBen Sales Analyst Sally Wood at firstname.lastname@example.org.
Happy Independence Day from MedBen! In observance of the holiday, our home office will be closed on Friday, July 4 and reopen at 8:00 a.m. on Monday, July 7. But should you need claims or benefits information in the meantime, there’s good news: MedBen Access, our online customer service center, is open ’til dawn’s early light, and beyond!
If you’ve never logged onto MedBen Access, it’s time you got acquainted – simply go to MedBen.com and click on the “MedBen Access” link. Then click on the “First time?” link in the Login box and follow the registration instructions.
Once you’re in, you have a number of useful management functions at your disposal, such as ordering ID cards, monitoring claims activity and reviewing change of information requests. Plan members can check a claim’s status, review Plan Document coverage and download forms, to name just a few of the 24/7 services available.
This risk of opioid abuse varies depending upon which state an individual resides in, says a new report from the Centers for Disease Control and Prevention (CDC).
According to USA TODAY, states differ in the amount of prescriptions they allow for doctors to write patients in severe pain. The link is simple: The more prescriptions a doctor writes, the greater the odds of painkiller addiction. When this occurs, the rates of opioid-related overdoses increase.
On average, US doctors prescribed 82.5 opioids per 100 US citizens in 2012. The southeast has the highest amount of prescriptions written for opioids, with Alabama leading at 149.2 prescriptions per 100 US citizens. Providers in Hawaii wrote the fewest painkiller prescriptions – just 52 for every 100 people. (West Virginia and Kentucky ranked 3rd and 4th highest, respectively, while Indiana was 9th and Ohio 12th.)
CDC director Tom Frieden states that although these medications have their benefits, “overdoses from opioid narcotics are a serious problem across the country… they are not the answer every time someone has pain.” The CDC says 46 people in the United States die from prescription painkiller overdoses each day.
Because of the severity of the issue being brought into the spotlight, there have been some states that are taking action, notes an NPR article on the report. For example, Florida has started monitoring the opioid output and by doing so, their opioid overdose fell 27%.
Other states are jumping on board. The monitoring has led to the shutdown of over 250 pain clinics abusing the prescription writing privilege and has led to the decrease in the overall opioid overdoses. “This is an epidemic that was largely caused by improper prescribing practices” with little policy and reinforcement to back up the abuse, Frieden says.
Complete state rankings can be found at NPR.org.
Playing in the sun may be fun, but the effects of its UV rays are not. UV rays have been proven to cause severe damage to the skin, including burns, darkening age spots, and premature aging. Even worse, they’ve been linked to causing various types of skin cancer.
To help protect yourself, it is important to know how to select the right sunblock. When making a purchase, keep in mind three factors: sun protection factor (SPF), spectrum, and water-resistance.
The SPF of any sunblock worn for lengthy sun exposure should be of at least 30, which will block out up to 97% of the harmful UV radiations. Also, be sure to get a sunblock that is labeled “broad spectrum.” This indicates that the sunblock is a barrier for both UV-A and UV-B rays. Finally, selecting a sunblock that is water-resistant will help protect not only against the water you and your family will be playing in on the hot summer days, but sweat as well.
After properly applying your sunblock (see below), if you notice that your skin is still starting to turn pink, find some shade or go inside. Do not let yourself burn. It also makes good sense to see your family doctor regularly so that he or she can help guide you to take full care of your skin – or if necessary, refer you to a good dermatologist.
In a 5-4 decision, the Supreme Court ruled today that selected corporations do not have to cover contraceptives for women if it conflicts with their religious beliefs.
According to the Associated Press, the decision marks the first time that the high court has ruled that a for-profit business can hold religious views under federal law. The case was brought before the court by the Hobby Lobby chain of crafts stores and Conestoga Wood Specialties Corp., a Mennonite-owned cabinet maker.
The Affordable Care Act requires that health plans cover certain preventive services at no cost to its members. Last year, the Obama administration revised the mandate for birth control coverage, exempting churches and religious non-profits. The ruling will broaden the exemption to include corporations that, as AP states, “are under the control of just a few people in which there is no essential difference between the business and its owners.”
Justice Samuel Alito wrote the opinion for the majority, which included Chief Justice John Roberts among its voters. The court’s four liberal justices dissented.
Some interesting research from the National Institute for Health Care Reform (NIHCR) demonstrates the usefulness of comparing outpatient care costs whenever possible. The nonprofit, nonpartisan organization found that average hospital outpatient department prices for common imaging, colonoscopy and laboratory services can be double the price or more for identical services provided in a physician’s office or other community-based setting.
The NIHCR news release states that “The average hospital outpatient department price for a basic colonoscopy, for example, was $1,383 compared to $625 in community settings, according to the study. For a routine blood test — a comprehensive metabolic panel — the average price in hospital outpatient departments was triple the price — about $37 compared to $13 in community settings.”
Other key findings include:
The study used 2011 private insurance claims data for 590,000 active and retired nonelderly autoworkers and their dependents to examine hospital outpatient department prices in 18 U.S. metropolitan areas, including Ohio cities Akron, Cleveland, Toledo and Toledo and Indiana cities Indianapolis and Kokomo.
A more detailed Research Brief is also available at the NIHCR website.
The use of mammograms to detect breast cancer has its advocates and detractors, and there’s no shortage of studies supporting arguments before and against screenings. One recent study, with results that fall firmly on the “for” side, found that mammograms of healthy women reduce deaths from breast cancer by almost 28%.
According to WebMD, the study evaluated 15 million Norwegian women, over 10,000 of whom died due to breast cancer. Nearly 90% of these women had not yet been invited to receive a mammogram under Norway’s national program – meaning that for every 10,000 women invited to get a screening, about 27 deaths from breast cancer could be avoided.
Meanwhile, medical technicians are pursuing a more accurate method of detecting breast cancer through the use of 3-D mammography. While this advanced imaging system would still be conducted the same way as a standard mammogram, doctors say they have found greater success in detecting more invasive cancers. The 3-D imaging allows for doctors to get a more precise and clear picture as to what is occurring inside the breasts.
Even with such breakthroughs, researchers strive to find mammography alternatives that are faster, more efficient, and less intrusive. In Israel, one such test called Octava Pink uses a woman’s blood sample to quickly determine if a person has breast cancer or not. The FDA is currently conducting trials on Octava Pink – and if successful, would certainly be great news for women everywhere.
MedBen follows American Cancer Society mammogram screening guidelines for women 40 and over, with the caveat that women should be made aware of both risks and benefits. And a reminder for our female Worksite Wellness members: you can monitor your compliance with mammograms and other critical wellness examinations by visiting the MedBen Access website and clicking on the Wellness Plan link under “My Plan”.
Employee Benefits News asks the question, “Where do e-cigarettes fit into an ACA-compliant wellness program?“
According to the final regulations of the Affordable Care Act, an employer can reward up to 50% of the cost of health insurance coverage for participating in a tobacco cessation program – the emphasis here being on “tobacco". E-cigarettes contain no tobacco, and based on this language, wouldn’t qualify for employers rewards.
But what about nicotine, the active ingredient in e-cigarettes and also found in tobacco? Here again, one can only go by the ACA language, which specifies “tobacco” cessation, not nicotine. And the final regulations make no reference to e-cigarettes.
So to sum up, e-cigarettes contain no tobacco, and therefore, e-cigarette users don’t qualify for employer tobacco cessation rewards if they kick the habit. Matter solved, right? Uh, no.
Alden Bianchi of the legal firm Mintz Levin notes that also within the final regulations, the definition of what constitutes a participatory wellness program refers simply to “smoking cessation” and the definition of an outcome-based wellness program merely refers to “not smoking,” with no reference to tobacco in either case. So what’s reads as a clear-cut rule in one instance is less so in others.
The upshot here is that an employer could point to the “tobacco” language in not allowing rewards for smoking cessation, but a wellness plan member who has successfully quit e-cigarettes could counter with the “smoking” language. Conversely, if an employer insisted that e-cigarette users smoke and were therefore not eligible for rewards, participants who’ve replaced regular cigarettes with the electronic version could argue that the lack of tobacco means they’ve successfully quit smoking under the letter of the law.
Confusing? You betcha. To be fair, e-cigarettes have only gained widespread popularity in the last couple of years, so it’s possible that they weren’t on Congress’ radar when the language was written. But given their growing usage, legislators hopefully will clarify on which side of the wellness rewards issue e-cigarettes fall.
According to HealthDay News, a recent report by the Centers for Disease Control and Prevention found that while growth of prescription drug use has slowed in recent years, overall numbers continue to rise. Nearly half of Americans said they took at least one prescription drug in 2013, compared with 39% in 1988-1994.
Drugs to manage cholesterol, high blood pressure, heart disease and kidney disease are the most widely used medications among adults, the CDC report found.
The results of this survey are hardly unexpected. As the number of Americans with chronic conditions continues to climb, it stands to reason that usage of drugs to control those conditions also increases. But higher usage is a doubled-edged sword: Drugs control the conditions, but continual usage raises the risk of dependency.
The best solution to slow the growth of pharmacy costs in your group health plan is, naturally, to reduce plan member’s need for prescription drugs in the first place. And promoting better health in the workplace can go a long way toward achieving this goal.
MedBen Worksite Wellness programs emphasize the doctor-patient relationship. By encouraging plan members to visit their primary care physician regularly, it improves the chances that potentially harmful conditions can be controlled through basic lifestyle changes, rather than medications.
Of course, most patients – even those who are zealous about healthy living – will invariably need a prescription. But MedBen has a solution there, too: To manage clients drug costs, MedBen offers Rx plans with pharmacy discounts that are among the best in the industry, especially for generic medications. By steering plan members to low-cost generics, employer and patient alike save money.
Our team will work with your group to put together a health package that helps to keep Rx costs low, through better discounts and improved employee health. To see for yourself how MedBen can benefit your business, contain Vice President of Sales & marketing Brian Fargus at email@example.com.
Occurrences of million-dollar medical claims are still comparatively small, but their numbers of late have grown considerably – another reason it pays for your business to take advantage of the sound health benefits management offered by MedBen.
According to Business Insurance, a new report by financial services company Sun Life finds that the incidence rate for catastrophic medical stop-loss insurance claims in excess of $1 million more than doubled in 2013 to 4.3 per 5,000 claims, compared with incidence rates of 1.8 in 2012 and 0.4 claims in 2010.
“We anticipate costs will only continue to rise as new technologies are adopted, advanced drug therapies are introduced, and the Affordable Care Act increases access for participants,” said Karin James, a vice president for Sun Life’s stop-loss division.
Without the safety net of a benefit ceiling, large claims take on an even greater significance – and with the rate of million-dollar claims growing, just one unhealthy claimant can impact the bottom line. But with MedBen’s self-funding solutions, we help employers reduce the potential risk.
MedBen reviews every claim for inappropriate codes and loss potential, but our advanced claims surveillance techniques place a special emphasis on bigger bills and inappropriate procedures. When we flag a questionable claim, medical specialists work directly with the provider to ensure an outcome that’s both cost-effective and patient-sensitive.
MedBen will help you find the right self-funding solution based on your group’s size, the amount of stop-loss protection, and your preferred level of involvement – and save you money. To learn more, contact, Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
A little personal wellness knowledge can go a long way. To help people achieve better health, the U.S. Department Health and Human Services now has a website, myhealthfinder.com, that generates a series of lists of recommended testing based upon a person’s age and gender. These series include testing that all individuals of that specific age and gender should receive, including those with a family history of health issues.
MedBen also understands that life can sometimes get busy, and it can be difficult to keep track of all the important dates on your calendar. That’s why we offer members of our Worksite Wellness program an exclusive service –- wellness compliance updates through our MedBen Access site.
Like myhealthfinder, MedBen wellness compliance allows individuals to see what tests they may need based on age and gender – with one important distinction. Our service is personalized, so members can see the date they last had a wellness exam or cancer screening, when they will next need a test, or if they’re overdue for one. All at your fingertips!
And that’s not all: Wellness compliance information is one of the many convenient features found on MedBen Access. Users can also check claims status, review their coverage benefits, download explanations of benefits, and more. Simply go to MedBen.com and click on the “MedBen Access” link on the top right of the page.
Workplace wellness promotion comes in all shapes and sizes. And here at MedBen, not only do we believe in walking the walk, we also believe in, er… totting the tot, as it were.
Like many of our clients that offer a worksite wellness program, we’re invested in finding ways to encourage our staff to live healthier lifestyles. We do this using multiple and ongoing methods, such as increasing HRA contributions for employees who exercise regularly at area health clubs. But we also offer shorter-term incentives… which is where the walking baked potato comes in.
This summer, MedBen employees have been invited to participate in a 13-week walking program. Employees form teams and walk together four times a week for 20 minutes. Participants must also complete one community or 5K walk during the program. Throughout the 13 weeks, walkers will be eligible for monthly gift card drawings.
To promote the program, our Managed Care Coordinator Tracie Claggett toured the home office yesterday as a “couch potato". Armed (that is, if a tater can be “armed") with a remote control, a cola bottle and a bag of potato chips (wait, isn’t that… well, best not to think about it), she extolled the benefits of getting off the sofa and slipping on the sneakers. What’s more, she did it with an air of dignity not generally found in a walking spud.
Employees who successfully complete the walking program will be rewarded with bonus time off from work… but more importantly, they will have kept active throughout the entire summer. As the program mascot says, “Even the slowest walker can lap a couch potato!”
Of course, MedBen doesn’t limit such creativity to our own team. Through our Worksite Wellness program, we can help your business dream up your own incentives to better employee health, as well as providing tried-and-true wellness solutions. Heck, we’ll even let you borrow the potato costume!
To learn more about how wellness promotions can benefit your workplace, contact MedBen Sales & Marketing Brian Fargus at email@example.com.