No later than October 1, 2013, all employers are required to provide a Notice to their employees providing information about the new health care Exchanges created by the Affordable Care Act (ACA). The Exchanges, now called Health Insurance Marketplaces, provide individuals and small employers access to certain insurance carrier’s health insurance policies. The Notice provides some basic information about those policy options and how to contact the Health Insurance Marketplace.
In order to comply with the ACA requirement, all employers, regardless of size, need to send the Notice to ALL of their employees – including those employees who are not on their health plan and those who do not work full-time. While the Department of Labor (DOL) recently clarified that there is no penalty for failing to send the Exchange Notice (DOL FAQ on Notice of Coverage Options released September 11, 2013), it did not waive the requirement that employers distribute the Notice to employees. The DOL FAQ on Notice of Coverage Options can be found at the DOL website.
In order to assist employers with this task, the DOL released two Model Notices earlier this year – one for employers that offer coverage to their employees, and one for employers that don’t offer coverage. If an employer offers coverage to some employees and not to others, the employer can either provide both notices to the respective employees, or they can provide the “offering” coverage notice and specifically indicate on page 2 who is eligible for coverage and who is not. You should also note the following:
Private sector solutions apparently have no place in today’s brave new health care world, The Wall Street Journal finds:
“[S]elf-insurance is now filtering down to businesses with 199 workers or fewer, as a hedge against ObamaCare’s federal mandates and the danger that costs on its small-business exchanges will soar. Some insurers are now selling popular products that allow groups as small as 25 to self-insure. [Editor’s note: Groups with as few as 20 employees can partially self-fund with MedBen Split Solution.] In a 2012 study, the Urban Institute found ObamaCare’s incentives will cause as many as 60% of small firms to convert without regulatory changes.
“So the White House, liberal pressure groups and state and federal regulators are trying to close what they call the self-insurance ‘loophole’ before more escape. Their political and actuarial fear is that if enough businesses don’t join, the exchanges could fail because too few younger and healthier people will subsidize everybody else.“In a June alarm titled ‘The Threat of Self-Insured Plans Among Small Businesses,’ the liberal Center for American Progress warns that ‘the result of this shift could cause an insurance premium death spiral.’ Note how businesses that pay for their workers’ health care are suddenly a ‘threat.’ Wasn’t coverage the point of ObamaCare?”
One would think with all the free publicity the Affordable Care Act has received in the past several years, the majority of Americans would by now have a pretty good understanding about such concepts as “the individual mandate” and “health insurance exchanges". But based on the findings of a new survey, one would apparently be wrong.
A new USA TODAY/Pew Research Center Poll shows that, among the 19% polled who are uninsured, nearly four in 10 don’t realize the law requires them to get health insurance next year. Among young people, whose participation is seen as crucial for the exchanges to work, just 56% realize there’s a mandate to be insured or face a fine.
The exchanges, which serve as a marketplace for uninsured individuals to buy insurance, are scheduled to begin enrollments on October 1. But only half of those surveyed know there will be a health care exchange available in their state – even less so in states that have refused to participate, defaulting instead to the federal exchange. Likewise, about half are aware that subsidies will be available for lower-income citizens.
As for opposition to the health care reform law, it has remained fairly high since its passage in March 2010 – and in this latest poll, the 53% disapproval represents the highest level yet. Moreover, 47% of respondents say the law will have a negative impact on the country as a whole, compared to 35% who expect a positive impact.
At MedBen, we believe that employers both large and small should benefit from the savings achieved by a healthy workforce. That’s why for two decades we’ve offered self-funded solutions for large and smaller employers.
Still, for companies that rely on the stability and security of fully-insured coverage, the prospect of “going it alone” may seem daunting. So what reason would a smaller employer have for risking the status quo? As it turns out, there are several.
Employee Benefit Adviser lays out the rationale as to why an increasing number of groups are exploring the advantages of self-funding:
If you work hard to contain your health care costs, now really is the perfect time to self-fund safely through MedBen. You can share in the savings that come from reduced employee claims and cut your premium costs dramatically.
To learn more about the benefits of self-funding, contact MedBen Vice President of Sales & Marketing Brian Fargus at email@example.com.
Last week, we alerted you to new regulations proposed by the Treasury Department and IRS on information reporting requirements under the employer mandate provision of the Affordable Care Act. As we noted, the agency is requesting feedback in regard to options for simplifying the reporting process, which has come under criticism by employer groups.
While final rules likely won’t be released until late 2013 or early 2014, it’s interesting to look at the specific reguations suggested under the proposal. They include:
The comment period ends on November 8, 2013. In the meantime, clients with questions regarding these proposals may contact MedBen Vice President of Compliance Caroline Fraker at firstname.lastname@example.org.
In hopes of encouraging doctors to exercise more caution in the prescribing of painkillers, the Food and Drug Administration has introduced new labeling guidelines for opioid narcotics, The Los Angeles Times reports. The change will affect OxyContin, Opana and other popular brand names.
Current labels for long-acting and extended-release opioids recommend their use for “moderate-to-severe” pain. The revised language will state that use should be limited to “pain severe enough to require daily, around-the-clock, long-term opioid treatment” for which alternative treatments have failed.
The FDA took the action in response to a recent surge in prescription drug overdoses, which in 2009 surpassed traffic accidents as a leading cause of preventable deaths in the U.S. In addition to changing label language, the agency will also require drug manufacturers to conduct new research aimed at identifying what doses and modes of use are most likely to harm patients.
While acknowledging the moves as steps in the right direction, experts feel more still needs to be done. “People who are in severe pain often take more than is prescribed to them, so limiting the label indication is not going to prevent that from happening,” said Lynn Webster, president of the American Academy of Pain Medicine.
More widely prescribed, fast-acting opioids, including hydrocodone, were not affected by the FDA order.
MedBen pharmaceutical plans encourage the use of generic equivalents whenever possible. Such medicines contain the same active ingredients as their brand-name counterparts, and are sold at a much lower cost.
Understandably, brand-name drugmakers would prefer that patients continue to stick to the pricier originals, and have employed various means to spur loyalty. One such method – offering coupons – has grown in popularity of late. But do such incentives really save the patient money?
A new analysis suggests that even with coupons, generics are still the better deal in the long run. According to Pharmalot, assistant professors from Harvard and Yale reviewed 374 brand-name offers – typically for chronic conditions, with a median savings of $60 – and found that lower-cost generic alternatives were available 58% of the time, while an FDA-approved therapeutic equivalent existed for 8% of the drugs.
“Despite the short-term savings achievable with coupons, they do not offset higher, long-term costs, because they’re nearly always time-delimited,” wrote the authors of the analysis. “Once a coupon program ends, patients with chronic disease face co-payments for these brand-name medications that are higher than for those generic alternatives.”
The authors also correctly noted that the coupons don’t offer true savings, because insurers still have to pay the higher price of the medications – and those extra costs are ultimately reflected in member premiums.
MedBen encourages pharmacy plan members to take advantage of an exclusive online Rx datbase. By logging on to MedBen Access and clicking on “My Rx", patients can enter drug names and see their retail costs, and check if lower-cost alternatives are available.
MedBen follows American Cancer Society guidelines that state women over 40 years of age should get annual mammograms – guidelines the organization has stood by even after the federal government’s controversial recommendation that women can wait until their 50s to begin screenings. And a new study appears to support the ACS’s judgment.
According to MedPage Today, the study of 7,300 breast cancer patients found that 71% of death from the disease occured in younger women with no history of mammography or with intervals of 2 years or more between mammograms. Median age at diagnosis of fatal breast cancer was 49, as compared with 72 for women who died of other causes.
“Even with effective adjuvant therapies, the best method for women to avoid death from breast cancer is to participate in regular mammography screening,” the authors concluded. “Regular screening increases the likelihood of detecting nonpalpable cancers, and annual screening further increases the likelihood relative to biennial screening.”
“Furthermore, detecting and treating breast cancer in younger women to prevent death may further increase the disease-free life years saved,” they added. “Our findings suggest decreasing the intensity of efforts to screen women older than 69 years while concomitantly emphasizing efforts to screening young women in particular.”
Female members of the MedBen Worksite Wellness program can monitor their compliance with mammograms and other critical wellness examinations by visiting the MedBen Access website and clicking on the Wellness Plan link under “My Plan”.
Following complaints that employer reporting requirements under the Affordable Care Act were too complicated, the U.S. Treasury Department has proposed new rules, the Associated Press reports. The agency seeks comment on options to reduce or streamline reporting by employers, insurers and health plan administrators.
In July, the Obama administration delayed the start date of the so-called employer mandate until 2015 to give the Treasury additional time to simplify the reporting process. Of particular concern to business groups was the redundancy of reporting the same employee information to multiple government agencies.
“Retailers are not interested in being overly burdened by bureaucratic red tape or time-wasting, duplicative reporting requirements,” Neil Trautwein, the top health policy official for the National Retail Federation, said in a statement.
Even with the delay, the administration still hopes employers will voluntarily begin reporting next year to ease the transition.
When the final employer reporting rules are released, MedBen will provide guidance to clients on how to proceed. In the meantime, clients with questions regarding the proposal are welcome to contact Vice President of Compliance Caroline Fraker at email@example.com.
In June, the United States Supreme Court handed down its ruling in United States v. Windsor – the highly publicized Defense of Marriage Act (DOMA) case. While the Supreme Court’s ruling was very specific regarding changes required in the areas of the law it addressed (i.e., inheritance tax issues for same-sex spouses), there are still many questions as to the application of this decision to employee benefit plans – predominantly group health benefit plans.
The Supreme Court’s opinion dealt only with the constitutionality of Section 3 of DOMA – the section that defined marriage as “between one man and one woman” – and the application of that definition to inheritance taxes. What is missing is clear guidance as to how this decision applies to spousal coverage under employee benefit plans – particularly whether or not health and retirement plans must be amended to make same-sex spouses in these plans eligible for coverage. This question is particularly vexing in states that already recognize same-sex partners. Several entities, including the American Benefits Council, have made formal requests of the Tri-Agencies (HHS, IRS, DOL) to issue interpretive guidance on this very issue.
Making things even more confusing are the many attorney newsletters and blog postings interpreting the Supreme Court’s decision for group health plans. In some cases, these firms have indicated that, for self-funded plans in states that do NOT recognize same-sex spouses (such as Ohio), plan sponsors will now be forced to decide whether they will cover any spouses at all. It is their contention that if these employers do cover ’spouses’ but continue to exclude same-sex spouses, the employer may risk litigation or discriminatory action – particularly if the plan specifically states that only opposite-sex spouses are covered. Such language could be determined, through litigation, to violate the Supreme Court’s ruling.
While we await further guidance on the spousal eligibility question, there are a host of other issues that will have to be reviewed in light of the decision. These are as follows:
Among the keys to reducing health care costs is reducing the “care gap” that results from plan members missing recommended wellness exams and screenings. MedBen, in conjunction with Verisk Health, offers a unique reporting platform that calculates a group’s Care Gap Index (CGI) – a score that assesses the type and degree of care gaps for individuals in a population.
Using a Predictive Modeling System, MedBen clients can see for themselves the potential economic impact of closing care gaps. The smaller the CGI, the higher the likelihood of a healthier workforce – which, in turn, increases productivity while improving your bottom line.
Furthermore, reducing the care gap can theoretically add years to the lives of your employees. A new report from the Centers for Disease Control and Prevention (CDC) says that nearly one-quarter of the deaths from cardiovascular disease could be prevented with basic lifestyle changes. By knowing where care gaps exist and encouraging plan members to schedule regular checkups, you can help your employees avoid heart disease, stroke and other serious conditions.
To learn more about how MedBen can help your group detect and close care gaps – and how advanced reporting tools will allow you to calculate the resultant savings – please contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
The 2013 Employer Benefits Survey released last month by the Kaiser Family Foundation shows that the popularity of self-funding continues to grow steadily. According to Passion for Subro, 61% of covered workers are in a self-funded plan – up slightly from 60% in 2012 and 59% in 2010. In the past decade, self-funding has seen an upward trend, rising over 10% since 2000.
One interesting, if not wholly unexpected finding, was the difference in coverage levels between large employers (200 or more workers) and smaller ones (3-199 workers): 83% of covered workers in the former groups are in a self-funded plan compared to just 16% in the latter.
Why the disparity? Many smaller firms believe they lack the resources to adequately cover their employees. But at MedBen, our experience tells a different story.
MedBen has provided self-funded administration for over two decades, saving money for groups both large and small in the process. And now, MedBen Split Solution is available as a true self-funded product for groups with as few as 20 employees.
If you work hard to contain your health care costs, “making the Split” is ideal for your group. You benefit from potential claims savings while still getting protection you from high claims activity. And you maintain plan design flexibility!
You are not too small to self-fund. To learn how Split Solution enables you to share in the savings that come from reduced employee claims, contact Brian Fargus, MedBen Vice President of Sales & Marketing, at email@example.com.
The staff of MedBen would like to wish you and your family a safe and relaxing Labor Day!
MedBen will be closed on Monday, September 2 and will reopen at 8:00 a.m. the following day. But even when we’re out of the office, our online customer services stay open around the clock.
MedBen Access: Plan members can use this site to check the status of a health claim, review benefit coverages, and more. To visit, simply visit MedBen.com and click on the MedBen Access link.
Rx Resources: This useful feature, available through MedBen Access to plan members who use PDMI as their pharmacy benefits manager, allows individuals to review personal prescription detail and benefit coverage, and compare lower cost alternatives. Click a plan member name under “My Rx Claims” on the MedBen Access sidebar to open.
FSA/HRA Online System: MedBen FSA and HRA members can use this site to review claim submissions, check payments issued, see total deposits posted to date and get answers to a variety of questions. In MedBen Access, select the “FSA/HRA Online Inquiry” option under the “My Plan” section on the sidebar. Alternately, you may log in directly to the site (using a separate User ID and PIN) by going to MedBen.com, clicking on the “Plan Members (Insureds)” button and selecting “FSA-HRA Account Information” from the “Online Services” drop-down menu.
Of course, the recently revamped MedBen.com itself offers a variety of resources, including links to additional online services, downloadable forms and network directories. Separate areas are available for employers, insureds and providers – just select the appropriate button to enter!
The Obama administration has announced another delay in implementation of the Affordable Care Act. The signing of final agreements with insurance plans to be sold on federal health insurance exchanges has been postponed from the original dates of September 5-9 to mid-September.
According to Reuters, sources cited “technology problems involving the display of insurance products within the federal information technology system” as a possible reason for the delay.
While the hold-up may be brief, experts warn that it could affect the October 1 start date for open enrollment into the exchanges. The Department of Health and Human Services fully expects the insurance marketplaces to open on time – but even prior to the announcement, several states said they’re scaling back their exchange launches, or considering doing so.
“[H]aving everything ready on October 1 is not a critical issue,” said a former Obama administration official who worked to implement the Affordable Care Act. “What matters to people is January 1, which is when the coverage is supposed to start. If that were delayed, it would be a substantive setback.”
MedBen is not participating in the exchanges, and the delay does not affect employers that carry private group insurance or self-fund their coverage.
The Affordable Care Act (ACA) requires that health plans providing medical benefits provide a uniform summary of their benefits to eligible individuals to be used in comparing any different coverage options that are available to these individuals. When a plan change is made that affects the summary of benefits and coverage (SBC), there are certain requirements on when the updated SBC should be provided to plan participants.
Per mandates promulgated under the ACA, any mid-year plan changes or amendments that affect your plan’s existing SBC (i.e., changes made at any time other than the first day of the plan year) must be provided to plan participants no later than 60 days prior to the date the change or amendment takes effect. This means that MedBen will need advance notice of any such mid-plan year benefit changes. In a best case scenario, MedBen would like to get such plan changes at least 90 days before the change is to become effective. This will allow MedBen the time needed to get appropriate stop-loss approval, prepare the plan amendment, make any necessary SBC changes and provide the plan sponsor with the required documents in time for distribution 60 days before the effective date of the change.
Likewise, SBC’s that contain plan changes that will be effective on the first day of a new plan year must be provided to plan participants no later than 30 days prior to the date the change takes effect. Again, MedBen would like advance notice of any changes that take effect on the first day of the plan year at least two months prior to the first day of the plan year so that MedBen can obtain appropriate stop-loss quotes and make the necessary changes to the SBC, in order to meet the ACA deadline.
In order to provide clients with continual access to online information regardless of bad weather or heavy web traffic, MedBen will be upgrading its Internet connection on the evening of Friday, September 13, beginning at 7:00 p.m.
Work on the upgrade is expected to last 3.5-4 hours, during which MedBen.com, MedBen Access, MedBen Secure and our other websites, as well as e-mail, will be unavailable. But we think you’ll find the brief break in services will be worth it!
Once online capacities have been fully restored, MedBen will offer redundant Internet connections; that is, two Internet companies will now provide service for our websites. Our new Internet company will serve as our primary connection, offering even faster retrieval of your claims and benefit data, while our existing company will provide backup.
So what does this mean to our clients? In the event of a storm or other event that causes the primary connection to do down, our access to MedBen websites and e-mail will automatically route to the backup, to allow an uninterrupted flow of information. Or should our primary connection get busy, the backup will be there to manage the additional visitors.
With redundant Internet connections, MedBen ensures that you have access to around-the-clock customer service. Clients with questions about the upgrade may contact Vice President of Information Systems Rose McEntire at firstname.lastname@example.org.
MedBen has just completed a seven-week Affordable Care Act Webinar Series. Led by MedBen Vice President of Compliance Caroline Fraker and offered exclusively to clients, each one-hour session focused on a different aspect of the Affordable Care Act and how it will affect employers in the coming months and years. Presentations were followed by an open question-and-answer period.
All seven meetings are now available for viewing on YouTube:
Webinars are just one way MedBen is keeping clients aware of the latest health care reform developments. Throughout the year, Fraker and other members of our MedBen University team have traveled the Midwest to explain how employers can best navigate their responsibilities under the ACA, and stay ahead of the latest federal rules. And we will continue to keep our clients informed during the rest of 2013 and beyond.
MedBen clients with questions regarding any of the information shared in these webinars are welcome to contact Caroline at email@example.com.
“Partly blaming the health law, United Parcel Service is set to remove thousands of spouses from its medical plan because they are eligible for coverage elsewhere.
“Rising medical costs, ‘combined with the costs associated with the Affordable Care Act, have made it increasingly difficult to continue providing the same level of health care benefits to our employees at an affordable cost,’ UPS said in a memo to employees.
“The company told white-collar workers two months ago that 15,000 working spouses eligible for coverage at their own employers would be excluded from the UPS plan in 2014. The Fortune 100 firm expects the move, which applies to non-union U.S. workers only, to save about $60 million a year, said company spokesman Andy McGowan.”
While UPS’ policy shift has made headlines nationwide, nothing explained in this article is new to MedBen clients. In fact, seven years ago, MedBen started advising its clients to encourage workers’ spouses to get coverage through their own employers. And those who have done so have experienced significant cost savings as a result.
MedBen’s clients have been learning about leading-edge plan design ideas that save money – and the majority have implemented those ideas and saved year after year.
Regardless of whether or not UPS was forced to change its medical plan in the face of health care reform, the reality is that it makes smart financial sense to remove spouses from employer coverage when outside coverage is readily available.
For additional information about how changes to spousal coverage can benefit an employer’s bottom line, contact MedBen Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
In an effort to reduce the overprescribing of opioids, CVS Caremark Corp. announced that it has taken the step of cutting off dispensing privileges, Reuters reports. The company said its stores and its mail-order pharmacy will no longer supply controlled substances for 36 doctors and other health care providers who it said could not justify their prescribing habits.
“This isn’t a definitive solution to the problem,” CVS Chief Medical Officer Troyen Brennan told Reuters. “We wanted to share what it was that we did and have other people in health care, including other pharmacies, look at what we did and discuss what some more comprehensive solutions might be.”
Brennan said the drugstore chain began revoking access for certain providers in late 2012. CVS took the action in response to a request by U.S. Drug Enforcement Administration for help in stemming the flow of prescription drugs where abuse is suspected.
Abuse of opioid prescription painkillers like Oxycontin ranks as the No. 2 cause of accidental death in the United States, CVS said. In 2009, painkiller use was cited in more than 15,500 overdose deaths, according to the U.S. Centers for Disease Control and Prevention.
A recent news item about a “largely unnoticed” delay for out-of-pocket cost limits under the Affordable Care Act created some confusion as for whom it was intended. As it happens, the one-year postponement affects only a small portion of health insurance plans.
While the maximum out-of-pocket limits will still apply to individual and (non-grandfathered) group health plans, employer-sponsored plans that have “separately administered” benefits have been granted a delay until 2015. As Sarah Lueck, Senior Policy Analyst of the Center on Budget and Policy Priorities, explains it:
“The Administration provided the exception in February for these plans, in which an employer has one insurer or administrator for its primary package of health benefits and a different insurer or administrator for discrete benefits, such as prescription drugs. Because employers and insurers have claimed it will be difficult to coordinate an overall maximum out-of-pocket limit across separately administered benefits, they sought and received the ability to avoid full compliance for one year.”
MedBen made clients aware of this transition relief earlier this year, and has also found a work-around for 2015. Clients who have questions regarding out-of-pocket limits under the health care reform law are welcome to contact Vice President of Compliance Caroline Fraker at email@example.com.