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01/14/18

  05:12:00 pm, by MedBen5   , 187 words,  
Categories: Announcements, Cost savings, Third party administration, Claims management

MedBen Claims Surveillance Continues to Save Clients Money

magnified dollar

MedBen's claims surveillance system, which screens and selects claims for specialist review, saved clients, on average, an additional 38% per selected claim in 2017... savings produced after network discounts are applied, but before claims are paid.

Our advanced surveillance technique takes claims processing to another level. This system works in tandem with our in-house processing, using physician-managed algorithms to find claims that may not meet medical necessity or appropriateness standards. If a claim is flagged, board-certified medical specialists further review the claim (with the client's approval) to find possible resolutions.

In dollars and cents, this added layer of claims analysis saved clients an average of $7.57 per employee per month (PEPM) in 2017. Furthermore, looking at the PEPM amounts from 2013 to 2016 reveals a five-year average client savings of $10.09 PEPM.

It should be noted that these savings come on top of savings derived from plan provisions, network discounts, and medical management. Taken together, these cost controls and other claim management strategies help MedBen clients remain under national plan spending trends.

Learn more about claims surveillance and other MedBen saving solutions by contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

  05:09:00 pm, by MedBen5   , 345 words,  
Categories: News, Wellness, Compliance

Judge Vacates EEOC Wellness Program Rules

checkup

“When you’re finished changing, you’re finished.”

Ben Franklin’s words ring true for those still struggling with the EEOC’s workplace wellness incentive rules. The EEOC’s May 2016 final rules outline how employers are permitted to offer wellness program incentives to employees and when those programs are considered voluntary. The rules were complex and often difficult to reconcile with the less complicated HIPAA wellness rules (which were in effect at the time and remain in effect today). However, in December 2017, a Washington D.C. Federal Judge vacated the EEOC rules in response to a lawsuit brought by the AARP (AARP v. EEOC, D.D.C. 1:16-cv-02113).

Judge John Bates’ ruling sides with the AARP, which has argued that the EEOC's wellness incentive rules (permitting health plans to include incentive penalties of up to 30% of the cost of coverage) are not a sufficient remedy for categorizing the wellness programs as voluntary.

But before running out to change your wellness program you should know two things about the Judge’s order. First, the Judge vacated the current EEOC wellness program rules – but not until January 1, 2019. The Judge reasoned that employers wouldn’t have sufficient time to re-design their plans for 2018 (“on they fly” as described by the Judge). Second, the Judge ordered the EEOC back to the drawing board, requiring that the Agency propose new rules by August 31, 2018. The EEOC must provide a reasoned explanation for considering workplace wellness programs voluntary even if those programs apply penalties.

What does this mean for your wellness program? It means that everything stays the same until it changes. That could be in the Fall of 2018 or in January 2019. Either way, it is important to note that none of this means making changes now and that any future changes may be ones we haven’t even imagined yet. So like Ben says, we’re not finished changing until we’re finished!

In the meantime, if you have any questions about the EEOC’s wellness program rules, the HIPAA wellness program rules, or any other aspect of wellness program design, feel free to contact MedBen Vice President of Compliance Caroline Fraker at 800-851-0907 or cfraker@medben.com.

01/12/18

  02:55:00 pm, by MedBen5   , 221 words,  
Categories: Dental, Research, Preventive care

Benefits of Dental Care Go Well Beyond Clean Teeth

dental chair

Dental checkups do much more than giving your teeth a good cleaning. Through twice-yearly exams, a dentist can monitor the condition of the teeth and gums to spot subtle changes that may need attention.

But that's only the half of it. Research shows that people who get their teeth professionally cleaned on a regular basis reduce their risk of heart attack and stroke.

Nor do the benefits end there: Many dentists also use these routine visits to check for signs of cancers of the lips, tongue, and cheek, in addition to other oral cancers, says Todd Coy, DMD, Director of Cleveland Clinic’s Department of Dentistry.

“Evaluation of the oral cavity, including the soft tissues, is part of my exam when patients are in the office for a checkup,” he says. “There are very few downsides to more frequent screening.”

In the first quarter of 2018, MedBen will be rolling out an enhanced version of its dental plan. MedBen PreceDent will offer lower costs through network care, as well as such value-added enhancements as dental implants and periodontal scaling. And of course, preventive care (which includes those twice-yearly exams) is covered in full.

If you'd like to get more information about how MedBen PreceDent promotes dental care that goes beyond the obvious, contact Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

01/10/18

  06:11:00 pm, by MedBen5   , 233 words,  
Categories: Announcements, News, Wellness, MedBen Employees

MedBen Takes an "Encompassing" Approach to Employee Health

MedBen is taking its company wellness efforts to another level, offering employees tips and tools for living a better life, while earning them extra vacation time in the process.

In 2017, MedBen introduced "enCompass," a complement to our internal WellLiving program. Through enCompass, we bring together six distinct components that contribute to one's personal wellbeing – physical, intellectual, financial, social, occupational, and emotional. Each of these components offered a unique set of activities, from workout classes and nutritional seminars to software training and stress management sessions.

By participating in enCompass presentations and activities, MedBen employees earned points that could be used toward extra vacation time. Those who achieved this goal represent over 10% of our employee population. In total, nearly one-third of our employees participated in the program in 2017.

enCompass reward winners

MedBen employees who earned a full day vacation include: Caroline Fraker, Sheri Gutridge, Tammy Jones, Erin Kelly, Brenda McLean, Tiffany Ricket, Stacey Spring and Kay Williams.
Half-day vacation earners include: Robin Becker, Ashlyn Degler, Cindy Dittoe, Janice Harris, Abbie Hughes, Lindsay Kirk, Becky McCune and Jackie Turner.

In 2018, MedBen will continue to promote the total wellbeing of its employees, in mind as well as body, with expanded enCompass programming. Congratulations to every MedBen employee who earned time off or participated in enCompass!

MedBen can work with WellLiving clients to offer similar activities and incentives to expand their wellness program. For more information, contact your Group Health Representative.

01/08/18

  08:10:00 pm, by MedBen5   , 348 words,  
Categories: Wellness, Heart, Diabetes, Preventive care

Crushing Goals and Excess Weight

scale

More than 50% of Americans make a resolution each year, yet only 8% are successful at achieving them. Among the top resolutions made each year are getting organized, saving money, and – at the top of the list – weight loss. By a happy coincidence, January is also Healthy Weight Awareness Month!

According to CDC, roughly 70% of America adults were classified as overweight or obese in 2014. Having excessive weight can pose a serious threat to one’s health, including an increased risk of heart disease, type 2 diabetes, joint problems, and other chronic conditions.

There are three key factors that play into weight: behavior, environment, and genetics. Unfortunately, there isn’t much we can do about genetics, but we can change our behaviors. Having a healthier and moderated diet, physical exercise of at least 30 minutes most days of the week, and setting goals to keep you on track are great ways to help subside excess weight – and they can give you an emotional boost as well!

Environment has a big impact on behavior as it sometimes deters physical activity. Someone that lives in a community without sidewalks is less likely to be physically active. However, keep in mind that malls and outdoor parks, offer great (and free) spaces to walk.

As always, MedBen WellLiving suggests consulting your physician before making any drastic lifestyle changes... even if they are for the better.

Full story »

01/03/18

  08:56:00 pm, by MedBen5   , 259 words,  
Categories: News, IRS

IRS Extends 1095 Form Distribution Period

IRS Building

Happy New Year from the IRS!

On December 27, 2017, the Internal Revenue Service gave employers sponsoring health plans a New Year’s gift. Again this year, the IRS has offered plan sponsors a 30-day automatic extension for the distribution of both 2017 IRS Forms 1095-B and 2017 IRS Forms 1095-C (as applicable) to their employees. Please note that no similar extension is available for filing the forms with the IRS.

The IRS has provided guidance (in IRS Notice 2018-06) and set the new distribution and existing filing deadlines, as follows:

  • March 2, 2018 – Deadline for distribution of IRS Form 1095-B (Health Coverage) or IRS Form 1095-C (Employer-Provided Health Insurance Offer and Coverage) to employees.
  • February 28, 2018 – Deadline for paper filing of IRS Forms 1094-B/1095-B or 1094-C/1095-C with the IRS. (Note: An employer can only file paper copies if it distributes fewer than 250 1095s on or before March 2, 2018.)
  • April 2, 2018 – Deadline for electronic filing of IRS Forms 1094-C/1095-C with IRS. (Note: Employers that distribute 250 or more Form 1095-Cs must file electronically.)

To recap, the Affordable Care Act (ACA) and its supporting regulations require that all employers offering health benefits to their employees report certain health coverage information to those employees as well as to the IRS. And just like last year, employer’s sponsoring health plans must collect, aggregate and distribute this information via Form 1095.

The forms and codes are pretty much the same as they were on last year’s forms. But as always, MedBen clients who have any questions about preparing or distributing these forms are welcome to contact MedBen Vice President of Compliance Caroline Fraker at 800-851-0907 or cfraker@medben.com.

01/01/18

A Note from Our Chairman and President

Doug Freeman and Kurt Harden

To our customers, consultants, and brokers:

Welcome to 2018! For MedBen, the coming year carries a special significance, as we will celebrate our 80th anniversary in May. As with any benchmark anniversary, it gives us a chance to look back at how we’ve grown, and what we’ve learned along the way.

Reflecting on our company’s past, it’s hard to believe that for almost 50 years, MedBen served primarily as a hospital services association, covering hospital room and board, but not physician services. Flash-forward to 1987 and our transition to a mutual life insurer, and it’s remarkable to see how our business has changed in a comparatively short time… both in size (from 25 employees in 1987 to over 140 today) and scope, as we today offer a variety of benefit management services, from third party administration to pharmacy benefits management to worksite wellness to Medicare value-based payment analytics.

MedBen’s growth has coincided with the rising popularity of self-funding. Nearly 70% of U.S. employees are currently covered under employer-funded plans… and with good reason, as we have seen first-hand the flexibility and cost savings this approach offers. So much so, in fact, that our TPA clients – once a small portion of our customers – now make up our biggest block of business.

But regardless of these changes, what has remained constant are the relationships we’ve developed with all of you over the decades. And it’s these connections that make our jobs so fulfilling. It’s our continual goal to find better ways to serve you and earn your business – if we ever come up short, please call us at the numbers below. Rest assured that the trust you place in us is never taken for granted.

On behalf of the entire MedBen staff, we offer you our thanks and very best wishes for a healthy and prosperous 2018!

Sincerely,

Doug Freeman
Chairman & CEO
(740) 522-7339

Kurt Harden
President & COO
(740) 522-7345

A quick reminder: MedBen will be closed on Monday, January 1 and reopen on Tuesday, January 2 at 8:00 a.m. EST. Should you have a claims or benefits question, please visit MedBen Access. Our online customer service center is available 24/7 for your convenience!

  10:05:00 pm, by MedBen5   , 377 words,  
Categories: Prescription, Cost savings

The “Cost Plus” Approach to Rx Benefits

pharmacist

A recent New York Times story identifies a fundamental problem in the pricing of medicines in our health care system today: It is difficult to determine what “cost” is for a medicine.

What a given pharmacy actually pays to stock a medicine in the pharmacy to sell may change from one order to the next based on a variety of factors. This is complicated by the fact that the amount a pharmacy is allowed to charge or what the pharmacy is paid for a medicine is determined by a contract between the pharmacy benefits manager (PBM) that manages the network of pharmacies (ex. Express Scripts, CVS/Caremark, Optum, etc.) and the pharmacy (Walgreens in the NYT article).

In the article’s example, the Walgreens pharmacy was allowed to charge $0.93 per pill for the cholesterol drug rosuvastatin – the network agreement between the PBM and Walgreens. In contrast, online Rx discounter Blink Health charged $0.51 per pill. But while Blink’s price was better, it was also able to secure a sizeable gross profit on this prescription. The data that follows is important in this determination.

AAWP – Average of Average Wholesale Price
AWAC – Average of Wholesale Acquisition Cost
ACA FUL – Affordable Care Act Federal Upper Limit
NADAC – National Average Daily Acquisition Cost

The NADAC price, in this case, is the price that matters and why Blink could sell at such a low cost and still make money. But how do employer health plans take advantage of this pricing approach for their plan members? We have the answer to the problem.

MedBen is launching a new Rx program that bypasses the industry standard of “AWP less discount and MAC pricing for generics” approach to drug pricing in favor of a “Cost Plus” basis of pricing.

The MedBen Rx program model will pay the pharmacy the average cost of the drug based on a proprietary national retail pharmacy survey (like NADAC, above) plus a dispensing fee that reflects the pharmacy services in filling a prescription. This method of pricing will provide MedBen groups with a pricing methodology that eliminates the “margin manipulation” that is possible in the current PBM AWP discount approach to pricing.

For more information on this money-saving pharmacy program, contact MedBen Vice President of Sales & Marketing Brian Fargus at 888-627-8683 or bfargus@medben.com.

12/29/17

  09:50:00 pm, by MedBen5   , 212 words,  
Categories: Wellness, Reporting, Diabetes, Hypertension, Cholesterol

Nearly One-Third of Adverse Health Tied to Chronic Conditions

checkup

Hypertension, diabetes, and high cholesterol are among the chronic conditions responsible for 30% of adverse health nationally, according to a recent report from Moody’s Analytics... conditions that can be better controlled through a focus on preventive care through worksite wellness.

The report also suggests that these conditions can be significantly impacted by a person's environment, upbringing, and other social determinants. But here, too, is where a wellness program like MedBen WellLiving can have a positive effect: Offering the same program participation incentives to all plan members – coupled with other trade secrets– improves the likelihood that a higher proportion of the employee population will get regular wellness exams and screenings regardless of individual differences.

Additionally, WellLiving emphasizes "family doctor first." By establishing and maintaining a physician-patient relationship, the family doctor is better positioned to detect an increased risk of hypertension, diabetes, and high cholesterol. All of these in addition to other conditions the report cites as primary contributors to adverse health, such as depression and substance abuse.

Better health and lower health care costs begins with a wellness program that promotes preventive care and condition management for all employees, and MedBen WellLiving was designed with those goals in mind. Get more information by contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

12/21/17

  04:01:00 pm, by MedBen5   , 357 words,  
Categories: Wellness

The Most Wonderful or Stressful Time of Year?

ugly sweater

Though known as “the most wonderful time of the year,” a study by Greenberg Quinlan Rosner Research found that people are more likely to feel increased stress during the holiday season. This could be due to increased financial burdens, pressures of gift buying, finding time to attend or host events, and seasonal depression.

When you’re in a stressful situation, your hypothalamus, a tiny region at the base of your brain, sets off an alarm system. Through a combination of nerve and hormonal signals, this system prompts a release of hormones, including adrenaline and cortisol. This causes your heartbeat and breathing to speed up and your muscles to tense.

The body can usually recuperate quickly from a single stressful situation. However, it’s when the condition becomes chronic that it poses a serious health threat, leading to heart conditions, depression, and rapid aging.

Knowing what causes your stress is the first step in fighting it. Then, do what you can to reduce it, or eliminate it completely. No, we’re not saying that you should cancel the holidays, but we are suggesting that you take it easy (see tips on how to manage holiday stress below) and be aware of signs such as fatigue or insomnia, irritability, or just a constant feeling of worry that indicate you may be dealing with stress. Be sure to see your family physician for any evidence of chronic stress.

Full story »

12/17/17

  11:23:00 pm, by MedBen5   , 273 words,  
Categories: Announcements, News, MedBen Employees

MedBen Employees Participate in Families Helping Families Program

Exchanging gifts with friends and family is fun, but sharing with those less fortunate is the true meaning of the holiday season... and once again, the MedBen staff has embraced the spirit of giving.

For 18 years and counting, MedBen has participated in the Licking County (Ohio) Families Helping Families program. Our employees worked together to raise funds and purchase presents, to ensure that the underprivileged children of our community enjoy a special holiday memory.

Families Helping Families

Licking County Job & Family Services (LCJFS), in conjunction with the Salvation Army, has coordinated the Families Helping Families program for four decades. Families Helping Families calls on individuals and groups to donate presents to brighten the holiday season for members of Licking County. Every year, approximately 600 children and 75 elderly community members receive a variety of gifts from anonymous donors.

This year, MedBen employees shopped for 16 children (from lists provided through LCJFS as well as House of New Hope, which helps foster children) ranging in age from seven months to 12 years old. Each child received clothing in addition to toys that were on their “wish list.”

MedBen has proudly partnered with multiple charities and non-profit organizations over the years. In addition to Families Helping Families, we've provided ongoing support to United Way, Food Pantry Network, A Call to College, Big Brothers/Big Sisters, the Midland Theatre and the Licking County Community Health Clinic, to name a few.

MedBen has called Licking Country home since 1938, and we've pleased to be able to assist the people of our community.

Individuals and groups who are interested in contributing to a future Families Helping Families drive are encouraged to contact LCJFS’ Jamie Spangler at 740-670-8736.

  11:14:00 pm, by MedBen5   , 228 words,  
Categories: Announcements, News, MedBen Employees

We're Home For The Holidays, But Still Open Online

wreath

Happy holidays from your friends at MedBen!

Our home office will be closed on Christmas Day, and will reopen at 8:00 a.m. Tuesday, December 26. We will close again on Monday, January 1 and reopen at 8:00 a.m. on Tuesday, January 2, 2018.

While we hope health matters don't interrupt your holiday enjoyment, should you have a question that needs a fast answer, we encourage you to visit us online. MedBen offers a variety of helpful services 24/7!

The MedBen Access website acts as your one-stop service center. Be it an inquiry about the status of a claim, the remaining balance in your FSA, or the cost of a prescription drug, MedBen Access has the information you need 365 days a year!

If you don’t already have MedBen Access bookmarked in your browser, the easiest route there is through the MedBen.com home page. Just click on “MedBen Access” (located on the top right corner of the page), type in your user name and password, and you’re in!

Also keep in mind that MedBen.com offers resources frequently requested by customers, such as a list of FSA-eligible expenses and instructions for reading EOBs. Just select the “Plan Sponsors” or “Plan Members” button on the home page, depending on your specific needs.

Oh, and if you haven't done so already, don't wait any longer to schedule your yearly wellness exam!

Best wishes for your continued health and happiness in 2018!

12/12/17

  04:00:00 pm, by MedBen5   , 256 words,  
Categories: Announcements, News, Privacy, Third party administration, Compliance, MedBen Employees

Fraker to Serve as SPBA Secretary/Treasurer

Caroline Fraker

MedBen Vice President of Compliance & Chief Privacy Officer Caroline Fraker will serve as Board Secretary/Treasurer of the Society of Professional Benefit Administrators (SPBA) for the 2018 year. Fraker joined the board in 2015.

As Secretary/Treasurer, Fraker will keep the minutes of the Board meetings, serve as custodian of certain SPBA records, and ensure that SPBA financial management policies are fulfilled in accordance with Board policy.

Fraker was a member of SPBA well before she was invited to join the Board, going back to when she started at MedBen in 1992. The organization performs an instructive role for third party administrators (TPAs) providing benefit services to private and public groups alike, she said.

“SPBA provides education and support to TPAs, and educates lawmakers on the finer points of health benefits," Fraker noted. "Not in any sort of lobbying capacity, but strictly to ensure they have the information they need to make informed legislative decisions.”

Formed in 1975, SPBA strives to advance the goals of benefits administrators as well as to provide advice that helps members better serve their clients and their clients’ plans. SPBA Board members meet monthly via conference call to discuss issues of importance to the Society’s members and their customers. Board members also host twice-yearly conferences open to all SPBA members, which are preceded by Board-only meetings.

A 30-plus year veteran of employee benefits, Fraker assists MedBen clients with regulatory compliance, contractual and risk management issues. In addition to her SPBA responsibilities, she also serves on the Government Affairs Committee of the Licking County Chamber of Commerce.

12/03/17

  11:18:00 pm, by MedBen5   , 232 words,  
Categories: Cost savings, Third party administration, Self-funding

Flexibility Adds to Self-funding Appeal

MedBen building

With all the uncertainly in the fully-insured market nowadays, it's little wonder that the popularity of self-funding continues to grow. Today, nearly 70% of U.S. employees are covered under employer-funded plans, as more businesses are seeing for themselves the flexibility (and savings) these plans offer.

In its State of the TPA Industry & Forecast for 2018, the Society of Professional Benefit Administrators (an organization on which MedBen Vice President of Compliance Caroline Fraker serves as a board member) projects that "employers will continue to move to self-funding for the ability to design and fully customize health plans that fit their specific work populations."

It is that flexibility, coupled with greater regulatory freedom, that makes self-funding an appealing alternative to groups looking for ways to control health care costs. And when you consider that employers pay only for their actual plan expenses, the choice becomes even more obvious.

In short, self-funding provides multiple avenues for saving employers money... and MedBen is an expert in working with groups to create health plans that take full advantage of these benefits. We help fully-insured groups make a smooth transition to self-funding, and help self-funded groups find additional saving opportunities.

With nearly 80 years of experience in benefits management, MedBen knows the important distinctions that make every group unique. Learn more about our self-funded solutions by visiting MedBen.com or contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

  11:03:00 pm, by MedBen5   , 479 words,  
Categories: Health Care Reform, IRS

“Cash in Lieu of Benefits” Considerations

Capitol-Caduceus-Bills

With many employers updating benefit packages effective January 1st, it is easy to overlook certain basic benefit options. Offering cash in lieu of benefits is a growing trend among employers, especially those considered Applicable Large Employers (ALE) under the Affordable Care Act (ACA). While it is still permissible to offer a cash incentive to employees who opt out of the employer’s group health plan, there are several important things to understand and consider before implementing or renewing such a program.

  • First, remember that any cash benefit provided to an employee will always be taxable. This rule applies no matter what type of cash option arrangement the employer implements. (Note that benefits provided through a Section 125 plan are subject to different rules.)
  • The “cash in lieu” amount must be counted in the affordability calculation determination under the ACA if the opt-out arrangement is deemed “unconditional” by the IRS. An “unconditional” opt-out arrangement is one in which payment is made to the employee based solely on the employee declining the employer’s offer of group health coverage. In this case, the employer must report the opt-out payment in addition to the standard employee contribution amount as that employee’s cost on line 15 of Form 1095-C.
  • If the offer of cash in lieu of enrollment is “conditional,” the amount does not need to be included in the ACA affordability calculation. The IRS defines a “conditional” opt-out amount as a payment made to the employee only if the employee satisfies a specific condition – generally, the requirement to show evidence that the employee is covered under another health plan or other insurance coverage.
  • The cash option cannot be provided by the employer to enable the employee to buy an individual policy either on or off of the Marketplace (Exchange).
  • The cash option must be offered to all eligible employees (or employees who are eligible as a specific class of employees) in the underlying group health plan. Other IRS rules prohibit an employer from applying the cash option to highly compensated employees only or just those with high claims.

Full story »

12/01/17

  08:11:00 pm, by MedBen5   , 256 words,  
Categories: News, Wellness, Cancer, Research, Preventive care

Nearly Half of Cancer Cases Preventable, Study Finds

cancer definition

A new study suggests that nearly half of cancer cases in the U.S. can be attributed to unhealthy habits – habits that could be changed through a focus on wellness and maintaining a doctor-patient relationship.

The American Cancer Society study found that 45% of cancer deaths and 42% of diagnosed cancer cases can be attributed to what the authors call “modifiable” risk factors, such as smoking, poor diet, excess alcohol intake, and prolonged sun exposure.

Cancer rates have dropped in recent decades, due in large part to a drop in cigarette smoking. Even so, the ACS notes that smoking is still responsible for 30% of cancer deaths... and a nationwide spike in obesity has negatively impacted the overall decline.

A wellness program like MedBen WellLiving can play a crucial role in reducing cancer rates. Promoting preventive care through age- and gender-appropriate screenings greatly improves the chance a cancer can be detected and treated successfully. Moreover, the cost difference between treating an early cancer vs. a cancer in its advanced stages can be substantial.

Equally important, WellLiving encourages regular wellness exams with a family doctor. A sustained relationship allows the physician to serve as a mentor, providing advice and a gentle nudge in the right direction should the patient find themselves on a course that could lead to cancer down the road.

We have it in our power to reduce our risk of developing cancer... and MedBen WellLiving can be a valuable ally in the fight. Find our more by contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

11/30/17

  04:48:00 pm, by MedBen5   , 513 words,  
Categories: News, Health Care Reform, IRS

Coming Soon: 2015 Employer Shared Responsibility Penalty Notices

IRS building

What does the IRS do while it awaits the outcome of tax reform? It works on identifying employers that are not complying with the Affordable Care Act’s (ACA’s) employer shared responsibility mandate.

In April, a Treasury Inspector General for Tax Administration (TIGTA) audit revealed that the IRS’ processes to ensure that applicable employers are compliant with the information reporting requirements mandated by the ACA were falling short. Well. that’s all changed.

The IRS has announced that they have begun issuing letters to inform applicable large employers (ALEs) of their potential liability for an Employer Shared Responsibility Payment (ESRP) in late 2017. The IRS determination of whether an employee may be liable for an ESR Payment is based on 2015 calendar year data reported to the IRS on Forms 1094-C and 1095-C during the first quarter of 2016.

IRS “Letter 226J” will notify employers that the IRS believes the employer owes money under the ACA’s Employer Mandate provisions for calendar year 2015. Two forms are included with the letter.

The first form, Form 14764 (Employer Shared Responsibility Payment Response), must be used to respond to the IRS’ inquiries. The other, Form 14765 (Employee Premium Tax Credit (PTC) Listing), lists each full-time employee that was allowed a PTC on his or her tax return for one or more months in 2015 and did not have an affordability safe harbor or other relief reported on such employee’s Form 1095-C. If an employer disagrees with all or a portion of the proposed ESRP, Form 14765 must be returned with the response marked to show corrections to Line 14 and/or 16 codes, as necessary.

Full story »

11/19/17

  11:07:00 pm, by MedBen5   , 275 words,  
Categories: News, Prescription, Wellness, Hypertension, Preventive care

New Blood Pressure Guidelines Add Millions to Hypertension Rolls

blood pressure

Nearly half of U.S. adults are now considered hypertensive, based on revised blood pressure guidelines developed by the American Heart Association and other medical groups. A reading of 130/80 will indicate stage 1 hypertension, a reduction from the previous standard of 140/90.

The new benchmarks mean that that an additional 30 million Americans (103 million overall) are now categorized as suffering from high blood pressure. People in the stage 1 or stage 2 (140/90 or higher) categories have a significantly increased risk of heart disease, stroke, and other cardiovascular conditions.

By lowering the hypertension threshold, family doctors will place an earlier emphasis on preventive care and healthier lifestyles for patients with elevated blood pressure readings.

The change is long overdue, said Dr. Luke Burchard, Medical Director for health care consultant (and MedBen partner) Avande. "The 140/90 threshold for treatment of hypertension never made sense to me, as we have known for decades that compared with 120/80, those patients had significantly more heart attacks and strokes. I've been a 130/80 target guy for years, and that's what I tell patients," he said.

The study authors noted that, despite the sudden surge of Americans considered hypertensive, only 2% of these new people need medication right away. Since nearly 90% of high blood pressure is caused by bad habits, the rest, they say, should go with such tried-and-true remedies as quitting smoking, better diet, and more exercise.

Still, in cases where medication is recommended, plenty of inexpensive generic options are available. "The meds have never been better and cheaper," Burchard said. "It's no more effort, and usually no more cost, to take the higher dose of a blood pressure drug than the lower, less effective dose to get to a target."

  10:50:00 pm, by MedBen5   , 351 words,  
Categories: News, Health Care Reform, Compliance

Labor FAQ Outlines Special Enrollment Guidance

Department of Labor

The Department of Labor (DOL) recently issued another FAQ in its series addressing implementation of the Affordable Care Act (ACA). In addition to guidance on the 21st Century Cure’s Act and other items, the DOL’s FAQ Part 35 focuses on new special enrollment requirements for group health plans.

As most plan sponsors know, group health plans are required to provide special enrollment periods to current employees and dependents when such employees or dependents lose eligibility under another group health plan or health insurance coverage in which the employee or their dependents were previously enrolled, and upon certain life events, such as when a person becomes a dependent of an eligible employee by birth, marriage, or adoption or dependents reach the plan’s limiting age.

DOL FAQ 35 now clarifies that employees and their dependents are eligible for special enrollment in a group health plan if they are otherwise eligible to enroll in the plan and, at the time coverage under the plan was previously offered, they had other group health plan or health insurance coverage (regardless of whether the coverage was obtained inside or outside of a Marketplace) for which they have lost eligibility.

Accordingly, if an individual loses eligibility for coverage in the individual market, including coverage purchased through a Marketplace (other than loss of eligibility for coverage due to failure to pay premiums on a timely basis or termination of coverage for cause, such as making a fraudulent claim or an intentional misrepresentation of a material fact), that individual is entitled to special enrollment in group health plan coverage for which he or she is otherwise eligible. These individuals will be eligible for special enrollment in the group health plan coverage regardless of whether they may enroll in other individual market coverage, through or outside of a Marketplace.

Plan sponsors should check their group health plans to make sure that the plan’s special enrollment provisions include an option for individuals losing eligibility for coverage inside or outside of the ACA Marketplace.

MedBen clients who have questions regarding this requirement are welcome to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or cfraker@medben.com.

While MedBen Closes for Thanksgiving, Online Services Always Open

horn of plenty

As the usual end-of-year festivities ramp up, the staff of MedBen would like to take this opportunity to wish you and yours a fun and stress-free holiday season.

While MedBen pauses to observe Thanksgiving Day, our offices will be closed on Thursday, November 23 and Friday, November 24. MedBen will reopen on Monday, November 27 at 8:00 a.m. EST.

Hopefully, you'll have bigger priorities than health care benefits during the Thanksgiving break... but should a coverage question arise, it's easy to find the answer by using our 24/7 online services.

  • MedBen.com: From the “Plan Sponsors” and “Plan Members” areas, you can view and download a variety of materials, including applications, prescription formularies, FSA/HRA reimbursement forms and provider network directories.
  • MedBen Access: Get detailed information about your health care coverage, such as specific plan benefits and claims status and history.
  • Rx Information: Available through MedBen Access (select the appropriate patient name under “My Rx Claims”), this useful site enables prescription plan members to check their Rx history, get detailed drug information and compare costs between brand-name medications and their generic equivalents.
  • FSA/HRA Online System: Available through MedBen Access (select “FSA/HRA Online Inquiry”), this site enables FSA and HRA members to check account balances, recent claims and payments.
  • Wellness Compliance: Available through MedBen Access (select “MedBen WellLiving”), this page allows MedBen WellLiving program members to check their compliance with recommended exams and screenings, and see when to schedule upcoming visits. (And by the way, don't forget to get your wellness exam before year's end!)

Once again, our very best wishes for an enjoyable Thanksgiving!

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