MedBen Client Satisfaction Survey


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  02:02:00 pm, by MedBen5   , 147 words,  
Categories: News, Wellness

American Heart Association Has Seven Simple Tips For Worksite Wellness

eating healthy

Simple changes can make a major difference in a person's well-being -- and for employers looking to promote a healthier workplace, the American Heart Association has seven messages that are words to live by.

According to Reuters Health, the association has released "Life's simple 7" -- guidelines by which a worksite wellness program can encourage heart health. The messages are: stop smoking, get active, lose weight, eat better, manage blood pressure, control cholesterol and reduce blood sugar.

The messages are targeted specifically to employers because “There are about 155 million working Americans today, that’s about half of our population,” said AHA president Dr. Elliott M. Antman.

“We want to inform people about what heart-healthy living involves and have companies recognized for promoting heart health,” Antman told Reuters Health by phone. “We hope the lessons learned from that environment will be carried home so workers’ spouses and family will benefit as well.”


  02:38:00 pm, by MedBen5   , 203 words,  
Categories: Announcements, News, Prescription, Cost savings

Pharmacy Cost Report Shows How "Middle Men" Can Save Money


Businesses often advertise that they "cut out the middle man and pass the savings on to you." And indeed, sometime that's an effective money-saving strategy. But not always.

Case in point: A new report on cost management for Medicaid pharmacy benefits demonstrates that keeping the "middle men" -- in this case, managed care organizations -- actually resulted in lower costs.

The report by trade association America’s Health Insurance Plans (AHIP) determined that in states in which an MCO manages Medicaid pharmacy costs (that is, benefits are "carved in"), the net cost per was 14.6% lower than the average net cost per prescription in states not carving in pharmacy ("carved out").

Other key findings in the report:

  • The 14.6% differential created a $2.06 billion net savings in state and federal expenditures in FFY2014 for states deploying the carve-in model.
  • The seven carve-out states had a 20% increase in net costs per prescription from FFY2011-FFY2014 — in stark contrast to the 1% increase in net costs per prescription experienced by the 6 states that recently switched from a carve-out to a carve-in model.
  • The seven carve-out states “missed” a total of $307 million in savings in FFY2014 which would have occurred had they used a carve-in model.

Hat tip to the NCPA Health Policy Blog.


  03:39:00 pm, by MedBen5   , 328 words,  
Categories: Wellness

Getting Your Back “Back” on Track

lifting with legs

“Lift with your legs, not with your back.” We’ve all heard it said a hundred times... and for good reason. It’s a smart bit of advice for anyone interested in avoiding a back injury.

Roughly 65 million Americans suffer from back pain, ranking it among the top reasons for physician visits. In addition to muscle strain caused by improper lifting, you can throw your back out of whack through accidents or sports injuries, or simply by carrying excess body weight.

Back pain can take multiple forms, from a steady aching along the spine to a sharp, localized pain. But fortunately, 95% of cases can be treated without surgery.

There are a variety of remedies for back pain available, ranging from heat wraps and massages to adding more vitamin D to your diet. Often, rest and exercise can provide relief, but for more severe cases, physical therapy may be necessary. Opioids, or “painkillers,” are also an option, but such drugs can be highly addictive, so caution must be taken if used.

If you suffer from persistent back pain, review the symptoms with your family doctor and discuss potential fixes. (If you also have numbness in your arms or legs, seek immediate medical help.) Hopefully, together you’ll find a solution that will have you “back” to your healthy self soon!

Full story »


  04:38:00 pm, by MedBen5   , 401 words,  
Categories: News, Health Plan Management, Cost savings

Municipalities Get Benefit Planning Advice At MedBen Roundtable

Municipality Roundtable

Government business representatives gathered on April 16 at the C. Arthur Morrow Conference Center in Newark, Ohio for the 9th Annual MedBen Municipality Roundtable. Through multiple presentations, current MedBen clients were able to see how their plan costs compared to that of other groups in the MedBen municipality block, while clients and non-clients alike were offered proven tips on the best ways to keep their medical and pharmacy plan spending in check.

Among employer groups, municipalities traditionally offer some of the most benefit-rich coverages. Union contracts can mean much lower out-of-pocket costs (and by extension, more frequent use of medical care) for plan members than those in the private sector, which make it a challenge for public employers to keep costs.

Fortunately, by following MedBen recommendations, municipality clients have on average kept their costs well under the national norms. Total MedBen municipality block costs only rose 2.5% from 2013 to 2014. Moreover, the block's five-year trend from 2010 to 2014 was just a 0.5% increase overall.

MedBen University will continue to offer additional roundtable and educational sessions throughout 2015. The following upcoming MBU sessions will also be held at the Morrow Conference Center:

Wellness in the Workplace Thursday, May 14
With client worksite wellness programs in place for nearly a decade, MedBen has gained expertise on how an increased focus on preventive care and lifestyle changes can benefit workplace health and productivity, as well as the employer’s bottom line. We’ll produce useful advice for businesses thinking about implementing a wellness program and share success stories that current wellness clients can adapt to their own programs.

Business Roundtable Thursday, May 28
At this premiere session, employers from a wide range of specialties will get a “big picture” look at the current state of health care planning and learn about the distinctive challenges employers in other fields face. You'll see how plan costs can vary among different industries – and discover how the savings strategies other companies use can benefit your business, too.

For additional information about these upcoming MBUs or to reserve a seat for one, please contact MedBen Sales Analyst Sally Wood at (800) 423-3151, Ext. 502 or

Additionally, MBU will continue to tour the Midwest, co-sponsoring benefits management sessions with MedBen brokers. These are typically invitation-only events for employers in the respective region... so if we haven't made it to your neck of the woods yet, keep an eye on your mail. Chances are good we'll be around there in the near future!


  03:50:00 pm, by MedBen5   , 274 words,  
Categories: News, Prescription

Nationwide Rx Spending Sees Largest Spike Since 2001


For the second time in as many months, a report shows that prescription drug spending spiked in 2014... due in large part to new specialty medicines.

According to WebMD, the report by the IMS Institute for Healthcare Informatics finds that U.S. drug spending jumped 13% last year to nearly $374 billion -- the largest single-year increase since 2001. The authors noted that new drug innovation, higher sticker prices and fewer patent expirations on brand-name medications contributed to the higher spending.

The study's findings echo those of an Express Scripts report released in March.

New drug development can be something of a mixed blessing. While there are many specialty drugs that provide unique or improved therapies, others serve to only combine existing medications at a much higher cost without offering any substantial improvements in care.

One thing is for certain: Specialty drugs are not only contribute to higher pharmacy plan costs, they're one of the main reasons for medical cost increases, period. So if you self-fund your group's health care coverage, you need plan management that pays particular attention to your pharmacy benefits. That's where MedBen comes in. Drug spending for our clients only rose an average of .5% last year.

The MedBen approach to pharmacy plans helps clients keep drug costs in check, by delivering 100% of paid rebates back to the employer and offering superior Rx discount rates. And we work with you to find the proper balance for specialty drug coverage -- ensuring plan members have access to the medicines they need without putting a burden on the company's bottom line.

Learn more about the MedBen Rx approach by contacting Vice President of Sales & Marketing Brian Fargus at


  03:00:00 pm, by MedBen5   , 255 words,  
Categories: News, Health Plan Management

MedBen On Schedule For ICD-10 Transition Deadline


Aesop (the fable guy) warned us that if you cry wolf too many times, the villagers will stop believing you. It's a lesson that is currently being played out by the federal government and a number of physicians and bill payers as the latest deadline for new medical codes approaches... but not MedBen.

Already delayed twice previously by Congress and Health and Human Services, the current implementation date for the ICD-10 family of diagnostic and procedural codes is October 1, 2015. And even though there has been no indication of a third delay, some physicians, payers, and vendors have yet to begin the conversion process, apparently confident that the implementation date will be pushed back yet again.

According to MedPage Today, a survey of more than 1,100 health care professionals from the Workgroup for Electronic Data Interchange found that the most frequently cited reason for not being ready for the ICD-10 conversion is the belief there will be another delay. This despite the fact that if the current date holds, many would be left scrambling to accommodate the new codes.

At MedBen, we're taking no such chances... which is why we're well on track to meet the October 1 deadline. "Our systems are currently compliant with ICD-10 codes," says Wayne Millard, MedBen Director of Data Processing and Technical Compliance.

Millard added that his team will be running connectivity tests with an external vendor and expects no major issues will arise. "The core work is completed," he said.

MedBen clients with questions regarding ICD-10 readiness may contact Millard at


  03:01:00 pm, by MedBen5   , 284 words,  
Categories: News, Wellness, Incentives

An Effective Wellness Program Doesn't Stop With Financial Incentives


Using financial incentives as a carrot to encourage worksite wellness continue to grow in popularity, according to a recent study. But at MedBen, experience has taught us that while an effective promotion tool, monetary perks alone don't sell a wellness program.

Business Insurance reports that 79% of employers participating in the National Business Group on Health and Fidelity Investments survey said they now offer financial incentives to encourage employees to participate in wellness programs. That's up from 74% in 2014.

Employers said they expect to spend an average of $693 per employee on wellness incentive programs this year, up from $594 in 2014 and $430 five years ago. Such incentives can take the form of cash, gift cards, reduced health care premiums or contributions to health savings accounts.

It's worth noting that financial incentives alone are no guarantee of wellness success. Less than half (47%) of employees earned their full wellness incentive amount last year, while 26% earned a partial amount.

MedBen WellLiving agrees that proper use of financial incentives can spur interest in a wellness program. But it's equally important for an employer to demonstrate a personal commitment to wellness that goes beyond dollars and cents.

MedBen recommends that its wellness clients create "champions" for the cause. Executives and managers must show that they're equally engaged in the program's success by being role models. They must also be open to constructive criticism from staff members, be it through feedback forms or an employee wellness committee. In doing so, the program gains credibility and momentum.

A good wellness program understands that the most effective incentives come in many forms. To learn more about the MedBen WellLiving approach to a healthier workplace, please contact Vice President of Sales & Marketing Brian Fargus at


  10:54:00 pm, by MedBen5   , 239 words,  
Categories: Announcements, Prescription

Opioids Misused By 1 In 4 Chronic Pain Patients, Study Finds


A recent study suggests that about one-quarter of chronic pain patients who are prescribed opioids use them improperly, Forbes reports.

According to the International Association for the Study of Pain. 20-30% of opioids prescribed for chronic pain are being misused. The study also concluded that approximately 1 in 10 painkiller users suffer from addiction.

“We find that although opioid misuse (the usage of opioids contrary to medical instructions) and addiction occur in a minority of opiate users, prescribers should closely monitor their patients for signs of these aberrant behaviors,” said study co-author David N. van der Goes, assistant professor in the Department of Economics at the University of New Mexico.

Studies like this underscore the dangers of using opioids, and why such drugs are best prescribed only after other options have been explored. Often, changes to diet, regular exercise and physical therapy can alleviate pain without the need for medications.

At MedBen, we team with pharmaceutical experts who dedicate themselves to keeping clients aware when red flags arise. Our selection of respected PBMs work with employers to track utilization patterns and associated costs of pharmacy plans, and notify physicians when circumstances suggest potential abuse.

For more information about MedBen pharmacy plan services, contact Vice President of Sales & Marketing Brian Fargus at

The Cleveland Clinic recently published an article that explains how opioids work, and some sobering facts about their use. It's well worth a read at the hospital's HealthHub website.


  11:40:00 pm, by MedBen5   , 209 words,  
Categories: Health Care Reform

Obamacare To Cost $800 Billion In Taxes Over 10 Years

There's a well-known adage that goes, "To make money, you have to spend money." And based on the level of taxing under the Affordable Care Act, the Obama administration apparently has a similar adage: "To save Americans money, you have to spend Americans' money."

During the years 2013-2022, the federal government will collect nearly $800 billion through a myriad of individual and business taxes... all in the name of saving Americans money on their health care costs. And as the Heritage Foundation chart below shows, the taxes to be collected in 2015 are less than half of what we'll collectively hand over in just seven years from now:

ACA Taxes

Columnist Alex Rendon observes that the timing of one of the taxes is, shall we say, "convenient":

"Obamacare contains 18 separate tax increases. A few of the biggest include a tax on 'Cadillac' health insurance plans, which doesn’t take effect until 2018, long after President Obama and many in Congress who voted for the tax in 2010 have departed Washington. Also, there is a tax on health insurance premiums and a higher rate on the Hospital Insurance payroll tax for single filers with incomes above $200,000 ($250,000 for married filers) that also applies to investment income."

Read more of Rendon's thoughts at The Daily Signal.

(Hat tip to InsureBlog.)


  04:16:00 pm, by MedBen5   , 242 words,  
Categories: News, Wellness, Cost savings

CDC: U.S. Death Rate From Hypertension Continues To Rise

blood pressure

The overall death rate from high blood pressure continues to rise in the United States, suggests a new report from the Centers for Disease Control and Prevention.

According to HealthDay News, the report found that U.S. deaths linked to hypertension have increased 23% since 2000. Conversely, death rates from all other caused dropped 21% during the same period.

The increase was especially significant for those 45 to 64 years old -- the death rate from high blood pressure in that age range rose 58% for men and 37% for women. Americans aged 85 and over also experienced a spike in hypertension-related deaths.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said, "High blood pressure is a leading cause of heart attack, heart failure, stroke, kidney failure and premature heart-related death."

The connection between hypertension and these deadly conditions demonstrates the importance of knowing what your blood pressure is and, if necessary, taking the proper steps to lower it. MedBen WellLiving takes a two-pronged approach to better health -- an emphasis on preventive care through regular wellness exams and specialized RN coaching for individuals at risk for hypertension and other chronic conditions.

By detecting high blood pressure risk as soon as possible and taking steps to control it, your employees benefit from improved lifestyles, as well as potentially avoiding costly medical bills down the road. To learn more about these and other benefits of MedBen WellLiving, contact Vice President of Sales & Marketing Brian Fargus at


  04:22:00 pm, by MedBen5   , 280 words,  
Categories: News, Health Care Reform

DOL Final Regulations Change Definition of Spouse Under FMLA

Department of Labor logo

On March 27, 2015, the United States Department of Labor’s rules amending the Family and Medical Leave Act’s regulatory definition of spouse became effective. Now, an eligible employee in a legal same-sex marriage will be able to take FMLA leave to care for his or her spouse, regardless of where the employee lives.

For employers, this change means that they must provide FMLA leave for all eligible employees in marriages that were valid in the place in which they were celebrated, whether those marriages are same-sex, opposite-sex, or common law. Prior to the rule change, the definition of spouse was determined based on the employee’s state of residence. Going forward, employers subject to FMLA must recognize same-sex spouses for FMLA leave if the marriage is valid in the state of celebration, regardless of where the employer does business or where the employee resides.

The DOL believes that the final rule’s definition will reduce the administrative burden on employers that operate in more than one state, or that have employees who move between states with different marriage recognition rules because employers will not have to consider the laws of the employee’s state of residence in determining the employee’s eligibility for FMLA leave.

Remember, civil unions are not considered marriages under FMLA. Eligible employees in same-sex civil unions, as well as opposite-sex civil unions, could still take FMLA leave for their own serious health condition, or to care for their child or parent, but they are not be eligible to take spousal leave, since a civil union is not considered a legal marriage.

MedBen clients who have questions regarding this regulation are welcome to contact MedBen Vice President of Compliance Caroline Fraker at


  08:50:00 pm, by MedBen5   , 132 words,  
Categories: News, Health Care Reform

Ohio Lowers Dependent Age Requirement for Self-funded Public Plans

Ohio State Building

Good news for Ohio public employers: Effective March 23, 2015, Ohio revised its dependent age requirement for self-funded public group plans. In effect, the change removes the extension of coverage required by these plan sponsors from “up to age 28” to “up to age 26.” This change brings Ohio law into line with the minimum coverage requirements mandated by the federal Affordable Care Act.

Although the way the law was modified by the legislature leaves some discrepancy between Ohio law and federal law, federal law will supersede Ohio’s.

Any MedBen clients who are Ohio public employers and wish to modify their self-funded plans may do so by contacting their Group Service Representatives. Clients who want more information on this change in Ohio law are welcome to contact MedBen Vice President of Compliance Caroline Fraker at


  08:31:00 pm, by MedBen5   , 203 words,  
Categories: Announcements, News, Prescription, Discounts, Cost savings

MedBen Self-funded Clients See Average 8% Rx Spending Drop In 2014


In 2014, MedBen self-funded clients experienced an overall average 8% DECREASE in pharmacy spending per member per month while most employers were experiencing 12% increases.

Employers who worked with MedBen drove higher generic utilization by aligning employee incentives with the plan. When the employee saved money by choosing a generic or lower cost brand name drug, the plan saved as well.

MedBen also passes along the entire discount for drugs, from brands to generics to single-source generics, to clients. So MedBen self-funded clients who made good benefit decisions were able to reap the rewards from those decisions.

“Most of the national pharmacy benefit mangers keep a drug spread... they contract for prescription drugs at one price and pass along a higher price to clients,” said Kurt Harden, President and COO of MedBen. “That is not our business model. Our clients chose self-funding to have greater control over their costs.

Harden cited the "100% pass-through approach" to pharmacy discounts as a distinctive way that MedBen helps clients save money. "It is one of the reasons our experience beat the market again,” he said.

Get more information about the MedBen Rx Advantage by visiting the MedBen website or contacting Vice President of Sales & Marketing Brian Fargus at


  08:29:00 pm, by MedBen5   , 99 words,  
Categories: Announcements, News

MedBen Tops Columbus Business First Survey

MedBen was recently recognized by Columbus Business First as the region's #1 third party administrator, based on the number of its employees that live in Central Ohio.

According to its annual survey results, MedBen, with 165 of its personnel residing in Licking, Franklin, Perry and surrounding counties, employs over 100 more area workers than the closest competitor.

MedBen is pleased to call Central Ohio (specifically Newark, where its home office is located) home and draw upon the enormous talents of the men and women who live in this area!

The full list is available for viewing at the Columbus Business Journal website.


  09:56:00 pm, by MedBen5   , 276 words,  
Categories: News, Consumer-driven Health Plans, Cost savings

The True Value Of High-deductible Health Plans

weigh in

High-deductible health plans (HDHPs) frequently get a bad rap as a way that employers can shift more health care costs over to employees, or as a deterrent for employees to get needed care. But when used effectively, HDHPs can benefit employer and employee alike.

We'll state right up front than an HDHP should not be seen as a simple fix to give employers short-term relief to rising health care costs. Better that employers focus on long-term savings solutions like those that MedBen provides its clients, including a proprietary claims surveillance system, a 100% return on pharmacy rebates, and actionable reporting tools that help you make intelligent benefit decisions.

According to Modern Healthcare, a study by the nonpartisan National Bureau of Economic Research examined claims data from 54 large U.S. employers and compared those that offered high-deductible options with those that do not. In the three years of data reviewed, researchers determined that 1) annual health care spending was, on average, 4.8% less for companies with HDHPs than those without them, and 2) there were “no differences in either emergency department or inpatient spending” by the end of the third year.

Bottom line, the key to an effective HDHP strategy is smart integration with your total benefits package. Toward this goal, MedBen features a turn-key health savings account (HSA) service that works in combination with your HDHP, balancing employee needs with employer cost considerations. We ensure that your financial interests are addressed while still encouraging plan members to make proper use of their coverage, be it for basic care or major surgery.

For additional information about the advantages of HDHPs, contact MedBen Vice President of Sales & Marketing Brian Fargus at


  09:23:00 pm, by MedBen5   , 507 words,  
Categories: News, Health Plan Management, Health Care Reform, Taxes

Obamacare Celebrates the Big 0-5

White House

Where has the time gone? It seems like only yesterday when President Obama and members of Congress were squabbling about the best way to ensure that all Americans had access to comprehensive and affordable health care coverage. And now here we are, five years to the day since the passage of the Affordable Care Act, and... well, there's still a whole lot of squabbling going on about it. But whatever the future of “Obamacare,” there's no question the law has permanently altered the health care landscape.

For those with individual health insurance, the results have been something of a mixed bag. The ACA has enabled millions of Americans who couldn't afford coverage to buy plans from the federal- and state-run health insurance marketplaces. The Obama administration recently estimated that 16.4 million adults have gained insurance under the law, while the Gallup-Healthways Well-Being Index puts the figure at closer to 10 million – though even that may be high when one factors in individuals who dropped coverage or whose plans were cancelled by their insurer.

Still, not every insured individual is happy about health reform's effects. The expansion of mandatory benefits under ACA rules means that many people who were satisfied with their basic coverage prior to the law's passage have been forced to buy more benefit-rich plans at higher premiums. Also, it remains to be seen how rigidly the IRS will enforce penalties on individuals who choose not to purchase coverage... which could adversely affect premiums for covered individuals in coming years.

Employers have unquestionably taken the biggest financial hit from the law. While most businesses with 50 or more employees already had group health coverage in place prior to 2010, the ACA placed on them new taxes and fees to help cover the costs of marketplace premium subsidies and coverage for high-risk individuals. Additionally, the law has excised caps on lifetime maximums, resulting in an increase of provider claims in excess of one million dollars.

However, the situation is markedly better for businesses that self-fund their group health coverage. While the taxes and fees remain an unpleasant reality, self-funded employers have much greater flexibility in regard to their plan design and range of benefit offerings. Equally important, health benefit managers like MedBen provide additional cost containment tools that can not only offset the new expenses, but can actually help businesses save money.

Moreover, MedBen offers self-funded groups a critical ally – namely, an expert compliance department that keeps a close eye on the latest ACA happenings. We ensure that our clients remain ahead of the latest reform rules, so they're not caught off guard by a new mandate that, if gone unnoticed, could result in costly penalties later.

Learn more about the MedBen Advantage in relation to health care reform by contacting Vice President of Sales & Marketing Brian Fargus at Current MedBen clients who have questions about the ACA are always welcome to ask Vice President of Compliance Caroline Fraker at

The Associated Press, USA Today and the St. Louis Post-Dispatch all feature articles today observing Obamacare's fifth anniversary.


  09:49:00 pm, by MedBen5   , 312 words,  
Categories: News, Wellness, Incentives

Best Wellness Incentives Are Those Backed By Employer Support


More employers are tying wellness program incentives to measurable improvements on the part of plan members, a recent survey found... but such an aggressive approach is not without risk.

According to the poll of 165 U.S. employers by the International Foundation of Employee Benefit Plans, 60% offer some type of health-contingent wellness incentive to their employees. And of those wellness programs that are incentive-based, about half offer financial rewards to employees who complete weight-loss programs, fitness challenges and other health-related activities.

Furthermore. over half of employers offering health-contingent financial incentives tie them to verifiable changes for the better, such as achieving or maintaining a healthy weight, reducing their cholesterol or quitting smoking, the survey revealed. The majority of employer who use this outcomes-based approach report a "somewhat" or "very positive" reaction from employees.

MedBen agrees that incentives can indeed help to motivate employees toward the long-term success of a wellness program. But with our MedBen WellLiving program, we typically advise clients to offer financial rewards for completing annual wellness exams or exercising regularly (to cite two examples), rather than for measures that some employees may consider objectionable.

While taking a more aggressive approach to incentives can give employees an extra "push" to meet wellness objectives, it also can potentially leave employers open to charges of discrimination. To protect themselves from legal liability, businesses must provide alternative goals for members who have physical disabilities.

Our experience has shown that if a company's executive team leads through example and demonstrates continued support for a program's success, employees are more likely to be invested as well. Incentives work best if they're simply one part of a greater overall commitment to better health in the workplace.

To learn more about MedBen WellLiving incentive solutions, contact Vice President of Sales & Marketing Brian Fargus at

Read more about the 2015 Workplace Wellness Trends Survey at the Business First website.


  10:17:00 pm, by MedBen5   , 234 words,  
Categories: Announcements

Specialty Drugs A Major Factor In U.S. Drug Spending Increase


The rise in spending for specialty drugs has contributed to a 13.1% increase in prescription drug spending in 2014, Business Insurance recently reported.

According to the Express Scripts 2014 Drug Trend Report, the overall increase in national drug spending last year was the highest rate in more than a decade. The study included group health claims and Medicare and Medicaid prescriptions.

Utilization of high-cost specialty medications increased 5.8% from 2013, while their costs increased a startling 25.2%. Moreover, these drugs accounted for 31.8% of overall drug spending in 2014, up from 27.7% the year prior. (Express Scripts said in a statement that over half of the rise in overall spending can be attributed to Hepatitis C therapies and compounded medications.)

As we noted last week on our MedBen University post, the overprescribing of specialty drugs can have a detrimental effect on an employer's pharmacy plan costs. MedBen has advised its clients to consider "discretionary drug exclusions" in cases where generic alternatives are available for high-cost brand medications.

While this may seem a drastic measure, excluding a specialty drug from coverage altogether -- instead of, say, requiring the plan member to first meet a deductible (that would like be quickly reached anyhow, leaving the plan to pick up the bulk of the cost) -- makes smart economic sense. In addition to the generic availability factor, many specialty medications have copayment discount cards that members can obtain to reduce the cost of the claim charge if necessary.


  10:06:00 pm, by MedBen5   , 228 words,  
Categories: News, Health Care Reform, Taxes

PCORI Meeting Its Goals, Government Accountability Office Reports

Remember the “PCORI fee," the annual charge all self-funded group health plans must pay to cover the cost of research to improve the delivery of medical care? According to the Government Accountability Office, your tax dollars have so far been properly used... though the administrative costs have run a bit high in the early going.

The Patient-Centered Outcomes Research Institute was established under the Affordable Care Act to promote research into how conditions and diseases can be most effectively diagnosed and treated. As of October 2014, the not-for-profit organization has awarded 360 contracts totaling $670.8 million, and expects to award $2.6 billion in grants by the end of 2019. In its report, GAO concludes that PCORI is operating in accordance with the requirements of the law.

The report also notes that PCORI, which is governed by a 21-member board and employs about 150 staff members, incurred a total of $235 million in administrative costs through fiscal 2014. Administrative expenses accounted for at least 20% of the organization's total budget in 2012 and 2013, though such costs are expected to drop to under 10% this fiscal year.

The (tax-deductible) PCORI fee for the current plan year (ending on or after Oct. 1, 2014 and before Oct. 1, 2015) is $2.08 per covered life. Employers subject to the fee must submit it by July 31 of the year immediately following the last day of the plan/policy year.

You can read more about the GAO report at Modern Healthcare.


  08:32:00 pm, by MedBen5   , 748 words,  
Categories: News, Prescription, Health Plan Management, Health Care Reform, Taxes, Reporting, Cost savings

MedBen University Roundtables Offer Industry Insights, Timely Advice

At MedBen, we are dedicated to giving our clients the information they need to make smart benefits management decision, in part through a variety of education session through MedBen University (MBU). In addition to presentations on such topics as self-funded solutions and wellness strategies, MBU also offers an annual series of roundtables. This week, MBU conducted two of these industry-specific events.

On Tuesday, MedBen and the Sherrill Morgan agency co-sponsored a municipality roundtable in Florence, KY. And this morning, MedBen hosted a hospital roundtable at the company's conference center in Newark, OH. In both instances, attendees learned about the health care cost trends in their respective industries, and saw first-hand how their own group plan costs compared to those of other, similar businesses administered by MedBen.

Brian Fargus

Both municipal and hospital employers have their own distinctive challenges and opportunities in regard to benefit planning. MedBen Vice President of Sales & Marketing Brian Fargus, who presented industry benchmark information at both roundtables, discussed how to use these opportunities to their best advantage.

Because government businesses often provide richer coverage with benefits negotiated through unions, Fargus said those employers need to place a special emphasis on pushing in-network care and including plan language that minimizes the employer's financial risk. Hospital employers, on the other hand, can keep medical and pharmaceutical costs down by taking advantage of their unique circumstances, by steering plan participants to their own facility for care and prescription fulfillment.

Fargus noted in both his presentations that the respective industries have also kept cost increases in check through such strategies as waiving coverage for spouses who have insurance and emphasizing wellness.

At the hospital roundtable, Fargus also observed that the elimination of lifetime maximums under the Affordable Care Act has led to a huge upswing in provider claims exceeding $1 million. "It underscores the importance of having a good stop-loss carrier," Fargus said, as well as finding other avenues for controlling costs.

Full story »

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