MedBen Client Satisfaction Survey


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  07:08:00 pm, by MedBen5   , 355 words,  
Categories: Wellness

Wellness Exam More than Just Disease Detection


Every few months, it seems another article comes out that questions the value of the annual wellness exam. At MedBen, we're convinced of their usefulness – and for reasons that go beyond early detection of chronic conditions.

In the latest contribution to the ongoing debate, The Wall Street Journal approaches the issue from both sides. On the one hand, some members of the medical community consider regular physicals "a waste of health-care resources" that doesn't reduce incidences of illness. Conversely, others find the yearly checkup to be "an important part of building a physician-patient relationship" that can lead to unexpected diagnoses.

Regardless of where one stands on the question of annual wellness exam in regard to detecting disease – and MedBen has seen first-hand how they can benefit the long-term health of a patient – there are other benefits that justify its time and cost:

Building a comfort zone. By developing and maintaining a doctor-patient relationship through a yearly checkup, both parties tend to feel more comfortable about talking openly regarding areas of concern.

Getting the big picture. Regular visits with the same doctor raises the likelihood of detecting crucial health changes – not just physical, but emotional and mental as well.

Greater accountability. If you've gotten into some unhealthy habits, the wellness visit is the perfect opportunity to redirect your efforts. Moreover, the simple knowledge that your doctor expects you to be accountable for your lifestyle choices can serve as a motivation to improve.

Focused testing, focused dialogue. Doctors use evidence-based guidelines for age and gender, so the wellness visit focuses on the tests that are of greatest use to the patient. And the concurrent conversation serves an equally valuable purpose – namely, to determine through testing and dialogue where the patient may be at risk.

MedBen WellLiving emphasizes doctor office testing over health risk assessments and on-site screenings. Annual wellness visits give the patient a true incentive to make positive changes – a key to continued good health and lower care costs.

Learn more about the MedBen WellLiving approach to your employees' better health by visiting or contacting Vice President of Sales & Marketing Brian Fargus at


  11:45:00 pm, by MedBen5   , 370 words,  
Categories: News, Health Care Reform

Marketplace Enrollments Up, But Not All News Good


The latest open enrollment period for individuals who wish to enroll in the federal health insurance marketplace ends on January 31. According to federal officials, over 11 million people have enrolled, surpassing last year's mark as well as the 10.5 million goal that the Obama administration set for the year.

However, while the number of people getting private health insurance under the Affordable Care Act looks impressive, it fails to take into account the trouble that's brewing underneath the surface:

Younger, healthier adults have been slow to sign up for coverage. The Wall Street Journal reports that only 26% of people who have enrolled in the federal marketplace are ages 18 to 34 -- well short of the 40% goal set by actuaries when the marketplaces were rolled out in 2013.

Many people who have coverage through the marketplace spend a substantial portion of their income on health expenses. According to a new study, even individuals with subsidies to make coverage more affordable are paying more on premiums, deductibles and other out-of-pocket payments than was originally predicted -- anywhere from 10% of their income to upwards of 25% for those with significant medical needs.

More insurers may leave the marketplace soon. One of the nation's major health insurers recently threatened to drop out of the federal and state marketplaces in 2017, citing lower-than-promised enrollment and high usage. Several smaller insurers already have dropped out or announced their intentions to leave if the financial situation doesn't improve.

On the Health Care Policy and Marketplace Review blog, health policy consultant Bob Laszewski recently offered his two cents on the 2016 outlook for Obamacare... and he says it's not just young people who need to enroll in the marketplaces to help them succeed:

"I worry more about the really poor take-up rates for the healthy people who have not signed up in the 200% of federal poverty level and above brackets than I worry about the percentage of the young who have signed up. Way too much emphasis is put on this age 18-to-35 statistic. Yes, they are more often healthy but under Obamacare the youngest pay one-third the premium of the oldest. We really need the healthy to sign up in much bigger numbers, that have so far been holding out, more than we need the young."


  08:56:00 pm, by MedBen5   , 575 words,  
Categories: News, Wellness, Health Plan Management, Cancer

Task Force Raises Recommended Mammography Age; MedBen Continues with Current Recommendations

pink ribbon

In spite of the latest change in the U.S. Preventive Services Task Force guidelines for mammography screenings, MedBen is keeping its current screening recommendations in place.

On January 11, the USPSTF released final guidelines regarding the age range and frequency of breast cancer screenings. Affirming a draft circulated last year -- and echoing preliminary guidelines offered back in 2009 -- the panel advised that screening mammograms are most effective for women ages 50 to 74, performed every two years.

Under the Affordable Care Act, the USPSTF language becomes a "B" preventive care recommendation, which means that group health plans must cover mammograms at full cost in accordance with the new guidelines. Additionally, Congress last month extended a law requiring health insurance companies to pay for annual mammograms for women in their 40s if their doctor recommends earlier screenings.

As concerns about false positives and unnecessary biopsies have arisen in the past few years, questions about the ideal age to start getting mammograms have increased accordingly. Last October, the American Cancer Society (ACS) revised its own guidelines, raising the minimum starting age from 40 to 45 and recommending annual mammograms from ages 45 to 54, and then every other year from age 55 until an age where life expectancy is ten more years.

At MedBen, our WellLiving program recommends that women start getting mammograms at age 40 every two years until their physician decides not to order the screening -- and we are continuing that recommendation. Further, we recommend that clients continue paying 100% of the cost of these screening mammograms as part of the WellLiving benefit, even in light of the USPSTF's final guidelines.

Full story »


  10:44:00 pm, by MedBen5   , 346 words,  
Categories: News, Wellness, Incentives

Employers More Invested in Wellness Incentives

blood pressure

"In it to win it"... it's a phrase frequently uttered by everyone from pro athletes to reality show contestants. And increasingly, the same philosophy applies to employers that offer wellness programs as well.

According to BenefitsPro, a recent survey of human resources professionals found that from 2010 to 2015, the median financial incentive for participation in certain health programs nearly tripled, from $150 to $400. The largest incentives are tied to getting annual wellness exams and screenings and tracking physical activity, both of which paid plan members a median of $100 – typically through reductions in premiums and contributions to member health accounts.

More employers tie incentives to participation (47%) than health outcomes (34%), while 18% use a combined criteria. As for how employers measure the success of their wellness program, 35% base it solely on member participation (down from 55% in 2010) and 17% consider "employees’ attitudes toward health and recognition of the importance of healthy living."

It's probably not a coincidence that wellness incentives have risen since the 2010 passing of the Affordable Care Act, which allows employers to offer bigger rewards. But it's obviously important to use the incentives wisely, to realize the maximum return on investment, in terms of employee satisfaction in addition to long-term monetary savings.

Through its WellLiving offering, MedBen has extensive experience in helping clients design wellness programs that provide support through financial rewards. We can help your business develop an incentive program appropriate to plan member needs – complemented by actionable reporting that not only demonstrates the overall progress of your program, but shows in pure dollars-and-cents whether or not the plan is benefiting you financially as well.

Moreover, our incentive recommendations are backed by a knowledgeable Compliance team that can advise on the legalities of the incentives, and offer guidance on ways to ensure that such incentives are equitable for everyone.

A strategic and educated approach to incentives can elevate a wellness program from a simple "perk" to a force for real and lasting change. To learn more abour how MedBen WellLiving can benefit both employee health and the bottom line, contact Vice President of Sales & Marketing Brian Fargus at


  10:15:00 pm, by MedBen5   , 304 words,  
Categories: News, Health Care Reform

President Obama Vetoes Bill to Repeal ACA

White House

It's official: The president has shot down an attempt to scrap the Affordable Care Act.

To the surprise of absolutely no one, on January 8 President Obama vetoed a bill to repeal the health care reform law, saying that it "would reverse the significant progress we have made in improving health care in America."

The legislation, and Obama's anticipated response, was largely a symbolic action in a presidential election year. Unlike earlier repeal efforts that passed in the Republican-led House but stalled in the Senate (also with more GOP members, but lacking a sufficient majority to pass such bills through regular votes), this time Republicans pushed legislation through both Houses by using the process of budget reconciliation that prevented a filibuster by Senate Democrats. The process demonstrated that with a Republican president in office, a repeal of the ACA is possible.

Obama's veto was only the eighth of his presidency, and Congressional Republicans don't have enough votes to override the president. Still, GOP members consider it a victory.

“This vote sends the signal to the president and the American people there are changes that need to be made in this law.” said Bill Hoagland, senior vice president of the Bipartisan Policy Center in Washington and a former longtime Republican staff member on the Senate Budget Committee. He did also note, however, that among Republicans “there is a recognition that you may not do away with a number of the provisions that are popular.”

Sylvia Mathews Burwell, the Secretary of Health and Human Services, expressed incredulity at the Republicans' actions. “We are in the final weeks of Open Enrollment for 2016 under the Affordable Care Act and saw unprecedented demand for January 2016 coverage. Yet at the same time, we continue to see efforts to repeal the ACA and turn back the clock,” she said in a statement.


  10:37:00 pm, by MedBen5   , 224 words,  
Categories: MedBen Analytics, Bundled Payments

MedBen Analytics Bundled Payment Webinars Offer Final Rule Analysis, Practical Advice

Last month, MedBen Analytics offered several bundled payment webinars to hospital administrators whose facilities will soon take part in a mandatory Comprehensive Care for Joint Replacement (CJR) program. The presentation from December 17 is now available for viewing below, and also at the new MedBen Analytics YouTube page.

Entitled "Understanding the Final Rules: Comprehensive Care for Joint Replacement," the webinar offers attendees an overview of value-based payments and a professional analysis of the CJR rules. The Centers for Medicare and Medicaid Services (CMS) will start the mandatory CJR program for selected health systems in April 2016.

Additionally, webinar co-presenters Kurt Harden, President and COO of MedBen Analytics, and Kimberly Hartsfield, Vice President of GE Healthcare Camden Group discuss practical next steps for best ensuring success in the CJR and insights for key savings opportunities. Attendees also are given an opportunity to assess hospital-specific historic performance.

MedBen Analytics will be conducting additional bundled payment webinars throughout 2016. Hospital, health system and physician group administrators who would like to be added to the webinar invite list are welcome to contact MedBen Sales Analyst Sally Wood at

Administrators that are interested in an analysis based on the lower joint replacement services using the Medicare Limited Data Sets for 2014 are welcome to contact Harden at 888-633-2364 or We also invite you to visit the MedBen Analytics website for additional information.


  09:24:00 pm, by MedBen5   , 293 words,  
Categories: News, Health Care Reform, Reporting, IRS

Affordable Coverage Threshold for ALEs Higher in 2016

A reminder for the 2016 plan year: The threshold for Applicable Large Employers (ALEs) – that is, those with 50 or more full-time employees – to determine whether or not the contributions they charge their employees for health coverage is affordable under Affordable Care Act rules has been raised to 9.66% of an employee's household income. This is a slight increase from last year's 9.56% threshold.

IRS Form 1095-C

As ALEs likely wouldn’t have access to employee household incomes, they can instead use any of three government-approved affordability "safe harbors":

  • 9.66% of the employee’s W-2 wages;
  • 9.66% of the employee’s rate of pay; or
  • 9.66% of the federal poverty line.

Once an employer determines that the contribution for coverage is affordable, that information must be noted on Line 16 of IRS Form 1095-C to avoid a financial penalty. You can learn more about applicable safe harbor codes by watching this segment from MedBen's recent ACA Reporting Workshop

Again, providing this information applies only to businesses with 50 or more full-time employees, so it's important to have an accurate employee count – particularly if you're on the under-50 "bubble." Accurately counting both your full-time and part-time employees will make a difference in which parts of health care reform apply to you and your health care plan. And, making this determination is required each calendar year using the prior calendar year’s employee information.

Rather than relying on outdated information, MedBen encourages clients to perform a new employee count every plan year. To assist with this task, we recently prepared a Determination of ALE document, which is available for download at

Clients who have questions regarding their full-time and full-time equivalent employee count, or who would like to inquire about IRS Form 1095 reporting services available through MedBen, are welcome to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or


  09:18:00 pm, by MedBen5   , 252 words,  
Categories: News, Prescription, Cost savings

While U.S. Drug Spending Jumps, MedBen Rx Controls Costs


Government numbers indicate that prescription drug spending in the U.S. will likely continue to spike in the coming years... but MedBen is helping its clients to buck the trend.

According to a recent analysis by the Centers for Medicare and Medicaid Services, Americans spent $297.7 billion on prescription drugs in 2014. That marks a 12% jump from the prior year, the largest annual increase in more than a decade. Moreover, federal officials estimate that yearly spending on medications will grow 6.3% on average through 2024.

The growing popularity of expensive specialty drugs, and rising medication costs in general, have contributed to the spurt in spending. But there is a silver lining: An analysis by the prescription drug price comparison site GoodRx revealed that in 2015, many of the most popular generic drugs went down in price, continuing a decade-long trend.

In 2014, MedBen clients saw their pharmacy plan spending rise just an average of 0.5%. A large part of the savings comes from simply returning to groups what is rightfully theirs – 100% of pharmacy rebates go back to the client.

Further, MedBen has for many years encouraged the use of generic drugs to save pharmacy plans money – on average, clients receive a 77.4% discount on retail generics. And we help to keep specialty drug costs manageable by working with groups to balance plan member needs with bottom line considerations.

Even in a climate of soaring prescription drug costs, the MedBen Rx Advantage works. To learn how we can benefit your business, contact Vice President of Sales & Marketing Brian Fargus at


  03:49:00 pm, by MedBen5   , 287 words,  
Categories: Announcements

A Note from Our Chairman

To our customers, consultants and brokers:

Hard though it may be to believe, yet another year has seemingly flown by. And before we close the book on 2015, we wanted to take a moment to wish you a Happy Holiday season on behalf of the entire MedBen staff!

Much like every year since the passage of the Affordable Care Act, 2015 has brought with it its own set of unique challenges, which will impact all of us in the months and years to come. But as often happens, these challenges have spurred MedBen into finding better ways of serving you – with improved technologies, more detailed reporting, and most importantly, new (or improved) ways of helping clients to save money.

Additionally, while we focus most of our energies on serving our self-funded employer block, MedBen continues to expand its service offerings. This year we formally introduced MedBen Analytics, LLC, which provides bundled payment solutions to health care systems. While this new service is designed specifically for hospitals and physician groups, some of the innovations we've developed in its conception will likely find applications in other areas of our business as well.

Once again, MedBen extends its warmest wishes for the holidays and sincere hopes for a prosperous new year. And remember, if you ever have anything on your mind – be it a question, comment or suggestion – we encourage you to call either of us anytime. We'll be happy to talk with you.


Doug Freeman

Chairman & CEO

Kurt Harden
President & COO

A quick reminder: MedBen will be closed on Friday, January 1 and reopen on Monday, January 4. Should you have a claims or benefits question, please visit MedBen Access. Our online customer service center is available 24/7 for your convenience!


  04:21:00 pm, by MedBen5   , 300 words,  
Categories: Prescription, Wellness, Cancer

Wellness, Not Drugs, Best Strategy for Cancer Prevention

cancer definition

Not that you really need another reason to preach the importance of timely cancer screenings and preventive care in general, but here's one anyway, via The New York Times:

"Most people would agree that it would be better to prevent cancer, if we could, than to treat it once it developed. Yet economic incentives encourage researchers to focus on treatment rather than prevention.

"The way the patent system interacts with the Food and Drug Administration’s drug approval process skews what kinds of cancer clinical trials are run. There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months than in drugs that would prevent cancer in the first place."

The article goes on to note that the "commercialization lag" – the length of time between receipt of a patent and FDA approval – discourages the development of drugs that require longer clinical trials to see results. So it's not surprising to learn that in the past four decades, there have been over 17,000 trials of patients with the lowest chance of survival, but only 500 for cancer preventions.

For patients, this suggests that it's better to be proactive about cancer prevention than hold out hope for a miracle drug. And prevention begins with healthy lifestyle choices backed by regular physician visits and appropriate testing.

MedBen Worksite Wellness encourages plan members to take advantage of free cancer screenings. Based on age and gender, we recommend getting a colonoscopy, mammography and Pap smear, as well as an annual wellness exam and cholesterol test.

Plan members can also check their compliance with critical wellness examinations by visiting the MedBen Access website and clicking on the "MedBen WellLiving" link under “My Plan”. To learn more about MedBen Worksite Wellness, contact Vice President of Sales and Marketing Brian Fargus at


  07:14:00 pm, by MedBen5   , 430 words,  
Categories: Announcements, News, Health Care Reform, Reporting, IRS

IRS Extends Employer Health Coverage Reporting Deadline

IRS building

On December 28, the IRS announced they have extended the deadlines for employers to file their 1094 and 1095 reporting forms for the 2015 tax year. This marks the second delay for these reports, which were originally to have been filed in early 2015.

The forms serve as verification to the IRS that employers are providing minimum essential coverage to their employees, in accordance with Affordable Care Act rules. Applicable Large Employers (those with 50 or more employees) must report using the IRS’ C-series forms and small employers offering coverage (those with fewer than 50 employees) must report using the IRS’ B-series forms.

The revised deadlines are as follows:

Filing Requirement Previous Deadline Extended Deadline
Sending 1095C forms to their Employees (if a large employer with 50 or more employees) or 1094B (if a self-funded small employer with fewer than 50 employees) February 1, 2016 March 31, 2016
Submitting 1094C transmittal with copies of 1095C (if a large employer with 50 or more employees) or 1094B transmittal with copies of 1095B (if a self-funded small employer with fewer than 50 employees) to IRS if not filing electronically February 29, 2016 May 31, 2016
Submitting 1094C transmittal with copies of 1095C (if a large employer with 50 or more employees) or 1094B transmittal with copies of 1095B (if a self-funded small employer with fewer than 50 employees) to IRS if filing electronically March 31, 2016 June 30, 2016

Additionally, the IRS will provide transitional relief to specific employees whose eligibility for tax credits under exchange coverage may be affected by their failure to receive their 1095B or 1095C forms prior to filing their individual returns for the 2015 tax year due to this extension.

The IRS still encourages employers to complete form distribution and filing as soon as possible, and will be prepared to accept these returns starting in January. Because of these extensions, other tax extension provisions that apply to other returns will not apply to these returns.

Please note that if your group is getting health coverage data reporting services through MedBen, this delay will not affect your ability to prepare the 1095 forms under your current timetable. If you haven't purchased these services through MedBen but would like to do so or want more information, please contact Vice President of Compliance Fraker at 800-851-0907 or at your earliest convenience.

One more reminder: If you're interested in learning more about the particulars of Form 1094-C and 1095-C reporting, we encourage you to visit the MedBen TPA YouTube page and view the videos from our recent ACA Reporting Workshop.

The formal information reporting extension notice is available to review on the IRS website. You can also read more about the deadline extension at the Health Affairs Blog.


  08:17:00 pm, by MedBen5   , 211 words,  
Categories: News, Prescription, Wellness

Study Recommends Revising Threshold for Prescribing Blood Pressure Meds

blood pressure

If you've been putting off getting your blood pressure under control because it's "not too high," new research suggests that you talk to your family doctor about medication options... particularly if you're at high risk for a heart attack or stroke.

According to HealthDay News, based on a review of 123 studies conducted between 1966 and 2015, researchers concluded that every 10 mm Hg drop in systolic blood pressure (the top number in a blood pressure reading) achieved through medication reduces heart disease risk by as much as one-fifth.

Current guidelines recommend starting medication when readings reach a threshold of 140/90 mm Hg for non-elderly individuals, and 150/90 for the elderly. "Our findings clearly show that treating blood pressure to a lower level than currently recommended could greatly reduce the incidence of cardiovascular disease and potentially save millions of lives if the treatment was widely implemented," lead author Kazem Rahimi said in a Lancet news release.

"The results provide strong support for reducing systolic blood pressure to less than 130 mm Hg, and blood pressure-lowering drugs should be offered to all patients at high risk of having a heart attack or stroke, whatever their reason for being at risk," Rahimi, the deputy director of The George Institute for Global Health at the University of Oxford in England, said.


  09:02:00 pm, by MedBen5   , 254 words,  
Categories: Announcements, Prescription, Wellness, Consumer-driven Health Plans, Online Services, Client Services

Holiday Hours... and a Few Reminders


The staff of MedBen wishes you all the best for the holiday season and the new year!

MedBen will close at Noon on Thursday, December 24, remain closed on Christmas Day, and reopen at 8:00 a.m. on Monday, December 28. For the New Year’s holiday, we will be open regular hours on Thursday, December 31, closed on Friday, January 1, and reopen at 8:00 a.m. on Monday, January 4.

Remember that if you need assistance with your health plan when MedBen is closed, the MedBen Access website is your one-stop customer service center. Be it a question about the status of a claim, benefit coverage specifics, or the cost of a prescription drug, MedBen Access has the information you need any time of the day or night – even on major holidays!

If you don’t already have MedBen Access bookmarked in your browser, the easiest route there is through the 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!

Another reminder, specifically for those groups with flexible spending accounts (FSAs): Depending on your plan design, you may need to use any remaining funds by December 31. Fortunately, there are multiple ways in which you can sensibly spend your FSA dollars – to view a list of eligible expenses, visit, click on either the “Plan Sponsors (Employers)” or “Plan Members (Insureds)” button, and select “IRS-Eligible Expenses” from the “Additional Resources” drop-down menu.

Finally... if you haven't gotten your wellness exam this year, please schedule one today!


  10:55:00 pm, by MedBen5   , 328 words,  
Categories: Announcements, News, Health Care Reform, Taxes, Cost savings, IRS

Cadillac Tax Delayed Until 2020

White House

As was widely expected, on December 18, President Obama signed into law the Consolidated Appropriations Act of 2016 -- an omnibus spending and tax package that included in its amendments a two-year delay of the Affordable Care Act’s (ACA's) "Cadillac" tax. The measure was fast-tracked, making it though both houses of Congress and onto the President's desk in less than a week.

The Associated Press reports that employer groups applauded the excise tax's delay and expressed hope for its eventual repeal. “A delay is great, repeal is even better,” said Steve Wojcik, vice president of public policy for the National Business Group on Health. “It’s a pretty onerous tax.”

As MedBen has advised clients since ACA's passage in 2010, every aspect of the health care reform law is subject to change, delay or repeal. And we believe the best self-funded plan strategy is taking sensible measures to keep health care costs as low as possible while working with our compliance team to ensure that the rules as they currently stand are being followed.

Even though the Cadillac tax will no longer take effect until at least 2020, MedBen still advises its clients continue to make whatever adjustments to their benefits necessary to manage health care plan cost increases. While it may be impossible to reduce costs to below the minimum dollar threshold at which the tax would kick in, any and all efforts will affect the plan’s liability.

The Cadillac tax is calculated using a health plan’s applicable COBRA rates, which, in turn, are based upon a health care plan's claim experience. Reducing this rate slows down your cost trend, better enabling you to remain under the minimum threshold.

MedBen can help clients determine their probability of being subject to the Cadillac tax. We will run your current COBRA rates through our modeling software so you can see your potential tax liability and provide an estimate of the penalty.

For additional information, please contact MedBen Vice President of Compliance Caroline Fraker at


  10:01:00 pm, by MedBen5   , 248 words,  
Categories: Wellness, Cost savings

Holiday Reminder: Wellness Compliance Knows No Season

wellness compliance

As the year winds down, thoughts of personal wellness sometimes take a back seat to holiday parties and other seasonal indulgences. But wellness is important regardless of what the calendar says, and not only for health considerations... depending on your health care plan, it may save you money as well.

Many employers that offer worksite wellness programs use financial incentives to encourage plan members to practice healthy lifestyles -- among the most popular being reduced premiums for getting an annual wellness exam. So if your program offers this incentive and you haven't gotten checked out yet or scheduled your 2016 exam, don't delay any longer!

Not exactly sure when you last got a wellness exam? If you're a member of the MedBen WellLiving program, you've got an easy way of staying on top of it -- wellness compliance updates through our MedBen Access site. This exclusive, personalized service allows individuals to see the date of their last exam and the suggested date for their next one, as well as other tests they may need based on age and gender.

To see your current wellness compliance status, just go to and click on "MedBen Access." Once you've logged in, select "MedBen WellLiving" from the side menu.

And remember, wellness compliance information is one of the many convenient features found on MedBen Access. Users can also check claims status, review their coverage benefits, download explanations of benefits, and more.

This concludes our wellness reminder... we now return you to your holiday frivolity.


  10:57:00 pm, by MedBen5   , 229 words,  
Categories: News, Prescription, Cost savings

Employers Take Measures to Reduce Specialty Drug Spending

pills and mortar

Employers are increasingly looking to control pharmacy plan costs by limiting their responsibility for specialty drugs, a new Towers Watson survey reveals.

“Although pharmacy represents approximately 20% of employer-sponsored medical benefits costs, it is increasing at a rate that accounts for roughly half of medical cost inflation and should be a top priority for employers,” stated Eric Michael, U.S. central division pharmacy leader for Towers Watson. “The price, utilization and delivery of specialty prescription drugs, many of which require special handling or delivery, are a top pain point for employers. Frustrated by their lack of success in controlling these growing costs, employers are beginning to consider new aggressive approaches.”

Drug Store News reports that, according to the survey, 53% of employers have added new coverage and utilization restrictions for specialty pharmacy, such as requiring prior authorization or limiting quantities based on clinical evidence.

MedBen has seen first-hand how specialty drugs can spike pharmacy plan costs, which is why it has advised clients to consider "discretionary drug exclusions" in cases where generic alternatives for high-cost brand medications are available. Should the patient or doctor still prefer to use an excluded drug, they can often obtain copayment discount cards to reduce the cost of the claim charge.

For additional information about how MedBen can help your business control costs on specialty pharmacy, contact Vice President of Sales & Marketing Brian Fargus at


  10:45:00 pm, by MedBen5   , 241 words,  
Categories: News, Health Care Reform

Two-Year Reprieve for Employers on the Cadillac Tax?

Capitol Building

If the growing chorus in Congress gets its way, the Cadillac tax on high-end insurance plans, currently scheduled for take effect in 2018, could be pushed back to at least 2020. Earlier this week, House Ways and Means Committee Chairman Kevin Brady (R-Tx.) released a two-year "tax extenders" bill as a back-up plan in case Congress and the White House are unable to reach an agreement that makes some tax breaks permanent.

Under the Affordable Care Act, the Cadillac tax -- so named because it penalizes (purportedly) "rich" benefit packages -- will impose a 40% excise tax on individual health plans worth more than $10,200 and family plans worth more than $27,500. But opposition to the measure has seen a steady increase in Congress, and not just among Republicans opposed to the ACA. Democratic leaders in both houses have favored its repeal, as well as presidential candidates Hillary Clinton and Bernie Sanders.

Backers of the tax counter that the projected $91 billion in revenue created by the tax over the next decade is essential to funding health care reform. “A two-year delay, I’m concerned, turns into a permanent delay,” said Sen. Mark Warner (D-Va.). And the Obama administration has repeatedly said that the president would veto any legislation favoring a repeal.

The medical device tax, also an ACA provision, could see a similar two-year delay.

Read more about the “tax extenders” bill and the current state of the Cadillac tax at Modern Healthcare and The Hill (here and here).


  05:07:00 pm, by MedBen5   , 200 words,  
Categories: Announcements, Health Care Reform, Reporting, IRS

ACA Reporting Workshop Videos Available On MedBen TPA YouTube Page

A collection of videos from MedBen's recent Affordable Care Act Reporting Workshop is now available on the MedBen TPA YouTube page. The videos offer in-depth information about how Applicable Large Employers (ALE) can comply with IRS reporting requirements as well as line-by-line advice on completed Forms 1094-C and 1095-C.

Videos can be accessed either through the main MedBen TPA page, or individually using the links below (listed in order of presentation):

A reminder: Form 1095-C must be provided to employees by February 1, 2016, and Form 1094-C to the IRS no later than February 29. But don't panic... it's not too late to get data reporting services through MedBen! If you would like more information, please contact Vice President of Compliance Fraker at 800-851-0907 or


  10:52:00 pm, by MedBen5   , 405 words,  
Categories: News, MedBen Analytics, Bundled Payments

MedBen Analytics Co-hosts Bundled Payment Webinar

Kurt Harden, President and COO of MedBen Analytics, and Kimberly Hartsfield, Vice President of GE Healthcare Camden Group, shared presenting duties during a bundled payment webinar on Thursday, December 3. A video of the presentation can be viewed below, and is also available at the new MedBen Analytics YouTube page.

Entitled "Understanding the Final Rules: Comprehensive Care for Joint Replacement," the webinar was offered to hospital administrators whose facilities will soon take part in a mandatory Comprehensive Care for Joint Replacement (CJR) program that the Centers for Medicare and Medicaid Services (CMS) will start in April 2016.

The CJR initiative was launched on the heels of the voluntary Bundled Payment for Care Initiative (BCPI). In her comments, Hartsfield noted that the BCPI has "reduced readmissions over 1% in the last four years, which has led to many saved lives and many saved dollars."

Hartsfield added that the CJR initiative, which would make hospitals financially accountable for most post-acute care delivered 90 days following hospital discharge, probably won't end with joint replacement care: "CMS is intent to do this with other procedures as well," most likely cardiac treatments.

Harden observed that the greater responsibility gives rise to a need for better analysis and reporting that allows hospitals to address readmissions, lengths of stay and other cost-oriented variables. "When you think about reporting for CJR, we always say 'begin with the end in mind' and what would success look like," Harden said. "Analytics should measure that which you wish to improve."

During his presentation, Harden demonstrated aspects of MedBen Analytics' proprietary analysis and reporting program, which turns Medicare claims data into actionable insights necessary to improve services. One feature he noted as particularly useful is the ability to "drill down" to claim level detail.

"It's important that you are able to quickly ascertain... the reason for the cost, so you might want to drill down even further and look at other things," Harden said.

MedBen Analytics and GE Healthcare Camden Group are offering additional webinars on Tuesday, December 15 and Thursday, December 17, both scheduled from 1 to 2 p.m. Hospital administrators interested in participating in either of the events may contact MedBen Analytics Sales Analyst Sally Wood at 800-423-3151, Ext. 502 or

Hospital administrators that are interested in an analysis based on the lower joint replacement services using the Medicare Limited Data Sets for 2014 are welcome to contact Harden at 888-633-2364 or We also invite you to visit the MedBen Analytics website for additional information.


  10:37:00 pm, by MedBen5   , 336 words,  
Categories: Wellness

Protect Yourself This Flu Season

flu check-in

With the cold and bitter air driving people indoors comes the cold and bitter flu season. Characterized by a high fever, runny nose, and total body aches that could last for weeks, the flu is a dangerous illness that affects up to 20% of the U.S. population each year. Seeing that we are already well into the flu season, which started in October and could last until May, isn’t it time you made sure you were protected?

MedBen WellLiving supports the advice that individuals 6 months and older should receive a flu vaccination. With the influenza virus constantly mutating, the vaccinations are continuously updating. Due to this, a new vaccination should be received each year.

Scared of needles? That’s okay – vaccinations come in an array of administration options, including a nasal spray for those ages 2-49. Another method includes an injection to the skin rather than the muscle, utilizing a smaller needle.

MedBen WellLiving recommends a visit with your family physician to discover which options are best for you. You may even be able to get the vaccination at your annual wellness visit, if you still haven’t made it to that appointment yet. Keep in mind that the vaccination takes about two weeks to become effective, so the sooner you make an appointment, the sooner you’re protected from the harsh symptoms of the flu.

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