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  04:20:45 pm, by MedBen5   , 164 words,  
Categories: Announcements, Discounts, Health Plan Management

MedBen Cost Containment Saves Clients Over $7 Million

MedBen Cost Containment Sample Case Study

The savings keep on coming!

Since introducing new claims cost containment measures in September of 2007, MedBen has saved clients an additional $7.3 million as of February 2009 – over $2 million the past six months alone! This is savings produced before claims are paid, and beyond what MedBen provides through plan provisions, medical management and other cost controls.

MedBen is a member of the AWAC Alliance, a physician-driven organization that provides advanced systems for cost containment. After MedBen applies network discounts to medical and Rx claims, AWAC uses surveillance software to screen every MedBen claim regardless of size, at no cost to the client. 80,000 clinical and financial algorithms are used to identify savings opportunities.

When the software flags a claim, it can be negotiated physician-to-physician for further savings, or ongoing care can be coordinated through AWAC. On average, MedBen and AWAC save clients 43% per flagged claim.

To learn more about ways MedBen can save your business money, please contact the MedBen Sales & Marketing Department at (888) 627-8683.

  04:18:43 pm, by MedBen1   , 122 words,  
Categories: Announcements

Latest DOL Information on COBRA

The Department of Labor has released additional clarifications on the new COBRA Continuation Coverage Assistance portion of the American Recovery and Reinvestment Act of 2009. Go here for the additional information.

What remains troubling is the requirement to provide notice about the availability of the new premium reduction to all individuals who had a qualifying event from September 1, 2008 through December 31, 2009, not just individuals who would qualify for the subsidy. This will certainly cause confusion.

MedBen is preparing our materials for current COBRA clients and will be following up in the next week. Current MedBen COBRA clients will receive assistance on this new requirement under your existing COBRA services agreement and at no additional charge. We’ll continue to update you as we receive information.


  05:25:52 pm, by MedBen5   , 223 words,  
Categories: News, Health Plan Management

COBRA Subsidies May Increase Health Care Costs

What health care costs

A recent article from USA Today regarding the COBRA provisions in the stimulus package touches on a potential consequence of the measure: the generous employer subsidy will appeal most to less healthy individuals.

As Tom Billet, senior benefits consultant of Watson Wyatt, points out, the high costs associated with COBRA – which typically exceed $400 a month for individuals, and over $1,000 a month for families – means that its greatest attraction has been to those who anticipate needing costly care during the coverage period. Offering a 65% employer subsidy, he says, will only serve to increase the appeal of COBRA to people with health problems. Without a corresponding opt-in by healthy individuals, overall health care costs will likely see an increase.

Kathryn Bakich, senior vice president and head of the health care compliance practice at Segal Co., believes that the COBRA provision will have just the opposite effect: The employer subsidy will attract healthy individuals who file fewer claims, thereby reducing insurance costs.

The article also notes that employers must notify former employees who are eligible for the COBRA subsidy by March 1. This includes all workers who were involuntarily terminated on or after September 1, 2008.

You can read the complete article here. Additionally, we’ve reproduced a chart included in the print version of USA Today, that highlights average employee and employer contributions to health insurance premiums.


  01:50:09 pm, by MedBen5   , 97 words,  
Categories: News, Health Plan Management

American Recovery and Reinvestment Act: Benefit and Employment Provisions

On February 17, President Obama signed into law The American Recovery and Reinvestment Act of 2009 (ARRA). Among the many conditions contained in the $787 billion economic stimulus package are three specific provisions related to employee health benefit plans, in addition to two relating to employment practices. In the five articles below, we provide a brief summary of each of the provisions and links to language from the bill pertaining to a specific provision.

To review the full text of the stimulus bill, visit the Library of Congress website and click on the American Recovery and Reinvestment Act (HR1) link.

  01:36:42 pm, by MedBen5   , 376 words,  
Categories: News, Health Plan Management

ARRA Employee Health Benefit Plan Provisions: COBRA

White House

The ARRA amends COBRA in several ways. First, eligible qualified beneficiaries (called “assistance eligible individuals” in the ARRA) can satisfy the payment of their COBRA continuation premium by paying 35% of the COBRA premium due. The ARRA requires employers to subsidize the remaining 65% of the premium for a period certain, generally not longer than 9 months. Employers paying the 65% will be able to offset such amounts by receiving a payroll tax credit against federal income and FICA taxes.

An “assistance eligible individual” is a person who: 1) is involuntarily terminated from employment and is eligible for COBRA any time between September 1, 2008 and December 31 2009; and 2) elects such COBRA coverage. Employees who were involuntarily terminated but have an adjusted gross income of more than $125,000 (single taxpayer) or $250,000 (joint tax return) must be given the option to continue to pay the full COBRA premium or will be required to repay the 65% subsidy as an additional tax due on the affected individual’s tax return.

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  01:32:06 pm, by MedBen5   , 368 words,  
Categories: News, Health Plan Management

ARRA Employee Health Benefit Plan Provisions: HIPAA Privacy

The ARRA amends multiple provisions of the HIPAA Privacy and Security Rules, including, but not limited to, the following:

Business Associate Liability and Contracting – The new rules apply the responsibility to, and liability for, appropriately securing protected health information (administrative, physical and electronic safeguards) to business associates in the same manner as they do to covered entities. This includes the application of civil and criminal penalties. Business Associate Agreements must also be updated to include all changes required by these new rules.

Notification of Breach of Security – The new rules require that written notification be made directly to any individual whose unsecured PHI has been, or is reasonably believed to have been, accessed, acquired or disclosed during a breach of security. The notice must be made within 60 days of the discovery of the breach. In the event that the individual’s location is unknown, an alternative notification must be made, including posting information regarding the breach on the covered entity’s website if information of more than 10 individuals was compromised. If information of more than 500 individuals was compromised, the covered entity is required to provide such notice of breach to a prominent media outlet and separately notify the Secretary of Health and Human Services (HHS). HHS will post all such notices on its website. The law provides a list of specific information which must be included in any notice provided.

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  01:27:58 pm, by MedBen5   , 633 words,  
Categories: News, Health Plan Management

ARRA Employee Health Benefit Plan Provisions: Trade Act

The Trade Act of 2002 provides certain rights to individuals who had been determined to have lost their jobs due to foreign imports or competition (TAA Eligible Individuals). Among these rights were a credit against their federal taxes of 65% of amounts paid for eligible health coverage, an additional COBRA enrollment period to begin upon their determination to be a TAA Eligible Individual, and a suspension of the 62-day period allowed in determining whether prior coverage is creditable against a plan’s pre-existing conditions limitations period from the time the person loses health coverage to the date he or she is determined to be a TAA Eligible Individual.

The American Recovery and Reinvestment Act of 2009 (ARRA) has expanded on these provisions in the following ways:

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  01:02:51 pm, by MedBen5   , 104 words,  
Categories: News, Health Plan Management

ARRA Employment Provisions: Work Opportunity Tax Credit (WOTC)

Currently, tax credit is available to employers who electively hire individuals from one or more of nine targeted groups. The amount of credit available to the employer is dependent upon the amount of qualified wages paid by the employer. If you are an employer currently taking advantage of this credit, you should know that two new categories of employees have been added for credit: unemployed veterans and disconnected youth who begin work for the employer in 2009 or 2010, provided the job starts after December 31, 2008. (“Disconnected youth” is generally defined as individuals between the ages of 16 and 24 who are not in school and not legitimately employed.)

  01:00:45 pm, by MedBen5   , 49 words,  
Categories: News, Health Plan Management

ARRA Employment Provisions: H-1B Visas

ARRA prohibits any employer receiving Troubled Assets Relief Program (TARP) funds or certain federal loans from obtaining H-1B Visas for two years unless they have made a good faith effort to recruit and employ United States citizens for the job for which the H-1B Visa is sought.


  03:49:02 pm, by MedBen1   , 38 words,  
Categories: Announcements, News

Dean to head HHS? Don't count on it

The Wall Street Journal Health Blog discounts rumours that former Governor and Democratic National Committee Chairman, Howard Dean will be tapped to run Health and Human Services. Kansas Governor, Kathleen Sebelius remains the front-runner. Read the article here.

  02:01:46 pm, by MedBen1   , 48 words,  
Categories: Announcements

MedBen Blog Upgrade

MedBen Blog will be down on Thursday morning between 7:00 a.m. and 9:00 a.m. EST for an upgrade that will allow us greater flexibility in providing useful, actionable information to clients. Keep coming back to MedBen Blog for the latest in plan design, industry, regulatory and benefit news.


  04:01:55 pm, by MedBen1   , 185 words,  
Categories: Prescription, Discounts, Health Plan Management

Generic Drug Use Hits New High - MedBen Clients Beat Average

Generic drug use in pharmacy benefit plans reached an average of 60.4% in 2008 according to the Takeda Prescription Drug Benefit Cost and Plan Design Report, 2008-2009 edition. MedBen clients experienced generic drug use averaging nearly 10% greater than this benchmark for the same time period.
Generic drug use is a significant factor in prescription plan cost because generic drugs regularly cost a fraction of the cost of brand name drugs. Greater use of generic drugs translates to lower plan costs.
The report charts a number of drug trends and marked another year of lower pharmacy reimbursements. In 2008, according to the report the average retail brand reimbursement was 16.1% off of AWP (Average Wholesale Price - a standard mark for brand drugs). MedBen clients experienced average discounts on retail brand drugs that were 10% better than this mark.
The report marked average retail generic reimbursements at 41.8% off of AWP while MedBen clients averaged generic discounts over 1.75 times that number.
MedBen has acheived these results through its unique prescription plan that delivers the entire discount on retail and generic drugs to clients.
You can download a copy of the report here.


  01:26:12 pm, by MedBen5   , 384 words,  
Categories: News, Health Plan Management

Combined Stimulus Bill Calls for Substantial Employer COBRA Subsidies

Capitol Building at Night

A follow-up to our earlier article on COBRA provisions in the “American Recovery and Reinvestment Act", aka the stimulus plan: The negotiated House and Senate bill keeps the House’s proposed premium subsidy but reduces the length of eligibility. Among the plan’s COBRA provisions:

  • The combined stimulus bill will require group health plans with 20 or more employees to subsidize 65% of COBRA coverage for terminated workers – equal to the House bill’s amount and greater than the 50% proposed by the Senate.
  • The provision applies to individuals who would have been COBRA eligible due to termination of employment from September 1, 2008 through December 31, 2009.This would also include individuals whose COBRA qualifying event date (the termination of employment) is before 9/1/08, as long as their 18 month period of continuation of coverage had not expired.

    Additionally, the law allows individuals who are eligible, but did not elect COBRA within their initial election period, to have a new 60-day election period to elect the subsidized COBRA to begin with the effective date of the act.

  • Qualifying individuals will be eligible for 9 months of employer subsidies. This is a reduction from 12 months on both the House and Senate bills.
  • Terminated workers with annual incomes greater than $125,000 for singles or $250,000 for couples would not be eligible for employer subsidies.
  • As noted previously, employers will receive a credit against payroll taxes, which includes both employee withholding and FICA taxes. If COBRA payments exceed the employer’s payroll tax liability, they will be treated as an overpayments and credited on the payroll tax as such.

A “55/10″ provision in the House bill would have required employers to offer COBRA benefits to individuals 55 and over for 10 years or until they are eligible for Medicare, whichever comes first. This provision was not mentioned in the Senate bill and is, as of this writing, not included in the final plan.

To read a Legislative Update from the Employers Council on Flexible Compensation (ECFC) on the combined bill, click here. Please note that the 60% employer subsidy indicated in the release has since been increased to 65%.

The combined stimulus bill is currently undergoing final Congressional review and, pending its approval, could be signed into law by President Obama as early as this weekend. Please check The MedBen Blog for updates on COBRA subsidies as well as other stimulus provisions that will affect employers.


  04:34:45 pm, by MedBen5   , 265 words,  
Categories: News, Health Plan Management

Stimulus Bill May Adversely Affect Employer COBRA Costs

Capitol Building

Stimulus bills approved by the Senate and House of Representatives are currently winding their way through final Congressional negotiations en route to President Obama’s desk for approval. While many of the bills’ features have been discussed and debated in the media, gone comparatively unmentioned is a series of provisions that could have an adverse effect on employer health care costs.

Both House and Senate bills would require employers to subsidize a portion of COBRA costs for individuals who have been involuntarily terminated. The House bill calls for a 65% employer subsidy of COBRA for up to 12 months with up to an additional six months of unsubsidized coverage, while the Senate bill reduces the subsidy to 50%. Those employees terminated on or after 9/1/08 through 12/31/09 will be eligible for the subsidy.

In addition, the House bill would grant extended COBRA benefits to individuals age 55 and older who have 10 or more years of service with an employer. Such individuals could remain on COBRA until becoming Medicare-eligible or obtaining coverage through a different group health plan. The Senate bill does not contain a similar provision.

One potential bright spot to COBRA premium cost-sharing: Affected employers may be able to take a credit against payroll taxes for the rest of the premiums.

To read a Legislative Update from the Employers Council on Flexible Compensation (ECFC) regarding these COBRA provisions, click here.

As of this writing, House and Senate negotiators have reached an agreement on a final version of the stimulus plan. When we have had a chance to review the compromise bill’s COBRA provisions, we will pass updated information on to you.


  04:40:44 pm, by MedBen5   , 286 words,  
Categories: Wellness, Health Plan Management

The Truth Behind Routine Cancer Screenings

Doctor with X-ray

“Why should I bother with a cancer screening? After all, I feel fine and I take care of myself. So why should I spend money when I don’t need to?” So goes the common wisdom about routine cancer screenings – when the odds are in my favor, it’s just not worth that extra expense!

But there are several reasons for promoting regular cancer screenings. The most important one is obvious – the sooner a cancer is detected, the greater the chance that it can be treated successfully. But there is also a significant financial consideration – the difference in cost between treating a limited cancer vs. a cancer in its advanced staged can be staggering. For example:

  • A stage I or II (limited disease) breast cancer typically requires a lumpectomy or simple mastectomy, plus chemotherapy, and costs between $30-$50,000. Should the cancer reach stage III or IV (advanced disease), the bills for modified radical mastectomy with major reconstruction, plus chemo and radiation therapies, can reach upwards of between $150-$300,000.
  • Colon cancer detected in its earliest stages will cost between $10-$50,000 for a colonoscopy and polypectomy. In its advanced state, the cancer usually requires a colectomy and a colostomy, plus chemo and radiation therapies, that will result in expenses totaling between $150-$300,000.

Truth is, a cancer caught in its earliest stages saves lives and money. And even when a screening shows a clean bill of health, its cost is more that offset by the potential expense should a cancer go undetected. That’s why all MedBen fully insured plans encourage routine screenings for breast, colon, cervical and prostate cancers by covering in-network screenings at 100%.

To learn more about MedBen fuly insured benefits, please contact MedBen Marketing Services at


  05:24:43 pm, by MedBen5   , 227 words,  
Categories: Prescription, Discounts, Health Plan Management

Breaking Down Drug Costs

Filling a Prescription

Just how do pharmaceutical companies price their products? As this article in the Employee Benefit News reveals, it doesn’t happen in a vacuum, and it involves quite a bit of number-crunching.

Multiple considerations go into the drug pricing process, from the manufacturer’s research and development costs to market demand and competition. Manufacturers also negotiate with pharmacy benefit managers (PBMs), who administer prescription plans and create networks with contracted pharmacies. In turn, the PBMs negotiate prescription prices with the pharmacies. On top of all that, generic drugs and mail order services factor into the total pricing equation.

Manufacturer discounts, rebates and other pricing concessions are common to larger PBMs. To quote from the article: “Successful PBMs are effective in leveraging their aggregated volumes and patient programs to achieve even deeper discounts.”

MedBen provides cost-effective retail prescription coverage to its clients through Pharmacy Data Management (PDM), a leader in pharmacy benefits management. The MedBen Prescription Plan passes 100% of paid formulary rebates onto the Health Plan through the PDM network. In addition, significant savings are generated by a cost pass-through approach to generic drugs.

Together, MedBen and PDM offer a level of transparency that equates to more plan savings for the employer. We have consistently beaten the odds by keeping annual Rx cost increases below the national average.

To learn more about MedBen pharmacy services, please visit the MedBen website.


  04:07:46 pm, by MedBen5   , 276 words,  
Categories: Wellness, Health Plan Management

A Healthy Internet Presence

Doctor on Computer Monitor

The Internet has become a virtual library of health information. Not to mention, a diagnostician, personal trainer, consumer watchdog and recordkeeper.

The Wall Street Journal highlights some of the more noteworthy sites available on the web. As you will see, there is a great deal of diversity out there, from a site that catalogs side effects of various medications to sites from Google and Microsoft that allow users to compile their medical records online, and share the information with physicians if they so choose.

MedBen has had a constant web presence since the launch of in 1997. In the ensuing decade, we have greatly expanded our content to provide clients with user-friendly, password-protected services featuring real-time data.

Our current websites include: MedBen Access, which offers 24/7 claims status and benefits information; MedBen Secure, which allows clients to receive reports with protected health information in a protected environment; and our MedBen FSA/HRA Online System gives participants an easy way to monitor plan activity. These and other customer service tools are available to MedBen clients anytime, anywhere.

Privacy concerns have been and will continue to be at the forefront of online health sites. That’s why MedBen makes client confidentiality its number one priority. On MedBen Secure, for example, your reports are downloaded over a secure line protected by Secured Socket Layering (SSL), the Internet standard for the transmission of secure data. This is on top of internal protection that double-checks the contact and content information in order to verify both are appropriate and accurate.

For more information about all of MedBen’s Internet services, visit our main website at and click on “Online Client Services".


  04:38:03 pm, by MedBen5   , 315 words,  
Categories: News, Wellness, Health Plan Management

CDHP and HDHP Participants Better Informed, Healthier

Mom & Daughter Making Salad

A survey by the Employee Benefit Research Institute finds that participants in a consumer-driven health plan (CDHPs), such as a flexible spending account (FSA) or a health reimbursement arrangement (HRA), or a high-deductible health plan (HDHP) make better informed health care decisions and are healthier in general. As reported in Employee Benefit News, nearly 10 million adults enrolled in such plans during 2008.

The survey showed that 3% of adults are enrolled in some type of CDHP, up from 2% in 2007. The number of adults enrolled in an HDHP held steady at 11%. Consumer satisfaction with the quality of care provided is similar in CDHPs to that of traditional plans, but lower for those participants only covered by an HDHP.

Of particular note is the survey finding that HDHP participants tend to be in better health than those with traditional coverage. On the one hand, it stands to reason that a plan with higher out-of-pocket costs would appeal more to those who stand less chance of incurring a major medical expense. But as the article points out, HDHPs also place a greater value on individual awareness of the cost of care, which in turn promotes a greater focus on personal wellness. So participants can benefit from HDHPs on a physical and emotional basis as well as a financial one.

The survey also revealed that HDHP participants sometimes delay or avoid getting care because of cost concerns. But 42% of the 13.4 millions consumers with a high-deductible plan report that they do not have a health savings account (HSA), despite their availability. By encouraging the addition of an HSA or an employer-funded HRA from which the participant can pay their deductible costs, the employer can go a long way toward preventing this behavior.

MedBen offers full-service administration of FSA, HRA and turn-key HSA, along with the administration of both fully insured and self-funded HDHPs. For more information, contact MedBen Specialty Services at (800) 297-1829.


  10:15:45 am, by MedBen5   , 225 words,  
Categories: Prescription, Discounts, Health Plan Management

Battling Back Against Rising Rx Costs

Pill Bottles and Drugs

Rising prescription costs may be an unavoidable reality of our health care system, but that doesn’t mean that consumers have to take the high prices at face value. This Wall Street Journal article offers some good ideas on how to keep out-of-pocket Rx expenses in check.

Asking your physician about generic alternatives to brand medications is always a good first step. Never assume that the prescription you’re given represents your best value. And with more and more discount stores and pharmacy chains boasting $4 generics to draw in business, it’s definitely to your financial advantage to check out what’s available!

Another money-saving alternative, not mentioned in the article, is the growing number of previous prescription-only medications, such as Claritin and Prilosec, now available in over-the-counter versions. Employers are increasingly covering most, if not all, of the cost for these OTC drugs, so long as a physician prescribes them.

For MedBen clients who use PDM for prescription management, you can also gather a good deal of information from our RxEOB website. This handy online service provides a variety of useful features, such as reviewing your medication history, reading detailed drug information, and comparing prices of equivalent generic or lower cost alternative drugs. To visit RxEOB, simply go to and click on “Online Client Services”, select “MedBen Access”, log in and click on “My Rx”.


  08:49:07 am, by MedBen5   , 162 words,  
Categories: Announcements, News, Health Plan Management

MedBen Saves Clients an Additional $5.4 Million in Just 12 Months!

Magnifying Money

Since MedBen added AWAC® advanced surveillance software to its claims review process last year, clients have benefited in a big way! From October of 2007 through September of 2008, MedBen clients have saved an additional $5.4 million using this physician-powered approach to claims cost containment – savings that go beyond MedBen’s plan provisions, network discounts and other cost controls.

The cumulative savings average out to be $13.23 per employee per month over 12 months. In August and September alone, MedBen clients saved over $1.2 million in claim costs. Even greater savings are expected in 2009 with more employers using this advanced cost control methodology.

Access to this surveillance system is made possible through the AWAC® Alliance, a select network of third party administrators, which MedBen joined in September of 2007. At a meeting of Alliance members in Minneapolis, MN this week, MedBen President Doug Freeman learned of our year-end savings results.

To read more about how clients are receiving significant savings with MedBen’s cost containment services, download this report.

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