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04/17/09

  04:35:41 pm, by MedBen5   , 350 words,  
Categories: News, Wellness, Health Plan Management, Incentives

MedBen Execs Analyze CDHP Survey

An article in Employee Benefit News gives consumer-driven health plans (CDHPs) a somewhat lukewarm review. According to a poll, employers that offer a CDHP are generally pleased with their performance, but have difficulty determining their return on investment (ROI).

MedBen helps employers take the guesswork out of ROIs with a comprehensive mid-year plan analysis, according to Brian Fargus, MedBen Vice President of Sales and Marketing. “The analysis gives our clients information that is both measurable and actionable, so they can see exactly how their plan is working and where additional savings may be possible,” Fargus said.

Fargus also alluded to the article’s statement that, “sometimes, it can be difficult for employers to know how healthy (or unhealthy) their workforce is.” While understanding how that can happen, he said that MedBen offers a claims-driven approach to worksite wellness plans that gives employers a better idea of overall employee health, and promotes education and early detection of cancers and other chronic conditions. “With our wellness program, you know what percentage of your employees are getting screened for these conditions, and where to target your wellness resources,” Fargus added.

The article cites the survey finding that most public employers are reluctant to offer a CDHP, claiming that their higher out-of-pocket costs discourage employees to seek care. Sharon Mills, MedBen Director of Administrative Services, said her experience finds otherwise. “Our government clients have been largely receptive to consumer-driven plans, in particular HRAs [health reimbursement arrangements]. The greater control employers have in their design helps them to ensure that participants don’t neglect needed care,” Mills said. “Plus, the funds in the account can be rolled over and used toward retirement.”

Lastly, the researchers predict “that there will be a gradual shift away from consumer-driven health and toward value-based health plan design,” in which participants receive incentives to improve their health. Mills said that MedBen has long promoted this approach. “We encourage our clients to design their plan around personal wellness. For example, the employer can make HRA contributions based on a participant’s attending company health seminars and making an effort to exercise regularly.”

04/10/09

  06:05:04 pm, by MedBen5   , 209 words,  
Categories: News, Wellness

Wellness Bill Reintroduced in Congress

Woman Weighing Herself on Scale

As talk of a nation health care program continues with no working plan on the horizon, some legislators have decided to focus their energies on one specific area of potential medical cost savings: employee wellness. To that end, members of the House and Senate have reintroduced the Healthy Workforce Act, first proposed in 2007. The bill would provide a tax credit to businesses that offer comprehensive employee wellness programs.

According to Employee Benefit News, The bill has not been made public yet, but assuming it parallels the 2007 legislation, it would offer a $200 tax credit per employee to companies with less than 200 workers, and $100 per employee to companies with over 200 workers, for offering health awareness workshops, smoking cessation and nutrition programs, and other wellness initiatives.

Even without the added carrot of tax savings, employers are increasingly introducing wellness programs as a way to decrease health care costs through a healthier workforce. MedBen offers an innovative, claim-based approach to worksite wellness that can be customized to the needs of the group. By placing the focus on coaching, early detection of chronic conditions and employee education, we promote a healthier workforce and reduce the risk of costly diseases.

For additional information about worksite wellness, contact MedBen Marketing at marketing@medben.com or (888) 627-8683.

04/08/09

  04:08:48 pm, by MedBen5   , 153 words,  
Categories: Announcements, Health Plan Management

COBRA Beneficiary Notification Period Nears April 18 Deadline

April 18 will mark two months since the COBRA Subsidy Provision of The American Recovery and Reinvestment Act of 2009 (ARRA) was enacted into law. That date also serves as the deadline for employers to notify qualified beneficiaries that nine months of COBRA assistance is available. This includes former workers who were eligible for coverage on or after September 1, 2008, but declined the initial COBRA offer. Qualified beneficiaries have 60 days from the date of notification to decide whether or not they wish to take advantage of the subsidy.

In March, MedBen Specialty Services sent spreadsheets listing all qualified beneficiaries to its COBRA client groups. Based on the requested information they provided, we have set out the proper notifications to those beneficiaries. We will begin to administer the new COBRA benefit subsidies upon receipt of applications for continued coverage. Current COBRA recipients who have already made non-subsidized March and April payments will be credited for future months.

04/02/09

  05:10:30 pm, by MedBen5   , 263 words,  
Categories: News, Health Plan Management

COBRA News: IRS Provides Detailed Definition of "Involuntary Termination"

Capitol Building at Night

On April 1, the IRS provided additional assistance to administrators of the COBRA premium subsidy. Entitled “Premium assistance for COBRA benefits", this document offers an extensive explanation of the subsidy program. The topics addressed include a more detailed definition of “involuntary termination", which has heretofore been left somewhat vague as to its meaning.

The document can be downloaded here. The legal definition of “involuntary termination” can be found on page 5 of the document. For your convenience, we’ve provided a more user-friendly translation of the definition:

An involuntary termination means a severance from employment by the will of the employer even though the employee was willing and able to continue working, rather than by the decision of the employee to end their employment. This definition also applies to an employer’s failure to renew a contracted employee.

Events that result in the loss of dependent status, such as divorce, aging out of eligibility, death of an employee, or absence from work due to illness or disability, are considered involuntary termination of health coverage, not employment. As such, they do not qualify an individual for the premium reduction.

Facts and circumstances will be considered when determining if a termination is involuntary. For instance, if an employee leaves a job in which it can be shown that the employee had knowledge that the employer would have terminated services, the termination is considered involuntary.

Should an employee in the private sector wish to appeal a termination status, it can be done through The Department of Labor. Government employee appeals are handled through The Department of Health and Human Services.

03/26/09

  06:53:57 pm, by MedBen5   , 310 words,  
Categories: News, Health Plan Management

National Health Care Reform Takes Root... Sort Of

White House

With so much attention focused on the COBRA stimulus provision these days, you may get the impression that we’re focusing on it to the exclusion of noticing the even bigger health care reform movement currently underway. On the contrary – we’re keeping a close eye on government efforts to ensure that every American has access to medical treatment.

So exactly what is happening with national health care reform, then? Well… not much. Not at the moment, anyhow.

The 2009 approach to across-the-board coverage is 180 degrees different than what we saw back in 1993. Then, President Clinton presented a comprehensive package that in essence gave government total administrative oversight over every citizen’s health insurance. Its ultimate rejection meant that President Obama would require a different method for selling national health care – namely, get the money up front and take care of coming up with an actual plan after that.

One starting point that the President has offered is that the new package would allow businesses to continue providing insurance to their employees. That will certainly be welcome by plan participants who like their current coverage, but it also spurs a host of questions. Will employers be required to provide coverage? Will individuals be required to buy it? Will the government offer a public plan that would compete with private insurers? And bottom line, who’s going to pay for it all?

The Wall Street Journal reports that a collection of health care groups will soon release a set of suggestions for overhauling health care. But it conveniently skirts the issue of a goverment-run plan and other hot-button topics.

This recent health care reform primer in the Los Angeles Times does a good job of breaking down where we presently stand and the challenges that nationwide coverage poses. As the plan starts to take shape, we’ll keep you updated on all the latest developments.

03/20/09

  04:53:02 pm, by MedBen5   , 194 words,  
Categories: Announcements

MedBen Welcomes New Regional Sales VP

MedBen Building

MedBen is pleased to announce the addition of a new associate to its Sales and Marketing team. Michael DeBois will serve as Regional Sales Vice President in Northern Ohio, Northern Indiana and Michigan. A twelve-year veteran of the group medical insurance industry, Michael will assist his region’s broker network with the sales of all MedBen product lines.

Michael has been successful as a consultant and carrier representative for the fully insured and self-funded markets. A graduate of Urbana (OH) University, he has served on the boards of Northeast Ohio Health Underwriters, Big Brothers/Big Sisters, Red Cross and Habitat for Humanity. Michael resides in Dover, Ohio, with wife Julie and their two children Jack and Josie. Please join us in welcoming Michael to MedBen!

As we have consolidated our Sales and Marketing Departments, we have reassigned sales regions to better serve our clients and brokers. Mike Crum will now oversee sales efforts in Southern and Central Ohio and West Virginia, and Blair Pickerill will oversee MedBen sales efforts in Southern Indiana, Kentucky and Tennessee.

If you have any questions regarding Regional Sales VP territories, please call our Sales and Marketing Department at (888) 627-8683.

03/19/09

  02:32:27 pm, by MedBen5   , 313 words,  
Categories: News, Health Plan Management

COBRA Model Notices Available Online

Just in case you were in need of another COBRA paperwork fix…

Capitol Building

The United States Department of Labor has issued several notices for employers and insurance issuers to notify individuals who are eligible for COBRA benefits, or those who currently have coverage, about the new employer subsidy. The documents are designed for the sender to modify the contents based on the recipient’s eligibility dates and length of coverage.

You can access the COBRA Model Notices page at the Department of Labor website. On this page you will find links to four distinctive notices:

  • A full General Notice to qualified beneficiaries provides information about the new COBRA premium subsidy as well as information included in a standard election notice.
  • An abbreviated General Notice includes COBRA subsidy information but omits the election notice, for individuals who already have COBRA coverage.
  • An Alternative Notice can be used by certain insurance issuers based on state requirements. This notice may be adapted to meet the rules of the state in question.
  • A Notice in Connection with Extended Election Periods is created specifically for assistance eligible beneficiaries who qualified for COBRA coverage between September 1, 2008 and February 16, 2009 – that is, prior to the passage of the stimulus bill on February 17. This notice must be mailed to qualified beneficiaries by April 18, 2009.

If you’ve been following this blog during the past few weeks, you’ve undoubtedly noticed that the COBRA subsidy provision is making increased demands on employers – administrative in addition to financial. As you sort through the new rules, keep in mind that MedBen Specialty Services has an experienced team that can take care of your group’s COBRA administration, from initial notification and billing to employer reporting. And we can do it at a fraction of what it would cost you to perform these services in-house.

For more information about MedBen COBRA services, contact our Sales and Marketing Department at (888) 627-8683.

03/16/09

  11:40:37 am, by MedBen5   , 196 words,  
Categories: News, Health Plan Management

House Ways and Means Committee Releases COBRA FAQ

Capitol BuildingThe COBRA Premium Reduction provision of the recently passed Stimulus Bill has, not surprisingly, raised a number of questions. To address the most frequently asked questions, the U.S. House Ways and Means Committee has published a COBRA “How To” Manual to download and print.

Of special notice to employers is that the FAQ defines “involuntary termination", which, although pivotal to qualifying for COBRA coverage, has received little clarification as to its actual meaning:

“QUESTION: How do I know whether or not I have been involuntarily terminated from employment?

“A. Involuntary termination is a termination that is at the direction of the employer. Note that termination for gross misconduct will generally disqualify an employee and his/her family from COBRA coverage. For more information on whether your termination is involuntary please call the Department of Labor’s Employee Benefits Security Administration’s Benefits Advisors at 1-866-444-3272.”

In addition to the FAQ, we’ve provided revised code sections for Ohio and Kentucky, applicable to each state’s “mini-COBRA” laws. You can download and print these documents below.

Frequently Asked Questions on the COBRA Premium Reduction

Ohio Continuation of Coverage (ORC 3923 38)

Kentucky Continuation of Coverage (KRS 304 18-110)

03/12/09

  11:46:40 am, by MedBen5   , 130 words,  
Categories: News, Health Plan Management

COBRA Subsidy Employer 2009 IRS Tax Forms

Washington Monument

As we’ve noted on this blog recently, employers who must pay the 65% COBRA subsidy will be able to offset such amounts by receiving a payroll tax credit against federal income and FICA taxes. For the convenience of these employers, below we have provided a downloadable version of the IRS Form 941 (updated January 2009), which they can use to receive credit for COBRA premium assistance payments. We’ve also included instructions for completing the form.

Please note that this is a quarterly tax form. The employer must file a new form by the end of April, July and October of 2009 and January of 2010 to receive the payroll tax credit for that quarter.

UPDATE: The IRS has posted on its website an FAQ about COBRA Coverage and Form 941.

  10:59:03 am, by MedBen5   , 143 words,  
Categories: News, Health Plan Management

ARRA's COBRA Provision Language

MedBen has received a number of requests to provide the actual Congressional language for the COBRA premium subsidy provision from the recently passed American Recovery and Reinvestment Act (ARRA), aka the stimulus bill. Below, you will find a link to the complete provision language that you can download and print.

If you find this document to be a tough read (not surprisingly, it’s a bit heavy on the legalese!), we’ve covered many of the most important points elsewhere on the pages of this blog. Click below to read more on the details of the COBRA provision.

03/09/09

  10:54:26 am, by MedBen1   , 284 words,  
Categories: Announcements, News, Prescription, Health Plan Management

Value of "unique" MedBen services: over $19 per employee per month

Currency in Hand

If MedBen partially self-funded clients use MedBen’s proprietary prescription drug program and the AWAC claim cost control program they will save an average of $19 per employee per month over MedBen competitors. This is above and beyond network discounts and plan design ideas that MedBen brings to clients.

A recent study of several competitors turned up the following:

  • Surprisingly, many third party administrators withhold from clients significant portions – if not all – of pharmacy rebates paid by manufacturers as part of the pharmacy benefit plan operation. Rebates are commonly paid by pharmaceutical manufacturers to pharmacy plans that distribute a drug formulary to clients. MedBen returns 100% of paid rebates to clients, averaging approximately $4.75 per employee per month.
  • Many third party administrators use national pharmacy benefit managers (PBMs) that withhold portions of the manufacturers’ discounts as part of their service fee. It is common for PBMs to withhold a portion of the generic drug discount. MedBen delivers the entire manufacturer’s discount to clients. In a recent comparison this resulted in a potential savings of $6.72 per employee per month for a MedBen client simply for using MedBen’s pharmacy program, which delivers significant brand and generic savings for clients.
  • MedBen is one of a handful of third party administrators using the advanced cost containment program available from AWAC to help self-funded plans control claim costs. The result has been been net savings of approximately $8.00 per employee per month for MedBen clients.

All totaled, these two decisions - MedBen’s proprietary pharmacy program and MedBen claim cost containment - translated to savings averaging over $19 per employee per month over the competition.

If you aren’t using both of the these programs, ask your broker and/or Regional Sales Vice President how you can.

03/04/09

  09:33:10 am, by MedBen5   , 426 words,  
Categories: News, Health Plan Management

Staying in Compliance with the New COBRA Rules

White House

As we reported here previously, new legislation affecting the administration of COBRA Continuation Coverage became effective on February 17, 2009 with the passage of the American Recovery & Reinvestment Act of 2009 (“ARRA”), otherwise known as the Economic Stimulus Bill. Although the primary purpose of the new COBRA rules is simply to provide a federal subsidy of COBRA premiums for certain COBRA qualified beneficiaries, the requirements under the rules are complex. Plan administrators of group health plans must act quickly to implement the procedures necessary to comply with these requirements.

Over the past week, MedBen has spent a great deal of time reviewing and analyzing the new COBRA rules. Although the rules are temporary, it is clear that much work must be done immediately to keep our clients in compliance. And, because we know that acting promptly will make all the difference in keeping your plans and participants up to date, MedBen has already begun working on modifying its systems and revising notices and election forms to keep you in compliance.

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  09:32:15 am, by MedBen5   , 496 words,  
Categories: News, Health Plan Management

ARRA's Required COBRA Tasks

  • Determine which group health plans are affected by the new law.
  • Identify all confirmed AEIs. AEIs are “Assistance Eligible Individuals” – those individuals who were involuntarily terminated on or after September 1, 2008, including all dependents of such individuals.
  • Identify all potential AEIs. Confirm the status of each individual who was offered or elected COBRA on or after September 1, 2008 but who was no longer on COBRA as of February 17, 2009. Update system to track appropriate qualifying event dates of these individuals.
  • Prepare and send no later than April 19, 2009 revised or supplemental COBRA Notices to all qualified beneficiaries with qualifying events on or after September 1, 2008, explaining the temporary change in the COBRA rules, the availability of COBRA premium assistance and any option to enroll in alternative medical coverage (if permitted by the employer).

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02/27/09

  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.

02/25/09

  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.

02/20/09

  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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