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New Rule Expands HDHP Options

IRS building

In response to President Trump’s Executive Order 13877, “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” the Treasury Department and the IRS were directed to consider ways to expand the use and flexibility of Health Savings Accounts (HSAs) and High Deductible Health Plans (HDHPs) consistent with the current HSA rules. Treasury Department Notice 2019-45, effective July 17, 2019, expands the list of preventive care benefits permitted to be provided by a HDHP without a deductible.

To expand the availability of services and treatments, the Notice explains that certain medical care services, including treatment and prescription drugs for certain chronic conditions, can be classified as preventive care for someone with that chronic condition. This allows HDHPs to cover these additional services and prescriptions at 100% under a HDHP, since they are now re-classified under the Notice as “preventive care.” The Notice specifically lists those chronic conditions which will now be classifiable as preventive care with respect to an individual with the relevant chronic condition.

However, for the HDHP to be compliant with these new rules, two separate conditions must be met for the chronic condition medical care or prescription to be considered preventive.

  1. Criteria. Each medical service or item, when prescribed or performed for an individual with the related chronic condition, must meet all the following criteria:
  • The service or item must be low-cost. This means that no high cost brand or generic drugs or treatment is eligible to qualify a treatment or prescription drug as preventive.
  • There must be medical evidence supporting high cost efficiency (a large expected impact) of preventing exacerbation of the chronic condition or the development of a secondary condition when using the low-cost treatment or prescription.
  • There must be a strong likelihood, documented by clinical evidence, that with respect to the class of individuals prescribed the item or service, the specific service or use of the item will prevent the exacerbation of the chronic condition or the development of a secondary condition that requires significantly higher cost treatments.
  1. The List. Only those conditions listed below qualify as preventive care under a HDHP:
Preventive Care for Specified Conditions For Individuals Diagnosed with
Angiotensin Converting Enzyme (ACE) inhibitors Congestive heart failure, diabetes, and/or coronary artery disease
Anti-resorptive therapy Osteoporosis and/or osteopenia
Beta-blockers Congestive heart failure and/or coronary artery disease
Blood pressure monitor Hypertension
Inhaled corticosteroids Asthma
Insulin and other glucose lowering agents Diabetes
Retinopathy screening Diabetes
Peak flow meter Asthma
Glucometer Diabetes
Hemoglobin A1c testing Diabetes
International Normalized Ratio (INR) testing Liver disease and/or bleeding disorders
Low-density Lipoprotein (LDL) testing Heart disease
Selective Serotonin Reuptake Inhibitors (SSRIs) Depression
Statins Heart disease and/or diabetes

Important Note: The Notice is very clear that the criteria does not expand the scope of preventive care beyond the above list. That means that medical care services or prescriptions that meet (or may meet) the criteria but are not on the list are not treated as preventive care as a result of this Notice or on any other basis.

If you are interested in updating your plan language to allow medical care and prescription treatments identified on the list above to pay at without deductible (or at a less deductible) under your HDHP, please contact MedBen Compliance Department or your Account Representative. If you have questions regarding this summary, please contact Senior Vice President Caroline Fraker at 800-851-0907 or


  11:55:00 am, by MedBen5   , 172 words,  
Categories: Cost savings, MedBen Rx, MedBen Rx Advocate, Rebates, Account Management

Pharmacy Rebates that Cost You Money

pill bottle

Many employers get caught up in the promised savings offered by rebate guarantees… but little do they know these guarantees could be costing them money, for several reasons.

The first issue with rebate guarantees is that the most significant rebates are associated with the most significant price tags. So, while you’re receiving a sometimes-sizeable rebate for a drug, your plan may be still paying more for a medication compared to a much less expensive alternative, that doesn’t provide a rebate.

The second issue is that set rebate guarantees generally mean that employers are not receiving the full rebate amount. Their pharmacy benefits manager (PBM) retains a portion for themselves.

MedBen Rx Advocate clients never have to worry about these tactics. Our clients know that the only guarantees offered from us is the lowest net-cost medication is always promoted to their population and any paid rebate is passed back to them at 100%.

If you would like for MedBen Rx Advocate to investigate your pharmacy plan for potential savings, give us a call at 888-627-8683.


  08:49:00 am, by MedBen5   , 178 words,  
Categories: Cancer, Preventive care, MedBen WellLiving

A $1.3 Million Late-Stage Cancer Diagnosis

cancer definition

Only 20% of employer-driven wellness programs offer colorectal screenings, leading to poor prognoses and national spending in excess of $7.4 billion for cancer treatment.

A recent Employee Benefit News piece tells how a man found himself stuck with $1.3 million in billed charges, borne by the employer, health plan, patient and his family, and attributed to a “consequence of a later-stage diagnosis” for his colorectal cancer. Sadly, he’s not alone – nearly 60% of diagnosed colorectal cases are discovered in a later stage due to under-screening.

From its start, MedBen WellLiving was built around plan members getting regular preventative screenings, including a colonoscopy every 10 years beginning at age 50. We’ve seen how early detection is key to obtaining a better prognosis for the patient while lowering health plan costs for employers.

With preventive care compliance as its foundation, MedBen WellLiving has driven positive results. Clients have seen only a 4.4% trend (versus a 6.4% for non-WellLiving clients) over the last five years and reduced health risks for their populations.

To learn more about what MedBen WellLiving has to offer you, contact our Marketing Department today at 888-627-8683.


  07:45:00 pm, by MedBen5   , 208 words,  
Categories: Dental, Heart, Preventive care, MedBen PreceDent

Good Dental Care Benefits Overall Health… and Teeth, Too

dental patient

Nearly 20 percent of adults aged 65 or older have lost all their teeth. And even though the Centers for Disease Control (CDC) states that they believe the number of those with tooth loss will decrease over the years (thanks to fluoride infused public water systems and fluoride toothpaste), threats to oral hygiene and health continue throughout life.

In addition to common predators of oral health – sugary chewing gum, limited brushing and flossing – chronic conditions including emphysema, heart disease, and hepatitis C have been linked to heightened risk of tooth loss. But as chronic conditions can impact oral health, the opposite is also true. Studies have shown that things like excess plaque along the gums is linked to heart disease and obesity.

MedBen PreceDent provides employers with a dental benefits package that covers twice-yearly exams and other preventive services at 100%, helping to reduce the need for major restorative care. By visiting their dentist regularly and receiving the necessary maintenance care, your plan members can maintain good oral health as well as improving their overall wellness.

MedBen PreceDent is available as a standalone dental product or better still, in conjunction with a comprehensive benefits plan. For more information regarding the advantages of providing dental coverage, contact the MedBen Marketing Department at 888-627-8683.


  10:50:00 am, by MedBen5   , 214 words,  
Categories: Wellness, Cancer, Preventive care

CDC May Change Male “Catch Up” Age for HPV Vaccine

HPV vaccine

The Advisory Committee on Immunization Practices (ACIP) recently voted to modify the recommended age for men to receive the human papillomavirus (HPV) vaccine. If approved by the Centers for Disease Control (CDC), the recommendation would increase the age of male recipients for a “catch up” of the HPV vaccination to 26 versus the previous age of 21. For women, the recommended age of 26 is already in place.

The HPV vaccination helps to prevent cancer-causing infections and precancers that are mostly sexually transmitted. The CDC states that vaccination is very safe and that “HPV infections and cervical precancers have dropped significantly since the vaccine has been in use.”

Currently, the CDC recommends two doses of the HPV vaccine for all boys and girls ages 11-12 but can be administered in children as young as nine. Under the Affordable Care Act, the CDC’s immunization recommendations are to be covered without cost sharing to the plan member as Recommended Wellness Services, if received through a preferred (in-network or Tier 1) provider. These services are intended to prevent potential future health problems, rather than to treat existing medical conditions.

If you have questions about Recommended Wellness Services covered under your plan, please contact your Account Representative. For more information about the HPV vaccination for yourself or your child, consult your family doctor.


  10:58:00 pm, by MedBen5   , 255 words,  
Categories: Announcements, Client Services, MedBen Employees, Account Management

Client Service Enhancements Strengthen Account Management

To enhance our client services, MedBen has made two important changes. Our Group Service Representatives (GSRs) will now be called Account Representatives, and we’ve created a new position called Account Manager.

We’d like to recognize five former GSRs who have been promoted to Account Managers, effective July 1, 2019: Janeen Andrews, Edith Grassette, Megan Miller, Bethany Peters, and Doug Ross.

MedBen Account Managers

"This new position is part of the evolution of our service model," said Lori Kane, Vice President of Administrative Operations for MedBen. "The hallmark of our service model for clients has been the two-person team. Those teams coordinate to provide account management for our clients and serve as their primary point of contact with MedBen. This builds on that model and provides greater accessibility to and accountability from MedBen’s Account Management team," Kane said. "We believe clients will see a difference as we continue to develop this model."

Andrews has been a GSR for MedBen since 2001. Her account management partner will be Megan Miller, who started with MedBen’s Customer Service Department in 2009. In 2010 Miller was promoted to Group Service Representative and then was promoted to Supervisor of Client Services in 2015. Miller is a graduate of The Ohio State University.

Grassette has been with MedBen since 2004, previously working for Cigna and Medco Rx. Her partner, Peters, started with MedBen’s Customer Service Department in 2015, becoming a Group Service Representative in 2016. Peters is a graduate of Mount Vernon Nazarene University.

Ross started as a Group Service Representative for MedBen in 2017 and is a graduate of Kent State University.

Congratulations everyone!


  12:38:00 pm, by MedBen5   , 189 words,  
Categories: Client Services, Quality, ISO, MedBen Employees, Claims management, Client Feedback

Client Satisfaction Matters to MedBen, So We Value Your Feedback

MedBen takes to heart the mission of being “the benefits partner that employers prefer.” That’s why we regularly send Client Satisfaction Surveys to our clients, asking for honest feedback about their experience with services provided. These surveys are studied and discussed by our Executive team, and when warranted, procedural changes are made based on your responses.

In 2018, survey results showed a 4.8 average rating (out of 5) for claims accuracy and 4.9 average rating for medical claims turnaround time. To maintain ISO Certification, MedBen sets stringent goals for accuracy and turnaround, so we’re pleased that clients take notice of the efficiency.

Additionally, clients awarded an average of 4.9 for staff professionalism, with a recent comment commending our “professional, dedicated staff who deliver outstanding service.” Respondents also gave a 4.9 for the staff’s ability to handle inquires and resolve issues (93% of all calls to Customer Service were resolved on the first call).

As always, we appreciate your willingness to complete these surveys. Your feedback is what keeps us evolving and helps us provide the exceptional services you deserve. If you have questions regarding MedBen’s Client Satisfaction Survey, please contact Project Manager Beth Painter at 900-423-3151, Ext. 420.


  02:49:00 pm, by MedBen5   , 147 words,  
Categories: Announcements, Prescription, Online Services, MedBen Employees, MedBen Access

Happy Independence Day! MedBen’s Closed July 4th, But MedBen Access Stays Open

American Flag

Happy Independence Day from the entire MedBen team! We hope you enjoy a safe and relaxing break as we celebrate America’s birthday.

In observance of the holiday, MedBen will be closed on Thursday, July 4 and will reopen on Friday, July 5 at 8:00 a.m. EST. But should you need information about your plan, we encourage you to visit our online MedBen Access service center.

For employers, MedBen Access enables designated administrators to enroll new plan members, view claims data, make changes to participation status, and even order ID cards. Group-specific drop-down menus help you find what you're looking for fast.

MedBen Access is equally useful for plan members. The site makes it easy to determine the status of a claim, check current deductible and out-of-pocket accumulators, review benefit coverage, and access Rx information.

Once again, have a great 4th of July and thanks for your continued relationship with MedBen!


  10:34:00 am, by MedBen5   , 176 words,  
Categories: Wellness, Preventive care, Primary care, Mental Health

Lowering Alzheimer’s Risk Benefits from Preventive Care

doctor-patient chat

Alzheimer’s disease attacks brain cells, affecting mood and memory loss, primarily in those over the age of 65. As the United States’ population grows older, so too does the prevalence of Alzheimer’s: 5.8 million Americans currently have the disease, and that number is expected to increase to nearly 14 million by the year 2050.

Though the number of those effected by Alzheimer’s is significant, only 16% of those individuals receive regular cognitive assessments. MedBen WellLiving advocates for an annual wellness visit with your family physician as an opportunity to discuss your mental health in addition to monitoring your physical condition.

Yearly exams allow the physician to become better acquainted with your family history and symptoms, and thus develop and modify an appropriate treatment plan. And as studies have demonstrated a link between Alzheimer’s and heart disease, diabetes, stroke, high blood pressure and high cholesterol, controlling these conditions helps to reduce Alzheimer’s risk as well.

Effective preventive care benefits mind and body alike. Get more information about the many ways WellLiving can help your employees by contacting the MedBen Marketing Department at 888-628-8683.


  08:52:00 am, by MedBen5   , 157 words,  
Categories: Announcements, Reporting

MedBen Offers New Reporting Dashboard

MedBen has now made accessing your plan performance easier than ever. The moment you log in, our easy-to-navigate executive dashboard puts practical information front and center.

  • The dashboard offers a dollar-and-cents snapshot of your recent medical and pharmacy claims activity, and interactive charts and graphs break down paid amounts (member vs. plan), inpatient admissions and other important data.
  • Benchmarking capabilities allow you to compare your plan performance against MedBen's blocks of business as well as companies nationwide. Your benchmarking choice is immediately reflected on the dashboard content.
  • Dozens of standard reports that provide added detail are readily accessible with the click of a button. Customized reports can be requested from MedBen at no extra cost.

Best of all, the dashboard complements our other reporting resources, including quarterly reviews that highlight plan trends and opportunities to make your plan even better. If you have questions about using the reporting platform, contact MedBen Marketing Analyst Morgan Hardy at 888-423-3151, ext. 424.


  06:44:00 pm, by MedBen5   , 172 words,  
Categories: Security, Privacy

At MedBen, Data Security is a Round-the-Clock Duty

Wendell Crain

Two high-profile health care companies recently reported data breaches that put the security of personal medical information at risk. Such incidents are all too common these days... and demonstrate why MedBen maintains a multi-tiered approach to protecting client data.

From the earliest days of electronic recordkeeping, MedBen put in place tape backups and other measures to keep your information safe. Today, we enlist a wide variety of external, internal, and physical safeguards to protect your data. We also regularly consult with security professionals to ensure that we are taking every possible action to stay ahead of potential dangers.

MedBen strives to be proactive in all areas of your data protection. But should new opportunities to improve security present themselves, MedBen will immediately take the appropriate measures to implement them.

When you place your trust in MedBen, we pledge to never take that trust for granted. Clients with questions regarding our cybersecurity measures are welcome to contact our Vice President of Information Systems and Chief Privacy Officer Wendell Crain at 800-423-3151, ext. 505 or


  08:01:00 am, by MedBen5   , 158 words,  
Categories: Wellness, Reporting, Diabetes, Preventive care

New Diabetes Cases on the Decline

glucose meter

Timely preventive care may have contributed to a decrease in diabetes diagnoses, says a new report from the Centers for Disease Control and Prevention (CDC). The number of new cases of diabetes among U.S. adults fell from 1.7 million in 2009 to 1.3 million in 2017, a 35% drop.

Lead report author Dr. Stephen Benoit suggests that recent efforts to encourage lifestyle changes prior to developing diabetes is partially responsible for the trend, though the CDC cautions that obesity, a common cause of diabetes, remains a problem.

MedBen WellLiving helps employers reduce diabetes risk by promoting prevention through regular wellness exams and screenings. We also provide detailed reporting that enables you to track the prevalence of diabetes and other high-risk conditions in your population, so you can properly direct education and incentives for program participation.

Reducing diabetes risk benefits from a targeted approach to better health, and MedBen WellLiving can help. Get more information by contacting the MedBen Marketing Department at 888-927-8683 or


  09:14:00 am, by MedBen5   , 167 words,  
Categories: Prescription, Cost savings, Pharmacy benefit manager (PBM), MedBen Rx, MedBen Rx Advocate

PBMs' Egregious Pricing Methodology Remains Untamed, but MedBen Rx Advocate Has the Solution

pills and prescription pad

A recent article in the Columbus Dispatch highlights how pharmacy benefits managers (PBMs) are making big profits on the backs of the taxpayers and threatening the existence of the independent pharmacy. The article focuses on the Ohio Medicaid program, but this issue is also hitting employer health plans in the same manner. Lack of pricing transparency remains, and PBMs aren’t willing to budge. This is where MedBen Rx Advocate steps in.

MedBen Rx Advocate exists for one purpose: To serve as an advocate for its customers and ensure that no party profits off the price of any given drug. Our solution ensures that the employer health plan can see exactly who is making what as it pertains to the administration of their pharmacy benefit plan.

MedBen Rx Advocate eliminates the ability to make margin on drugs and is strictly fee-based. That in turn saves the employer money and is also fair to the dispensing pharmacy.

To learn more about MedBen Rx Advocate, contact our Marketing Department at 888-627-8683.

  08:49:00 am, by MedBen5   , 210 words,  
Categories: Announcements, News, Third party administration, Self-funding, MedBen Employees, SPBA, Caroline Fraker

Fraker Named SPBA Chair

Caroline Fraker, MedBen Senior Vice President

MedBen Senior Vice President & Chief Privacy Officer Caroline Fraker was recently named Chair of the Society of Professional Benefit Administrators (SPBA) effective June 1, 2019. SPBA is the national association of third party administration (TPA) firms that manage client employee benefit plans.

“We’re happy that Caroline has agreed to serve as Chair,” said Anne Lennan, SPBA president. "Her industry experience has been a great asset to our organization as we work to support our Member administrators of self-funded plans with information and advocacy.”

Fraker said she was honored to be named Chair. "The SPBA offers education and support to TPAs, and by extension the clients they serve. I'm pleased to play a part in ensuring that every self-funded employer receives knowledgeable service," she said. Fraker joined the SPBA Board in 2015.

In addition to TPA awareness, Board members regularly visit Washington DC to educate lawmakers on the finer points of health benefits. "We're not there as lobbyists, but rather as a resource to offer the TPA perspective on legislative matters," Fraker said.

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


  06:09:00 pm, by MedBen5   , 345 words,  
Categories: Wellness, Preventive care, Primary care, MedBen WellLiving

Managing Migraines


Over 39 million Americans and one billion people worldwide suffer from migraines. The third most prevalent illness in the world, migraines affect 12% of the population, primarily individuals between the ages of 25 and 55.

Migraines can last anywhere from 4 to 72 hours and are more common in women. As most people can’t function normally with a migraine, Americans lose 113 million work days at a cost to employers of $13 billion annually.

Though the cause of migraines is unknown, it is thought to be related to family genes and changes in the brain. Other associated factors include anxiety, depression, sleep disturbances, caffeine overuse and snoring.

Migraine symptoms include severe throbbing and recurring pain (usually on one side of the head), nausea, vomiting, dizziness, and extreme sensitivity to light, touch, and smell. These symptoms make migraines different from other headaches, which tend to be more chronic and steady.

Over-the-counter and prescription medications, massage therapy, patient education and simple lifestyle changes (see below) can all be helpful in treating migraines and headaches. Also, be sure to get plenty of rest.

If you feel that you may be suffering from migraines or if you often have a headache two or more days per week, visit your family doctor. And if the onset of your headache is sudden and severe, seek immediate medical care.

Full story »


IRS Announces 2020 HSA Inflation Adjustments

IRS building

The IRS has announced its annual cost-of-living adjustments affecting health savings accounts (HSAs) for calendar year 2020. The annual limit on deductible contributions to an HSA will go up by $50 for individual coverage and $100 for families next year.

  • HSA Contribution Limits – The 2020 annual HSA contribution limit for individuals with self-only HDHP coverage rises to $3,550, while the limit for individuals with family HDHP coverage increases to $7,100.
  • HDHP Minimum Required Deductibles – The 2020 minimum annual deductible for self-only HDHP coverage goes up $50 to $1,400. Family HDHP coverage increases $100 to $2,800.
  • HDHP Out-of-Pocket Maximum – The maximum limit on out-of-pocket expenses, including deductibles and copays (but not premiums), for individual HDHP coverage jumps $150 to $6,900. The limit for family HDHP coverage climbs $300 to $13,800.

MedBen clients with questions regarding these adjustments are welcome to contact Director of Administration Sharon A. Mills at (800) 423-3151, Ext. 438 or


  08:44:00 am, by MedBen5   , 128 words,  
Categories: Cost savings, Dental, Preventive care, MedBen PreceDent

Small Dental Claims Now Reduce Risk of Bigger Problems Later


Adding MedBen PreceDent to your benefits plan is a small investment that can deliver big dividends. A dental plan that promotes regular preventive care lowers your risk of disease and costly claims down the road.

At a dental checkup, your dentist can detect not only potential tooth and gum issues, but such non-dental conditions as heart disease and diabetes. Twice-yearly cleanings also help to decrease the risk of high blood pressure and stroke.

Additionally, being proactive rather than reactive about dental care benefits your bottom line. Maintaining good oral health through regular checkups costs substantially less than getting a crown or dental implant.

With MedBen PreceDent, you can address minor matters before they develop into more painful problems. To learn more, contact our Marketing Department at (888) 627-8683 or


  11:14:00 am, by MedBen5   , 158 words,  
Categories: Wellness, Heart, Preventive care, Primary care, MedBen WellLiving

Family History of Heart Disease Benefits from Preventive Care

EKG and stethoscope

Coronary artery disease kills over 370,000 Americans every year, so it’s not surprising that many individuals have a family history of the disease… and it’s one reason why MedBen WellLiving promotes the importance of preventive care.

“You are at increased risk if you have a parent or sibling with a history of heart disease before age 55 for males or 65 for females,” says cardiologist Sapna Legha, MD of the Cleveland Clinic. She adds that proper diet, exercise and regular blood pressure and cholesterol tests can help protect the heart.

MedBen WellLiving encourages all plan members to get wellness exams and screenings from their family doctor, to increase health awareness and prevent future complications from unmanaged conditions. Those without a family history of disease will also benefit greatly from building a doctor-patient relationship.

Visiting your family doctor regularly is a simple and effective way to reduce disease risk. For more information about MedBen WellLiving, contact our Marketing Department at 888-627-8683 or


  10:56:00 pm, by MedBen5   , 144 words,  
Categories: Announcements, News, MedBen Employees

MedBen Employees Raise Over $15,000 for Local Food Pantry

Rick Snoor and Chuck Moore

MedBen recently presented donations totaling $15,434.70 – the culmination of multiple fundraising efforts – to the Food Pantry Network of Licking County. The Food Pantry will use the contributions to acquire, store, and distribute nutritious food to financially deprived members of the community.

The MedBen staff raised the funds through weekly dress-down payments as well as by participating in the annual Operation Feed fundraising campaign. MedBen has been a decades-long supporter of the Food Pantry… in fact, in the past ten years we have donated over $60,000 to the cause.

in addition to the Food Pantry, MedBen regularly contributes to United Way, Families Helping Families, Big Brothers/Big Sisters and other worthy charities. We’ve called Licking Country home since 1938, and we've pleased to be able to assist the people of our community.

The Food Pantry Network welcomes online donations... please visit their website to learn how you can help!


  08:17:00 pm, by MedBen5   , 120 words,  
Categories: Prescription, Cost savings, Transparency, Pharmacy benefit manager (PBM), MedBen Rx, Rebates

With MedBen Rx, Employers Pay Only What’s Necessary


The MedBen Rx approach to drug pricing is straightforward. We keep client costs low by reimbursing pharmacies what they pay for prescription drugs, plus a reasonable dispensing fee. By doing so, we ensure that self-funded employers get the maximum value from their prescription plan.

We tell you exactly what the drug’s starting cost is rather than giving you an inflated price minus a discount, allowing you the transparency you deserve.

Controlling your drug costs means having a plan design, formulary, rebate and reimbursement strategies that work in your favor – not the pharmacy benefit manager’s. MedBen Rx embodies this “client first” strategy.

Learn about how the MedBen Rx difference benefits your business by contacting the MedBen Marketing Department at 888-627-8683 or

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