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  04:14:10 pm, by MedBen5   , 369 words,  
Categories: Prescription, Health Plan Management

MedBen Promotes Prescription Plan Transparency -- And Maximum Client Savings


A recent Fortune magazine article paints an unflattering portrait of pharmacy benefits managers (PBMs) that make huge gross profits from a non-transparent payment model. It’s a strategy that some third party administrators may shrug off as “just good business"… but not MedBen.

In the article, writer Katherine Eban profiles a non-profit health care employer that hired a national PBM to reduce their prescription drug costs, only to find its Rx bills soaring. A bit of detective work by the employer revealed that the PBM greatly padded its “spread” – the difference between how much it paid to buy drugs and what it sold them for. The profits on this practice typically range from $8 to $10 a prescription, but in one extreme case, the PBM reaped a spread of $65.62 on a single bottle of a generic antibiotic.

PBMs who engage in tactics like this use the employer’s unfamiliarity with drug pricing to their financial advantage. What’s more, they may contractually keep pharmacies from disclosing the amount they’ve been paid. And all you can do is take them at their word that they’re saving you money… and maybe they even are, but certainly not as much as you could be saving.

At MedBen, however, our responsibility to the client is to keep pharmacy costs as low AND as clear-cut as possible… and maximize client savings while doing so. That’s why we have an established partnership with (as the article calls them) a “transparent PBM".

This new breed of Rx manager, which comprises only a small share of the total PBM market, takes a flat administrative fee for each prescription, rather than profiting from spread or other unstated incentives. And they will let you know how much they pay the pharmacies.

In addition, 100% of drug company rebates and other discounts go directly into our clients’ health plan. Some third party administrators will hold back a portion of these rebates – or not divulge them at all. But MedBen will make sure that you receive every dollar that’s coming to you, and verify it with easy-to-understand reports.

Working with a transparent PBM can lead to real prescription plan savings. To learn more, contact MedBen Vice President of Sales and Marketing Brian Fargus at


  04:45:55 pm, by MedBen5   , 360 words,  
Categories: News, Health Care Reform

Government Shutdown Ends With No Major Changes To Health Care Reform Law

Capitol Building

After 16 days of offers and counter-offers, in-party squabbling and plummeting popularity polls, Congress has finally worked out a deal to fund the federal government, thus ending the shutdown. President Obama signed the measure into law late Wednesday.

And as for the Affordable Care Act, which heavily contributed to the disagreements that led to the two-week hiatus? Well, it’s pretty much where it was on September 30.

At the outset, it appeared that Republican members of the House were prepared to dig in their heels until they came away with some headline-making change to the health care reform law. But when it became obvious that Senate Democrats were not about to offer a significant compromise, the less conservative representatives got cold feet and accepted the Senate proposal.

To be sure, Democrats did make one minor concession: A new requirement that people who receive government subsidies to pay for their health insurance first get verified for eligibility. But that’s a far cry from delaying the individual mandate, which Republicans pushed at the outset of the shutdown.

While there are multiple factors as to why Republicans conceded the battle – the looming debt ceiling deadline, internal disagreements about which ACA rule should be stricken or postponed – it’s likely that polls showing the GOP’s favorability at an all-time low dealt the decisive blow. Whatever misgivings Americans have about health care reform, closing down the government to take another crack at revamping it clearly did not sit well with most of the population.

(Ironically, Senate Democrats did consider delaying the transitional reinsurance fee – a per-member tax assessed on group health plans to cover high-cost cases in the individual market – for one year, but it was dropped from the final agreement.)

So health care reform remains more or less on track, with several major reform rules shortly to take effect. (The 12-month employer mandate delay, announced well before the shutdown, still stands.) If you’re looking for information about the new requirements, we invite you to view our recent series of ACA webinars. Additionally, MedBen clients with questions about the law are welcome to contact Vice President of Compliance Caroline Fraker at


  05:07:49 pm, by MedBen5   , 244 words,  
Categories: Announcements, Prescription, Wellness, Health Plan Management

We're Closing Early This Friday, But Online Services Always Open

MedBen Access

On Friday, October 18, MedBen will be closing at 12:00 p.m. EST for a companywide recognition event. We will reopen at 8:00 a.m. EST on Monday, October 21.

Although our client service departments will be closed early that day, you can still get answers to many of your questions online:

  • MedBen Access offers around-the-clock claims and benefits information for your medical and dental plans. Simply go to and click on “MedBen Access".
  • For those who use Pharmacy Data Management (PDM) as their pharmacy benefits manager, you can check on prescription claims and find lower cost drug options through MedBen Access by clicking on your name under “My Rx Claims” in the sidebar menu.
  • Members of the MedBen Worksite Wellness (iHealth) program can double-check their compliance with recommended health screenings and checkups on MedBen Access by selecting the “iHealth Information” option under the “My Plan” section.
  • If you’re a MedBen Flexible Spending Account (FSA) or Health Reimbursement Arrangement (HRA) participant in addition to having other coverage, use MedBen Access to review your FSA/HRA activity. Select the “FSA/HRA Online Inquiry” under the “My Plan”.

Also keep in mind that offers resources frequently requested by customers, such as a list of FSA-eligible expenses and instructions for reading EOBs. We designed our recently revamped website to make these and other materials simpler to find – just select the “Plan Sponsors” or “Plan Members” button on the home page, depending on your specific needs.


  04:11:37 pm, by MedBen5   , 317 words,  
Categories: Wellness

Doctor-Patient Relationship Promotes Better Health, Saves Money


We frequently mention on this blog how MedBen’s Worksite Wellness program takes a “physician-first” approach – members are encouraged to use their family physicians as gatekeepers of care, rather than relying upon impersonal onsite checkups. We find that by maintaining a doctor-patient relationship, members are more likely to practice healthy habits while reducing their risk of developing a chronic condition.

But there’s another way this partnership pays dividends. Simply put, it saves money… for plan members as well as the employer.

If a doctor detects a disease in its earliest stages, it can potentially mean a difference of hundred of thousands of dollars in medical costs. Moreover, as physician Richard Young, MD relates on his blog, a family doctor who knows your medical history can also advise you whether a medical course of action is worthwhile:

“[A] patient said to her family doc, ‘My CPAP technician said I need a new CPAP machine and a new sleep study.’ The family doc asked her a few questions, then said, ‘You don’t need a new machine or a new sleep test.’ The patient was comfortable with this conclusion, best I could tell.

“Think about it. He made no extra money for saving the greater system several thousand dollars. He did not get a cut of the insurance money that wasn’t spent[…] He talked her out the unnecessary test and treatment just because it was a core value of his.”

A primary care physician that cautions against unnecessary care, Young notes, offers a “hidden source of savings that doesn’t appear on an insurance company analysis or Medicare report.“ Likewise, a wellness program that enourages plan members to establish a family doctor relationship at the outset in turn promotes a healthier bottom line for the employer.

For additional information about MedBen Worksite Wellness, contact Vice President of Sales & Marketing Brian Fargus at


  10:27:45 am, by MedBen5   , 318 words,  
Categories: News, Health Plan Management, Health Care Reform

Avoid The Fully-insured Customer Battles By Switching To Self-funding

Health Insurers Scramble to Keep Healthy Customers“, says a recent Wall Street Journal headline:

“Several [health insurers…] have recently warned customers of big rate hikes if they don’t immeditely renew their policies.

“At issue is a battle for healthy policyholders. Each company wants as many healthy people as possible on its books in hopes that their premiums will help offset an increase in costs from an expected wave of new customers who – with the help of the new health law – will be gaining insurance for the first time and may have health conditions to address.”

The article details the tactics that several high-profile insurers have used in retaining clients. One sample correspondence instructed customers to renew their current plans within 30 days of receiving the letter, or get switched to a pricer policy. A mandatory notice regarding optional plans available on state-run marketplaces was relegated to a footnote.

At MedBen, we view this “scramble” for healthy clients from a different perspective: If your claims activity is so good that you’ve got insurers AND the government competing for your business, then the truth is you have probably outgrown your fully-insured health care plan. Instead, you should consider the advantages of self-funding.

Employers with as few as 25 employees will save money as a self-funded group. Your money stays with you until claims are paid, so you can continue to earn interest on it. Plus, you keep what you don’t spend!

With MedBen as your plan administrator, we will see to it that you get the maximum value for your money. You’ll also get services not available from many other health care benefits managers, such as advanced claims surveillance to find additional savings and interactive reporting to spot spending trends.

For more reasons why it’s time for your business to explore the switch to self-funding, contact MedBen Vice President of Sales & Marketing Brian Fargus at


  12:45:18 pm, by MedBen5   , 277 words,  
Categories: Wellness, Health Plan Management

MedBen Wellness Coaching Makes A Big Difference To Plan Member

Specialized nurse coaching for plan members who may be at risk for certain conditions is a key feature of MedBen’s Worksite Wellness program. And sometimes, a single session can have a life-altering effect.

A nurse coach with our wellness program shared the following experience with us (the identity of the plan member remained private):

A 55-year-old employee, whose employer had just added MedBen Worksite Wellness to its health care coverage, was encouraged by the nurse to get her first colonoscopy. During a follow-up conversation with the nurse several months later, the employee reported that she recently underwent a screening.

“My doctor found one benign polyp and one cancerous, Stage 1 polyp,” she told her coach. “They are going to do a colectomy next month.

“Thanks to my wellness program it was found before it spread further.”

As this anecdote shows, timely screenings can help to detect cancer in its earliest stages, thereby preventing a more serious condition – and more costly care – down the road. In fact, a recent Kaiser Permanente study found that regular colonoscopies can sometimes reduce the risk of death from colon cancer by nearly 70%.

Selected employees and dependents entered into MedBen’s Specialty Care Program receive guidance through customized education and counseling. The nurse coach contacts the plan member via phone, letter or e-mail, and schedules periodic follow-up calls on a regular basis. The service is voluntary, and information obtained by the coaches is not reported to the employer.

To learn more about how worksite wellness can improve the health of all of your employees while saving your business money, contact MedBen Vice President of Sales & Marketing Brian Fargus at


  04:59:37 pm, by kthran   , 252 words,  
Categories: Announcements, News

MedBen Observes National Customer Service Week

On this National Customer Service Week, we at MedBen are pleased to spotlight the hard work of the men and women in our client service departments.

“While we appreciate our client service teams all the time, this week gives us the opportunity to recognize the employees that are on our front line, providing great service skills to our valued customers,” said Brenda McLean, Director of Client Services for MedBen.

MedBen group service and customer service representatives are committed to promptly addressing the needs of the client. To ensure that plan administrators always have a dedicated person available to assist them, we assign a pair of group service reps to every self-funded employer – a strategy that, based on our feedback, clients seem to appreciate:

  • “[Our group service reps provide] timely responses to immediate needs when issues arise.”
  • “Great response and timeliness of service reps…”
  • “They are professional, knowledgeable and I get issues taken care of ASAP.”

As for customer service, our representatives are available extended hours to answer all manner of questions from employers, plan members and providers. Immediate access to claims and benefits information enables reps to settle inquiries in a matter of minutes. In fact, 98% of customer questions are resolved on the first call.

To the members of our client service teams, we thank you for a job well done. Keep up the great work!

For additional information about how MedBen client services can benefit your group, contact Vice President of Sales & Marketing Brian Fargus at


  04:17:10 pm, by kthran   , 292 words,  
Categories: Health Plan Management

MedBen Reporting Tools Help You Bridge The "Care Gap"

Among the many features of MedBen’s intelligent reporting tools, clients have the ability to review their group’s “care gap” – a measure of what preventive exams and screenings your employees should be receiving compared to what they’re actually getting.

Care gap

To demonstrate this reporting functionality, as well as highlighting the importance of following wellness guidelines, we looked at a representative block of MedBen business for the last 12 months. By comparing plan members who had a low care gap – that is, who followed preventive care recommendations based on their age and gender – to those who missed recommended tests and/or checkups, we learned that the average claims cost for the low care-gap plan members is over five times less than for those with higher care gaps (see table).

Breaking the data down by chronic conditions, we also found that plan members with diabetes (the fastest-growing, most common chronic condition) who had a moderate-to-high care gap spent, on average, $14,821 in claims costs over the 12-month period analyzed, compared to just $8,176 for those with low care gaps. And the average claims costs of higher vs. low care-gap claims for plan members with heart disease was, respectively, $32,637 and $17,247. So in both cases, spending on patients who followed care guidelines was nearly half of those who did not.

Seeing how the care gap affects your group’s bottom line is just one of many ways MedBen’s data analytics platform can benefit you. Our leading edge processes also help to identify and target high-risk members in need of clinical interventions, track outcomes, and visualize the financial impact of plan changes.

For additional information about how our advanced reporting services can save your business money, contact MedBen Vice President of Sales & Marketing Brian Fargus at


  04:06:34 pm, by kthran   , 249 words,  
Categories: Announcements, News, Health Plan Management

MedBen Aces Latest ISO 9001 Audit

ISO Certified

“The recommendation from this audit is that your certification continues.”

That’s the conclusion of SAI Global following its most recent audit of MedBen’s compliance with ISO 9001:2008 standards. Conducted September 19, the audit examined the company’s internal procedures in the development and processing of health care benefit plans, and found no issues in their execution by employees.

In the evaluation report, the ISO auditors praised MedBen’s employees and “support from top management” – compliments that pleased Chairman & CEO Doug Freeman.

“ISO quality standards only work if there is a companywide effort to follow the processes we’ve put in place,” Freeman said. “So it’s important to me that the auditors see that our commitment starts at the top… but everyone here plays an equal role in that commitment.”

During the audit, the ISO review team also commended members of the MedBen staff who were asked about specific processes used in their jobs, noting their professionalism and knowledge.

MedBen earned ISO 9001 Certification in September of 2005 – one of the first benefit companies in the world to achieve that distinction. By using this proven quality system, the company works to ensure its claims processing, customer service and other daily practices exceed customer expectations.

In addition, semi-yearly audits enable MedBen to confirm that work procedures are continually followed and revised as necessary. This latest audit – the company’s 16th since the initial certification – produced the same outcome as all previous ones: A verification that its promise of quality performance continues to be upheld.


  03:42:53 pm, by kthran   , 316 words,  
Categories: News, Wellness

October Is Breast Cancer Awareness Month

Pink Ribbon

It is not precisely clear what causes breast cancer. Research has suggested age, gender and estrogen exposure may contribute. While anyone can get the disease, older women are at a greater risk.

Non-invasive (stage 0) and early stage (I and II) breast cancers have a better prognosis than cancer in its later stages (III and IV), and can typically get treated at a much lower cost – sometimes, hundreds of thousands of dollars less. Screening is the best way to find breast cancer in its earliest stages, and the most effective method is an X-ray of the breast called a mammogram. Visit your gynecologist regularly and have an open discussion about what tests you should be having.

One key to proper prevention – and, in turn, keeping your health care costs down – is knowing when your next test is due. That’s where MedBen Worksite Wellness can help.

MedBen Worksite Wellness plan members can track their mammogram compliance by visiting MedBen Access. To see recommended screening dates, or double-check if you missed a test, simply go to, click on “MedBen Access” and select the “iHealth Information” link under “My Plan”. MedBen Worksite Wellness also provides annual guidelines for cancer prevention and early detection, personalized for age and gender.

Full story »


  01:45:36 pm, by kthran   , 458 words,  
Categories: News, Health Care Reform

The Government Shutdown And The Future Of Obamacare


Effective today, the federal government is closed for business. Not totally, mind you – just selected bits and pieces not required by law to continue operations or deemed “non-essential", such as national parks, U.S. Capitol tours and free museums. And the closure will continue until Congress agrees on a spending bill.

The government shutdown occurs on the same day that open enrollment is scheduled to begin for health insurance Marketplaces offered under the Affordable Care Act (aka “Obamacare") – the law that just happens to be a huge sticking point in Congress, and a major reason for the shutdown.

The initial spending bill, approved by the Republican-led House of Representatives, included a provision to cut off Obamacare funding for the next 12 months. Ultimately, that demand was replaced by a one-year delay in the implementation of the “individual mandate", which requires individuals to carry health care coverage or pay a penalty. This final bill was quickly rejected by the Democrat-majority Senate.

So until the two parties find some middle ground on the health care reform law, the federal government will remain shut down. But not, ironically, the Marketplaces, which went live this morning (albeit not without numerous glitches).

How come? Because Obamacare is a permanent entitlement, similar to Social Security or Medicare. And as such, it isn’t subject to annual funding by Congress.

Full story »


  04:34:05 pm, by kthran   , 294 words,  
Categories: Health Plan Management

When Looking To Reduce Hospital Costs, Remember Bigger Isn't Better

A common conviction of the “bigger is better” line of thinking is that large metropolitan hospitals offer superior care than their smaller regional counterparts. But as Partners Community Health Plan members are discovering, size doesn’t tell the whole story.

To be sure, most big hospitals do provide an excellent standard of service. But almost all types of care available from major metro facilities can also be obtained from regional hospitals, and at the same outcome levels. Further, comparable treatment is often available from these smaller hospitals at a significantly lower cost.

With Partners, you can reduce your health care costs by getting treatment from area facilities, while sparing yourself the burden of extra travel time. Here are several examples of the saving differences typical of metro vs. Partners-member community hospitals:

  • The delivery of a normal newborn at Columbus, OH metro hospitals costs, on average, $2,934. In comparison, the same procedure at Fairfield Medical Center costs $1,294 (avg.) – a savings of 56%. (Ohio Hospital Association 2010 Claims and MedBen 2011 Claims Data)
  • A colonoscopy costs, on average, $2,963 at Cleveland, OH metro hospitals, and $4,968 at Toledo metro hospitals. But the same procedure at Fisher-Titus Medical Center costs just $2,387 (avg.) – 19% and 52% less, respectively. (Ohio Hospital Compare)
  • A major joint replacement or reattachment of lower extremity without major complications costs, on average, $14,116 at Nashville, TN metro hospitals. The same procedure at Murray-Calloway County Hospitals costs $11,201 (avg.), or 21% less. (Centers for Medicare & Medicaid Services Payment Values, 10/10 through 9/11, State of Tennessee)

We will be happy to provide additional price comparisons for all areas in which we currently offer Partners Community Health Plan. To learn more, please contact MedBen Vice President of Sales & Marketing Brian Fargus at To see if Partners is available in your area, visit


  09:02:43 am, by kthran   , 237 words,  
Categories: News, Health Plan Management

Lack Of Insurance Knowledge A Problem, But MedBen Has The Solution

Knowledge, as they say, is power… and in the case of health insurance, the more you know, the better your odds of staying healthy and saving money. At MedBen, it’s our goal to keep clients informed about all aspects of their coverage.

As insurance has expanded beyond comparatively simple major medical plans into preventive care and consumer-driven offerings, it’s not surprising that more people aren’t sure how health care coverage works. According to WebMD, a recent health insurance literacy poll by the American Institute of CPAs found that more than half of Americans can’t define such basic terms as premium, deductible and copay.

To ensure that plan members understand how to navigate their coverage, or know where to turn when they need specific information, every new MedBen self-funded groups receives a customized New Group KIt. Included with the kit is a CD containing “MedBen Basics” – a series of documents covering such topics as using the member ID card, reading explanations of benefits (EOBs) and logging on to MedBen Access, our claims and benefits information website. The Plan Members area of also offers several of these Basics in addition to forms, provider directories and other resources.

Of course, our customers can get answers to any of their health care coverage questions by calling the MedBen Customer Service Department. Representatives are available Monday through Friday, 8:00am-6:30pm EST, by calling (800) 686-8425 or e-mailing


  09:45:25 am, by kthran   , 310 words,  
Categories: News, Incentives

With Worksite Wellness, Incentives Don't Have To Be Big

Money talks – and, apparently, motivates people to walk as well. But at MedBen, we’ve learned that positive wellness reinforcement comes in many varieties.

According to MedPage Today
, a recent review of wellness incentive studies by University of Toronto researchers showed that attendance at exercise classes increased by an average of 12% for individuals who received financial rewards for participation. In most of the studies, the money – which varied anywhere from $3.00 a week as high as $47.00 – was held until the end of the program, but this lack of immediate gratification didn’t appear to be a drawback as long as participants were kept informed of their “reward status".

“This is consistent with findings from previous systematic reviews that generally observed improved dietary behaviors, smoking cessation, and weight loss, respectively, in the short term and while financial incentives remained in place,” the researchers wrote

So while it may come as no surprise that a monetary carrot can spur people to change their behavior, MedBen has found with its Worksite Wellness program that cash enhancements need not be large – or even necessary for incentivizing.

On the one hand, our experience has shown us that wellness plan members respond well to such rewards as time off, reduced health insurance premiums or employer contributions to a personal HRA. But if promoted properly, smaller rewards like gift cards and catered lunches can be equally effective.

And then there are the incentives that cost little to nothing, such as conducting an internal competition or giving recognition through the company newsletter or intranet. With the support of management and the multiple worksite wellness tools provided by MedBen, even the smallest gesture can have a powerful impact.

To learn more about how MedBen Worksite Wellness can help you motivate your workforce to better health, contact Vice President of Sales and Marketing Brian Fargus at


  08:42:04 am, by kthran   , 271 words,  
Categories: News, Health Plan Management

More Employers Are Going Solo With CDHPs

MedBen has offered consumer-driven health plans for nearly 15 years… and in that time, we’ve seen it transform from a niche product into a valuable tool for employer cost savings, as well as a way to give employees a greater role in health care spending choices.

And not only are businesses using CDHPs as an alternative or complement to a regular PPO plan, more and more are employing it as their sole source of coverage. According to Business Insurance, a National Business Group on Health survey recently found that over 20% of employers say CDHPs will be the only plan design they offer to employees in 2014.

So what is it about the consumer-driven plan option that appeals to employers? Lower costs are one reason. A Kaiser Family Foundation report released last month found that the average cost of family coverage through CDHPs was nearly $1,500 less per employee than PPO coverage.

The Affordable Care Act also increasingly factors into the decision-making process. Some of the costlier provisions, such as the “Cadillac tax” that will impose a penalty on higher health costs, can be avoided through a greater emphasis on CDHPs.

With options ranging from FSAs and HRAs to the administration of a HDHPs tied to individual HSAs, MedBen can put together a CDHP solution that’s equally effective for self-funded or fully insured employers. And we’ve got the experience, backed by demonstrated employer savings, to ensure that your group’s plan satisfies both your coverage and your financial needs.

To learn more about MedBen CDHP options and how they can benefit your business, contact Vice President of Sales & Marketing Brian Fargus at


  12:05:00 pm, by MedBen5   , 120 words,  
Categories: News, Health Care Reform

Questions About Marketplaces And HR? Watch This MedBen Webinar

With the rollout of health insurance Marketplaces (previously referred to “Exchanges") just a few months away – and enrollment for them, mere days – it’s possible you may not fully understand their purpose, or if you’re a business owner or human resources representative, how they affect you. To address these questions, MedBen Vice President of Compliance Caroline Fraker recently conducted a webinar on the topic “Exchanges and Your HR Department".

Fraker also spoke on a number of other topics pertaining to the Affordable Care Act and its affect on employers, all of which are available on the MedBen TPA YouTube page. Clients with questions regarding these webinars, or the health care reform law in general, are welcome to contact Caroline at


  05:45:20 pm, by kthran   , 278 words,  
Categories: News, Health Plan Management

U.S. Health Spending Continues To Grow; MedBen Helps Employers Keep It In Check

With 75 years of health care management under its proverbial belt, MedBen has seen plenty of fluctuations in nationwide health spending over the decades – from periods of relatively slow upticks to the double-digit increases of the early 2000’s. And now, after multiple years of mild growth, experts predict that total health spending will see larger bumps, albeit not nearly as big as those experienced prior to the recent recession.

MedCity News reports that over the next decade, U.S. health spending will go up an average of 6.2% per year, based on projections by government actuaries. Additionally, they estimate that the health care segment of the nation’s economy will amount to a fifth of the nation’s gross domestic product in 2022.

What accounts for the upturn? The auditors attribute it to an improving economy and the rising number of baby boomers moving into Medicare. As for the effect of health care reform, they see only “modest” savings from changes in the law. “It’s a little early to tell how substantial those savings will be in the longer term,” Gigi Cuckler, one of the actuaries, told reporters.

Since health spending will only continue to rise, it’s critical for your business to partner with an ally that looks out for your financial interest. At MedBen, we’ve developed a multi-tiered cost containment strategy, at the heart of which is an advanced claims surveillance system. We use financial and clinical algorithms to determine savings opportunities, loss potential and fraud risk for every claim we process, regardless of size.

To see documented proof of how MedBen claims surveillance saves employers money, contact Vice President of Sales and Marketing Brian Fargus at


  04:10:01 pm, by MedBen5   , 511 words,  
Categories: News, Health Plan Management, Health Care Reform

Employee Exchange Notice Requirement Nearing October 1 Deadline

Capitol Building

No later than October 1, 2013, all employers are required to provide a Notice to their employees providing information about the new health care Exchanges created by the Affordable Care Act (ACA). The Exchanges, now called Health Insurance Marketplaces, provide individuals and small employers access to certain insurance carrier’s health insurance policies. The Notice provides some basic information about those policy options and how to contact the Health Insurance Marketplace.

In order to comply with the ACA requirement, all employers, regardless of size, need to send the Notice to ALL of their employees – including those employees who are not on their health plan and those who do not work full-time. While the Department of Labor (DOL) recently clarified that there is no penalty for failing to send the Exchange Notice (DOL FAQ on Notice of Coverage Options released September 11, 2013), it did not waive the requirement that employers distribute the Notice to employees. The DOL FAQ on Notice of Coverage Options can be found at the DOL website.

In order to assist employers with this task, the DOL released two Model Notices earlier this year – one for employers that offer coverage to their employees, and one for employers that don’t offer coverage. If an employer offers coverage to some employees and not to others, the employer can either provide both notices to the respective employees, or they can provide the “offering” coverage notice and specifically indicate on page 2 who is eligible for coverage and who is not. You should also note the following:

Full story »


  04:21:02 pm, by MedBen5   , 214 words,  
Categories: News, Health Plan Management, Health Care Reform

Employee Coverage and Self-funded Savings -- So Where's The "Threat"?

Private sector solutions apparently have no place in today’s brave new health care world, The Wall Street Journal finds:

“[S]elf-insurance is now filtering down to businesses with 199 workers or fewer, as a hedge against ObamaCare’s federal mandates and the danger that costs on its small-business exchanges will soar. Some insurers are now selling popular products that allow groups as small as 25 to self-insure. [Editor’s note: Groups with as few as 20 employees can partially self-fund with MedBen Split Solution.] In a 2012 study, the Urban Institute found ObamaCare’s incentives will cause as many as 60% of small firms to convert without regulatory changes.

the White House, liberal pressure groups and state and federal regulators are trying to close what they call the self-insurance ‘loophole’ before more escape. Their political and actuarial fear is that if enough businesses don’t join, the exchanges could fail because too few younger and healthier people will subsidize everybody else.

“In a June alarm titled ‘The Threat of Self-Insured Plans Among Small Businesses,’ the liberal Center for American Progress warns that ‘the result of this shift could cause an insurance premium death spiral.’ Note how businesses that pay for their workers’ health care are suddenly a ‘threat.’ Wasn’t coverage the point of ObamaCare?”



  04:32:42 pm, by MedBen5   , 237 words,  
Categories: News, Health Care Reform

With Exchange Enrollment Start Date Looming, Confusion, Opposition Abound

One would think with all the free publicity the Affordable Care Act has received in the past several years, the majority of Americans would by now have a pretty good understanding about such concepts as “the individual mandate” and “health insurance exchanges". But based on the findings of a new survey, one would apparently be wrong.

A new USA TODAY/Pew Research Center Poll shows that, among the 19% polled who are uninsured, nearly four in 10 don’t realize the law requires them to get health insurance next year. Among young people, whose participation is seen as crucial for the exchanges to work, just 56% realize there’s a mandate to be insured or face a fine.

The exchanges, which serve as a marketplace for uninsured individuals to buy insurance, are scheduled to begin enrollments on October 1. But only half of those surveyed know there will be a health care exchange available in their state – even less so in states that have refused to participate, defaulting instead to the federal exchange. Likewise, about half are aware that subsidies will be available for lower-income citizens.

As for opposition to the health care reform law, it has remained fairly high since its passage in March 2010 – and in this latest poll, the 53% disapproval represents the highest level yet. Moreover, 47% of respondents say the law will have a negative impact on the country as a whole, compared to 35% who expect a positive impact.

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