Formulary updates for prescription plans administered by Pharmacy Data Management, Inc. (PDMI) are now available at MedBen.com – simply click on “Plan Sponsors” (for employers) or “Plan Members” (for insureds) and select “Prescription Formularies” from the “Form” drop-down menu.
The new formularies become effective January 1, 2017. As always, plan administrators with questions about the formularies can contact their Group Service Representative, while plan members can call MedBen Customer Service at (800) 686-8425.
Groups use either the Focus formulary or the Outcomes formulary. Focus offers the most cost-effective drug options, while Outcomes offers broader choice while still delivering significant cost savings. If you're not sure what type of formulary you use, check with your plan administrator or log on to MedBen Access.
Should you still need a 2016 formulary, they will remain available on the MedBen website until the end of the year.
The tax-free benefits of flexible spending accounts (FSAs) helps plan members to save money on their health care spending... but using FSAs to their maximum advantage requires a bit of prior planning.
Many FSA members are currently deciding how much of their salary they want to place into their account. To determine the proper contribution amount, the best strategy is to consider health-related purchases over the past several years and use that as a starting point. MedBen clients can review their recent spending activity by logging into MedBen Access and clicking on “FSA/HRA Online Inquiry” under the “My Plan” section.
In 2017, the FSA contribution limit will be $2,600, though employers do have the option of setting a lower amount. If you're certain that you'll spend the set limit on qualified medical expenses, you can maximize the value of your FSA by making the full allowed contribution. Otherwise, consider your standard annual costs ‒ dental expenses, vision exams and materials, recurring prescriptions, and so forth ‒ and use them as your contribution baseline. Funds will be taken from your paychecks throughout the year, but the full contribution amount will be available for use on January 1.
When planning, it's critical to remember that a "use it or lose it" rule applies to FSAs. While some employers will offer a 2-1/2 month grace period to use up your remaining funds or let you roll up to $500 into the next year, ultimately any unused funds must be spent or forfeited. FSA members unsure about their group's policy should check with their plan administrator or call the MedBen Flexible Spending Unit at (800) 297-1829.
The shift from fully-insured group health plans to self-funded coverage continues, with more and more businesses realizing its savings potential. And not just large companies, either... as benefit managers like MedBen offer solutions to minimize risk, even smaller businesses are successfully making the transition.
According to Benefits Pro, a recent study by the Employee Benefit Research Institute found that between 2013 and 2015, the percentage of mid-sized companies offering at least one self-insured health plan increased from 25% to 30%. Among small businesses, the percentage jumped from 13.3% to 14.2%.
Meanwhile, self-funded businesses may soon benefit from lower rate increases. Willis Towers Watson’s Marketplace Realities report forecasts 2017 cost growth of just 4-5% for self-funded plans, compared to 7-8% for fully-insured plans.
But cost savings is just one reason more businesses are making the switch to self-funding. Plan control, access to analytic information, and the ability to design wellness initiatives have all increased self-funded appeal. MedBen helps clients of all sizes take advantage of these and other benefits.
If your business has 25 covered lives or more, you can gain from the cost-saving potential of self-funding while getting maximum use out the design and regulatory freedoms it offers. Contact MedBen Vice President of Sales & Marketing Brian Fargus to learn more.
MedBen continues to maintain high standards of quality, says the latest independent audit of the company's ISO 9001 compliance.
According to the auditing firm SAI Global, MedBen's management system, which was put in place to ensure process consistency across the company, is being followed and utilized. Additionally, MedBen management provides "appropriate input and support" to ensure that the established ISO standards are met.
"The recommendation from this audit is that your certification continues," the audit report reads.
The audit, conducted on October 20, reviewed MedBen processes in performance monitoring and measurement, management responsibility and review, and product realization. In these and other areas, the staff has implemented and improved on the company's quality management system.
Having ISO standards only works when every employee is invested in following them, noted MedBen Chairman & CEO Doug Freeman. "It takes a companywide effort to maintain quality and consistency, and I'm pleased that these audits repeatedly show that everyone here has bought in to the idea," he said.
MedBen achieved ISO 9001 Certification in 2005, and undergoes semi-annual follow-up audits to ensure continued quality performance. In 2017, the company will undergo an extensive multi-day review in order to receive recertification.
Back in May, MedBen highlighted new wellness rules from the Equal Employment Opportunity Commission (EEOC) regarding the use of incentives to promote participation in corporate wellness programs. These rules, which go into effect on or after January 1, 2017, place a limit on how much financial incentive employers can offer to their employees to encourage healthier habits.
To give more detail about the EEOC rules and how it will affect their wellness plans, the MedBen Compliance team has put together a summary document containing additional information. The document was recently e-mailed to our clients by their Group Service Representatives, but in case you missed it, it is also available for download from the MedBen website.
As was noted in the earlier article, the EEOC rules provide guidance to ensure that wellness programs comply with the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). The ADA prohibits employers from making disability-based inquiries or requiring medical exams for employment or benefit purposes, while GINA restricts employers from requesting, requiring or purchasing genetic information which includes information about an employee's or family member's disease state or medical history.
Common to both ADA and GINA rules is a set limit on wellness incentives that employees can offer to employees and their spouses ‒ no more than 30% of the total cost of self-only coverage. It's important to note, however, that this amount must take into account both financial and in-kind incentives, such as time-off awards, prizes, and any other item of value.
MedBen is currently assisting WellLiving clients that need to make changes and working with them to ensure that their wellness programs are compliant with the new rules, but all clients with questions regarding the final EEOC rules are welcome to contact Caroline Fraker at 800-851-0907 or email@example.com.
When discussing hypertension, we tend to focus on its physical effects, such as its link to heart disease, stroke and diabetes. But doctors warn that high blood pressure may affect your mental capacity as well.
According to HealthDay News, a new scientific statement from the American Heart Association warns that having high blood pressure may increase one's risk of dementia. Statement author Dr. Costantino Iadecola said that hypertension is "the worst possible thing for the brain," as damage to its blood vessels leads to hardening of the arteries and an inability to control blood flow critical to normal brain operations.
While high blood pressure is a pervasive condition (about 1 in every 3 American adults have it), it's also treatable through such basic lifestyle changes as a healthier diet and regular exercise, as well as prescribed medication. Equally useful for individuals is having access to a proven worksite wellness program for advice and motivation.
Through MedBen WellLiving, plan members have a two-pronged approach to controlling high blood pressure and other chronic conditions: primary prevention that promotes annual wellness exams and building a doctor-patient relationship, which allows earlier detection and treatment; and specialty care that identifies high-risk members and offers individualized coaching from registered nurses.
For the employer, WellLiving provides regular reports, one of which includes their population’s compliance with various wellness categories and nurse coaching calls.
Effective preventive care addresses the body and mind alike, and helps employers promote a healthier workplace, which in turn leads to increased productivity and reduced absenteeism. Learn more about the benefits of MedBen WellLiving by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Following lengthy speculation, the Internal Revenue Service (IRS) has at last formally announced the annual inflation adjustment for health flexible spending accounts (FSAs) for the 2017 tax year.
The 2017 dollar limitation on voluntary employee salary reductions for contributions to health FSAs is $2,600, marking a slight increase from the current $2,550 maximum. Additionally, the dependent care FSA maximum annual contribution for next year is $5,000, unchanged from 2016.
The announcement comes some months after the IRS released 2017 contribution limits and out-of-pocket maximums to health savings accounts (HSAs) tied to a high-deductible plan. In most cases, the amounts were frozen in place, with a small increase in single contribution limits ($3,400, from $3,350 in 2016) being the sole exception.
MedBen clients who wish to implement FSA changes, or who have any questions regarding FSA contributions, are welcome to contact Director of Administrative Services Sharon A. Mills at (800) 423-3151, Ext. 438 or email@example.com.
Verisk Health, the company that MedBen has partnered with to provide clients with detailed reporting services, recently rebranded to Verscend Technologies (Verscend). But while their name is different, the company's commitment to analytic solutions remains unchanged.
Since 2010, our relationship with Verisk has enabled us to offer an unprecedented level of visibility in the health status of client populations, giving us the resources to pinpoint opportunities for improving care and reducing costs. Under the Verscend name, the company will further optimize health care and create even better outcomes, says Verscend CEO Dr. Emad Rizk.
Through the data analytics and reporting platform developed by Verisk/Verscend, MedBen clients receive unique insight into the financial and clinical risks they face, allowing them to chart an effective course of action. Leading-edge processes include drill-down functionality that indentifies high-risk members in need of medical interventions, a population analyzer that tracks utilization and cost trends, and outcome tracking through sophisticated cohort tools.
Clients that have questions about any aspect of our reporting services may get in touch with their Regional Sales Manager. Employers not currently working with MedBen who would like to learn more about advanced analytic solutions are encouraged to contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
The CDC states that more than 40% of adults have felt pain in their mouth in the last year. So, it’s easy to see why you should be brushing, flossing, and rinsing regularly. But these tasks could do more than just keep teeth clean – they could also help protect you from other chronic conditions.
Though the connection between oral hygiene and other certain chronic conditions is still being debated, evidence has shown a correlation between the two. Periodontics disease has been linked to conditions such as heart disease, diabetes, dementia, and rheumatoid arthritis. In addition, gum disease has been linked to poor heart health, including heart attacks.
Some researchers believe that one link can be found when oral bacteria escapes into the bloodstream, injuring major organs. It’s also thought that inflammation related to oral conditions can lead to inflammation in other parts of the body.
Whether the connections prove to be coincidence or a direct link, MedBen WellLiving has always suggested being proactive. Properly cleaning your teeth and gums, monitoring changes in your mouth such as red, inflamed gums, bleeding, or sores that will not heal, as well as visiting your dentist twice a year are highly recommended.
If you have concerns with your oral health or want more information on how to properly care for your mouth, pay a visit your dentist or family physician.
The ongoing issue of high prescription drug costs have led to media scrutiny, congressional hearings, and charges of price-gouging. MedBen prefers to remain above the fray, and instead focus on ensuring that our clients pay as little as possible for their pharmacy coverage.
"Drugmakers Point Finger at Middlemen for Rising Drug Prices," reads a recent Wall Street Journal headline. Those "middlemen" include pharmacy benefit managers (PBMs), which serve as consultants and price negotiators for employers that offer drug plans.
While it strains credibility to lay too much blame at the feet of a "middleman," it is true that many PBMs do retain a portion of the rebates and discounts they receive on behalf of their clients. Drugmakers argue that their cost increases reflect, in part, the money that PBMs hold back.
At MedBen, we follow a simple rule: "The client's money belongs to the client." Not most of it... all of it. That is why we enlisted the services of a PBM that shares our attitude.
MedBen clients can be assured that 100% of paid pharmacy rebates go directly into their health plan. We offer a transparent, full pass-through Rx model that results in better client savings. The same applies to pharmacy discount rates, including generic discounts that are among the best in the industry.
Regardless of all the finger-pointing happening over drug prices, there are genuine opportunities for employers to save money on their pharmacy plan costs, and MedBen specializes in providing timely client solutions. Learn more about how we do it by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
Just like in sports, the best offense is a good defense ‒ and the same goes for your health. Promoting healthier lifestyles and practicing preventive care leads to better outcomes.
According to WebMD, a recent Danish study determined that individuals who suffer a heart attack before the age of 50 are nearly at twice the risk of an early death compared to the general population. This higher risk is driven mainly by conditions such as high blood pressure, diabetes and obesity, which are more common among people who've had a heart attack. All of these conditions leading to the heart attack, if detected and managed early, could help to eliminate the risk of a chronic condition imploding.
Following such healthy habits as regular exercise, good diet and not smoking, can reduce heart attack risk by as much as 92%. And having access to a proven worksite wellness program like MedBen WellLiving provides individuals with an additional layer of support.
By offering WellLiving, your employees have a solid foundation on which to build better lifestyles. Our "physician first" approach promotes plan members getting regular wellness exams from their family doctors, which offers a forum to discuss ways to improve and maintain healthy habits. Plus, plan members who have a higher risk of developing a chronic condition can receive individualized nurse coaching through our specialty care program.
Living a healthy lifestyle may not always be easy, but the rewards are well worth it. Learn what wellness can do for your workplace by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Hard though it may be to believe, we've already entered the final quarter of 2016. If you're a self-funded employer, that means it's time to get serious about preparing for a critical health care reform mandate: Providing the IRS with an accurate accounting of health coverage for full-time employees. MedBen offers helpful services to complete this task.
Per the Affordable Care Act, health coverage data collected during 2016 must be aggregated and reported to employees no later than January 31, 2017 on IRS Form 1095, and reported to the IRS no later than February/March 2017 (depending on filing requirements) on IRS form 1094. Applicable Large Employers (those with 50 or more employees), or ALEs, must report using the IRS’ C-series forms, and small employers (those with fewer than 50 employees) offering coverage must report using the IRS’ B-series forms.
MedBen has again partnered with MyBenefitsChannel (also known as Five Points Technology) to provide reporting assistance for ALE clients. MyBenefitsChannel has several service options available to help ALEs create and distribute Form 1095-C to employees and prepare and file Form 1094-C with the IRS. MedBen will also be available to assist clients who are small employers by offering related IRS Forms (1095-B – employee notice and 1094-B – IRS transmittal) services for a nominal fee.
Even though the January deadline is over three months away, we strongly recommend that our clients purchase these services as soon as possible.
Regardless of your preferred approach, it is important that you start planning now.
MedBen clients with questions regarding this information may contact their Group Service Representative or Vice President of Compliance Caroline Fraker at 800-851-0907.
Benefits consulting firm Sherrill Morgan, a company that MedBen has worked with for nearly two decades, was recently named by Ohio Business Magazine as among the "2016 Best Workplaces in Ohio."
As one of the magazine's inaugural group of winners, Sherrill Morgan was praised as "a place where a worker feels valued." Based in Covington, KY (right on the Ohio border), the company has provided employer consulting services since 1969.
MedBen congratulates Sherrill Morgan on this impressive achievement!
Employees who have vision benefits tend to take better care of their eyes, a new analysis finds. It's another reason why group vision coverage through MedBen VisionPlus is an affordable way to promote employee health that goes beyond standard medical care.
According to BenefitsPro, a review of data derived from a 16-year consumer study showed that over 87% of Americans with vision coverage intend to get an eye exam within the next 12 months, compared to only 67% of those without a vision benefit. Similarly, following the exam, 67% of individuals with a benefit will get new eyewear, as opposed to just 34% without a benefit.
Of course, to promote better eye care to your employees, it pays to have the right vision plan. With MedBen VisionPlus, you can put together an inexpensive vision package that encourages regular exams and corrective eyewear. Plan members can choose to use network providers at a reduced cost to them, or go outside the network if they prefer.
Moreover, the health benefits of eye care doesn't stop with diagnosing vision problems. By examining blood vessels in the eyes, doctors can detect early signs of chronic conditions like high blood pressure, high cholesterol, and diabetes.
Employers benefit from offering vision coverage, too: It gives them a competitive advantage when recruiting new employees. Find out all the ways MedBen VisionPlus enhances your health care plan by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
A recent EBN opinion piece on self-funding makes the observation that "TPAs have no financial incentive to comprehensively review all [claim] payments." At MedBen, we believe just the opposite ‒ as a third party administrator, it is entirely in our best interest that every claim receives a thorough examination.
If the advantages of self-funding had to be encapsulated in one word, a good candidate would be "control." Through self-funding, you control plan design, plan language, and above all, plan costs. And a good TPA like MedBen is invaluable in helping employers realize the maximum financial return from having a higher degree of control.
MedBen often highlights its claims surveillance system, and for good reason: By screening every claim using advanced algorithms, we ensure that claims that may otherwise be overlooked are found and addressed. From there, board-certified medical specialists further review flagged claims and, if necessary, work with the provider to reach a proper resolution.
In 2015, MedBen clients realized an average savings of $13.61 per employee per month through claims surveillance. That represents a 26.5% reduction on a reviewed claim.
Moreover, MedBen has the staff stability and expertise to help you make the most of your plan control in other areas, such as matching proper benefits to the employee population, or using plan language to prevent overpayments for care when less costly alternatives are available.
Earning client loyalty is all the "financial incentive" MedBen needs to do the job right. Learn more about how we help you control your health plan by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Colonoscopies are critical to the early detection and treatment of colon cancer, but they're not the only thing that can help you spot the disease. You also have to pay attention to signals from your digestive system, researchers warn.
"The old saying 'listen to your gut' holds true when it comes to your health. If you notice differences that persist more than a week, contact your physician," said gastroenterologist Dr. Amit Singalin, representing colleagues at the University of Texas Southwestern Medical Center.
"Many conditions can cause digestive symptoms, but if it is cancer and you catch it early, you'll have a better prognosis," he added.
Persistent lower belly pain or discomfort, or substantial changes in bowel movements, may indicate early warning signs for colon cancer. But even if no symptoms are present, every adult age 50 and older should be screened for the disease.
MedBen WellLiving promotes age-appropriate screenings for colon cancer and other chronic diseases. Our program also encourages primary prevention through regular wellness exams, which helps your physician monitor individual changes that may alert him or her to the onset of a serious disease.
"Keep analytics clear, simple, and interactive in order to deliver effective care transformation messages." That was the message Kurt Harden, President and Chief Operating Officer of MedBen Analytics, delivered to hospitals, health systems, and consultants at a recent national conference for the newest iteration of the Centers for Medicare and Medicaid value-based payment initiative known as the Comprehensive Care for Joint Replacement (CJR).
Harden spoke at the CJR Boot Camp held in Miami, Florida on September 24th and 25th, talking with participants about the use of analytics to guide care transformation. “There is very good information available about how health systems across the country have saved money in lower joint replacements. Build analytics with this knowledge in mind,” he said.
CJR is mandated in 67 markets across the United States, and affects over 800 health systems performing lower joint replacements for Medicare recipients. MedBen Analytics performs data analytics services for hospitals participating in the CJR program, turning Medicare claim data under the program into care improvement insights.
In his comments, Harden encouraged participants to keep care transformation analytics focused on key cost-saving areas and avoid being distracting by “interesting but unactionable” data. He also gave examples from MedBen’s proprietary analytics portal, showing how to mine the Medicare claims data for savings opportunities in the CMS value-based care initiatives.
“The post-acute setting is rich with savings potential,” Harden observed. “Skilled nursing care, readmissions, even home health care costs should be monitored closely.”
MedBen Analytics is a subsidiary of MedBen Administrators and provides analytics services for health systems across the country. Organizations interested in discussing MedBen Analytics can call Harden at 888-633-2364 or email him at email@example.com.
With the implementation of the controversial Cadillac Tax postponed until 2020, it's easy for employers to put thoughts of it on the backburner... or hope that it simply goes away. But neither approach is a sound strategy, which is why MedBen recommends that clients continue to make whatever adjustments to their benefits necessary to manage health care cost increases. And our Compliance team can help.
In its current form, the Cadillac tax would assess a 40% penalty on health plans in excess of $10,200 for single coverage or $27,500 for family coverage. Earlier this year, President Obama proposed changing the threshold amount to one that would vary based on regional individual health care costs, but no action has been taken on that proposal. And while it's possible that the tax could someday be repealed, much will depend on the outcome of this year's presidential and congressional elections.
For employers, the smartest action is to assume that the Cadillac tax will take effect in 2020 and prepare accordingly. One important fact to remember is that, for Cadillac tax purposes, the value of a health care plan is determined not just by what the plan offers, but by the overall costs of the plan calculated using the same methodology as used in determining the same plan’s annual COBRA rates. So simply removing a benefit here and there will not significantly affect the coverage cost in relation to the threshold amount if the overall plan costs are not affected.
Clients who would like help determining their probability of being subject to the Cadillac tax are welcome to contact MedBen Vice President of Compliance Caroline Fraker at firstname.lastname@example.org. She'll be happy to run your plan through a special calculator to determine how much you may owe should the tax take effect.
U.S. health care spending growth has been relatively moderate this decade, but some recent numbers suggest that costs could soon see an upswing. For employers, it's an ideal time to review their current health plan administrator and ensure that measures are in place to control potential spending spikes.
According to the Los Angeles Times, the U.S. Labor Department says that health care spending rose 1% in August ‒ the largest single-month increase in more than three decades. While that may not seem like much, similar increases over a year's time could lead to a double-digit spending jump.
Among the factors accounting for the monthly growth increases in hospital services costs and prescription drug pricing. Overall, average drug prices have climbed 6.3% in the past 12 months... and the likelihood is that future years will bring similar increases. Fortunately, MedBen can assist employers in beating these trends.
If you received our new Client Report, you know that we've highlighted some of the ways we help groups control their health plan costs, from our provider-driven claims surveillance system to our advanced reporting platform. And for pharmacy plans, we offer total price transparency, with 100% of pharmacy rebates and discounts returned to the client.
One of our most effective savings tools, plan design, draws upon our years of expertise in third party administration. Our goal is to regularly meet with clients and consultants to review plan activity and discuss ways to further improve care while reducing medical spending.
If you're not a current client, we'd be happy to talk about your current health benefits package and how we can help you defy health care spending trends. Contact Vice President of Sales & Marketing Brian Fargus at email@example.com to learn more.
At an employee appreciation luncheon on Friday, September 9, MedBen honored employees who have reached anniversary benchmarks in 2016. The recognition presentation was co-hosted by MedBen President & COO Kurt Harden and Vice President of Compliance Caroline Fraker. Harden is also among the employees who are celebrating their 25th year with the company.
Harden joined MedBen as Director of Public Affairs in 1991, when the company was primarily a mutual life insurer with a small workforce and an up-and-coming third party administration division. At the luncheon, he thanked everyone for their continued service and singled out those employees also celebrating benchmark anniversaries. "Your loyalty and good work motivate me, and together we all make MedBen a success," he said.
Also receiving special congratulations at the luncheon on their 25th Anniversary were: Sheri Gutridge, Senior Accountant; Monica Jackson, Claims Examiner III; and Cathy Valentine, Data Prep and Data Entry Manager.
Sheri Gutridge has been a member of the MedBen Accounting Department from her very first day, starting as a Staff Accountant following a short stint as a temp. "I have never considered going to another department," she said after the event.
A regular at the lunchtime exercise classes offered by MedBen, Gutridge said that she appreciates how the company "strives to promote wellness." As for what she enjoys most about being an employee, she replied, "It's a wonderful working environment. I hope to be here until my retirement."
Monica Jackson has also worked for just one department (Claims) in her 25 years at MedBen, and in a single capacity, as a Claims Examiner. But as she's gained valuable experience, her responsibilities have grown accordingly. In addition to her own examiner duties, she also trains new examiners and reviews their claims for accuracy.
Jackson cites her co-workers as the best part about working at MedBen. "All the people I work with are great," she said.
Cathy Valentine first joined MedBen as a Submission Control Clerk in the Claims Department, and held various Claims positions before becoming a member of the Data Services team. "After 25 years, I still enjoy coming to work every day," she said.
Valentine added that she is amazed by how much data storage has changed from 1991, when claims were saved to microfiche, then later to disks and now digitally. Likewise, MedBen itself has changed, always with an eye toward improving the client experience. "All of the many employee benefits and products that have been introduced over the years continue to inspire me," she said.
Other MedBen employees honored at the event include: