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  04:51:00 pm, by MedBen5   , 308 words,  
Categories: Health Care Reform, Taxes, Compliance, PCORI, Affordable Care Act

Reminder: PCORI Filing and Fee Due Deadline Approaching

IRS Building

It’s that time of year again! As in years past, no later than July 31, 2019, all self-funded employer health plan sponsors are required to file and pay their Patient-Centered Outcomes Research Institute (PCORI) fee. But there’s good news this year!

The PCORI Fee payment requirement is nearing sunset. If your health plan has a plan year start date of November 1st, December 1st or January 1st, the July 2019 PCORI filing and payment will be your last at $2.45 per covered life.

If your plan year starts on February 1st through October 1st, you will owe $2.39 per covered life this year and your last PCORI payment and filing will be next year in July 2020.

All self-funded plan sponsors are required to pay a fee based on the average number of covered lives under their eligible plans – that includes employees, retirees, spouses and dependents. Self-funded plans subject to the requirements include self-funded medical benefit plans, including most non-ERISA self-funded plans and retiree-only plans. Other self-funded plans subject to the fee include self-funded HRAs and FSAs which are not integrated with a plan sponsor’s self-funded major-medical plan. Dental-only, vision-only, EAP, disease management, and wellness plans are exempt.

All plan sponsors must use the IRS Form 720 dated April 2019 to record and remit the amount due. The IRS Form 720 has been modified to include the payment amounts due this year. Make sure to complete the correct section of Part II for “Applicable self-insured health plans” and select the correct payment amount based on your plan’s plan year end date.

IRS Form 720

This year’s payment schedule can be found on the MedBen website along with more information about calculating and remitting the fee to the IRS. As always, if you need more information about how to count covered lives under your plan or how to prepare and remit your payment, don’t hesitate to contact your Group Service Representative.


MedBen Shatters Industry Norms

MedBen building

MedBen medical and pharmacy claim costs rose only 0.4% per employee for clients in 2018, shattering national data norms that reported an average of 6% cost increases. Our pharmacy claim costs alone dropped 2.7% last year, due to the introduction our new program MedBen Rx Advocate.

Those low numbers are in keeping with recent MedBen activity. From 2015 to 2018, MedBen clients saw a medical/pharmacy claim cost trend of 4.5%, compared to a four-year national claim cost trend of 6.55% (based on a recent survey).

What does that difference in four-year trend mean for employers? For a 300-life group, it can add up to about three-quarters of a million dollars in savings.

To learn more about MedBen strategies for reducing your claim costs, contact our Marketing Department at 888-627-8683 or

Memorial Day Reminder

American Flag

The staff of MedBen hope you and your family have a safe Memorial Day weekend, and thank all those who have served and sacrificed for our nation's freedom.

Our home office and client services will be closed on Monday, May 27 in observance of the holiday. We will reopen at 8:00 a.m. on Tuesday, May 28. But should you need claims and benefits information during the holiday weekend (or any other time), MedBen Access is available to help you 365 days a year. Simply go to and select "MedBen Access."

Pharmacy plan members can check on prescription claims and find lower cost drug options through MedBen Access by clicking on the "Rx" button located in the "My Claims" section of the site. And FSA or HRA participants can see their balances, claims submissions and payments by selecting the "FSA/HRA Online Inquiry" option under "My Plan."

Thanks for your continued relationship with MedBen!


  10:23:00 am, by MedBen5   , 166 words,  
Categories: Prescription, Cost savings, Transparency, MedBen Rx

Price Disclosure in Rx Ads Doesn’t Tell Full Story

pills and mortar

The Trump administration recently announced that drug makers will now have to include prices in their TV advertising beginning this summer.

Prescription drug cost transparency is a good thing… and MedBen makes transparency a keystone of its pharmacy plans, so clients know their actual drug costs. But while Rx ad disclosures are useful, further context is needed.

Today, too many pharmacy benefits managers are making excessive profits by manipulating the margin on drugs, then charging it to their customers. And employers still don’t know what the actual cost of the drug is.

MedBen Rx is different.
We start low by using the average price pharmacists pay for a drug and add a fair dispensing fee. That way, what a plan pays for a drug reflects its real cost – that’s true transparency. On average, the MedBen Rx difference saves clients 11% on prescription drug purchases.

With MedBen Rx, pricing is simple: You pay less, period. Find out more by visiting or contacting our Marketing Department at


  08:44:00 pm, by MedBen5   , 187 words,  
Categories: Announcements, News, MedBen Employees

Kelly Completes Chamber Leadership Program


MedBen Director of Compliance and Medical Management Erin Kelly recently completed the Community Leadership program offered through the Licking County (OH) Chamber of Commerce. The nine-month program fosters the intellectual growth of local leaders by strengthening their management skills and expanding their community knowledge.

Kelly found the program to be a valuable resource. "Much of it focused on identifying individual strengths and learning to develop and apply these in our professional and personal lives. These are skills that will benefit me now and into the future," she said.

Kelly added that the program also provides the chance to learn more about what Licking County has to offer. "I hadn’t previously realized how many opportunities there are to get involved and make a difference. This provided me inspiration to take a more active role in my community,” she said.

Joining MedBen in 2007, Kelly served as a Customer Service Representative and Group Service Rep before joining the Compliance Department in 2011. She was named a Director in 2018.

A graduate of George Mason University, Kelly is an active supporter of the American Red Cross and Licking County Humane Society.

Congratulations, Erin!


  11:14:00 am, by MedBen5   , 148 words,  
Categories: Wellness, Cancer, Heart, Diabetes, Hypertension, Preventive care, Cholesterol, Primary care, MedBen WellLiving

Adding Fiber to Your Diet Reduces Disease Risk

family making salad

According to a recent study, people who eat between 25 and 29 grams of fiber per day reduce their risk of developing heart disease, diabetes and colon cancer by 15-30%.

“Americans are getting, on average, about 12 and a half grams of fiber each day, which isn’t enough,” said wellness expert Michael Roizen, MD, who did not participate in the study. “This study showed a sizeable reduction in health risks from getting at least 25 grams of fiber.”

Found in fruits, vegetables and whole grains, fiber also helps to lower blood pressure, bad cholesterol and body weight.

Eating fiber-rich foods is a great complement to other preventive measures, such as getting an annual wellness exam from your family doctor. MedBen WellLiving can help your organization put together a focused program that promotes better health through physician care and healthier lifestyles.

To learn more about MedBen WellLiving, contact our Marketing Department at 888-627-8683 or


  07:37:00 pm, by MedBen5   , 129 words,  
Categories: Wellness, Heart, Preventive care, MedBen Employees, MedBen WellLiving

MedBen Teams Up to Battle Heart Disease

HeartChase Team MedBen

For the fourth consecutive year, MedBen was well-represented at the Licking County (OH) HeartChase, sponsored by the American Heart Association (AHA). On May 4, area organizations met in the Newark town square to promote healthy hearts, raise funds to combat heart disease, and get a little exercise by performing team activities.

Event participants have so far raised nearly $120,000 to help reduce heart disease-related deaths and improve the cardiovascular health of Americans.

Heart disease prevention is an important aspect of the MedBen WellLiving program, which promotes healthy habits through preventive care and disease management... so we're pleased to do our part for better health!

Learn more about how your organization can have a good time for a good cause in your community by visiting the HeartChase page at the AHA website.


  03:04:00 pm, by MedBen5   , 341 words,  
Categories: Wellness, Hypertension, Preventive care, Specialty Care

Blood Pressure, By the Numbers


If you have high blood pressure (also called hypertension), you’re hardly alone out there. About 1 in 3 U.S. adults share your condition.

And just because you don’t “feel” like you have high blood pressure doesn’t mean you’re in the clear. The condition is called the “silent killer” for a reason – many people who have it don’t even know it. The only way to be sure is to check your blood pressure regularly.

When you see your family doctor for your annual wellness exam, the visit typically begins with a blood pressure reading. Ideal blood pressure is below 120/80, while high blood pressure is above 140/90. The two respective numbers represent pressure in your blood vessels when your heart beats (systolic) and when your heart rests (diastolic).

Why is controlling your blood pressure a big deal? By doing so, you reduce your risk of health disease and stroke, the first and third leading causes of death in the United States. Reducing pressure on your arteries also lowers your odds of aneurysms, dementia and cognitive impairment. So merely hoping for the best is not a wise strategy.

If you are at risk for high blood pressure, MedBen WellLiving can help. We provide personalized guidance from RN Health Consultants to assist you in bringing your blood pressure numbers back down to normal.

Full story »


Case Study: Direct Contracting Further Lowers Client Costs

stethoscope and 100 dollar bills

MedBen facilitates direct-to-employer contracting, bringing together employers and providers in plans that promote regional care. Recently, a client looking for cost reduction opportunities saw the benefits first-hand.

A manufacturer with a traditional PPO plan already had cost controls in place through MedBen and lower-than-average medical costs... but asked us to suggest ways to reduce their costs even further without cutting care.

Working with MedBen, the client signed direct contracts with two hospitals in areas with a high employee presence. Also, we helped the client set up a wrap network with incentives to use local care.

In the first year following direct hospital contracting, the client saw an 18% reduction in their medical spending. Incentives and access to lower-cost care increased area hospital utilization. For the employees, it translated to reduced out-of-pocket costs.

MedBen clients who have alternative coverages in place are seeing healthier workplaces and cost savings. If you'd like to hear additional success stories, contact Vice President of Sales & Marketing Brian Fargus at 888-627-8683 or


  11:52:00 am, by MedBen5   , 183 words,  
Categories: Prescription, Cost savings, MedBen Rx, MedBen Rx Advocate, MedBen Rx Alliance

MedBen Clients Reduced Costs Nearly 3% Using Rx Solutions

pharmacist measuring pills

In an era where employer pharmacy plans routinely face annual double-digit cost increases, MedBen clients are seeing things differently.

Employers who utilized MedBen pharmacy solutions in their 2018 plans realized an average 2.7% decrease in per-member spending from 2017. The cost reductions coincide with last year’s emergence of MedBen Rx’s innovative programs to help clients lower their pharmacy spending.

MedBen Rx offers two unique ways to help employers avoid the wholesale price “margin manipulation” inherent in traditional pharmacy plans: Rx Advocate, which bases client drug costs on the prices the pharmacy pays plus a reasonable dispensing fee; and Rx Alliance, which builds partnerships between hospitals, pharmacies and qualified organizations to offer the lowest drug prices possible.

Pharmacy case studies and cost reduction strategies are regularly discussed at MedBen University events, so if you’ve recently received an invite to an upcoming roundtable, we encourage you to attend and discover for yourself how MedBen Rx can help your business share in the savings.

Additionally, MedBen has dedicated an entire website to its pharmacy solutions: There, you’ll find program descriptions, an Rx Report Blog, and an FAQ page.


  05:52:00 pm, by MedBen5   , 232 words,  
Categories: Health Care Reform, Third party administration, Compliance, Self-funding, Transparency, Billing, Government

Fraker, SPBA Members Discuss Surprise Billings in D.C.

Caroline Fraker

MedBen Senior Vice President Caroline Fraker visited Washington, D.C. with fellow members of the Society of Professional Benefit Administrators (SPBA) Board of Directors on April 23, to speak with House Committee on Education and Labor officials on the subject of "surprise billing."

"We spoke with staffers of both Democrat and Republican representatives," Fraker said. "There's a bipartisan consensus to find a solution to people getting unexpected medical bills."

Surprise billing often takes the form of undisclosed out-of-network fees, such as a bill from a non-network anesthesiologist performing in an in-network hospital. Both political parties are calling for greater transparency in hospital pricing practices.

Fraker noted the committee is considering various ideas, including arbitration for surprise bills over a certain dollar amount. "Big mistake,” she said. “Arbitration takes time and causes backlogs."

One proposal Fraker thinks does have potential is requiring that any physician performing a service in an in-network hospital must agree to bill per the network contract. “We agreed it makes practical sense that a provider working in a network facility be paid as a member of that network,” she said.

The SPBA serves as a non-political resource to help legislators and other officials make informed decisions about self-funding matters. Fraker, a 30-plus year veteran of employee benefits, joined the SPBA Board in 2015.

MedBen clients who would like to discuss health care price transparency are welcome to contact Fraker at 800-851-0907 or


  04:25:00 pm, by MedBen5   , 177 words,  
Categories: Wellness, Heart, Mental Health, MedBen WellLiving

"Family Doctor First" Benefits Physical and Mental Wellness

doctor-patient chat

Millions of Americans are feeling pretty stressed these days, and it's not doing their hearts any good. In a worldwide Gallup poll, about 55% of U.S. respondents said they'd felt stress "a lot of the day" before… and a separate analysis found that a person with a stress disorder was 37% more likely to develop cardiovascular disease than those without the disorder.

Studies like these illustrate the close bond between mind and body, and illustrate why MedBen WellLiving emphasizes "family doctor first." When the patient builds a professional relationship with their primary care physician, they often feel more open to discuss stressful feelings.

In turn, if the physician detects the onset of heart disease, they're better situated to talk to the patient about its causes. Or if specialist care is required, a doctor that knows the patient can direct them to someone who best matches their personality and needs.

MedBen WellLiving helps your health plan promote the total benefits of the doctor-patient relationship. Get more information by contacting Vice President of Sales & Marketing Brian Fargus at 888-627-8683 or


  03:57:00 pm, by MedBen5   , 360 words,  
Categories: Wellness, Heart, Hypertension, Preventive care, Mental Health

Just Relax, Already!


It’s easy to say, “Hey, don’t stress out.” But if you tend to dwell on the usual causes of anxiety – work, relationships, finances and so on – finding a path to relaxation can seem like a formidable challenge. So how to go about it?

First of all, it can be tough to relax if you’re not fully rested. For most adults, 7-8 hours of sleep a night is essential. Follow a set sleep and wake schedule, minimizing sound and light in your bedroom (i.e., no TV). For best results, avoid caffeine and other stimulants before bedtime.

Hobbies are a proven relaxer, be they physical (gardening, painting) or more cerebral (reading, music). Simple actions like a hug or petting a dog release serotonin, a feel-good hormone. Oh, and that old saw about laughter being the best medicine? As a stress reliever, few things beat a good chuckle.

Exercise is another way to better relaxation... and not just jogging or yoga, either. Breathing exercises lower stress by reducing muscle tension and feeding oxygen to your body. In a seated position away from distractions, breathe slowly and deeply through the nose to a count of five, then exhale out of the mouth to a count of six. Repeat for two minutes or more.

Finally, if you find you can’t seem to relax not matter what you do, make an appointment with your family doctor to discuss healthy and effective ways to put your mind and body at ease.

SOURCES: ACS Distance Education, Huffington Post, Mental Health America

Full story »


MedBen Municipality Clients Saw Lower Claim Costs in 2018

Municipality Roundtable

"In 2018, per-employee net claim costs for our municipality block decreased 4.9% from 2017," announced MedBen Vice President of Sales & Marketing Brian Fargus at the 13th Annual Municipality Roundtable on April 11. This reduced cost factors both medical and pharmacy claims.

Considering pharmacy alone, in 2018 MedBen municipality clients realized a 9.3% cost reduction in Rx claims per member. The drop coincided with the introduction of MedBen Rx, pharmacy programs that pay claims based on actual drug costs.

Fargus also highlighted the positive effect of direct-to-employer contracting on lowering plan costs: "Municipalities that used direct-to-employer contracting in 2018 saved, on average, an additional $1,500 per employee per year." Nearly one in five health plans now contract directly with hospitals and physicians to reduce care costs.

MedBen will be conducting additional MedBen University sessions in 2019 that examine claims and utilization trends, including our annual Employer Benefits Roundtable in Newark, Ohio. Invitations for this event, which focuses on self-funded private sector businesses, have been mailed out, so keep an eye out for yours!


  04:34:00 pm, by MedBen5   , 153 words,  
Categories: Wellness, Preventive care, Influenza

Flu Season Not Over Yet

flu shot

If you’ve made it safely though flu season so far, congratulations… but don’t let your guard down just yet.

According to the Centers for Disease Control and Prevention (CDC), an unexpected second viral wave has extended this flu season to 21 weeks, the longest in 10 years. Experts say this current flu strain, which started in mid-February, is stronger than the initial strain that began around Thanksgiving.

While this season isn't as harsh as last winter's, the CDC estimates that between 35,000 and 55,000 Americans will die from the flu and its complications. Over 41 million people have showed flu symptoms.

If you haven't gotten a flu shot yet, it's not too late to visit your family doctor for a vaccination. But even if you have, it's still important to take common-sense preventive measures, such as washing your hands frequently and covering your mouth and nose when you sneeze. And if you're sick, please stay home and rest!


  03:50:00 pm, by MedBen5   , 193 words,  
Categories: Wellness, Preventive care, Cholesterol, Specialty Care

Statins Alone No Guarantee of Lower Cholesterol


Taking statins alone doesn't guarantee lower cholesterol, suggests a new study in which fewer than half of participating users of the drug failed to reach target cholesterol levels.

Using data that tracked over 165,000 statin users, researchers found that over a two-year period, just 48.8% saw a reduction of 40% or more in LDL or "bad" cholesterol. The researchers also concluded that statin users who didn't achieve target cholesterol levels were 22% more likely to develop cardiovascular disease than those who did.

Lowering cholesterol is vital to longevity, which is why high cholesterol is among the risk factors for which individuals can receive intervention and management through MedBen WellLiving. Our specialty care program identifies plan members who could benefit from one-on-one, disease-specific counseling through nurse coaching.

Candidates for specialty care are contacted by an RN Health Consultant via phone, letter or e-mail and offered customized education and coaching. To encourage a long-term commitment to reducing bad cholesterol, follow-up calls can be scheduled on a routine basis.

Specialty care is just one way that MedBen WellLiving helps employers promote a healthier workforce. To get additional details, contact Vice President of Sales & Marketing Brian Fargus at 888-627-8683 or


  09:14:00 pm, by MedBen5   , 192 words,  
Categories: News, Health Plan Management, Hospitals, Research, Primary care

ER Visits Up, but Non-Emergency Usage Down

emergency room

Emergency room visits rose to an all-time high of 145.6 million in 2016, according to a new survey from the Centers for Disease Control and Prevention. However, the percentage of ER patients who needed regular care fell from 5.5% in 2015 to 4.3% in 2016 – a decrease that may indicate more people with non-emergencies are seeking remedies from their family doctor or less-pricey urgent care facilities first.

ER benefits can be tricky, as no health plan wants to discourage individuals from visiting an ER when the need is vital. But the relative convenience of the ER results in visits from patients who could be better served by a primary care physician, ultimately costing the client much more for the same care. MedBen helps clients strike the proper benefits balance.

As with all aspects of plan design, MedBen works with clients to help them offer ER and urgent care benefits that properly address employee population needs. Demographics, geography and claim history all factor into the plan design process, and MedBen is experienced in considering all these elements.

Learn more about MedBen's strategic approach to plan design by contacting Vice President of Sales & Marketing Brian Fargus at 888-627-8683 or


  02:10:00 pm, by MedBen5   , 175 words,  
Categories: Announcements, News, Reporting

MedBen Introduces Enhanced Reporting Platform

growth chart

To give employers the most accurate and up-to-date information possible, MedBen has partnered with Deerwalk, Inc. to provide an upgraded data analytics and reporting platform. The strong reporting that MedBen clients come to expect is now even stronger.

With our enhanced reporting platform, we’ve kept what works and added valuable new features, including:

  • Client data now updated every two weeks (previously monthly).
  • Report generation using up to five years of data, rather than on a rolling two-year basis.
  • Reports and charts can be customized and auto-generated on a scheduled basis.

The enhanced MedBen reporting platform incorporates hindsight (what happened and why?), insight (what’s happening right now?), and foresight (what’s going to happen next, and what should I do about it?). This integrated analytics approach offers clients actionable clinical insights and detail unrivaled in data reporting.

We’re confident you’ll find that our enhanced reporting platform takes data analysis to a higher level. A MedBen team member will be in contact with you soon to offer you a demonstration of the dashboard and the new reporting features.


  09:27:00 pm, by MedBen5   , 213 words,  
Categories: Wellness, Hypertension, Preventive care

Controlling Blood Pressure Essential to Long-Term Health

blood pressure reading

When you see your family doctor, they'll likely check your blood pressure regardless of the purpose for your visit... and for good reason. High blood pressure affects a third of adults ages 40-59 and nearly two-thirds of those 60 and older.

"If left untreated, [high blood pressure] can lead to increased risk of a heart attack, heart failure, stroke and vision loss," warns Dr. Kevin Wile, a family medicine physician at Penn State Health. "It essentially has the ability to affect almost any organ in the body if you go a long time without controlling it."

The American Heart Association now defines high blood pressure as 130/80 and over. Because high blood pressure is often linked to other health problems – smoking, obesity, poor diet, lack of exercise – it helps to have a medical ally to keep your blood pressure in check.

MedBen WellLiving focuses on early detection of high blood pressure and other chronic conditions. Because even moderately high blood pressure puts individuals at greater risk for disease, our wellness program encourages your employees to develop a doctor-patient relationship so elevated blood pressure can be detected and controlled.

Having MedBen WellLiving in your corner helps promote a healthier employee population. Get more information by contacting Vice President of Sales & Marketing Brian Fargus at or 888-627-8683.


  03:25:00 pm, by MedBen5   , 191 words,  
Categories: Prescription, Cost savings

Overprescribing Drugs Raises Costs, Health Risks

pills and prescription

The ongoing movement to reduce prescription drug spending focuses primarily on the cost factor. But as Shannon Brownlee and Judith Garber contend in a Stat opinion piece, overprescribing of drugs also carries financial and health risks.

"Between 2000 and 2012, the proportion of adults in the U.S. who were taking five or more medications nearly doubled, from 8.2 percent to 15 percent," write the co-authors, who are staff members of the Lown Institute. Among adults age 65 and over, 42 percent take at least five medications.

While recognizing that multiple medications are sometimes needed, Brownlee and Garber argue that overprescribing can lead to potentially fatal adverse drug events: "If nothing is done, adverse drug events over the next decade can be expected to cause 4.6 million hospitalizations of older Americans, 74 million outpatient visits, and nearly 150,000 premature deaths."

Brownlee and Garber predict that a focus on reducing overprescribing could save up to $62 billion over the next decade in unnecessary hospitalization for older adults alone.

For patients who visit multiple doctors, it's critical to ensure that every one of those doctors is aware of the prescription (and non-prescription) drugs they're taking to reduce the risk of adverse interactions and duplication.

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