With all the Affordable Care Act (ACA) regulations self-funded employers have to follow, it's easy to overlook regular updates to required preventive care. But MedBen keeps a close eye on the latest recommendations so you don't have to.
Under the ACA, non-grandfathered health plans are required to cover preventive care recommendations at 100% when services are obtained through an in-network provider. The recommendations come from the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts that assigns an "A" or "B" letter grade to the care based on its balance of benefits and harms.
Additionally, the ACA requires non-grandfathered plans to cover immunizations recommended by the Advisory Committee on Immunization Practices and guidelines supported by the Health Resources and Services Administration that are applicable to women and children. Your MedBen plan document addresses all these recommended services, including screenings, counseling, medications, and immunizations.
The USPSTF continuously researches and reviews data, leading to the release of new or updated recommendations. When a new recommendation is released, it is required to become effective on the first day of the first plan year following one year from the date the recommendation was finalized. So if a new recommendation was released in October 2015, it would not need to be implemented until the first plan year following October 2016.
Every year, the MedBen compliance department assembles a checklist tailored to your health plan and containing possible modifications that need to be addressed in the upcoming plan year, including both ACA and non-ACA related items. For example, in addition to the newly required A or B recommendations, the checklist may suggest updating certain language in the plan document to provide more protection to the health plan or list possible cost-saving techniques.
Once your plan administrator advises on what changes should be adopted by completing the checklist, MedBen moves forward with implementation and preparation of the necessary amendments and SBCs (Summaries of Benefits and Coverage).
It's no secret that cancer risk is closely linked to lifestyle choices. But the possibility that nearly half of cancer-related deaths may be due to bad habits is still a sobering thought, and a strong argument for encouraging healthier behavior.
AFP Relax News reports that a Harvard Medical School review of health data revealed that 20-40% of cancer cases and around 50% of cancer deaths could potentially be prevented by adopting healthy lifestyles. Conversely, females who met the criteria for such lifestyles — drinking only in moderation, not smoking, exercising regularly and maintaining a proper weight — reduced their risk of getting cancer by an average of 33% compared to those who didn't meet the criteria, and healthy males reduced their risk by an average of 25%.
Adopting a healthier lifestyle and focusing on prevention "should remain a priority for cancer control," the study authors advised.
MedBen WellLiving focuses on primary prevention, including annual wellness exams and screening for cancer and other chronic diseases. But however essential these regular tests may be, they make up only half of the equation. Equally important is the professional relationship between the family doctor and patient, which can provide education and motivation to make critical lifestyle changes... the first step to lowering cancer risk.
Of course, in addition to helping prevent long-term complications from unmanaged health conditions, primary prevention through MedBen WellLiving helps to reduce medical costs through reduced health care utilization and claims. Learn more about how worksite wellness can benefit your group by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
You can also read more about the Harvard study at the Pittsburgh Tribune-Review.
The Equal Employment Opportunity Commission (EEOC) recently released final rules regarding the use of incentives to promote participation in corporate wellness programs — and if you offer MedBen WellLiving, you may need to make critical changes to your program to meet the new regulations, says Vice President of Compliance Caroline Fraker.
"The new EEOC rules go into effect in 2017, and place a limit on how much financial incentive employers can offer to their employees to encourage healthier habits," Fraker noted.
The rules, which provide guidance to ensure that wellness programs comply with the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA), are as follows:
The ADA Rule
The GINA Rule
Prior to the release of the EEOC rules, the 30% maximum on cost incentives pertained only to “health-contingent” wellness programs, or those that require plan members to meet a specific health-status factor standard (i.e., achieving a specified cholesterol level) to get the cost reward or avoid a penalty. “Participatory” wellness programs, which are generally available without regard to an individual’s health status (i.e., getting an annual wellness exam), were exempt from this limitation, but no longer are.
Because MedBen WellLiving is considered a participatory wellness program, clients who are currently offering cost incentives exceeding 30% will have to modify their program design to comply with the new EEOC rules. In addition, employers who require plan participants to get a WellLiving medical examination in order to be eligible for a certain health benefit plan (a “compliant” plan) will need to modify this strategy.
MedBen will notify clients that need to make changes and work with them to ensure that their programs are compliant with the new rules and offer appropriate incentives. Both of these rules apply to employers beginning on the first day of the first plan year on or after January 1, 2017.
MedBen WellLiving clients with questions regarding the final EEOC rules are welcome to contact Fraker at 800-851-0907 or firstname.lastname@example.org. You can also read more about the rules at Healthcare Dive.
MedBen Director of Data Services Andrea Corn recently completed the Community Leadership of Licking County program, offered through the Licking County (OH) Chamber of Commerce. For completing the nine-month program, Andrea received a Certificate of Achievement at a commemorative ceremony on Friday, May 13.
The Leadership program allows participants to interact with a diverse group of people from various job categories, including professors, nurses and business experts. Those accepted into the program are taught the importance of "strength-based" leadership in which the individual focuses on developing specific attributes at which they excel, while gaining useful exposure to area industry professionals.
When asked about the value of the program, Corn replied, "It offers great opportunities to learn from other participants and get insights from business leaders. Plus, you learn a lot about the Licking County community."
As for how completing the program will benefit her, Corn said, "You get a real push to better yourself at your job as well as life in general." No doubt, MedBen clients will also benefit from the lessons that Andrea has learned!
Congratulations, Andrea... and lead on!
Bundled payments and other alternative payment methods already popular for Medicare claims will soon be used by commercial group health plans to save money while promoting quality care, says MedBen Vice President of Compliance Caroline Fraker.
In a recent article published by the Society of Professional Benefit Administrators (SPBA) and directed at third party administrators (TPAs), Fraker noted that while bundled payments are currently used primarily for Medicare patients, as their advantages over the traditional fee-for-service model become better understood, the quality-focused approach will eventually become the norm for claims administration to self-funded plans as well.
“The benefits of these alternative payment models are clear — increases in quality of care, decreases in lengths of stay and readmission and the realignment of inpatient and post-acute care,” Fraker writes. “And as these hospitals […] experience how these benefits affect their bottom line, they will seek to apply these same cost-saving, quality-improving methods to their commercial payor models. It is happening already.”
Fraker goes on to observe that as the transition to quality-based payment models progresses, TPAs like MedBen will play an important role in helping hospitals through specialized claims data tracking and analysis. MedBen already provides analytics and processing services for providers participating in the Medicare programs, known as Bundled Payment Care Initiatives (BPCI), and hospitals who are part of a larger mandatory bundle program for lower joint replacements – Comprehensive Care for Joint Replacement (CJR).
At MedBen, we can use our proven benefits administration expertise in a variety of areas, from reconciling different plan designs to employee engagement issues and employer strategies. And ultimately, the benefits from the smart use of bundled payments will translate to lower plan costs for employer and employee alike.
In her concluding comments, Fraker writes: “[The Centers for Medicare & Medicaid Services] and [Capability Maturity Model Integration] are handing us the keys to the future of claims payment. Go ahead and unlock the door.”
The federal agencies overseeing the Affordable Care Act have recently finalized changes to the existing Summary of Benefits and Coverage (SBC) template in order to improve the readability for consumers, and to expand the amount of information that the consumer receives from this document. Self-funded health plans and insurers are required to provide a SBC, which includes a description of what the plan covers, cost sharing responsibilities, and a glossary of commonly used coverage and medical terms, in order to help individuals make more informed choices among plan options and to better understand their coverage.
The new template includes more information about cost sharing, such as enhanced language to explain deductibles and a requirement that plans address individual and overall out-of-pocket limits.
All SBCs include coverage examples that demonstrate the cost sharing amounts for which an individual might be responsible. Currently, the SBC contains two such examples, which focus on diabetes care and childbirth. The new template adds a third example addressing coverage for a foot fracture, so that a consumer understands the services and expenses that a plan will cover in an emergency scenario.
Use of the new template will be required for plans and insurance policies with plan years beginning on or after April 1, 2017. This also means that the new template should be used for SBCs that will be distributed for any open enrollment period preceding the April 1, 2017 plan year.
There are no changes to the existing SBC distribution requirements, which are:
If you are a MedBen client, please make sure to provide us with enough time to update your SBC and send it to you for timely distribution. It is important that you inform us in advance if you will be making changes to your plan documents which require changes to your SBC.
Should you have any questions about SBCs, please contact Compliance Specialist Sierra See, J.D., in MedBen’s Compliance Department at email@example.com.
HealthDay recently reported that a two-decade study of hypertension found that the ability to review a patient's blood pressure patterns is more effective in determining the risk of stroke or early death than simply relying on individual readings. "Our study suggests that looking at someone's blood pressure over time and whether it increases slowly or steeply may provide additional information above only the level of blood pressure at a certain time," said researcher Dr. Marileen Portegies of the Erasmus University Medical Center.
MedBen WellLiving emphasizes the importance of plan members establishing and maintaining a professional relationship with a primary care physician — the logic being, the longer the doctor-patient relationship, the greater the odds that the doctor can detect individual anomalies that may suggest a possible health problem. This new study demonstrates just how useful such information can prove.
Hypertension is the number one risk factor for stroke, but a notable drop in high blood pressure after age 65 is also linked to the condition. In such cases, WellLiving believes it's essential for the family doctor to have easy access to a detailed health history.
In addition to promoting the "physician first" approach, WellLiving also provides specialty care for plan members identified at high risk for hypertension and other chronic conditions. Those identified receive customized and confidential coaching from an RN Health Consultant.
Learn more about MedBen WellLiving by visiting MedBen.com or contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
A new pharmaceutical study reveals a money-saving reason to promote the importance of an open doctor-patient communication to your health plan members, and encourage the use of the drug comparison feature on MedBen Access.
According to Stat, the study found that Americans spent an extra $73 billion between 2010 and 2012 on pricier brand-name drugs because physicians failed to mention to their patients that generic equivalents were readily available. And nearly one-third of those additional costs came in the form of patient out-of-pocket payments.
While there is no guarantee that every discussion between doctor and patient will lead to the prescribing of lower-costs generic equivalents, it certainly improves the odds. The knowledge that the patient would prefer the less expensive alternative if available will usually steer the doctor in that direction.
Of course, MedBen-administered plan members who are prescribed brand-name drugs should definitely take advantage of MedBen Access to ensure that they're getting the best value for their pharmacy dollar. By logging in to the site, clicking on your name under "My Rx Claims" and selecting "Drug Lookup," you can research generic and therapeutic alternatives to many popular brand-name drugs, and use this information to discuss available options with your doctor.
MedBen WellLiving has always promoted developing a professional physician-patient relationship through annual wellness visits and recommended screenings. In addition, you should also seek visits with your physician when you have questions or concerns about a topic relating to your health, including stress.
Stress, in some form, is a normal part of life. WebMD states that forty-three percent of all adults suffer adverse health effects of stress, costing more than $300 billion annually. Good stress is what keeps us alert and efficient, but bad stress (distress) can cause the body harm.
Recognizing the symptoms of stress to alleviate them is important. Headaches, upset stomach, elevated blood pressure, chest pain, and problems sleeping are some of the related symptoms. Although the body’s reaction to stress is trying to help protect it, if left untreated and become recurring, the symptoms can lead to a much greater issue, such as excessive absenteeism from work or chronic conditions like heart disease.
Stress is different for everyone – the triggers, symptoms and effects, and coping methods vary from person to person. But no matter the cause of your stress, seek guidance. As always, be honest with your physician – they are there to help you and your health.
At MedBen, we continually evaluate and make changes to our data security procedures. As the threats have grown, we have been proactive in finding ways to stop them.
MedBen approaches security from three perspectives: external, internal and physical. In all three instances, we have in recent months added new safeguards to our existing protections. You can download our revised Data Security document from the MedBen website.
"With incidents of ransomware and other types of malware on the rise, it's a daily job for my security team and I to stay informed of the latest threats," said Rose McEntire, MedBen Vice President of Information Systems and Chief Security Officer. "But we put in place every precaution possible to protect client data."
McEntire added that security team members review daily updates from the Society of Professional Benefit Administrators (SPBA) and National Institute of Standards and Technology (NIST), and frequently attend webinars and seminars on cybersecurity. "We also enlist cybersecurity consultants to review our environment and make recommendations for further protections," she said.
Key to maintaining security is the full involvement of the MedBen staff, noted Wendell Crain, MedBen Director of Security, Infrastructure and Web. "You can have all the safeguards in the world in place, but at the end of the day the human element is still essential to security. So we keep every employee informed about how to spot potential malware and what to do if they spot a threat," Crain said.
MedBen clients with questions regarding company data measures may contact McEntire at email@example.com.
MedBen and other area businesses braved cool temperatures and looming rain clouds to promote heart health and have a few hours of fun at the inaugural Licking County HeartChase on Saturday, April 30 in Newark, Ohio. In addition to participating in the morning's activities, MedBen served as a local sponsor for the event, which was created by the American Heart Association (AHA).
MedBen was well-represented at HeartChase, as 12 departmental teams comprising 38 employees and their families gathered together for some healthy competition while raising funds to aid the fight against heart disease. Company Chairman & CEO Doug Freeman, also in attendance, served on the event's executive leadership team.
Teams participated in a variety of heart-related stunts, such as navigating a bounce house obstacle course, guessing fast food calorie counts and performing CPR in time to the Bee Gees' classic "Stayin' Alive." Participants also found "Power Ups" throughout the event area and entered them into the HeartChase smartphone app, which tracked the team's points.
So, did MedBen take first place? Well, no... but the event raised over $90,000 to chase away heart disease, so we'll call that a "win."
Learn more about how your business can have have a good time for a good cause in your community by visiting the HeartChase page at the AHA website.
The IRS recently released its annual cost-of-living adjustments affecting health savings accounts (HSAs) that are tied to a high-deductible plan for calendar year 2017. Most of the amounts stay frozen in place from the previous year, with a small increase in single contribution limits being the sole exception.
MedBen clients with questions regarding HSA contributions and out-of-pocket expenses are welcome to contact Director of Administrative Services Sharon A. Mills at (800) 423-3151, Ext. 438 or firstname.lastname@example.org.
MedBen continues to maintain high standards of quality, as proven by the most recent audit of our management system on April 6, 2016. Once again, in conclusion of our latest external audit it was recommended that our ISO 9001 Certification continue.
In the Audit Report prepared by SAI Global, the auditor cited the level of input from management to make sure that "the quality management system provides the intended controls, customer satisfaction and improvement opportunities." Also noted were the company’s ongoing efforts to meet customer needs and use client feedback to drive management system improvement.
The auditor also praised MedBen's workplace, stating that the "tour of facilities showed and supported [an] excellent work environment and facilities." Such observations are especially important to the management team, said Chairman and CEO Doug Freeman.
"I believe that quality service and workplace satisfaction go hand in hand," Freeman said. "Providing an enjoyable work environment helps to promote our quality goals, and it's why many of our employees have remained with MedBen for over a decade... and in some cases, multiple decades."
MedBen undergoes semi-annual audits to ensure that the quality standards established to achieve ISO 9001 Certification in 2005 continue to be met over ten years later. In 2017, our company will undergo an even more extensive multi-day review in order to get formally recertified.
A Los Angeles Times article highlights the extreme disparity in prescription drug costs between pharmacies. It's a harsh reality that demonstrates the usefulness of Rx pricing information available through MedBen Access and other online sites.
As major pharmacy operations consolidate, the price differences from one pharmacy to another can vary greatly. The article sites one generic drug that ranges in cost from $45 to nearly $1,000 for a 30-day supply, depending on what pharmacy is filling the prescription.
For group health plan members, such differences can be invisible, especially for those who only pay a flat cost for a drug regardless if it's a brand name or generic. But if the drug is not covered under the plan, cost variances take on a much greater importance. In such cases, free online sites and apps like GoodRx, which compare drug prices at pharmacies across the U.S. and even offer discount cards, are indispensable.
However, even when patients have the safety net of pharmacy coverage, it's still useful to know exactly how much the plan is paying for their prescriptions – after all, higher drug costs are ultimately reflected in higher premiums. At MedBen, we offer a handy tool through our member services site, MedBen Access.
In addition to allowing patients to see the total plan cost for their medication on top of what they pay out of pocket, MedBen Access provides a useful way to see how the cost fares against therapeutic alternatives. In many cases, the price difference can be significant.
Current MedBen clients with questions about their pharmacy plan design are welcome to contact their group service representative. Or if you're not a client and interested in learning in learning about other ways that MedBen can save your group money on pharmacy costs, please contact our Vice President of Sales & Marketing Brian Fargus at email@example.com.
Affordable Care Act rules and regulations are a minefield that can trick up even a seasoned HR professional... and it's why MedBen Compliance is always ready to guide clients, brokers, and consultants through the details, via phone calls, meetings, webinars, and educational materials. And every year, ACA updates are an essential component of our MedBen University events.
A recent Benefits Pro article notes that since the introduction of the ACA, employers have been put "in the position of becoming compliance officers." And while it may be true that health care reform has loaded human resource departments with new and unwanted responsibilities, the MedBen compliance team makes every effort to lessen HR burdens as much as possible.
As the article notes, the potential fines for non-compliance of ACA laws are as varied as they are costly: "Employers will have to pay $2,160 per employee (after the first 30) if not providing health insurance or for an incorrect plan, and $3,240 for each employee getting a subsidy through the marketplace. Penalties for not filing certain documents in time, such as form 5500 or form 1094C, can add up to $1,100 per late day."
If you're a MedBen client, you never have to take on health care reform single-handedly. Any time you have a question, just contact our Vice President of Compliance Caroline Fraker at 800-851-0907 or firstname.lastname@example.org.
A new study suggests that women turning 40 may benefit from regular mammograms, challenging other recent recommendations that women can wait until the age of 45 or 50 to begin screenings. Findings from the research were presented at the American Society of Breast Surgeons annual meeting in Dallas earlier this month.
MedBen's worksite wellness program, WellLiving, continues to recommend that women start getting mammograms at age 40 every two years until their physician decides not to order the screening.
According to HealthDay, the review of female patients between the ages of 40 and 44 found that 50% had an above-average risk for breast cancer, and therefore would be eligible to begin screening mammography at age 40. The study also found a significant percentage of women would qualify for other breast screening methods, including breast MRI and genetic testing.
"We believe formal risk assessment is essential for women ages 40 to 44 in order to identify those who require screening mammography to start at the age of 40, and those who would qualify for screening MRIs and genetic testing," said Dr. Jennifer Plichta, a breast surgery fellow at Massachusetts General Hospital and Brigham and Women's Hospital in Boston.
MedBen WellLiving clients can access a wellness compliance page via MedBen Access to check if they are due for mammograms and other cancer screenings.
On April 21, MedBen concluded a multi-day Indiana trip with a MedBen University (MBU) event in Lawrenceburg. Entitled "Taking Charge of Your Health Care Costs" and cosponsored by Pinnacle Advisory Group, this free seminar touched on a variety of innovative ways that employers can control their group health spending.
Attendees at the event learned about some of the latest advancements in group health care cost containment – among them, genetic tests that can determine drug compatibility and eliminate wasteful spending.
In his presentation, MedBen Vice President of Sales & Marketing Brian Fargus offered cautionary advice on avoiding false claims of guaranteed discounts, creative repricing gimmicks and other tactics used to make self-funded employers believe that they're not getting the best value for their health care dollar. He emphasized the fine print and disclaimers sometimes found on repricing reports, such as "aggregate results may vary signifcantly by geographic area" and "results are not a forecast of projected claims costs."
Equally important to controlling costs is having a basic knowledge of health care reform and how the Affordable Care Act affects your business. MedBen Vice President of Compliance completed the MBU with an update on ACA regulations, planning for 2016 reporting, and preparing for the 2020 introduction of the Cadillac Tax.
Fraker also discussed recomended changes to plan subrogation language following a Supreme Court decision that allowed an accident victim to retain payment from his health plan even after he received a court settlement. MedBen clients who would like additional information about this case are welcome to contact Fraker at 800-851-0907 or email@example.com.
Members of the MedBen sales team continued their mini-tour of Indiana with a stop at the Evansville-Area Human Resource Association (EHRA) Spring Conference. Vice President of Sales & Marketing Brian Fargus and Regional Sales Managers Brooke Hupp and Mike Ketron attended this day-long gathering of area HR professionals.
Not only do events like this afford the opportunity for MedBen to promote its growing line of benefits management services for employer groups, they also provide a valuable opportunity to speak with experienced HR representatives and learn from their day-to-day experiences. In this way, we can better ensure that our service offerings meet the needs of employer and employee alike.
In addition to the trade expo, the conference features discussions on a varity of HR-related workplace topics, including disability issues and labor matters. EHRA is an affiliate chapter of the Society for Human Resource Management (SHRM) and the leading professional association for HR professionals in the tri-state area of Southwestern Indiana, Kentucky, and Southern Illinois.
Again, we remind you to follow Twitter and this blog for information about upcoming events that MedBen is schedule to attend!
Members of the MedBen sales team were pleased to represent the company at the 52nd Annual Human Resources Conference and Expo on April 19. The event, presented by the Indiana Chamber of Commerce and held this year in downtown Indianapolis, is the state’s longest-running HR conference.
At the expo, Vice President of Sales & Marketing Brian Fargus and Regional Sales Managers Brooke Hupp and Mike Ketron met with HR professionals from Indiana and other Midwest states to discuss third party administration, worksite wellness, and bundled payment reporting, in addition to other group benefit management services available through MedBen.
Attendees also had the opportunity to learn about regulatory compliance, conflict management and other relevant HR topics, and participate in training workshops.
MedBen plans to participate in additional HR expos in 2016, including the Ohio Human Resource Conference on September 21-23. We'll announce other upcoming events on this blog as well as Twitter... and we hope to speak to you in person soon!
Health care security concerns continue to capture the media's attention, as the term "ransomware" has quickly entered the vernacular. It's a growing problem that demands constant attention... which is why MedBen maintains a multi-pronged response to cyber threats.
In 2015, ransomware attacks increased by 35% from the prior year. Even before the recent surge, MedBen already had numerous security measures in place to thwart malicious software, but we're never content to simply stand in place.
In addition to continually evaluating our internal protocols, MedBen regularly consults with security professionals to ensure that we are taking every possible preventive action to safeguard your information and stay ahead of looming dangers. Moreover, an outside auditing firm conducts unscheduled attempts to breach our security, all of which have been unsuccessful.
Equally important, the MedBen staff is trained to remain vigilant to possible attacks. Suspicious-looking e-mail attachments and questionable sales calls are reported to Vice President of Information Systems and Chief Privacy Office Rose McEntire, and notices of potential viruses, spyware, and phishing threats are posted on our Intranet site.
MedBen has had an in-house information systems team in place since the introduction of our internal mainframe network in the late 80’s. Even back then, long before the Internet turned cybersecurity into a 24/7 job, we made client security and privacy a priority. And while the sheer volume of malware – 430 million new variants in the last year alone – constantly presents new challenges, we stay committed to protecting your personal information.
MedBen clients with questions regarding our cybersecurity measures are welcome to contact McEntire at firstname.lastname@example.org.