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05/04/12

  01:05:57 pm, by MedBen5   , 233 words,  
Categories: Health Plan Management

Popularity Of Consumer-Driven Health Plans Continues To Grow

Reuters recently reported on the surge in popularity for consumer-driven health plans, which offer lower premiums and greater participant control of medical care funds in exchange for higher deductibles.

Currently, 59% of companies with 1,000 or more employees offer account-based coverage options, such as flexible spending accounts and health reimbursement arrangements. That’s up from 53% last year, according to a survey by Towers Watson and the National Business Group on Health.

The survey also revealed that when employees have a choice between CDHPs and more traditional plan options, an increasing number are going the personal account route. This year, 27% of eligible employees are enrolled, a 35% jump from 2011.

CDHPs continue to gain in popularity for multiple reasons. Certainly, the reduced premiums appeal to employers and employee alike, as does the ability to pay for health care expenses with pre-tax dollars. And with the passage of health care reform, higher deductibles offer businesses a way to avoid the Affordable Care Act’s excise tax on benefit-rich “Cadillac” health plans.

MedBen has administered CDHPs for over a decade. In addition to a full range of account options, we provide seamless plan integration and account coordination. Plus convenient online services that allow easy account management, and tools to make wise health care consumer decisions.

To learn more about the benefits of consumer-driven health plans, we invite you to contact MedBen Vice President of Sales and Marketing Brian Fargus at 888-627-8683.

  11:10:32 am, by MedBen5   , 162 words,  
Categories: News, Wellness

Drug Shortages Still High, But Numbers Are Improving

The number of scarce drugs is still higher than anyone would like, but the situation has definitely improved since last year. According to the Food and Drug Administration, 42 new shortages have been reported so far this year, compared to 90 in the same period in 2011.

As Reuters notes, the FDA stepped up its efforts to combat shortages last year when 250 medicines were in short supply, up from 56 in 2006. Many of the shortages were for cancer drugs and other vital medications, leaving doctors to find more costly or less effective alternatives, or even postpone care.

The most recent FDA list states there are currently about 120 drugs regarded as being in short supply. And the scarcity of drugs like leucovorin, used in the treatment of childhood leukemia, or fentanyl, used in anesthesia, are still affecting patients. The FDA is working with companies to resolve the issue.

Earlier this year, the agency loosened its rules regarding foreign medicines to allow temporary importation of needed cancer drugs.

  10:48:26 am, by MedBen5   , 218 words,  
Categories: News, Health Plan Management

If ObamaCare Falls, Ball's In GOP's Court

The Supreme Court may have already decided the fate of the Affordable Care Act – and to the surprise of many, there’s a halfway decent chance that the entire law could be thrown out. Which would suit many Republicans in Congress just fine.

But should health care reform go back to square one, what do GOPers suggest as an alternative? Not much of consensus there.

As POLITICO notes, Republicans haven’t collectively embraced a full-fledged replacement strategy for health care reform, instead agreeing on a few basic tenets of health policy. For example, most Republicans support the ACA requirement that insurance companies accept all applicants. Most, but not all.

“It’s a terrible idea,” Rep. Tom Price (R-Ga.) told POLITICO. He has offered a replacement plan that he said emphasizes voluntary coverage rather than requiring Americans to carry insurance.

Price has been pushing his plan since 2009, and as such, it has more traction than other health agendas. He proposes that Americans receive tax credits, based on income, to help them buy coverage. Groups could pool together to buy health care, and consumers could shop for insurance across state lines.

Of course, presumptive GOP presidential candidate Mitt Romney also has an alternate plan in mind – one that relies more on state-level reforms and private competition than the existing law.

  10:06:33 am, by MedBen5   , 171 words,  
Categories: News, Wellness

Want To Live Longer? Start Jogging, Study Says

Jogging regularly can improve your life expectancy, a new long-term study suggests.

According to HealthDay, Danish researchers compared the mortality of joggers and non-joggers who took part in the population study of 20,000 people aged 20 to 93 that began in 1976. Included in that group were 1,878 joggers, who were asked about how fast and how often they jogged.

In the ensuing 35 years, 10,158 non-joggers died, compared to 122 joggers – a 44% drop in the risk of death for joggers. Male joggers extended their life by 6.2 years, and women by 5.6 years.

“We can say with certainty that regular jogging increases longevity,” Peter Schnohr, chief cardiologist of the Copenhagen City Heart Study, said in a news release from the European Society of Cardiology. “The good news is that you don’t actually need to do that much to reap the benefits.”

The researchers determined that simply jogging at a slow pace for one to two and a half hours weekly provided the most significant benefits. “You should aim to feel a little breathless, but not very breathless,” said Schnohr.

05/03/12

  04:49:51 pm, by MedBen5   , 296 words,  
Categories: News, Wellness, Health Plan Management

Incentives, Communication Vital To MedBen Clients' Wellness Successes

Phil Annarino of Fisher-Titus Medical Center

In 2007, MedBen launched a Worksite Wellness with a simple idea – detect and treat health risks as early as possible. Five years later, employers who have put the plan in place are seeing real results. At last week’s Wellness Conference, representatives from two MedBen clients talked about the success of their respective programs.

Yesterday, we highlighted Park National Corporation’s presentation. Today, we offer an overview of Fisher-Titus Medical Center’s approach to wellness.

Phil Annarino, Vice President of Human Resources at Fisher-Titus Medical Center‘, believes that hospitals not only have a vital interest in keeping their own employees healthy, they also should serve as the central coordination point for population health management. “Hospitals are best positioned to promote a message of community wellness and personal accountability for good health,” he said in his presentation.

By using Fisher-Titus’ company claims history, MedBen Worksite Wellness detected health patterns that would benefit from specialized nurse coaching. Employees and dependents who have been identified with high cholesterol, diabetes and other key conditions are contacted by home phone or letter for disease-specific education.

To encourage participation, Fisher-Titus pays for all required wellness tests at 100% when rendered through a participating provider. As a further inducement, employees who do not complete required tests by a specific date must pay a premium surcharge for the following plan year.

Like Park National, Fisher-Titus uses a variety of communication tools to keep employees in compliance, including bulletin boards, Intranet and the company newsletter. Employees also receive a Wellness Guidelines brochure, and are advised to use the MedBen Access website to check their wellness compliance status.

MedBen thanks Phil for providing his insights at the Wellness Conference. For additional information about MedBen Worksite Wellness, we invite you to call Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.

  12:43:41 pm, by MedBen5   , 207 words,  
Categories: News, Health Plan Management

Medicare Fraud Sweep Results In 107 Arrests

One positive outcome of the health care reform law that’s hard to dispute: a heightened effort to crack down on Medicare fraud. Last year, the federal government recovered a record $4.1 billion in fraudulent health care payments. And yesterday, the Obama administration announced that a new Medicare fraud sweep resulted in 107 arrests for schemes involving a total of $452 million in false claims.

According to The Wall Street Journal, nearly half of that total was perpetrated by just seven individuals in Louisiana over six years. They were accused of signing up elderly, mentally ill and drug-addicted patients for mental-health services that were never rendered or were medically inappropriate.

The WSJ also notes that the “departments of Justice and Health and Human Services… say they are trying to shift their focus to stopping the government from paying false claims rather than trying to recover the money later.”

MedBen has a similar vigilance to uncover fraud as early as possible. Our Anti-Fraud Unit reviews questionable claims, and other related information, to help conserve plan assets. Additionally, claims examiners are trained to refer potentially fraudulent claims to their departmental manager.

If you’d like to learn more about our anti-fraud measures, contact Vice President of Sales & Marketing Brian Fargus at (888) 627-8683.

  11:50:19 am, by MedBen5   , 233 words,  
Categories: News, Wellness

High Acidity In Energy Drinks Can Permanently Damage Teeth

The high acidity levels in sports and energy drinks can erode tooth enamel, according to a recent study published in the journal General Dentistry. Teenagers, many of who consume such drinks on a daily basis, are in particular danger of doing irreversible damage to their teeth, researchers say.

“Young adults consume these drinks assuming that they will improve their sports performance and energy levels and that they are ‘better’ for them than soda,” says Poonam Jain, BDS, MS, MPH, lead author of the study. “Most of these patients are shocked to learn that these drinks are essentially bathing their teeth with acid.”

Medical News Today reports that researchers tested the acidity levels of 13 sports drinks and nine energy drinks by immersing samples of human tooth enamel in each beverage for 15 minutes, followed by immersion in artificial saliva for two hours.

After the five days of testing, the researchers found evidence of enamel erosion. Both types of drinks did damage, but energy drinks appear to cause twice as much damage to teeth as sports drinks.

Jennifer Bone, DDS, MAGD, a spokesperson for the Academy of General Dentistry, recommends that sports and energy drinks be consumed in moderation. Also, users should chew sugar-free gum or rinse the mouth with water following consumption of the drinks. “Both tactics increase saliva flow, which naturally helps to return the acidity levels in the mouth to normal,” she says.

05/02/12

  05:17:24 pm, by MedBen5   , 285 words,  
Categories: News, Wellness, Health Plan Management

MedBen Clients Achieve Healthier Workplace With Wellness Focus

Jill Evans of Park National Corporation

In 2007, MedBen launched a Worksite Wellness with a simple idea – detect and treat health risks as early as possible. Five years later, employers who have put the plan in place are seeing real results. At last week’s Wellness Conference, representatives from two MedBen clients talked about the success of their respective programs.

Today, we highlight Park National Corporation’s presentation. On Thursday, we’ll offer an overview of Fisher-Titus Medical Center’s approach to wellness.

Jill Evans, Assistant Vice President of Human Resources at Park National Corporation, oversees the health care needs of nearly 1,300 medical plan members. Since partnering with MedBen in 2008 to introduce an “opt-out” wellness program, the percentage of members receiving annual wellness exams, cholesterol screenings and colonoscopies has more than doubled.

“After three years, the costs for asthma, hypertension and coronary artery disease are coming down, or at least remaining neutral instead of increasing,” Evans said in her presentation, adding that status reports help them track the cost of specific conditions.

Key to these accomplishments is offering incentives for program participation. Park pays 100% of the recommended screenings when completed by an in-network provider. Covered participants who complete recommended screenings by a designated date are “compliant” and receive lower premiums, deductibles and co-insurance for the following year. Those who do not move to the higher-cost “non-compliant” plan.

Also important is maintaining participant awareness of the program. To that end, Park uses an assortment of screening reminders – everything from restroom and kitchen flyers to automated phone messages, to ensure the message gets across.

MedBen thanks Jill for providing her insights at the Wellness Conference. For additional information about MedBen Worksite Wellness, we invite you to call Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.

  05:05:02 pm, by MedBen5   , 215 words,  
Categories: News, Wellness

Sleep Habits Can Genetically Influence Weight, Study Says

It’s universally accepted that proper diet and exercise can help people stay in shape. Also benefical in keeping off the pounds – an extra hour or two sleep each day. And a new study suggests that slumber habits can actually modify genetic and environmental influences on BMI (body mass index).

According to Medical News Today, researchers from University of Washington Medicine Sleep Center in Seattle used self-reported data from identical and fraternal twins about their sleep patterns as well as their weight and height. Two-thirds of the participants were women, and their average age was 36.6 years.

The authors found that:

  • The participants who slept at least nine hours per night were slimmer than those who slept less.
  • Participants who slept less than 7 hours per night had a higher genetic risk of a greater BMI
  • For those sleeping over nine hours per night, genetic factors accounted for approximately 34% of variations in weight
  • For participants sleeping less than 7 hours each night, genetic factors accounted for about 70% of variations in weight
  • For participant sleeping between 7 to 9 hours each night ("normal” sleep), genetic factors accounted for about 60% of variations in weight

Neurologist and lead author Nathaniel Watson said that while BMI and sleep are both inherited features, variations in the twins’ weight could be linked to their sleep duration.

  04:22:21 pm, by MedBen5   , 244 words,  
Categories: Prescription

Providers Slowly Adapting To E-Prescriptions

While much medical information is now communicated electronically, many doctors still write prescriptions the old-fashioned way – with pen in hand. The New York Times recently examined the advantages of e-prescribing, and the progress (and lack thereof) in getting providers to adopt the system.

The push to transmit drug instructions directly to the pharmacist has benefits that go beyond simple convenience. A 2010 study of prescription processing found that for every 100 paper prescriptions, 37 contained some kind of error – and that number doesn’t take into account legibility issues. In contrast, only 7 in 100 errors were detected when e-prescribing software was used.

Previous studies of prescriptions in hospital settings turned up error rates of about 5 per 100 paper prescriptions – most of which were not serious, but a handful of which carried potential for harm. Even so, only about 36% of all prescriptions were delivered electronically in the United States in 2011 – and 70% of hospitals have yet to make the change.

So what keeps more providers from going 100% electronic? Certainly, cost is a consideration. As the Times article notes, the 2009 stimulus package helps doctors financially, but payments are included as part of Medicare and Medicaid reimbursements and spread out of five years. So the upfront costs can be formidable.

Another hurdle is the extra work time involved in entering data to electronic records. “These systems are far from plug and play,” says Rainu Kaushal, a professor of medical informatics at Weill Cornell Medical College and co-author of the 2010 study.

05/01/12

  01:33:33 pm, by MedBen5   , 185 words,  
Categories: News, Health Plan Management

Health Care Spending Reveals A Positive Trend

As this chart from The New York Times shows, health care spending has slowed dramatically over the past ten years. So what’s responsible for this trend?

Certainly, the recession has played a major role, as many people have reduced the frequency in which they seek care. But as the Times notes, some of the slowdown seems to be attributable to changing behavior by consumers and providers of health care – a hopeful indication that the lower rates of growth will continue as the economy improves.

It’s also noteworthy that the slowdown commenced prior to the enactment of the Affordable Care Act in 2010. It suggests that some of the reduced growth can be credited to earlier efforts in the private sector to reduce spending, such as consumer-driven health plans and a greater emphasis on generics over brand name drugs.

“The tectonic plates might be beginning to shift,” said Karen Davis, the president of the Commonwealth Fund, a nonprofit research group in New York. “It’s hard to believe everything that’s been tried over the last decade to slow spending wouldn’t be making a difference.”

  12:44:00 pm, by MedBen5   , 218 words,  
Categories: News, Health Plan Management

Court Decision Could Give Health Exchanges Headaches

One of the weightier questions that would arise if the Supreme Court strikes down the individual mandate: What becomes of state health exchanges?

Should the justices find the requirement that most Americans buy insurance to be unconstitutional, the state-run insurance marketplaces, expected to be operational in 2014, would find themselves in a quandry. Lacking the mandate, the exchanges would likely experience adverse selection: More unhealthy people would pay into the system than healthy ones, resulting in higher premiums – which, in turn, would further drive healthy people away.

As for states that have yet to begin building exchanges, Politico notes that they may face a dilemma as well. If the Court doesn’t also strike down the rules preventing insurers from charging more or denying coverage to sicker people, local insurance companies would put pressure on those states to pass mandates. Massachusetts has had such an enforcement in place since 2006.

Other options may also be explored, such as allowing people to enroll in health insurance only during certain times of the year, or penalizing uninsured people when they seek care at taxpayer expense. Or, as Anthony Wright of Health Access California suggests, create a system that automatically enrolled people unless they opt out of coverage.

The mandate “isn’t the only solution to the issue of adverse selection,” Wright said.

04/30/12

  05:09:50 pm, by MedBen5   , 135 words,  
Categories: News, Health Plan Management

IRS Releases HSA Inflation Adjustments For 2013

On Friday, the IRS released the cost-of-living adjustments affecting health savings accounts (HSAs) for calendar year 2013. The HSA contribution limits and high-deductible health plan (HDHP) out-of-pocket maximums will both increase. The HDHP minimum required deductibles, which did not change in 2012, will also go up next year.

  • HSA Contribution Limits – The 2013 annual HSA contribution limit for individuals with self-only HDHP coverage is $3,250, and the limit for individuals with family HDHP coverage is $6,450.
  • HDHP Minimum Required Deductibles – The 2013 minimum annual deductible for self-only HDHP coverage increases to $1,250; for family HDHP coverage, $2,500.
  • HDHP Out-of-Pocket Maximum – The 2013 maximum limit on out-of-pocket expenses for self-only HDHP coverage is $6,250, and the limit for family HDHP coverage is $12,500.

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

  04:55:11 pm, by MedBen5   , 185 words,  
Categories: News, Wellness, Health Plan Management

The "Other" Costs Of Obesity

As we noted here a few weeks ago, the nationwide obesity epidemic adds almost $190 billion a year to U.S. medical costs – acounting for over 20% of total U.S. health spending. But as Sharon Begley of Reuters details, medical expenses tell only one part of the story.

To accomodate America’s expanding waistlines, businesses, governments and individuals have to spend money for wider seats – on wheelchairs and in sports stadiums and bus stops. Moreover, as more people have joined the ranks of the extremely overweight, productivity has suffered: Obesity-related absenteeism costs employers as much as $6.4 billion a year.

And it doesn’t stop there. Belgey writes:

“Some costs of obesity reflect basic physics. It requires twice as much energy to move 250 pounds than 125 pounds. As a result, a vehicle burns more gasoline carrying heavier passengers than lighter ones.

“‘Growing obesity rates increase fuel consumption,’ said engineer Sheldon Jacobson of the University of Illinois. How much? An additional 938 million gallons of gasoline each year due to overweight and obesity in the United States, or 0.8 percent, he calculated. That’s $4 billion extra.”


Read more at Yahoo! Health.

04/27/12

  06:11:07 pm, by MedBen5   , 413 words,  
Categories: Announcements, News

MedBen Hospital & Wellness Conference Covers Variety Of Subjects

MedBen President and CEO Doug Freeman

On Thursday, April 26, MedBen clients and other guests filled the new MedBen Conference Center for the 10th Annual Hospital Roundtable. For the first time, MedBen also held its yearly Wellness Conference on the same day, for the convenience of clients who regularly attend both events.

The event marked the “unoffical” debut of the conference center, located next door to our home office in Newark, Ohio. MedBen will officially open the site with a ceremony in mid-May.

As in previous years, the roundtable gave health care clients an opportunity to look at their health plan costs and utilization as benchmarked against MedBen’s growing block of Midwest hospital plans. Following introductory remarks by MedBen President and CEO Doug Freeman, Executive Vice President and COO Kurt Harden discussed key hospital cost and utilization data, compared against MedBen’s hospital and self-funded business blocks, as well as national cost norms.

Brian Fargus, MedBen’s Vice President of Sales and Marketing, offered an overview of MedBen hospital client case studies that highlighted cost-saving benefit changes, including a coinsurance-only plan. He also gave a walk-through of Verisk Sightlines, a resource used by MedBen that provides detailed information of where health care dollars are being spent, and why.

Pam Davis, who recently joined MedBen as a Regional Sales Manager, concluded the Hospital Roundtable portion of the even with an examination of “The Discount Game” – the ways some health insurance carriers make promises of provider network discounts while shifting attention away from the real customer costs.

MedBen Conference Center

Leading off the Wellness Conference, Gastroenterologist Shakil A. Karim, D.O. of Licking Memorial Health Systems explained the importance of colonoscopies for early detection of colon cancer. The disease is among the most preventable cancers, yet 1 in 3 U.S. adults who should get screened have not yet done so.

Following Dr, Karim was Rayvelle Stallings, M.D., Chief Medical Officer of inVentiv Medical Management, who discussed the physical and financial value of worksite wellness programs. She noted that poor lifestyle choices have lead to expanding prevalence in expensive chronic diseases, which is why over 7 in 10 employers are seeking wellness solutions.

Concluding the conference, guests heard from MedBen clients Park National Corporation and Fisher-Titus Medical Center, represented by Jill Evans and Phil Annarino, respectively. Both companies have successully implemented wellness programs, and Jill and Phil explained the methods their employers used to build and maintain employee interest through incentives and communication.

Next week, we’ll further highlight several of the guest speakers and their presentation topics.

  04:00:12 pm, by MedBen5   , 183 words,  
Categories: News, Health Plan Management

Appendicitis Study Reveals Wide Price Disparity

A few weeks back, we posted a piece here about the differences in preventive care costs from one provider to another. Recent research also demonstrates a similarly wide disparity in hospital charges.

According to HealthDay, a California study of the costs of treating acute appendicitis in 2009 found charges as low as $1,500 and as high as $180,000. The median charge that year was nearly $34,000, based on the review of 19,000 patients aged 18 to 59, most of whom had an appendectomy and were hospitalized three days or less.

The researchers said the disparity is typical of price variations across the United States. Also, while about two-thirds of the differences could be attributed to patient level and hospital factors, including length of stay, severity of illness and hospital type, 32% remains unexplained.

A spokeswoman for the American Hospital Association said each patient’s course of care is different. And, “the costs also reflect more than the cost of serving an individual patient,” said Marie Watteau, the association’s director of media relations. “They reflect the costs of maintaining essential health care services for their community 24 hours a day, seven days a week.”

  11:08:29 am, by MedBen5   , 240 words,  
Categories: News, Health Plan Management

Change To OTC Rules Debated By House Subcommittee

On April 25, politicians and health industry representatives argued the impact of limitations on the use of consumer-driven health plans for the purchase of over-the-counter drugs on consumers, physicians and employers.

As noted on the Tax-News website, prior to 2011 FSA and HRA participants could use account funds to buy OTC funds without a prescription. A provision in the Affordable Care Act eliminated that benefit, save for insulin purchases – which means taxpayers must now purchase non-prescribed OTC medications with after-tax dollars.

The change has, not surprisingly, been unpopular with consumers, and has resulted in extra paperwork for doctors.

At the hearing by the House of Representatives’ Subcommittee on Oversight of the Committee on Ways and Means, Chairman Charles W. Boustany (R-La.) said that the CDHP limitations negatively affect medication access and affordability. “Too often in Washington, officials make decisions about health care policy based on abstract theories and budgetary scores,” Boustany said.

Paul Van de Water, a Senior Fellow at the Center on Budget and Policy Priorities, testified that the limitations made sense “both as tax policy and as health policy, and repealing any of them would be unwise”. He also claimed that CDHPs “encourage the overconsumption of health care".

In response, Scott Melville, President and CEO of the Consumer Healthcare Products Association (CHPA), countered that as millions of people rely on OTCs for relieve from mild ailments, eligibility of these medicines under CDHPS offers “significant value to the American consumer”.

04/26/12

  10:28:36 am, by MedBen5   , 266 words,  
Categories: News, Wellness

Cancer Screenings: When To Test, And When Not

Getting a cancer screening is vital to better health. Also vital: Not getting a cancer screening.

Confusing? Well, let’s elaborate on those seemingly contradictory statements. A benchmark of smart preventive care is getting appropropriate cancer tests per the age guidelines recommended by the American Cancer Society and other medical groups – age 40 and up for mammograms, 50 and up for colonoscopies, and so forth.

However, it’s also important to consider the warnings in cases where a screening could do more harm than good. Case in point: The U.S. Preventive Services Task Force recommends that men 75 and older no longer be given a routine prostate cancer screening. But many men in that age group continue to be tested for the disease.

As The New York Times reports: “The test is notoriously unreliable in older men, who often have elevated P.S.A. scores as a result of natural aging or an enlarged prostate. And even when cancer is found as a result of a P.S.A. test in older men, it typically is so slow-growing that it will never cause harm.”

MedBen currently follows the American Cancer Society recommendation that screening should begin at age 50 for men who are at average risk of prostate cancer. But the ACS website also notes that “[b]ecause prostate cancer often grows slowly, men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit.” The best advice is that men first speak with their doctor about the procedure’s risks as well as its benefits.

  09:10:55 am, by MedBen5   , 173 words,  
Categories: News

Many People Ignore Prescription Drug Instructions, Study Finds

New research reveals that only about one out of three Americans correctly follow doctor’s orders when taking prescription drugs, according to The Wall Street Journal Health Blog.

Demonstrating true fortitude in the name of medical progress, Quest Diagnostics analyzed nearly 76,000 urine samples in 2011, then matched the results with physicians’ records of the drugs prescribed for each patient. They found that 63% of patients on prescription drugs failed to adhere to their doctor’s instructions.

Of the two-thirds that strayed, about 40% weren’t taking the prescribed drugs to begin with – either the prescription went unfilled or unused, treatments were skipped, or the medications were diverted to illegal sales channels. The other 60% of misusers were taking drugs not prescribed to the patient – typically painkillers, sedatives or amphetamines.

Results of misuse were consistent across income levels, gender and the level of health coverage, said Jon R. Cohen, Quest’s chief medical officer, speaking to the Health Blog. The study does note that some patients were tested specifically because their doctors suspected misuse, while others were randomly selected.

04/25/12

  05:10:13 pm, by MedBen5   , 428 words,  
Categories: News, Health Plan Management

SBC Requirements for Health FSAs

As we’ve noted in earlier blog posts, the Affordable Care Act has imposed a significant new disclosure requirement: the Uniform Summary of Coverage document. Known as a Summary of Benefits and Coverage (SBC), the document must contain a standardized overview that individuals can use to uniformly compare health care plan offerings. MedBen is in the process of preparing these for clients.

The federal government has issued final regulations and related guidance implementing this requirement. Included in these regulations are explanations of how consumer-driven health plans (CDHPs) fit into the SBC model. Below, we examine what types of health flexible spending accounts (FSAs) are excepted from the requirements.

A health FSA is excepted – that is, a SBC does not need to be provided – if these two conditions are met:

1. Maximum Benefits Condition – The maximum benefit payable from the health FSA does not exceed the greater of:

  • Two times the employee’s salary reduction election; or
  • The amount of the employee’s salary reduction for the year plus $500.

Put another way:

  • If the employer contribution is $500 or less, the Maximum Benefit Condition HAS been met. But if the employer contributed more than $500 and the employee contributed $500 or less (i.e., employer $600, employee $400), the condition HAS NOT been met.
  • If the maximum benefit payable for employee and employer is a one-for-one match – for example, if the employee can contribute up to $600, and the employer matches that $600 – the Maximum Benefit Condition HAS been met. But if the employer contributed $700 – a contribution in excess of a one-to-one match – the condition HAS NOT been met.

A health FSA funded solely by employee contributions would, by definition, satisfy this condition.

2. Availability Condition – Other non-excepted group health plan coverage (e.g., major medical coverage) must be made available to the same class of participants by reason of their employment. (The regulations do not define “class of participants”, but at this time we presume that they refer to distinctions in coverage availability between, say, full-time employees eligible for both major medical and health FSA participation, and part-time employees eligible only for the health FSA.)

If a non-excepted health FSA is integrated with other major medical coverage, information about it can be included in the appropriate spaces on the major medical SBC for deductibles, co-payments, co-insurance, and benefits otherwise not covered by the major medical coverage. But if a stand-alone health FSA doesn’t satisfy the two conditions, a separate SBC must be provided.

MedBen clients with questions about health FSAs in relation to the SBC document can call Sharon A. Mills, Director of Administrative Services, at (800) 423-3151, Ext. 438.

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