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  04:51:00 pm, by MedBen5   , 345 words,  
Categories: Wellness

May is Mental Health Awareness Month

consoling friend

Mental health does not receive nearly the publicity that it should compared to other elements of wellness. Even though one in five Americans suffer from mental illness, and over a million mental health screenings were completed online at Mental Health America last year alone, the topic remains taboo to many.

Millions of people suffering from extreme stress, anxiety, or depression may not be receiving the care they need. In fact, less than 50% of those with a diagnosis in mental health sought guidance. This could be due to the fact that a recent survey showed that less than 25% of those diagnosed with a mental illness thought people to be considerate of their condition.

Nevertheless, MedBen WellLiving has always supported a honest relationship with your physician, including discussing symptoms of extreme stress, anxiety, and depression. Such common symptoms include behavior straying from a person’s norm, such as a social person now isolating themselves or an active person now sleeping the majority of the day (or not at all). Eating habits can also change when someone is suffering from a mental illness.

Recognizing these symptoms within ourselves is important, but so is recognizing them within others. If you believe that you or someone you love may be suffering from a mental illness, seek guidance immediately. Your family physician should be able to guide you through the correct steps.

Full story »


  11:11:00 pm, by MedBen5   , 252 words,  
Categories: Stop-loss, Cost savings, Third party administration, Captives

MedBen Stop-Loss Captive Offers Cost Savings Through Shared Risk

Jay Ritchie

The MedBen stop-loss captive save clients money while reducing financial risk, says Jay Ritchie, Executive Vice President of Tokio Marine HCC.

Speaking at the 2017 Employer Roundtable on May 11, Ritchie noted that the success of MedBen's captive is based on its straightforward design. "By keeping things simple and avoiding unnecessary costs and excessive fees, clients realize lower costs while still offering broad benefits."

A captive brings together employers with good claims experience to spread risk among multiple groups. In doing so, small to mid-sized businesses get the advantages of larger employers, including plan design flexibility, claims data transparency, and cost management.
A key to the captive is an added "captive layer" between the employer specific deductible and stop-loss coverage, in which a portion of the group’s collective stop-loss premium is held. Claims above the specific deductible are paid from this layer, and any funds remaining in it go back to the employers.

"Employers in the stop-loss captive use the captive layer as a shock absorber," Ritchie said. "This added layer translates to lower volatility in the stop-loss specific claim layer, which in turn lowers employer risk. And the captive's cost containment can reduce short and long term cost trends."

In addition to his position at Tokio Marine HCC, Ritchie also serves as Chairman of the Board for the Self-Insurance Institute of America (SIIA).

Employers interested in joining the MedBen stop-loss captive can do so at their current effective date. To learn more, contact Vice President of Sales & Marketing Brian Fargus at

  11:05:00 pm, by MedBen5   , 327 words,  
Categories: News, Health Care Reform, Taxes, IRS

Reminder: PCORI Filing and Fee Deadline Approaching

IRS Building

As in years past, it's time for all self-funded employer health plan sponsors to file and pay the required Patient-Centered Outcomes Research Institute (PCORI) fee. While hope continues that payment of this fee may be suspended as part of the current Administration’s efforts to reduce the burden of Affordable Care Act (ACA) regulation on plan sponsors, to date that has not happened. This means that PCORI fees must be reported and paid to the Internal Revenue Service (IRS) no later than July 31, 2017.

All self-funded plan sponsors are required to pay a fee based on the average number of covered lives under their eligible plans – including employees, retirees, spouses and dependents. Plans subject to the requirements include self-funded medical benefit plans, such as ERISA and non-ERISA self-funded plans as well as 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 from the fee requirement.

All plan sponsors must use the IRS Form 720 dated April, 2017 to record and remit the amount due. This year, the form has again been modified to include the payment amounts due under the schedule shown below. Make sure to complete the correct section of Part II for “Applicable self-insured health plans” (line 133) and select the correct payment amount based on your plan’s year end date (line 133 (a) or (b)).

This year’s payment schedule is below. If your plan year ended on October 31, 2016, November 30, 2016 or December 31, 2016 you will owe $2.26 per covered life. All other plan years owe $2.17 per covered life. Remember, a “covered life” means each and every individual you have covered under an applicable plan (i.e., employee, retiree, spouse, and dependents).

MedBen clients who need more information about how to count covered lives under their plan or how to prepare and remit your payment, don’t hesitate to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or


  05:18:00 pm, by MedBen5   , 227 words,  
Categories: Announcements, News

Millard Completes Chamber Leadership Program

Cheri Hottinger & Wayne Millard

MedBen Director of Data Processing & Technical Compliance Wayne Millard recently completed the Community Leadership of Licking County program, offered through the Licking County (OH) Chamber of Commerce. For completing the nine-month program, Wayne received a Certificate of Achievement at a commemorative ceremony on Friday, May 12.

The Leadership program allows participants to interact with a diverse group of business experts from various job categories. 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, Millard replied, "In addition to learning about the workings of businesses around Licking County, you also learn about the most important skills you bring to your job that make you one of a kind."

As for how completing the program will benefit him, Millard said, "By networking with other business people in the area, I developed relationships that can further my career while helping to build important relationships for MedBen."

Millard joined MedBen in 1999 and was named a director in 2015. He has earned Masters in Business Administration and Information Systems Management, and a Bachelor of Science in Computer Information Systems, from Devry University. He has also earned 15 health care certifications from America's Health Insurance Plans (AHIP) and other industry organizations.

Congratulations, Wayne!


  02:22:00 pm, by MedBen5   , 227 words,  
Categories: Announcements, News

Team MedBen Challenges Heart Disease at AHA Event

For the second year running (literally), MedBen participated with other area businesses in the Licking County HeartChase on Saturday, May 6 in Newark, Ohio. MedBen also served as a corporate sponsor for the event, which was created by the American Heart Association (AHA) to promote heart health awareness.

HeartChase 2017

A total of 27 MedBen employees participated in the 2017 HeartChase, a friendly corporate contest in which teams competed for points in a variety of heart-related activities and games. These challenges ranged from a human foosball match to a classic game of cardio concentration, as well as numerous opportunities to find "Power Up" words for additional points. As you can see from the photo above, we definitely had our game faces on!

In total, approximately 300 community members joined together to raise over $120,000 for the AHA... $30,000 more than the 2016 HeartChase event. And while MedBen didn't quite pull off the win (hey, there's always next year!), our "Code Blue" squad took 9th place among the 69 participating teams, and five of our teams placed in the Top 30.

MedBen Chairman & CEO Doug Freeman and President & COO Kurt Harden also participated in the event's Executive Challenge, each meeting their fundraising goal to raise money toward heart disease prevention. They will serve as co-chairs for next year's HeartChase.

Learn more about participating in, or organizing, a HeartChase event in your community by visiting the AHA website.


  11:11:00 pm, by MedBen5   , 329 words,  
Categories: News, Health Care Reform, Self-funding, American Health Care Act

AHCA Clears House Hurdle, But Faces Uphill Senate Battle

Capitol Building

It took a lot of old-fashioned wheeling and dealing, but on May 4 the Republican block of the House of Representatives managed to pass the American Health Care Act (AHCA) with 217 "yea" votes ‒ just one vote above the minimum number required for passage. Now the bill moves to the Senate, where its members are expected to make major changes, or even introduce alternative legislation.

Leading up to the successful vote, the biggest obstacle in the way of AHCA victory regarded coverage for individuals with pre-existing conditions. The current bill promises that such coverage will remain available to all, though potential cost concerns proved a deal-breaker for some GOP House members.

While the AHCA debate has focused primarily on individual coverage, there are provisions in the bill that will affect self-funded employers as well. These include:

  • Removing employer mandate penalties effective 2016, though employer reporting remains;
  • Delaying the Cadillac tax until 2026;
  • Repealing employer and individual contribution limits to health flexible spending accounts (FSAs), for taxable years beginning after December 31, 2016; and
  • Expanding health savings accounts (HSAs) to allow both spouses to make catch-up contributions beginning in 2018, and increasing maximum contribution limits.

Of course, the likelihood is that any bill that survives the Senate will be very different than the House version. In addition to zero backing from Democrats, Republican Senators face numerous difficulties in passing the current AHCA bill: Lukewarm public support, opposition by major medical organizations and patient advocacy groups, and a pending Congressional Budget Office review that may make the bill an even harder sell.

While we obviously don't know for certain what the future holds for the AHCA or health care reform in general, we do have some thoughts on what may happen, and what we'd like to see in the final bill... and we'll be sharing them at our upcoming MedBen Employer Roundtable on Thursday, May 11 in Newark, OH. If you haven't already signed up, please do so today by contacting Sales Analyst Sally Wood at or (800) 423-3151, ext. 502.


Check Your Compliance with HSA and HDHP Requirements

IRS Building

Health savings accounts (HSAs) are becoming more and more popular as a vehicle to empower health savings and lower premium costs, but the related regulations – particularly those pertaining to the associated high deductible health plan (HDHP) – can be confusing.

The Internal Revenue Service (IRS) applies detailed rules on the set-up and administration of HSAs. In order for the account holder to benefit from tax advantages associated with such an account, the individual must also be covered under a qualifying HDHP.

To ensure that your HSA is in compliance, we recommend that you review it against our new educational summary, High Deductible Health Plan (HDHP) used with Health Savings Accounts (HSAs), which can be found at

As always, the MedBen Compliance Department is here to help you with the design of your HDHP. Additionally, the IRS has information regarding HSAs available on its website at If you have any questions, please contact Director of Compliance Annette McNair at or (800) 423-3151, ext. 410.


  06:43:00 pm, by MedBen5   , 160 words,  
Categories: News, Hospitals, MedBen Analytics, Bundled Payments, Research, Value-based care

With Readmissions, Cost Savings Are in the Details

hospital bed

Among the advantages of MedBen Analytics' proprietary reporting platform is that it allows providers to drill down into hospital readmission data. Now, a new study demonstrates the financial value of this accessibility.

University of Michigan researchers recently found that hospitals participating in bundled payment and other value-based programs have lower readmission rates than those that use fee-for-service alone. From 2005 to 2015, program participants saw a 2.9% reduction in readmissions each year for heart failure patients, as well as 2% drop for heart attack and a 1.9% decrease for pneumonia.

With MedBen Analytics, hospitals have the ability to review readmission details - even those that occurred at different hospitals - and compare current episodes with benchmark data. Using this information, providers can evaluate readmission activity, analyze their underlying causes, and make changes as needed.

MedBen Analytics delivers insights on readmissions, lengths of stay and other cost-oriented variables, enabling hospitals to make informed care decisions. Learn more by contacting MedBen President and COO Kurt Harden at 888-633-2364 or


  07:39:00 pm, by MedBen5   , 221 words,  
Categories: Prescription, Wellness, Cost savings, MedBen University, Municipalities

MedBen Municipality Group Costs Rose Just 1% in 2016

Municipality groups administered by MedBen are seeing only minimal cost growth, according to an analysis of industry-specific benchmarks at the 11th Annual MedBen Municipality Roundtable on March 30.

In presentations to attending clients, MedBen President and COO Kurt Harden and Vice President of Sales & Marketing Brian Fargus reviewed cost and utilization trends for their medical and pharmacy plans, and pointed out areas of opportunity for future savings. Their observations included:

  • Per employee per year (PEPY) costs for MedBen’s municipality block rose only 1% in 2016, well below the current trend leading stop-loss carriers are using. The five-year trend for our municipality block averaged 3.2% per year.
  • Of the 14 municipalities performing better than their industry block average in claims costs, ten (or 71%) utilize our proprietary wellness program, MedBen WellLiving.
  • In regards to pharmacy plans, MedBen presented examples of the impact of high cost combination medications and provided recommendations on how to control the effect of those costs.

Of course, much more information was shared at Municipality Roundtable, as is the case at all MedBen University events. Speaking of which, interested employers (clients and non-clients alike) can get more useful advice on plan design, wellness, health care reform, and other topics at the 2017 MedBen Employer Roundtable on Thursday, May 11. For more information or to sign up, contact Sales Analyst Sally Wood at (800) 423-3151, ext. 502 or emailing


  10:36:00 pm, by MedBen5   , 326 words,  
Categories: Wellness

Welcome Back, Allergies


According to the Centers for Disease Control, allergies are the sixth leading cause of chronic illness in the U.S., with an annual cost in excess of $18 billion. It is estimated that more than 50 million Americans suffer from allergies each year.

Seasonal allergies are those allergies that come with the change of seasons and usually begin in February. However, a mild winter and rainy spring (sound familiar?) promotes rapid growth of these allergens, which means they can be prevalent even sooner.

Approximately two-thirds of spring allergy sufferers actually have year-round symptoms. These include a runny nose, coughing, sneezing, and/or itchy, watery eyes (or even dark circles around them).

The most common seasonal allergy triggers include grass, pollen, and mold. Though these are triggers for symptoms, the actual cause of allergies lies within the immune system. It mistakes innocent things in the environment for a serious threat and attacks them, resulting in symptoms.

Combating the symptoms often includes an antihistamine, but knowing your triggers is important to ensure you’re taking the right precautionary and reactive measures. To do so, a trip to your family doctor is a good place to start. They may refer to see an allergist who will further investigate the cause and treatment regimen for your symptoms.

Full story »

  04:14:00 pm, by MedBen5   , 107 words,  
Categories: Announcements, News, MedBen Analytics, Comprehensive Care for Joint Replacement (CJR)

CJR Year 1 Reconciliation Reports Available

MedBen Analytics logo

Earlier today, CMS delivered the Comprehensive Care for Joint Replacement (CJR) Performance Year 1 (PY1) Reconciliation Reports and related files. MedBen Analytics has begun the process of auditing the Net Payment Reconciliation Amount (NPRA) for our clients.

A hospital will earn a positive NPRA if the aggregate capped episode cost for PY1 (episodes ending on or before 12/31/2016) is less than the aggregate target price and the composite quality score was Acceptable Good or Excellent.

The CMS CJR Reconciliation: Performance Year 1 reports will be sent to our clients via secure email today. Clients with questions regarding these reports may contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or


  09:03:00 pm, by MedBen5   , 207 words,  
Categories: News, Prescription, Wellness, Research

Prescription Adherence Crucial to Better Population Health


The New York Times reports that approximately 125,000 deaths and at least 10% of hospitalizations can be attributed to lack of prescription adherence. From a financial perspective, negligence costs the American health care system between $100 billion and $289 billion a year.

“Studies have consistently shown that 20% to 30% of medication are never filled, and that approximately 50% of medications for chronic disease are not taken as prescribed,” according to a review of research in Annals of Internal Medicine. Those who do take medications take only about half the prescribed doses, regardless of their condition's severity.

These numbers demonstrate that, simply by following doctor's orders, patients can better control their condition, or cure it altogether. And they'll likely save money by doing so.

MedBen works with clients to bolster prescription adherence through a variety of measures, such as strategic pharmacy plan design with an emphasis on lower-cost generic alternatives, and incentives to encourage population health through our WellLiving program. Closely tied to this is emphasizing to plan members the importance of maintaining a relationship with their family doctors, which promotes personal accountability in addition to preventive care.

Learn more about the ways MedBen can help your business foster a healthier workforce by contacting Vice President of Sales & Marketing Brian Fargus at


  03:48:00 pm, by MedBen5   , 235 words,  
Categories: News, Wellness, Cancer, Research, Preventive care

Task Force, Doctors Weigh in on Screening Start Dates

Two cancer screening-related items recently made the news, both of which address the question of when (or if) such tests are appropriate:

  • The U.S. Preventive Services Task Force (USPSTF) has walked back from its 2012 position that most men should forego a screening for prostate cancer, then claiming that its risks outweigh any benefits. In an April 11 draft recommendation, the panel says now states that “the decision about whether to be screened for prostate cancer should be an individual one,” and that men between the ages of 55 and 69 should discuss the pro and cons with their physician and make decisions based on their own values and preferences.

    The USPSTF's revised guidance concurs with what the American Cancer Society (ACS) and MedBen WellLiving recommends: Men age 50 and above (or younger, in cases of high risk) should talk to their family doctors to determine if prostate screening is right for them.

  • Another USPSTF decision that has engendered a fair amount of debate is its recommendation that women without a family history of breast cancer wait until age 50 to have a yearly mammogram. But a new survey found that 81% of responding physicians believe that breast cancer screenings for women should begin at age 40, and 88% say screenings should start no later than 45.

    MedBen WellLiving also recommends annual mammograms for women age 40 and over, while ACS screening guidelines encourage personalized screening decisions for women ages 40 to 44, with routine mammograms starting at 45.


MedBen Helps Clients Controls High Claimant Costs

MedBen building

High cost claimants are among the leading contributors to health care spending, topping even medical inflation, pharmaceuticals and specific diseases. A study from the American Health Policy Institute and Leavitt Partners found that claimants who cost $50,000 or more in a year are the top cost driver for 43% of large employers, and comprise 31% of total spending among employers’ health plans. On average, a high-cost claimant costs an employer about $122,000 annually.

Recognizing that plan members sometimes require high-priced treatment, MedBen has multiple means to keep claim costs in check with self-funded plans. The first step is to make sure the plan isn’t paying for services it shouldn’t be. With large claims, there is higher risk of paying for something that is not medically necessary or inappropriate. A self-funded plan has the latitude to manage claim costs by customizing the review of particular types of claims. MedBen can flag claims requiring clinical review by using dedicated surveillance software that triggers the specialized medical review of claims before payment is made to the health care provider.

MedBen has found that using a panel of over 125 board-certified medical specialists is key to the claims management approach. Reviewing claims flagged for potential clinical questions or problems, they work with the provider to reach a proper resolution ‒ all before the plan pays the provider, so employers don’t have to recoup expenses later. Using this method of claim review, MedBen saves an average of 26.5% on all clinically reviewed claims and in 2016 saved its clients an average of $9.75 per covered employee per month. That’s money the health plan can use to provide other benefits to its employees.

Full story »


  03:43:00 pm, by MedBen5   , 206 words,  
Categories: MedBen Analytics, Bundled Payments, Value-based care

In Claims Analysis, Experience Makes the Difference

MedBen Analytics

The rise of alternative payment models has, naturally, brought with it a number of services designed to assist providers in the difficult task of using the data made available by CMS as part of the bundled payment programs. Interpreted properly, this data can make the difference between success and failure under the program.

In addition to the fact that the MedBen Analytics reporting platform offers variety, ease of use and drill-down functionality, we possess an advantage that few others can cite: Detailed claims analysis based on nearly 80 years of health care and benefits administration experience.

From our start as a Hospital Services Association in 1938, MedBen has made a business of working with health care systems, hospitals and physicians. Since 1990, we've carved out a niche as a third party administrator, offering innovative solutions for health care systems and their employee benefits plans. And today, we work with health care systems to develop bundled payment solutions, drawing upon our expertise to provide unique insights.

Claims analysis goes beyond data sorting ‒ MedBen Analytics offers a level of reporting than only decades of experience can provide. If you're interested in a demonstration of our system or additional information, please contact MedBen President & COO Kurt Harden at 888-633-2364 or email


  10:58:00 pm, by MedBen5   , 271 words,  
Categories: Prescription, Wellness, Hospitals, Cost savings, MedBen University

MedBen Hospital Block Costs Rose Just 4.8% in 2016

At the 15th Annual MedBen Hospital Roundtable, MedBen President and COO Kurt Harden and Vice President of Sales & Marketing Brian Fargus shared with attendees a wealth of information about their medical and pharmacy plans, including how their costs compared other hospitals and strategies to maintain low cost trends. Below we highlight a few of their observations:

  • Per employee per year (PEPY) costs for MedBen’s hospital block cost rose only 4.8% in 2016, which is half of the current trend leading stop-loss carriers are using. The five-year trend for our hospital block averages 2.8% per year.
  • Of the seven hospitals performing better than our hospital block average in claims costs, five (or 71.4%) utilize our proprietary wellness program, MedBen WellLiving.
  • Looking to pharmacy, while there is no silver bullet for high specialty drug costs, hospitals dispensing to their employees at “own use” pricing generally saw lower pharmacy costs. As an example, when “own use” discounts were applied to one of MedBen’s hospitals not currently taking advantage of the arrangement, their costs would have dropped 42.7% had this pricing been in place.
  • MedBen also reviewed examples of high cost “combination” medications and recommendations for a discretionary drug formulary to help control the effect of high cost drugs with low cost generics available.

Again, this makes up only a small portion of the useful information offered at the Hospital Roundtable. And incidentally, non-hospital groups will soon have an opportunity to see how their company compares with other businesses in their size range, and get money-saving tips, at the MedBen Employer Benefits Roundtable on Thursday, May 11. Sign up by contacting Sales Analyst Sally Wood at (800) 423-3151, ext. 502 or emailing


  05:10:00 pm, by MedBen5   , 225 words,  
Categories: Wellness, Cost savings, Preventive care

Primary Care Critical to Population Health Management

Doctor and Patient

The importance of primary care physicians to improved population health goes well beyond "simple office visits," says Asaf Bitton, an internist and assistant professor at Harvard Medical School and Brigham and Women's Hospital, to The Daily Briefing:

"Primary care, when done well, is a method of care that basically offers valuable core functions for people and health systems. It offers first-contact access, it offers coordination, it offers continuity, it offers comprehensiveness, and it offers a whole-person approach. These functions are complex and deeply valuable to people.

"If you want a system that produces population health, that addresses those key functions, including providing a safe, patient-centered system, you have to have a robust primary care foundation."

Dr. Britton's comments lie at the heart of what MedBen espouses through its WellLiving program: The relationship between the patient and the family doctor sets the foundation for population health management... and by building this relationship through regular wellness exams and screenings, the doctor is better able to advise the patient regarding the proper path they should take to achieve optimal health.

In short, the WellLiving "physician first" approach translates to a healthier workplace... and, as our experience has shown, long-term employer savings. Learn more about the physical and financial advantages of population health management through WellLiving by contacting MedBen Vice President of Sales & Marketing Brian Fargus at


  04:48:00 pm, by MedBen5   , 153 words,  
Categories: Announcements, News, MedBen University

New MedBen Benefits Roundtable Offers Useful Employer Information

MedBen University

MedBen University (MBU) is pleased to announce an additional event for the 2017 season: The Employer Benefits Roundtable, which will be held at the C. Arthur Morrow Conference Center, 1821 W. Main Street, Newark, Ohio (located next to the MedBen home office) on Thursday, May 11, from 8:30 a.m. to 1:00 p.m. EST.

At this free roundtable, our team of benefits management professionals will speak on a variety of helpful topics for self-funded employers, including:

  • Benefit design and reimbursement trends;
  • Cost and utilization comparisons by group size;
  • Emerging trends in population health management; and
  • What's in store next for health care reform.

Unlike our recent industry-specific roundtables, this event is open to all employers, be they MedBen clients or non-clients.

If you haven't had an opportunity to attend an MBU session this year, we invite you to join us at the Employer Benefits Roundtable! To RSVP, simply contact MedBen Sales Analyst Sally Wood at (800) 423-3151, ext. 502 or emailing


  10:54:00 pm, by MedBen5   , 442 words,  
Categories: News, Health Care Reform

Revised SBC Template Required for Employer Plans

Sierra See

The Affordable Care Act (ACA) requires that issuers and health plans provide a Summary of Benefits and Coverage (SBC), including a description of what the health plan covers and the cost sharing responsibility of the consumer, in order to help individuals make more informed choices among health plan options and to better understand their coverage. Self-funded health plans and health insurance companies are also required to provide a comprehensive uniform glossary of commonly used health coverage and medical terms.

The federal agencies overseeing the ACA have recently finalized changes to the existing SBC template in order to improve the readability for consumers, and also to expand the amount of information that the consumer receives from this one document. The new templates include 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 SBC’s include coverage examples that demonstrate the cost sharing amounts an individual might be responsible for in three common medical situations. Currently, the SBC contains two coverage examples, which address diabetes care and childbirth. The new template offers a third coverage example which addresses 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 SBC’s 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. SBC’s are required to be distributed, as follows:

  • Thirty (30) days prior to the plan year; or
  • On the first day of the plan’s open enrollment period, whichever is earlier; and
  • Sixty (60) days prior to an “off” plan year change that effects the information listed in the SBC;
  • Within ninety (90) days of a special enrollment event for individuals enrolling in such event. If the individual requested the SBC earlier than that date, it should be provided as soon as reasonably possible, but no later than seven (7) days following the request;
  • To newly hired employees; and
  • Within seven (7) days of an eligible individual’s request.

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 Sierra See, J.D., in MedBen’s Compliance Department at


  08:58:00 pm, by MedBen5   , 222 words,  
Categories: News, MedBen Analytics, Bundled Payments

Bundled Payment Rollouts Delayed Again

MedBen Analytics

On March 21, the Centers for Medicare and Medicaid Services delayed the expansion of the Comprehensive Care for Joint Replacement (CJR) as well as the implementation of cardiac bundled payment initiatives. This marks the second such postponement of these mandatory programs in as many months.

According to a statement by the Department of Health & Human Services (HHS), the reason for the delay is "to allow time for additional review" and modifications if necessary, and to ensure participants understand the rules.

At MedBen Analytics, we believe that a program works best when all participants are fully engaged in its success. And while we work with hospitals who participate in voluntary programs like the Medicare Bundled Payments Care Initiative (BPCI) as well as in mandatory models like CJR - and have in both instances received positive feedback about our reporting portal and the resultant savings - we think that the decision to implement a value-based payment program is best left to providers, not to the government.

MedBen Analytics was created to give providers the insights they need to improve performance - and our goal is win clients by proving that the bundled payment model saves clients time and money over traditional fee-for-service. If you ever have questions about how our services can benefit your business, please call MedBen President & COO Kurt Harden at 888-633-2364 or email

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