Benefits Consulting Group of Florida, Inc. – Orlando, FL

By Leah Shepherd

Will the link between employment and health insurance survive?

That’s one of the serious questions that a new report from the Employee Benefit Research Institute (EBRI), a nonprofit research organization based in Washington, D.C., raises about the future of employee benefits.

Paul Fronstin, head of the health research and education program at EBRI, noted that the Affordable Care Act “levels the playing field like it’s never been before,” as employees will not necessarily have to depend on getting health coverage through work.

“Employers are just not sure if they’ll be offering coverage in the future,” he added.

In fact, the U.S. Congressional Budget Office estimates that 3 million to 5 million fewer Americans will obtain coverage through their employer each year from 2019 through 2022 than would have been the case without the ACA.

Starting next year, the ACA will require employers with at least 50 full-time employees to offer a minimum level of health coverage to workers, but some employers may prefer to pay a tax penalty instead of paying for the coverage. The need to recruit and retain good talent is what keeps employers offering benefits.

Kathryn Gaglione, a spokesperson for the National Association of Health Underwriters, says, “Offering comprehensive, competitive benefits makes for a more robust workforce and better compensation for individuals trying to support families … Many American business owners understand the benefit to offering employees and their families coverage. Employer-sponsored health plans might change, but they won’t be going anywhere.”

Most employees want and expect health insurance through their employer, especially knowing that it’s much less expensive to receive group coverage that comes with an employer’s premium contribution than to buy individual coverage on a health insurance exchange (with no employer contribution).

Nonetheless, “one could argue workers won’t need their employers any more for health benefits once the law is fully implemented, and health exchanges become a viable option to job-based health benefits,” Fronstin said.

COMMON ERRORS IN MEDICAL RECORDS

Outpatient medical records often contain missing or inaccurate data, including:

• New prescription medicines aren’t listed, or medicines are listed that the patient isn’t taking anymore.
• An incorrect or outdated dosage of prescription medicine.
• Duplicate prescriptions for brand-name and generic medications.
• Over-the-counter remedies, such as pain relievers, vitamins or other supplements, aren’t listed.
• Incomplete or missing information about medication allergies.
• Erroneous information about treatment outcome, such as a condition that is noted as resolved but is still a problem.
• Updated information about lab results is missing.
• Details about symptoms, as reported by the patient, are missing.
• Inaccuracies in diagnosis.
• Missing information or updates from another provider.

Insurers are changing how they pay for cancer care, aiming to control soaring costs and push oncologist to adhere to standardized treatment guidelines.  UnitedHealthcare, Cigna and Aetna are among the insurers experimenting with new payment methods.

The following are some quick tips that may help you lesson your exposure to a DOL audit:

• Maintain all documents related to welfare benefits plans in one location
• Designate one person at the company to take charge of the welfare benefits plans
• Review and understand all plan documents
• Make sure all ERISA-covered benefit plans comply with relevant laws such as ACA and HIPAA
• Respond to employee and beneficiary requests for an SPD and Plan Document within 30 days
• Amend SPDs and Plan Documents to reflect any changes to plan design or legal requirements
• Distribute Required notices, such as COBRA and SBC notices, within required timeframes
• If Form 5500 must be filed, be sure to complete all components accurately and file before the required deadline
• Establish written procedures for disputes and claims resolution

March 31, 2014

On July 1, 2014, a limited list of medications & products will experience a drug classification change and may increase in cost.

Due to a move from First DataBank to Medi-Span as the source for drug classification, these medications will have different indicators as a brand or generic drug, with a few moving to Over-The-Counter (OTC) status.  Most of these drugs will no longer be considered a generic product and the brand copay or coinsurance defined by your plan may apply.

• For copay or coinsurance plans, members will generally pay a higher cost for medications if they are considered brand.
• For high-deductible or consumer-driven health plans, the full cash price is not expected to change for members.  However, after members reach their deductible, the same pricing change may apply.

Less than five of these drugs are included in our top 500 most commonly used medications, published every January 1 and July 1 as part of our PDL updates.  A small number of these medications will become classified as OTC, and these lower -cost medications are typically excluded from pharmacy benefit coverage.

We continue to offer the highest value medications in the lowest tier possible, providing your employees options and flexibility.  Tier 1 is the lowest-cost option for your employees.

We will notify impacted members via letter 60 days in advance of the effective date.  Members will be informed they can learn more about lower-cost options by:

• Call customer Service at the toll-free member phone number on the back of their health plan ID card.
• Logging in to myuhc.com and choosing “Manage My Prescriptions” after July 1, 2014.

     The Obama administration announcd Wednesday March 5th that some Americans with health insurance policies that don’t meet standards set by the president’s new health law will be allowed to keep their plans into 2017, three years later than envisioned.

     The delay, which could put off the cancellation of some health plans until after President Barack Obama leaves office, may have limited practical effect.

Employers with the equivalent of 50-99 full time employees, the Employer Shared Responsibility of the ACA, will not take effect until 2016.

Employers with 100+ full time equivalent employees, offering coverage to 70% of their full time employees will be counted as fulfilling the Employer Shared Responsibility  mandate in 2015.  This is a transitional measure and by 2016, large employers will need  to provide coverage to 95% of their full time employees.

Our Winter “For Your Benefit” flyer was sent our Friday, January 24, 2014.   Along with the flyer we sent out a letter giving some information about our relationship with BenefitMall and the payroll services they offer.  We hope you find the flyer enjoyable and informative and we wish you the best for the coming year.

By Victoria Calvaliere – Reuters

New York – A federal judge has ruled that four organization with ties to the Roman Catholic Church are exempt from a provision of the Affordable Care Act that requires them to provide coverage for contraceptive services and counseling to their employees.

Judge Brian Cogan in U.S. District Court in Brooklyn found that the four New York-area Roman Catholic entities – two schools and two health care organizations – faced “some present detriment” by being forced to comply with the contraception mandate or face financial penalties.

The federal government can appeal the ruling.

Under the Affordable Care Act, nonprofits, including those linked to a religious entity, are required to provide contraceptive care under their health care plans to employees or authorize a third party to voluntarily pay for and provide the coverage.  Fines for not complying with the provision can be up to $100 a day.

Churches and houses of worship are exempt from the requirement.

Arguing that the mandate violates their right to religious liberty, the four New York-area organizations – the Catholic Health Care System,  Catholic Health Services of Long Island, Cardinal Spellman High School and Monsignor Farrell High School – along with the Archdiocese of New York, had sued to seek a permanent injunction.  The four organizations insure about 30,000 individuals of all faiths.

Catholic doctrine holds that contraception and sterilization are immoral and interfere with the creation of life.

Siding with the organizations, the judge Monday ruled the mandate “has caused and will continue to cause plaintiffs harm” by forcing them to either violate the tenets of their religious faith or be required to pay substantial penalties.

The Archdiocese of New York welcomed the decision.

“The court has correctly cut through the artificial construct which essentially made faith-based organizations other than churches and other houses of worship second-class citizens with second-class first Amendment protections”, spokesman Joseph Zwilling said in a statement.

As part of health care reform vaccines are considered a Preventive Service.  For health care reform compliant plans, member will have no cost share for Preventive Services.

• Flu
• Pneumonia
• Shingles

IMPORTANT:  Until a group or member moves into a health care reform compliant plan, coverage for vaccines will continue to process under the Wellness benefit and cost shares may apply.