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

As part of The Affordable Care Act (ACT), The Summary of Benefits & Coverage (SBC) is a mandated document that establishes standards that group health plan sponsors and insurers must use when offering group or individual health insurance.  The SBC’s purpose is to accurately describe the benefits and coverage, cost sharing requirements,  exclusions and limitations of the plan.  This mandate is effective September 23, 2012 and includes strict timeframes for generation and distribution of the SBC.  Penalties apply for non-compliance.

We will be sending information to our clients that pertan specifically to the insurance carrier that provides their coverage, on how the carrier will be handling the SBC notices and the employer responsibilities.

Please contact us with any questions you may have.

Aetna announced September 18, 2012 that Central Florida Regional Hospital-HCA Affiliate and Osceola Regional Medical Center-HCA Affiliate will rejoin the Aetna Orlando FL network effective October 1, 2012 for the following products:

• HMO
• Aetna Open Access HMO
• Quality Point-of-Service (QPOS)
• Aetna Choice POS
• Aetna Health Network Option (HNO)
• Aetna Health Network Only (HNO)
• Managed Choice POS
• Aetna Choice POS II

Previously some insurance companies did not cover these preventive services for women at all under their health plans, while some women had to pay deductibles or copays for the care they needed to stay healthy. The new rules in the health care law requiring coverage of these services take effect at the next renewal date – on or after Aug. 1, 2012—for most health insurance plans. For the first time ever, women will have access to even more life-saving preventive care free of charge.

According to a new HHS report also released today, approximately 47 million women are in health plans that must cover these new preventive services at no charge.  Women, not insurance companies, can now make health decisions that will keep them healthy, catch potentially serious conditions at an earlier state, and protect them and their families from crushing medical bills.

The eight new prevention-related services are:

• Well-woman visits.
• Gestational diabetes screening that helps protect pregnant women from one of the most serious pregnancy-related diseases.
• Domestic and interpersonal violence screening and counseling.
• FDA-approved contraceptive methods, and contraceptive education and counseling.
• Breastfeeding support, supplies, and counseling.
• HPV DNA testing, for women 30 or older.
• Sexually transmitted infections counseling for sexually-active women.
• HIV screening and counseling for sexually-active women.

To learn more about the health care services you may be eligible for at no extra charge under the Affordable Care Act, go to http://www.healthcare.gov/prevention

 For information about the U.S. Department of Health and Human Services report on the number of adult and adolescent women eligible for the preventive services at no charge after Aug. 1, 2012, see http://aspe.hhs.gov/health/reports/2012/womensPreventiveServicesACA/ib.shtml

MLR 2011 premium rebate checks have either been sent or will be sent by August 1, 2012. To the clients that United and Florida Blue notified us they were receiving rebates, we have sent an email providing guidance on the distribution of the MLR rebates. However, if you have any questions, please call our office at 407-896-9600.

Excerpt from Reuters article by David Morgan before Supreme Court upheld 2010 Patient Protection and Affordable Care Act, June 28, 2012

U.S. health insurance companies are due to pay out $1.1 billion in rebates to employers and individuals this summer, under a new industry regulation imposed by President Barack Obama’s health care law.

Rebates are due by August 1 and would be paid out by health insurance plans that cover 12.8 million beneficiaries in the individual and group markets.

HHS office could not fully estimate how many of those beneficiaries would receive an actual check from their insurers and they could not identify specific insurers that would be required to provide rebates.

Just over $700 million in rebates, or nearly two-thirds of the $1.1 billion total, will be paid by insurance plans in the group markets for small and large employers. The remaining one-third comes from insurers in the individual market.

The rebates stem from a provision of the healthcare law that requires insurers to spend at least 80% of premiums on medical care or quality improvements, rather than advertising and administrative costs, salaries or bonuses. Insurers that devote less to actual heathcare services must pay customers the difference.

About 4.1 million people who are covered by individual insurance plans would receive a direct rebate, which HHS said would average $152 per family.

But the remaining 8.7 million beneficiaries are covered through the small and large employer markets and would receive only a portion of the rebate value depending on their share of premium costs. Officials said employers may choose to pass along the value of the rebate due their employees in forms other than cash, such as lower premiums or added benefits.

Insurance plans covering 67 million beneficiaries met the standard this year, HHS said.

May 18, 2012

by Larry Grudzien, JD

The IRS has created a chart that illustrates the types of coverage that employers must report on the Form W-2. Certain items are listed as “optional” based on transition relief provided by Notice 2012-9 (restating and clarifying Notice 2011-28). Future guidance may revise reporting requirements but will not be applicable until the tax year beginning at least six months after the date of issuance of such guidance. The chart reviews the reporting requirements for Box 12, Code DD, and has no impact on requirements to report these items elsewhere. For example, while contributions to Health Savings Arrangements (HSA) are not to be reported in Box 12, Code DD, certain HSA contributions are reported in Box 12, Code W (see General Instructions for Foms W-2 and W-3). The chart was created at the suggestion of and in collaboration with the IRS’ Information Reporting Program Advisory Committee (IRPAC). IRPAC’s members are representatives of industries responsible for providing information returns, such as Form W-2, to the IRS. IRPAC works with IRS to improve the information reporting process.

To access the chart use link below:
http://www.irs.gov/newsroom/article/o,,id=257101,00.html

“Healthwatch” blog (5/11), Elise Viebeck reports, “A rule created by the 2010 healthcare law and finalized Friday will yield about $1.3 billion in insurance rebates for nearly 16 million Americans, according to estimates by the Kaiser Family Foundation. The rule know as the medical loss ratio (MLR), mandates that insurers spend roughly 80 percent of all premium on healthcare rather than on marketing, executive bonuses or other administrative costs.”

The Wall Street Journal (5/12, Radnofsky, Subscription Publication, A4) says the new guidelines require insurers to state that the check comes as a result of the Affordable Care Act. The Journal calls it an attempt by the White House to draw attetntion to the benefits of the law as the fall elections near.

Halperin: ACA Rebates Are A Big Deal. In Time (5/11) Mark Halperin writes, “From almost the moment the Affordable Care Act (a/k/a ‘ObamaCare’) was signed into law, the Administration has been playing defense, “yet “the rebate provision of the law . . . the fruits of the so-called 80/20 rule’ – is about to kick in big time, as millions of Americans receive rebate checks or premium reduction from insurance companies who have failed to spend enough on patient care.” Halperin adds, “This cash could be a true game changer in public attitudes” and he notes that Secretary Sebelius “explains the measure in a Friday blog post” on the HHS site.

As of April 2, 2012, Blue Cross Blue Shield of Florida, Inc. has become Florida Blue. The new name, logo and tagline – “In the pursuit of health” will soon be utilized in signage, sponsorships and advertising.

You will no longer be able to fax in enrollment forms as of June 2012. Aetna has introduced eBusiness for 24 hour turn around times for non-urgent enrollment, changes and/or termination of benefits. You may access the eBusiness tool through Aetna Producer World.
Aetna is offering you 3 methods to submit forms:
1. For non-urgent requests, mail your transactions to EnrollmentSGSE@aetna.com, This process may take up to 5 business days.
2. For 24-hour turnaround time for non-urgent enrollment access the enrollment tool in eBusiness through Producer World.
3.For Urgent enrollments or immediate processing call Aetna at 1-888-422-2128.

We are celebrating our 20th Anniversay and would like to take this opportunity to thank you for making this possible. Our goal has always been to keep you informed of the latest trends while finding the best value for your insurance dollars. It’s been our priviledge to serve the community since 1992 and we continue to be your Health Care Advocate!