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Thursday, September 06 2012

The HR resource every business needs
HR News Alert
September 2012

 

Brought to you by: Greentree Management & Insurance, Inc.

Employee Loyalty Linked to Satisfaction with Benefits

Employees of small businesses who are very satisfied with their company benefits are more likely to report greater job satisfaction and a stronger sense of loyalty to their employers, according to recent findings from a MetLife study. Aside from salary, health coverage ranked as the number one benefit driving loyalty among those employees interviewed for the study.

Younger Workers Place High Value on Benefits
The study, which included several hundred interviews of small business employees (those working for companies with fewer than 500 employees), also highlighted a number of key differences between younger and older workers when it comes to employer-provided voluntary benefits:

  • 46% of younger workers identified employee benefits as an "important reason" behind their selection of employers, as opposed to 29% of older workers.
  • One-half of younger workers reported relying more on employer-provided benefits to achieve financial security due to current economic conditions, while 37% of older workers reported the same.

Both younger and older workers would rather pay more of the cost for employee benefits than lose those benefits. More findings from the study are available from MetLife. For help with benefit planning, check out our featured Benefits Trends and Benchmarking Tools and work with your broker or other trusted benefits advisor to analyze your company's needs.


 

5 Tips to Prepare Your Business for a Natural Disaster

As Hurricane Isaac recently reminded us, natural disasters can happen suddenly at any time. The loss of essential records, files, and other materials during a disaster is commonplace and can not only add to your damage costs, but may also delay your return to normal operations.

Securing Company Documents and Equipment
To reduce your vulnerability, determine which records, files, and materials are most important; consider their vulnerability to damage during different types of disasters (such as floods, hurricanes, and earthquakes) and take steps to protect them.

  1. Confirm your insurance. Make sure you're aware of the details of your flood insurance and other hazard insurance policies, specifically which items and contents are covered and under what conditions. Check with your insurance agent if you have questions.
  2. Back up essential files. Regularly back up vital electronic files (such as billing and payroll records and customer lists) and keep backup copies in a secure off-site location. Important papers (plans, legal documents, etc.) should also be stored securely off-site.
  3. Consider the location of equipment susceptible to damage. Raise computers above flood level, move heavy objects to low shelves, and secure any equipment that could move or fall during an earthquake.
  4. Take inventory. For both insurance and tax purposes, you should maintain written and photographic inventories of all important materials and equipment. Estimate the cost of repairing or replacing each essential piece of equipment in your business.
  5. Perform regular building maintenance and repairs. Periodically evaluate the building envelope to make sure that wind and water are not able to penetrate the building.

Our section on Planning for Workplace Emergencies includes additional guidelines on developing an emergency action plan to protect your employees and business during a disaster.


Online Advisor Can Help Employers Comply with COBRA

Did you know the federal government provides free interactive guidance for help complying with COBRA? The COBRA Advisor is an easy-to-understand online tool that can help you determine your compliance with key requirements under the law, including requirements related to:

  • Notices,
  • Qualifying events,
  • COBRA election procedures,
  • Duration of continuation coverage, and
  • Paying for COBRA.

COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and eligible spouses and dependents the opportunity for a temporary extension of health insurance where coverage under the group plan would otherwise end due to certain qualifying events

The information provided in the Advisor is not intended as legal advice. Employers, including those with fewer than 20 employees, may also need to comply with state "mini-COBRA" laws and should check with their state insurance departments for specific requirements.

If you're looking for more easy-to-understand guidance, our Steps to Success provide a series of "how-to" interactive guides to help you understand and manage COBRA, FMLA, and other key HR responsibilities, such as hiring employees and conducting performance reviews.


Reminder: New SBC Notice Requirements Take Effect Soon

After a six-month delay in the original effective date, group health plans (including grandfathered plans) will soon need to comply with a new requirement under Health Care Reform to provide a summary of benefits and coverage (SBC) so that employees can more easily compare insurance options.

The new SBC notice requirements are effective for plan years and open enrollment periods beginning on or after Sept. 23, 2012. If you need a refresher, the following are some key points for group health plans:

  • An SBC must be provided to plan enrollees at specific times, such as upon application for coverage and at renewal, as well as upon request.
  • Insured group health plans can satisfy the requirement if the issuer provides a timely and complete SBC to the participant or beneficiary.
  • Combining information for different coverage tiers, different cost-sharing selections (such as levels of deductibles and copayments), and different add-ons to major medical coverage (such as FSAs, HRAs, HSAs, or wellness programs) into one SBC is permissible, provided the appearance is understandable.
  • SBCs may be provided either as a stand-alone document or in combination with other summary materials (for example, an SPD), if the SBC information is intact and prominently displayed at the beginning of the materials and in accordance with the SBC timing requirements.
  • The SBC must comply with certain appearance and format requirements and must use terminology understandable by the average plan enrollee; an SBC template along with instructions and related materials that may be used to satisfy the notice requirements, is available online.

The U.S. Department of Labor has released three sets of Frequently Asked Questions (FAQs) which address a number of issues relating to the SBC notice requirements. The FAQs also make clear that, during the first year of applicability of the new SBC rules, penalties will not be imposed on plans that are working diligently and in good faith to provide the required content in an appearance that is consistent with the final regulations.

For more information on the new SBC notice requirements, please visit our section on Health Care Reform.


Protecting Employees from Workplace Violence

Nearly 2 million workers in the United States report having been victims of workplace violence each year. While nothing can guarantee that an employee will not become a victim, there are steps employers can take to reduce the likelihood of workplace violence.

What is workplace violence?
Workplace violence is any act or threat of physical violence, harassment, intimidation or other threatening disruptive behavior that occurs at or outside the workplace. It can range from threats and verbal abuse to physical assaults and even homicide. Workplace violence can affect and involve employees, clients, customers, and visitors.

What are my responsibilities as an employer?
Under federal law, an employer has a legal duty to provide a workplace free from recognized hazards that are causing, or are likely to cause, death or serious physical harm to employees.

According to the U.S. Occupational Safety & Health Administration (OSHA), the best protection employers can offer is to establish a zero-tolerance policy toward workplace violence against or by their employees. It is critical to ensure that all employees know the policy and understand that all claims of workplace violence will be investigated and remedied promptly. Other recommended actions include:

  • Providing safety education so employees know what conduct is not acceptable, what to do if they witness or are subjected to workplace violence, and how to protect themselves.
  • Securing the workplace using video surveillance, extra lighting, or alarm systems as appropriate, and minimizing access by outsiders through identification badges, electronic keys, and guards.
  • Limiting the amount of cash on hand, especially during evenings and late night hours.
  • Equipping field staff with cellular phones and hand-held alarms or noise devices, and requiring them to prepare a daily work plan and keep a contact person informed of their location throughout the day.
  • Instructing employees not to enter any location where they feel unsafe and facilitating a "buddy system" or police assistance in potentially dangerous situations or at night.

Where can I find additional information?
To learn more about workplace violence prevention, including risk factors, prevention programs, and training resources, visit OSHA's website on Workplace Violence.

Posted by: William J. Flax AT 03:30 pm   |  Permalink   |  Email
Tuesday, August 07 2012

The HR resource every business needs
HR News Alert
August 2012

 

Brought to you by: Greentree Management & Insurance, Inc.

Paid Leave Tops List of Employer-Provided Benefits in Private Industry

Access to paid leave remains high on the list of employer-provided benefits for full-time workers in the private sector, according to data from March 2012 which was reported by the U.S. Bureau of Labor Statistics in July.

  • Paid vacation was available to 91% of full-time workers and 35% of part-time workers.
  • 90% of full-time workers and 40% of part-time workers received paid holidays.
  • Paid sick leave was offered to 75% of full-time workers and 23% of part-time workers.

The report, "Employee Benefits in the United States," is based on data from the National Compensation Survey, which provides comprehensive measures of compensation cost trends and incidence and provisions of employee benefit plans.

Additional findings included:

  • 86% of full-time employees in the private industry had access to medical care benefits.
  • Retirement benefits were available to 74% of full-time workers in the private industry.

More details and survey results are available in the report. To learn more about employer-provided benefits, visit our section on Employee Benefits.


 

Employee Pay: 3 Common Mistakes and How to Avoid Them

The federal Fair Labor Standards Act (FLSA) sets some basic rules when it comes to paying employees minimum wage and overtime, but certain common pay practices can violate the law without employers even knowing it. If any of the following sound familiar, it may be time for a compliance check.

1. "All Our Employees Are Exempt - They're Salaried"
Don't assume that just because you pay your employees a salary, they are considered exempt (not entitled to the FLSA minimum wage and overtime pay protections). Similarly, giving an employee a high-ranking job title such as "manager" does not, by itself, determine the employee's status. In order for an exemption to apply, you must ensure that an employee's specific job duties and salary meet all the requirements of the law for the specific exemption claimed.

2. "We Don't Need to Pay Overtime - Our Employees Volunteer to Work Late"
Non-exempt employees must be paid for all hours worked, including time spent doing work not requested by the employer but still allowed (otherwise known as working "off the clock"). Employees generally may not volunteer to perform work without the employer having to count the time as hours worked. It is the responsibility of management to exercise control and see that work is not performed if the employer does not want it to be performed.

3. "Overtime Doesn't Apply - We Use Contract Workers"
While it is true that independent contractors are not entitled to overtime pay because they are not considered "employees" covered under the FLSA, the mere existence of a contract stating that a worker is an independent contractor is not sufficient to determine the worker's status. Analyze the underlying nature of each relationship in light of all relevant factors to ensure that each worker is properly classified. 

Note that state wage and hour laws may also apply to employment subject to the FLSA. When both the FLSA and a state law apply, the law setting the higher standards must be observed. If you have any questions regarding permissible pay practices, please consult a knowledgeable employment law attorney. Our section on Employee Pay includes information on other issues related to employee compensation.


Does Your Employee Wellness Program Comply with HIPAA?

Encouraging employees to adopt healthier lifestyles--for instance, by offering an incentive to workers who quit smoking--can often be a win-win for both employers and employees, but be careful that your program does not violate the federal Health Insurance Portability and Accountability Act (HIPAA).

Wellness Programs and HIPAA Nondiscrimination
HIPAA's nondiscrimination provisions generally prohibit group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductible, copayment or other cost sharing requirements based on a health factor. However, there is an exception that allows plans to offer wellness programs. In general:

  • Programs that do not require an individual to meet a standard related to a health factor in order to obtain a reward are not considered discriminatory under HIPAA, such as a program that reimburses employees for the cost of smoking cessation aids regardless of whether the employee quits smoking.
  • Programs that require individuals to satisfy a standard related to a health factor in order to obtain a reward must meet five additional requirements to comply with HIPAA. An example of this type of program is one that requires an individual to obtain or maintain a certain health outcome in order to obtain a reward (such as being a non-smoker or exercising a certain amount).

In order to be subject to HIPAA's nondiscrimination requirements, a wellness program must be, or be part of, a group health plan. If an employer operates a wellness program as an employment policy separate from the group health plan, the program may be covered by other federal or state nondiscrimination laws, but it would not be subject to HIPAA's nondiscrimination regulations.

As with any employee program, check with a knowledgeable employment law attorney to ensure that your program complies with all applicable state and federal laws, including nondiscrimination laws other than HIPAA. Our Health and Wellness section contains valuable information for employers designing their own programs to improve employee health.


Additional Medicare Tax for High Earners Coming in 2013

The IRS has released Questions and Answers relating to the Additional Medicare Tax for high earners which goes into effect in 2013 as part of Health Care Reform. Below are five things employers should know about the tax.

  1. The Additional Medicare Tax rate is 0.9% for taxable years beginning after December 31, 2012.
  2. The additional tax applies to an individual's wages, other compensation, and self-employment income (together with that of his or her spouse if filing a joint return) over certain thresholds.
  3. Employers are responsible for withholding the Additional Medicare Tax on wages or compensation they pay to an employee in excess of $200,000 in a calendar year.
  4. An employer has this withholding obligation even though an employee may not be liable for the Additional Medicare Tax because, for example, the employee's wages or other compensation together with that of his or her spouse (when filing a joint return) does not exceed the $250,000 liability threshold for married filing jointly.
  5. There is no requirement that an employer notify its employees when it begins withholding the additional tax, and there is no employer match for the Additional Medicare Tax as there is with the regular Medicare tax.

For More Information
You may review the Questions and Answers in their entirety on the IRS website. Be sure to check out our Summary by Year for other upcoming requirements related to Health Care Reform.


Quick Facts About the Americans with Disabilities Act

The federal Americans with Disabilities Act (ADA) recently celebrated its 22nd anniversary. Title I of the ADA prohibits private employers with 15 or more employees from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training, and other terms, conditions, and privileges of employment. 

Did you know . . .
Title I of the ADA also covers medical examinations and inquiries.

  • Employers may not ask job applicants about the existence, nature, or severity of a disability. Applicants may be asked about their ability to perform specific job functions.
  • A job offer may be conditioned on the results of a medical examination, but only if the examination is required for all entering employees in similar jobs.
  • Medical examinations of employees must be job related and consistent with the employer's business needs.

Medical records are confidential.

  • The basic rule is that with limited exceptions, employers must keep confidential any medical information they learn about an applicant or employee.
  • Information can be confidential even if it contains no medical diagnosis or treatment course and even if it is not generated by a health care professional. For example, an employee's request for a reasonable accommodation would be considered medical information subject to the ADA's confidentiality requirements.

Employees and applicants currently engaging in the illegal use of drugs are not covered by the ADA when an employer acts on the basis of such use.

  • Tests for illegal drugs are not subject to the ADA's restrictions on medical examinations.
  • Employers may hold illegal drug users and alcoholics to the same performance standards as other employees.

ADA Resources for Small Businesses
In addition to a variety of formal guidance documents, the U.S. Equal Employment Opportunity Commission has made available a wide range of fact sheets, Q&A documents, and other materials related to ADA compliance on its Disability Discrimination website. Our ADA-Disability section has more information regarding employer obligations under the Americans with Disabilities Act.

Posted by: William J. Flax AT 04:00 pm   |  Permalink   |  Email
Monday, July 30 2012

 
GT Logo

 

 

We at Greentree Management & Insurance, Inc. want to make sure our clients and associates are prepared to deal with Healthcare Reform.

Keeping You Informed

As a result of the recent Supreme Court decision to uphold the Health Care Reform Act, Greentree is taking a pro-active approach so that our clients are aware of all the implications surrounding this act.  We have made an investment in technology and continuing education, thus allowing us to remain current with the law.  We will periodically email updates and reminders regarding various aspects of the law and compliance issues.

If at anytime you have questions regarding Healthcare Reform and how it may affect you and your organization, please don't hesitate to contact us.

William J. Flax, CBC
President
Greentree Management & Insurance, Inc.

Posted by: William J. Flax AT 11:30 am   |  Permalink   |  Email
Friday, July 27 2012

Independence Blue Cross (IBC) is pleased to announce GeoBlue products will now be available to members who travel internationally.  The leader and innovator of health insurance programs for world travelers, GeoBlue serves the health care needs of business travelers and expatriates and their families. 

Delivering Global Expertise and Exceptional Service

Domestic health plans often limit coverage abroad and generally do not have the capabilities to handle medical assistance and international claims.  GeoBlue delivers global expertise, exceptional service, and a carefully selected international community of doctors and hospitals in nearly 200 countries.

Two Plans for Long or Short Travel Durations

  • GeoBlue for Expat - For employees traveling internationally for six months or more, this program includes coverage of hospitalization, maternity and chronic care, a robust international wellness program, and no restrictions on how long a member may spend in the United States.
  • GeoBlue Traveler - For employees traveling internationally for up to 180 days, this program includes rich benefits covering hospitalization and medical evacuation.

Employees may benefit from a worldwide community of English-speaking doctors and 24/7 concierge-level assistance with both plans.  Members will:

 

  • receive help with locating doctors and scheduling appointments;
  • be guaranteed payments for cashless access to care;
  • receive help with arranging necessary follow-up treatment.  

See attached for more information:  GeoBlue Flyer 

I hope you find this information regarding GeoBlue helpful to you and your employees.  If you have any questions or would like a quote, please do not hesitate to contact us.
 

 
Posted by: William J. Flax AT 03:05 pm   |  Permalink   |  Email
Monday, July 23 2012

We recently received a notice from Independence Blue Cross regarding their relationship with Abington Emergency Physician Associates, PC (AEPA).  AEPA, the physician group who exclusively staffs the emergency departments at Abington Memorial Hospital and Lansdale Hospital, has terminated its contract with Independence Blue Cross as of July 1, 2012.

As a result, effective July 1, 2012, AEPA is no longer participating in IBC's network.  Members will still be able to receive emergency services from AEPA at Abington Memorial Hospital and Lansdale Hospital.  However, members enrolled in commercial HMO/POS plans may be balanced billed the difference between the reasonably necessary costs IBC pays for emergency services, and AEPA's charges for these services, if care was received from AEPA in the emergency departments of Abington Memorial Hospital or Lansdale Hospital on or after July 1, 2012.

Medicare Advantage HMO/POS/PPO members are not impacted by this change as they cannot be balanced billed by AEPA.  Since AEPA physicians remain participating in the Highmark Blue Shield network, AEPA claims for commercial Personal Choice/PPO members will be covered at the Highmark contracted network rate, and AEPA physicians are precluded from balance billing the member.

Members who are balance billed may contact our office, before paying your bill, to allow our experienced staff to help resolve the situation.

Please visit www.ibx.com/puttingcustomersfirst for more information and a list of frequently asked questions.

If you have any questions regarding this issue, please do not hesitate to contact us.
 

 
Posted by: William J. Flax AT 01:44 pm   |  Permalink   |  Email
Tuesday, July 03 2012

As a result of last week's US Supreme Court ruling, we would like to share this detailed analysis we received from one of our trusted advisers.

 

US Supreme Court Upholds Affordable Care Act

 

The US Supreme Court on June 28, 2012 upheld the Affordable Care Act (ACA), ruling that the law's individual mandate is a constitutional exercise of Congress's power to impose taxes. With the Court's decision, compliance efforts likely will move ahead at full speed with major provisions of the ACA becoming effective in 2013 and 2014.  

 

In a 5-4 decision, Chief Justice Roberts, joined by Justices Ginsberg, Breyer, Sotomayor and Kagan, concluded, "The Affordable Care Act's requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."  

 

In the Court's analysis of the ACA's Medicaid provisions, it held that it would be unconstitutional for the federal government to withhold all Medicaid funding in order to force states to comply with the Medicaid expansion. Chief Justice Roberts wrote, "Nothing ... precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding."  

 

The Court ruled that the Anti-Injunction Act, which limits lawsuits challenging a tax before it is assessed, does not apply because Congress specifically provided that the penalty payment enforcing the individual mandate would not be treated as a "tax." Notwithstanding acceptance of Congress's penalty label for purposes of application of the Anti-Injunction Act, the Court ruled that for purposes of determining whether the individual mandate is constitutional, the penalty payment falls within Congress's general power to tax and, therefore, is upheld.  

 

The decision arises from cases brought by the state of Florida (and joined by 25 other states), the National Federation of Independent Business, and several individuals challenging the constitutionality of the individual mandate and the Medicaid expansion. The cases were later consolidated.

 

In their dissent, Justices Kennedy, Scalia, Thomas and Alito wrote that the law should have been struck down in its entirety.

 

With the exception of the limitation on the federal government's authority to withhold Medicaid funding, all provisions of the ACA stand and compliance efforts likely will move ahead at full speed. In preparation for the major coverage expansion to occur under the ACA in 2014, the Administration is expected to release a host of regulations dealing with the definition of minimum essential coverage, employer coverage and reporting requirements, and an array of new taxes and fees. Clients should be aware of provisions of the law set to take effect in 2013 and 2014, including those listed in the table below.  

 

Provisions of the Affordable Care Act That Take Effect in 2012, 2013 and 2014

 

2012

* Medicare hospital value-based purchasing program
* Increase in physician quality reporting requirements in Medicare
* Additional Medicare pilot programs on alternative payment methodologies, e.g., accountable care organizations
* Increased requirements for hospitals to maintain not-for-profit status
* Fees from insured (including self-insured) plans transferred to the Patient-Centered Outcomes Research Trust Fund

 

2013

* Increase Medicare payroll tax by 0.9% on high-income earners
* Impose a 3.8% tax on net investment income of high-income individuals
* $500,000 cap on health insurers' deduction for executive compensation  
* Eliminate employer deduction for Medicare Part D subsidy
* FSA limitations
* Excise tax on medical device manufacturers and importers
* Medical expense deduction floor increases to 10%  
* Nationwide bundled payment pilot begins in Medicare
* Increased Medicaid reimbursement for primary care
* Medicare physician comparison data available to the public
* Reductions in Medicare payments for select hospital readmissions
* Expanded coverage of preventive services by Medicaid

 

2014

* Employer mandate and individual mandate
* Employer and insurer reporting requirements
* New health insurance market reforms take effect
* State health insurance Exchanges established
* Premium tax credits and cost-sharing subsidies available to certain individuals in Exchange insurance products
* Medicaid expansion to new populations (100% federal match to states for newly-eligible populations through 2016)
* Annual fee on health insurers
* Medicare/Medicaid DSH payment cuts begin
* Independent Payment Advisory Board (IPAB) issues first report to Congress if Medicare spending exceeds growth target

 

Post-2014

* Excise tax on high-cost employer-sponsored coverage (2018) 

Political reactions

The Court's ruling will not end the political debate over health care, which will remain a central issue in the 2012 elections and beyond. The law stands as the centerpiece of the domestic record  of President Obama, who today said, "Whatever the politics, today's decision was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court's decision to uphold it." The President added, "With today's announcement it is time for us to move forward to implement and, where necessary, to improve this law."  

 

In comments in response to the ruling, presumed Republican presidential nominee Gov. Mitt Romney said, "What the Supreme Court did not do on its last day in session, I will do in my first day in office. I will act to repeal Obamacare."  

 

Following the release of the decision, House Majority Leader Eric Cantor (R-VA) announced that the House on July 11 will hold a vote on legislation to repeal the ACA in its entirety. The measure likely will pass the Republican-controlled House, but it is unlikely to advance in the Democratic-controlled Senate.

 

Repeal of the ACA has been a primary focus of congressional Republicans and remains a central objective of many Republicans' campaigns in the November elections. Efforts to repeal all or part of the law will remain difficult unless Republicans maintain control of the House, win the presidency, and win at least a majority in the Senate in the November 2012 elections.

 

Republicans to date have not coalesced around a proposal to replace the ACA. Further efforts to control rising health care costs, including reforms to federal health entitlement programs and health-related tax expenditures, will be at the center of budget and deficit-reduction debates that are expected to dominate Washington after the November elections.

Background on the law

 

The Affordable Care Act was enacted in March 2010; it comprises the Patient Protection and Affordable Care Act of 2010 (which President Obama signed on March 23, 2010) and the Health Care and Education Reconciliation Act of 2010 (which the President signed on March 30, 2010).

 

The primary goals of the ACA are to: (i) expand coverage to an estimated 32 million Americans without health insurance; (ii) reform the delivery system to improve quality and drive efficiency; and (iii) lower the overall costs of providing health care.

 

To accomplish the goal of expanding coverage, the ACA mandates that all Americans maintain a minimum level of health coverage (the so-called individual mandate) or face a tax penalty. The law expands Medicaid coverage and provides federal premium tax credits and cost-sharing subsidies to assist low and moderate income individuals without affordable employer-sponsored insurance in obtaining health insurance through state-based insurance Exchanges. The ACA mandates, for the first time, that employers with 50 or more full-time employees provide certain minimum benefits or pay penalty fees.

 

The law also implemented insurance market reforms, including a ban on exclusions for pre-existing conditions, premium rate restrictions, extension of dependent coverage through age 26, and mandatory coverage of preventive services.

 

A mix of Medicare and Medicaid reimbursement cuts; provisions to reduce fraud, waste, and abuse in those public programs; other delivery system reforms; and a series of tax increases on individuals, corporations and the health industry are used to offset the cost of the law.

We hope find this information useful.  If you have any questions regarding the US Supreme decision or Health Care Reform in general, please do not hesitate to contact me.

Posted by: William J. Flax AT 09:00 am   |  Permalink   |  Email
Wednesday, June 27 2012

Due to the economy, we realize that many of our clients may have difficulty meeting their financial obligations in a timely manner.  As a result, we would like to share important information that has recently come to light from our dealings with Aetna.

We recently learned that if an employer with group insurance coverage through Aetna is termed three times within a twelve month period, upon the third termination, Aetna will not allow the group to be reinstated.

Unfortunately we are not always notified by the insurance carrier that one of our clients is in jeopardy of being canceled.  If you ever receive a late payment or cancellation notice, please contact us immediately so that we may intervene with the insurance carrier on your behalf and avoid possible termination of your insurance coverage.

 

Thank you for your attention to this matter.  Please contact us if you ever have any questions or concerns regarding your insurance coverage.

 
 
Posted by: William J. Flax AT 01:33 pm   |  Permalink   |  Email
Wednesday, June 27 2012

We recently received a notice from Independence Blue Cross regarding standard quarterly changes to the Select Drug Program formulary, effective July 1, 2012.  Some of the changes include:

  • additions of generic and brand drugs to the formulary;
  • deletions of brand drugs from the formulary;
  • additions to the list of drugs that require a physician to obtain prior authorization.

Full list of formulary updates

Prior Authorization Changes

Independence Blue Cross is making changes to their guidelines concerning procedures that support safe prescribing of prescription drugs.  Prescription medications are necessary to effectively treat certain medical conditions; However, they have the potential to be unsafe when not used properly.  In order to ensure that IBC members are using prescription drugs safely, IBC implements saf prescribing procedures, which includes applying prior authorization requirements to certain medications.

Prior authorization requirements were placed on the following drugs when they entered the marketplace:

  • Edarbyclor
  • Ervedge
  • Inlyta
  • Jentadueto
  • Kalydeco
  • Picatol

Communications

Members affected will be notified by IBC regarding changes to the formulary and their options.  Also, changes will be detailed in the IBC August edtition of Update magazine.

If you have any questions regarding these changes, please do not hesitate to contact us.  

 

 

 
Posted by: William J. Flax AT 01:32 pm   |  Permalink   |  Email
Wednesday, June 27 2012

The Affordable Care Act (ACA, or Health Care Reform law), as you may know, includes changes that are being phased in over a number of years.  Additional benefits for certain Women's Preventive Health Services is the latest set of changes to take effect.

Women's Preventive Health Benefits

For plans that renew or become effective on or after August 1, 2012, all of the following women's health services will be considered preventive.  Some of these services may have already been covered*. When provided in-network, these services generally will be covered at no cost share: 

  • Well-woman visits (annually)
  • Prenatal visits (routine preventive visits)
  • Screening for gestational diabetes
  • Human papillomavirus (HPV) DNA testing
  • Counseling for sexually transmitted infections
  • Screening and counseling for human immunodeficiency virus (HIV)
  • Counseling and screening for interpersonal and domestic violence
  • Breastfeeding support, supplies and counseling
  • Generic formulary contraceptives, certain brand formulary contraceptives, and FDA-approved, over-the-counter female contraceptives with prescription are covered without member cost share (for example, no copayment).  Certain religious organizations or religious employers may be exempt from offering contraceptive services.   

For more information on this latest change, please visit:

 

www.healthcare.gov/law/resources/regulations/womensprevention.html 

    

If you have any questions regarding this update or Health Care Reform in general, please do not hesitate to contact us.

*Some plans may be grandfathered and not subject to all of the requirements of the health care reform law.  Grandfathered plans may not include all of these benefits or member cost-sharing may apply.  

 

 
Posted by: William J. Flax AT 01:29 pm   |  Permalink   |  Email
Wednesday, June 27 2012

Are You Protected?

 

Family Pic - disabilityYou and your family depend on your paycheck - it's your most valuable asset. 

How can you protect your income and assets against the risk and impact of a disability?

 

Watch this video and find out how you can protect your income - TODAY:

 

Income Protection Video

 

 

 

Call me to learn more and to obtain a free quote. 

I look forward to hearing from you!

 

William J. Flax, CBC

President 

Greentree Management & Insurance, Inc.

 
 
Posted by: William J. Flax AT 01:19 pm   |  Permalink   |  Email

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