| Greetings!
We hope that this edition of the PBG Newsletter finds you well. Please take a moment to read important information concerning second quarter rate approval, new popular products and new product possibilities for your upcoming renewal, possible changes to HSA benefits, more on Health Care Reform, and much more! Please notice that we have an upcoming Seminar on March 4 - information is provided below. If you are interested in attending please RSVP by Monday, February 28th!
Blue Cross Blue Shield of MA has recently introduced a Hospital Choice Option which limits the premium increase by encouraging customers to urge employees to seek care at lower cost facilities, while the option to receive care at a higher cost facility remains available, at a higher out-of -pocket cost. This product is the fasted to launch in Blue Cross of MA history. Harvard Pilgrim and Tufts Health plan have shown interest in following suit and also offering tiered products.
More and more small business have opted for tiered plans as a means of huge savings on health insurance expenses. Popularity is sure to continue to grow, as a new Massachusetts law signed by Goveror Patrick will take effect this coming August. The law will require Massachusetts health plans to offer at least one limited or tiered network product that is at least 12% less expensive than a comparable full-network offering.
A tiered network plan offers a patient the option to choose where to receive medical care, although a higher cost may accompany the choice of a more expensive facility. A limited network plan simply excludes high-cost facilities altogether.
Both limited and tiered network plans address one of the primary reasons for the high-cost of healthcare in Massachusetts: the huge disparity in rates among doctors and hospitals that provide the same services with the same quality of outcome.
Two pieces of legislation that would remove restrictions on health savings account (HSA) health plans have been introduced on Capitol Hill.
Both bills strike down the rule that HSA funds cannot be used for over-the-counter medicines without a prescription. This is a fairly new restriction that was implemented January 1, 2011 as part of the Affordable Care Act (ACA). Prior to the law taking effect, this feature was very popular among the more than 10 million HSA users, helping them save money on the medicines they needed.
Senator Kay Bailey Hutchison (TX) and Representative Erik Paulsen (MN-03) have sponsored the bills in the Senate and House, respectively. Members of the Senate Finance Committee and House Ways and Means Committee will debate the bills before they can move to the full chambers for consideration.
Contact your members of Congress in the House and Senate and let them know that you support restoring this benefit to HSA health plans. In the meantime, the HSA Alliance will keep you informed on the progress of these two bills, S.312 and H.R.605 .
Source
Medicare's Chief Actuary, Richard Foster, whose office is responsible for independent long-range cost estimates has declared that two of the central promises of President Obama's Heath Care Reform Law will most likely fail: that Medicare costs will be held down and that individuals enrolled in Medicare plans will be able to maintain that same coverage if they are satisfied with it.
Republicans wanting to repeal the health care legislation are hopeful that Foster's predictions will help their cause, while Obama officials disagree are convinced that he will be proven wrong.
"Foster said analysis by his office shows that the health care law will raise the nation's health care costs, because the newly insured will be receiving medical services they would have otherwise gone without...the law funnels savings from Medicare cuts to provide coverage to uninsured workers and their families."
"As for people getting to keep their health insurance plans, Foster's office is projecting that more than 7 million Medicare recipients in private Medicare Advantage plans will eventually have to find other coverage...The health care law gradually cuts generous government payments to the plans" causing an increase in premiums or termination of the plans altogether. Many seniors have chosen private plans because of the lower out-of-pocket costs - if this changes, many seniors may be forced to find alternate coverage. Coverage in the traditional Medicare program will still be guaranteed, but supplementary coverage will be a necessity
Social Security
It is suggested you start this process 60-90 days prior to the beginning of the month you turn 65:
For starters you can contact Social Security or obtain information by either visiting their website ( www.ssa.gov ) which provides valuable information or you can contact your nearest Social Security office.
If visiting the Social Security website you can apply online by clicking on " Applying Online for Retirement Benefits ".
It will be necessary you provide the Social Security Administration originals of the following documents:
Birth Certificate
Marriage License
DD214 Military Service Discharge
(Information can be sent by mail or dropped off at one of their locations)
Social Security Income benefits do not begin until Age 66. If you want benefits to begin at the Age 66 it is necessary you file in advance. It will also be necessary to obtain Medicare.
When you receive your Social Security file number you can then apply for Medicare Part A & B.
Medicare Part A & B
The Medicare website ( www.medicare.gov ) is a useful website. You can apply on line for this coverage. You must do so within a 7 month (3 months prior to and 4 months after) period of your Age 65 birth date. It is recommended you do it at the same time you apply for Social Security.
Part A is Hospital coverage and is provided to you at no premium cost except for a few exclusions. There is a yearly deductible. Once the deductible amount has been satisfied Medicare Part A covers 80%.
Medicare Part B is Medical coverage which you pay a monthly premium for. Cost ranges depend on yearly income. A yearly deductible must be satisfied and then Medicare Part B covers 80%.
Between Medicare Part A & B you will now have an upfront deductible and then approximately 80% of your medical coverage excluding Drug coverage.
Medigap Private Health Insurance
This is medical and hospital coverage that pays Medicare Part A & B deductible amounts the 20% of expenses not covered by Medicare Part A & B. It is strongly recommended that members enrolled in Medicare, obtain this supplementary insurance.
Supplementary insurance is available once members have obtained Medicare Part A & B. Coverage can be purchased through private Medical Insurance companies like Blue Cross Blue Shield, Harvard Pilgrim & Tufts. You can also obtain this coverage through associations like AARP.
www.bluecrossma.com/medicare.org is a useful website to learn about their product options and you can sign up for coverage here.
Medicare Part D (Drug Coverage)
Medicare Part D provides prescription Drug Coverage.
BCBSMA's website is a great resource ( www.bluecrossma.com/medicare.org ) because Medicare Part D coverage is complex. Plans vary significantly in coverage and cost. Dependent on the amount of prescription drug coverage or types of medication one takes is helpful in determining the most suitable plan. Speaking to a qualified representative is recommended to discuss what will work best for you.
Long Term Care Insurance
LTC is recommended coverage as well because it is not covered by Health Insurance. Long term care insurance provides coverage for "custodial care" i.e. help with Dressing, Eating, Transferring, Bathroom and other activities of daily living.
To view this article as a PDF file, click here .
Information provided by Chris Peris of Partners Benefit Group.
Ceridian COBRA Services, one of the largest COBRA Administration Firms in the country has recently been under scrutiny for terminating a COBRA participant's health coverage because his payment was 2 cents short. After being questioned by news reporters, Ceridian stated that the insurance coverage had been reinstated after reviewing the situation and that they "followed the normal procedures that were in complete compliance with the law and with regulations."
Terminating health coverage for a premium shortage of 2 cents is actually not in compliance with COBRA Law, under the "not significantly less" rule in regards to short payments. According to Matt Isbell of COBRA Resources, Inc, a COBRA expert who educates COBRA Administrators throughout the country, the rule is as follows:
Not Significantly Less Premium Payments
The final regulations establish a mechanism for the treatment of payments that are short by an insignificant amount. Sometimes the error has been clearly one of transposed digits on a check tendered for payment; in other instances, payment has been short by such a small amount that it would be unreasonable to attribute the shortfall to anything other than mistake. Either the plan must treat the payment as satisfying the plan's payment requirement, or it must notify the qualified beneficiary of the amount of the deficiency and grant the qualified beneficiary a reasonable period of time of 30 days for the deficiency to be paid.
Not Significantly Less Premium Defined by 2001 Final COBRA Regulations
An amount is not significantly less, if and only if, the shortfall is no greater than the lesser of the following two amounts:
(1) Fifty dollars ($50.00), or (2) 10 percent of the amount the plan requires to be paid.
Example: A qualified beneficiary owes $485.00 per month for continuation coverage. On January 17, 2003 a payment is received in the amount of $458.00. The payment is $27.00 less than the full required premium.
Not Significantly Less Criteria: $50.00 or 10% of $485.00 ($48.50)
Result: Since the premium is less than the lower amount of the two figures above($48.50), then the payment is by regulation not significantly less.
http://greenmountainpayroll.org/CA%20Manual.pdf
It is important for employers to understand what the COBRA policies are, even if you have a third party administrator assisting you with COBRA Administration. At Partners Benefit Group, we take advantage of educational and training opportunities to maintain the level of expertise that our clients expect. If you have any questions regarding COBRA policy or are interested in having Partners Benefit Group service your COBRA Administration, please contact either your account manager or our COBRA Administrator, Maria Eramo .
To read the entire article from abc News concerning the Ceridian COBRA mihap, click here .
Sincerely,
Maria Eramo
Partners Benefit Group, Inc. | 
