| Greetings! This
month's newsletter contains important information concerning changes with various
carriers, scheduled Medicare pay cuts, amended Grandfather Status regulations,
and more. Please read on and contact your account manager if you have any questions.
Thank you.
Doctors are preparing themselves
for a 23% Medicare pay cut which could affect availibility of health care services
to 46 million Americans. Congress has continually delayed Medicare cuts since
the 1990's, and if action is not taken by December 1, 2010, the cuts will inevitably
result in an estimated two-thirds of doctors refusing care to Medicare patients. In
the 1990's a formula was devised for automatic Medicare cuts to keep costs from
spiraling out of control. Scheduled cuts have continuously been defferred, and
the cost of the cuts now totals over $280 billion dollars. The American Medical
Association is calling for a 13-month reprieve that would allow Congress to develop
a new payment plan at a cost of $1 billion per month. There is a debate on whether
or not this cost should be added to the deficit or paid for by cuts in other areas. These
Medicare cuts come at a time when many Baby Boomers are just now reaching retirement
and will begin to use Medicare benefits. It will also affect the elderly and disabled,
as well as military service members, families, and retirees, because Tricare payments
are linked to Medicare. We will be sure to keep you and your
employees updated on the Congressional decision of the scheduled December 1st
Medicare pay cuts as we learn of the details.
Effective January
1, 2011:
The new standard pharmacy plan offered to the Small Group Market
will be the $10/$35/$60/$100 plan - the lowest cost drug plan offered by BCBSRI. As
a result of this change, if a group is enrolled in either the $7/$30/$50/$75 or
$7/$30/$50/$75 with $500 Deductible plans they will automatically be moved to
this new standard plan at renewal. Updated Benefit materials
will be included with the January renewal kits. Effective
April 1, 2011:
BCBSRI will no longer offer the following Rx Drug Plans:
- $7/$25/$40/$40
- $7/$15/$30/$30
For
groups renewing prior to April, these plans may be renewed for one more year.
Effective November 15, 2010 The Departments of Treasury, Labor, and Health and
Human Services announced that they are amending the Interim Final Regulations
on grandfathered health plan status under the Patient Protection and Affordable
Care Act (PPACA). The new amendent will alow employers to provide the same level
of coverage through a new health plan carrier while keeping grandfathered status,
so long as the change does not significantly raise costs, reduce benefit levels,
or alter employer contributions. The amendment will also allow employers to change
funding from Administrative Services Only (ASO) to fully insured without losing
grandfathered status. The original regulations mandated
that changing carriers would cause a group health plan to lose its grandfathered
status. The changes to the legislation are not retroactive and also do not apply
to individual plans. Policyholders are responsible to provide (as carriers are
also required to obtain) documentation regarding benefits, individual cost sharing,
employer contributions, and annual limits to determine that there are no changes
triggering a loss of grandfathered status.
Harvard Pilgrim's First Seniority
Freedom (Private Fee For Service) Plan will not be renewing its Medicare contract
effective January 1, 2011. All coverage for members enrolled will automatically
end on December 31, 2010. Harvard Pilgrim will continue to
offer two Medicare Supplement plans with varying levels of coverage and cost.
The following benefits accompany a HPHC Medicare Supplement Plan: - The
Choice to go to any Medicare participating physician or hospital
- No referrals
necessary
- Easy to use plan
- Continuous Open Enrollment
- Fitness
benefit of $150 yearly reimbursement
Tufts
Health Plan Also Offers Medicare Plan Options: Medicare
Preferred HMO, from Tufts Health Plan is the lowest cost option of any Medicare
Advantage plan in Massachusetts and is available to both groups and individuals.
The Tufts Medicare Complement Plan uses the same network of providers as commercial
products, the the Medicare Supplement and Prescription Drug Plan is available
to employers that offer coverage to retirees. Please contact
your account manager should you have any questions.
According to a recent survey
of employers, the number of workers with a deductible of at least $1,000 has tripled
since 2006. As a means of saving money in such an unsteady economy, health insurance
plans with higher deductibles and lower premiums are becoming increasingly more
popular. With this trend however, comes worry that consumers are foregoing preventive
care such as colonoscopies, blood tests, and routine physical exams making it
more likely that they will end up in the Emergency Room or Hospital for extended
care for ailments that may have otherwise been avoided. The
choice for employers to move to high-deductible plans can prove practical and
beneficial if tied to either a Health Savings Account (HSA) where policyholders
can set aside tax-deductible money for medical expenses, or a Health Reimbursement
Arrangement (HRA), an employer-funded health care account covering specified medical
expenses. As an incentive to receive preventive care, Health
Care Reform does require insurers to pay for several costly procedures such as
colonoscopies and mammograms that people with high-deductible plans might otherwise
skip, and beginning in 2014, deductibles for workers in small groups will be limited
to $2,000/$4,000 deductibles. Please click here for a list
of covered preventive services under the Patient Protection Affordable Care Act,
provided by Harvard Pilgrim Health Care.
Non-Covered
Dental Services:
Recent legislation in several states (listed below) now
prohibits insurers from requiring dentists to accept their discounted fee for
services if the procedure performed is not covered by the plan. An employee's
liability for such a service must be determined between the dentist and the employee.
While Guardian's systems are updated, EOBs received by members may indicate that
the liability for service is limited to a pre-arranged fee, however, fees can
no longer be imposed upon dental providers for services not covered by Guardian's
dental contracts. States impacted by this legislation include:
Alaska, Arizona, California, Idaho, Iowa, Kansas, Louisiana, Mississippi, North
Carolina, Oklahoma, Oregon, Rhode Island, South Dakota, Virginia and Washington.
New Multi-Coverage Plan: With the new Guardian Multi-Coverage
Plan, employers with 3 or more employees can choose coverage and benefit amounts
that are most appropriate for their needs. Up to 5 products can be offered all
in one package, including a combination of LTD, STD, Life, AD&D, and critical
illness coverage. Click here for more information!
Pennsylvania
currently accounts for more than 20% of the nationwide total of enrollees in the
federal program known as the Pre-Existing Condition Insurance Program. This "high-risk"
insurance plan is meant to provide coverage for uninsured people with pre-existing
conditions who have been without health insurance for at least six months, and
are unable to obtain health insurance because of medical conditions. After
only one month of operation, Pennsylvania's high-risk plan was already running
at 50% capacity (the plan will enroll up to 3,500 people) due to the low monthly
rate of $283, compared to other states whose rates run as high as $972 per month
and are currently running at 10% capacity or lower. The PA plan also has a broader
range of acceptable pre-existing conditions, and has an online application process
which speeds up enrollment. High-risk coverage is scheduled
to be available until 2014, until new regulations take effect forbidding insurers
to deny coverage on the grounds of pre-existing conditions. For
more details on Pennsylvania's high-risk plan or to apply for coverage, click
here.
Harvard Pilgrim's Grandfathering Policy After
assessing the relative advantages and disadvantages of maintaining a grandfathered
plan, Harvard Pilgrim has concluded that "grandfathering" is generally
not beneficial for our employer accounts and members for several reasons. Grandfathered
status significantly limits an employer's ability to make modifications to its
benefit plans. The primary "benefit" of having a grandfathered plan
is temporary exemption from the prohibition on cost sharing for certain preventive
care. We also believe that the support of multiple grandfathered plans will add
significant administrative cost to the health care system. As
a result, Harvard Pilgrim has decided not to offer grandfathered plans to fully
insured accounts with less than 2,000 eligible employees. Fully insured accounts
with more than 2,000 eligible employees and self-insured accounts may choose to
remain grandfathered. We encourage you to contact your Account Executive if you
have any questions about your plan's grandfathered status. Upcoming
Benefit Changes In response to the Affordable Care Act,
the changes below will be made to your plan design. For groups renewing before
January 1, 2011, these changes will go into effect upon their renewal after September
23, 2010. For groups renewing on or after January 1, 2011, these changes will
go into effect on January 1, 2011, except for the child dependent coverage change
as noted below. Preventive Care - Harvard Pilgrim will
no longer impose cost sharing on any in-network adult annual visits, well child
visits, annual gynecological visits, routine pre-natal and post-partum visits,
or for the select preventive services and diagnostic tests described in the attached
list. Durable Medical Equipment - Harvard Pilgrim will
remove all annual dollar limits from its Durable Medical Equipment (DME) benefit
and continue or introduce a 20% or greater coinsurance for DME beginning on July
1, 2011 (subject to regulatory approval). Child Dependent
Coverage - Harvard Pilgrim will provide coverage to child dependents until
age 26.
This change will go into effect on all group renewals after September
23, 2010. Lifetime Limits - Harvard Pilgrim will eliminate
lifetime dollar benefit limits on essential health benefits for its group plans. Your
current rates will not be adjusted as a result of these benefit changes. Updates
from Tom Hamel, Manager of Broker Relations, Harvard Pilgrim Health Care.
Sincerely,
Maria Eramo
Partners Benefit Group, Inc. | 
