| Greetings! Please
take a moment to read through the latest issue of the PBG Newsletter. This issue
contains important information regarding FSA/HSA/HRA changes and new plan opportunites
for the small business market. As always, please feel free to contact us should
you have any questions.
Effective January 1, 2011,
a provision of the Patient Protection and Affordable Care Act will change the
way FSA, HRA, and HSA account participants are reimbursed for certain types of
Over the Counter (OTC) expenses. The new provision requires a doctor's prescription
for over the counter medicines submitted for reimbursement through health FSA
or HRA accounts. The use of FSA/HRA debit cards will not be allowed for these
purchases and therefore manual claims must be submitted. Debit cards tied to HSA
accounts will still work for OTC medicines, however it will be the account holder's
responsibility to keep record of prescriptions for those purchases. A 20% excise
tax will be incurred for any ineligible items purchased with HSA dollars without
proof of prescription. This new law effects all FSA/HRA/HSA
plans beginning 1/1/11, regardless of the plan year date, and regardless of whether
2010 or 2011 funds are being used. Any expenses for OTC medicines incurred before
January 1st will NOT require a prescription for reimbursement even if the claim
is made after the effective date of the change. OTC items may
still be purchased without a prescription if paid out-of-pocket, and there is
no change to how regular prescription medications are reimbursed by FSA or HRA
funds. Insulin, prescription medicines and some OTC supplies - such as bandages,
crutches, blood sugar test kits and contact solution - will continue to be eligible,
if your health care FSA allows. Please follow the instructions
below for reimbursement of OTC medicines as of January 1, 2011: If
buying medicine off the shelf you will need to submit an FSA claim form, copy
of your receipt and your provider's prescription. The prescription must include: - Your
name
- Name of medicine
- Dosage and form
- Quanitity
Prescribed
- Instructions
- Signature of provider
who wrote the prescription?
If a Pharmacist
is filling your prescription you will need to submit an FSA claim form with your
receipt. Ask for a receipt that includes: - Prescription
number
- Your name
- Date of Purchase
- Dollar Amount
Please
click here for a list of OTC items that may or may not be eligible for reimbursement
without a prescription as of January 1, 2011.
As of January 1, 2011 Blue Cross
Blue Shield of MA is downsizing their product portfolio. This will have no impact
on your account until your 2011 renewal. Although they have downsized their product
portfolio they have also added a standard Hospital Choice Cost Sharing optional
rider. Hospital choice cost sharing (HCCS) will be included
as a standard benefit change for most small group products. Small groups (1-50
eligible employees) who wish to keep the single level hospital coverage they have
now will need to upgrade the coverage at the time of their renewal. HCCS
will give members the opportunity to control their share of medical costs for
hospital care because what they pay will depend on the hospital chosen. An additional
co-payment will apply to inpatient admissions, day surgery, lab work, xrays and
short term rehabilitation when services are rendered at a hospital that is meeting
quality benchmarks but are higher cost providers. It is
important to remember that this is an optional rider and employers will have a
choice to opt out of this change.
This
annual survey of employers provides a detailed look at trends in employer-sponsored
health coverage, including premiums, employee contributions, cost-sharing provisions,
and other relevant information. The survey continued to document the prevalence
of high-deductible health plans associated with a savings option and included
questions on wellness benefits and health risk assessments. The 2010 survey included
3,143 randomly selected public and private firms with three or more employees
(2,046 of which responded to the full survey and 1,097 of which responded to an
additional question about offering coverage). Researchers at the Kaiser Family
Foundation, the National Opinion Research Center at the University of Chicago,
and Health Research & Educational Trust designed and analyzed the survey. Click
here for source.
This year, doctors recommend the flu vaccine
for children age 6 months and older and all adults. This year's vaccine will protect
against both the seasonal and the H1N1 flu, so you will only need to get one vaccine.
(A booster shot will be required for any children under 9 years old who have never
had the flu shot.) While the flu vaccine is recommended for everyone 6 months
of age and older, some people are at increased risk of having flu-related complications.
So it's especially important for the following groups to receive the yearly flu
vaccine: - Children 6 months through 4 years of age
- People
>50 years of age
- People 6 months - 18 years of age who are receiving
long-term aspirin therapy.
- Women who will be pregnant during flu season
and postpartum women
- People > 6 months of age who have:
- Chronic
conditions, including asthma, diabetes, heart or respiratory diseases
- Suppressed
immunity.
- Any condition that can compromise respiratory function or the
handling of respiratory secretions or that can increase the risk of aspiration.
- Residents
of nursing homes and other chronic-care facilities.
Blue
Cross Blue Shield HMO, Medicare Advantage, and Blue Care Elect PPO plan members
will have a $0 copayment for the flu vaccination at participating doctor and nurse
practioner offices, given that no other service is provided during that visit.
Sincerely,
Maria Eramo
Partners Benefit Group, Inc. | 
