June 10:  Health Care Reform- Changes to Health Accounts; Update on COBRA Subsidy Extension; Important Horizon BCBSNJ Updates                                                     

The health care reform law, which consists of the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA), makes some significant changes to accounts such as health flexible spending accounts (health FSAs) and health savings accounts (HSAs). These include:

• Reimbursement permitted for medicine or a drug only with a prescription (except for insulin).
• Contributions to health FSAs limited to $2,500 per year, subject to cost-of-living increases.
• Increased tax on withdrawals from HSAs and Archer MSAs not used for medical expenses.

This Customized Benefit Solutions, Inc. Legislative Brief describes the new rules related to these accounts and when the changes take effect.

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Update:  COBRA Subsidy Extension  

Prior to leaving for Memorial Day recess, the House of Representatives discarded provisions from a jobs bill that would have extended the ARRA subsidy to help newly laid-off workers pay for health insurance under support of the Consolidated Omnibus Budget Reconciliation Act (COBRA). In efforts to trim spending, House managers dropped the COBRA extension from the American Workers, State, and Business Relief Act of 2010.  

House leaders plan to address the lapse in COBRA extensions with a separate bill when they return to work on June 7th. Therefore as of today, eligibility for the COBRA subsidy remains for Involuntary Terminations on or prior to May 31, 2010 and will not cover new involuntary terminations after May 31, 2010.

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Horizon BCBSNJ - Walgreens No Longer Participating in CVS Caremark Pharmacy Networks

Walgreens recently announced its decision not to participate on a go-forward basis in CVS Caremark’s PBM pharmacy networks for new and renewing clients.

CVS Caremark announced that Walgreens will be removed from its commercial pharmacy network in 30 days, effective July 9, 2010, and from its Medicare Part D pharmacy network, effective January 1, 2011.

This announcement was unexpected, and Horizon Blue Cross Blue Shield of New Jersey is working closely with CVS Caremark to ensure a smooth transition for members.

Click here to view Horizon BCBSNJ Brief Notes Vol. 19, No. 705, which includes additional information which may help you address any inquiries you receive.

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Horizon BCBSNJ- Coverage for Dependents Under Age 26 Years Prior to Effective Date - Q&A

Horizon Blue Cross Blue Shield of New Jersey will allow covered individuals under age 26 to remain on their parents’ health insurance policies, effective May 1, 2010 for fully insured plans to help families avoid a gap in coverage. This is before the federal effective date of plan years beginning on or after September 23, 2010. Self-insured groups are also able to opt-in to this arrangement to prevent disenrollment of certain members who would otherwise be eligible for coverage on or after September 23, 2010.

The carrier's decision to apply this coverage early is causing some confusion. Click here to view Horizon BCBSNJ Brief Notes Vol. 19, No. 701, which includes questions and answers to help address the questions you may have.

April 29 : Extension of Dependent Coverage; Carriers Announce Early Extension; COBRA Subsidy Extended; Nursing Mothers Law

Health Care Reform:  Extension of Dependent Coverage

On March 23, 2010, President Obama signed into law the health care reform bill, the Patient Protection and Affordable Care Act. This legislation, along with the Health Care and Education Reconciliation Act of 2010, makes sweeping changes to the U.S. health care system, including an extension of health insurance coverage to young adult children up to age 26. Though many of the changes will be implemented over the next several years, the extension of coverage to young adult children takes effect in as little as six months from enactment. This Legislative Brief provides a summary of the provisions of the law requiring the extension of dependent health coverage.

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Aetna, Amerihealth, and UnitedHealthcare Announces Early Extension of Dependent Coverage

Three carriers have announced that they will extend dependent coverage earlier than the federal legislation requires.  For young adults who are graduating/ aging off their parents' policy, Aetna, Amerihealth and UnitedHealthcare will be continuing coverage for these individuals who would have otherwise had their coverage terminated.  For more information, please click here for Aetna, Amerihealth, and UnitedHealthcare.  Please note:  UnitedHealthcare has not extended dependent coverage on Oxford policies at this time. 

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COBRA Premium Subsidy Extended Through May 2010  

The American Recovery and Reinvestment Act of 2009 (ARRA) provided a temporary subsidy for the cost of COBRA continuation health coverage. The COBRA premium subsidy has already been extended twice, first in December 2009 and then in March 2010. On April 15, 2010, President Obama signed The Continuing Extension Act of 2010, extending the eligibility period for the subsidy.   Employer-provided notices must be modified to include the additional subsidy period and the ability to reinstate COBRA for affected individuals.  This Legislative Brief discusses this important development.

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Breaks for Nursing Mothers Now Law

Among its many components, the recently passed health care reform bill included a provision that modifies the Fair Labor Standards Act (FLSA) to require employers to provide reasonable break time and a private place for female employees to express milk after giving birth. There are five requirements that employers must abide by:

• Employers must provide reasonable break time for nursing mothers.
• A private place other than a bathroom must be provided for the breaks.
• Compensation during the breaks is not required.
• Small employers need not comply if doing so would present an “undue hardship.”
• State laws that provide greater protection to nursing mothers still apply.

The section of the law with this provision took effect on March 23, 2010, so employers must immediately take action to comply with this law (except those in a state that already mandates breaks for nursing mothers). Employers should:

• Identify one or more private locations for nursing mothers.
• Review and modify relevant policies and procedures, including break policies, breast-feeding policies and employee handbooks.
• Communicate with managers supervisors about the changes.

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March 26th: Congress Passes Landmark Health Care Reform Bill

On March 21, 2010, the U.S. House of Representatives passed major health care reform legislation, the Patient Protection and Affordable Care Act. The legislation was previously passed by the U.S. Senate in December 2009 and was signed into law by President Obama on March 23, 2010.

In addition to the main bill, the House also passed a budget reconciliation bill. The Health Care and Education Reconciliation Act of 2010 includes changes to the main bill sought by the House. These changes must now be passed by majority vote in the Senate, with any amendments agreed to by the House, and signed by the President before they take effect. 

How Health Care Reform Will Affect Your Business

Although the reform package has yet to be finalized, major changes are looming. Some of the package’s provisions that will affect employers include:

• Employer Mandates. Effective in 2014, most employers with 50 or more employees must offer coverage to employees. Employers who do not do so may be subject to hefty penalties. The benefit plans offered will also have to meet certain requirements.  
• Individual Mandates. Citizens and legal residents will be required to have a certain level of health coverage, or pay a tax penalty. These rules could restrict the usage of high deductible health plans and will decrease the chance that your employees will decline coverage under your plan.
• Coverage Subsidies. Small employers that provide health insurance for employees will be eligible for a tax credit. Also, employers who provide insurance to retirees over age 55 who are not eligible for Medicare are eligible for a temporary reinsurance program.
• Health Benefit Exchanges. In 2014, state exchanges will be established for small businesses and individuals to shop for health insurance. Larger businesses will be able purchase coverage in the exchanges in the future.
• Insurance Reforms. These reforms require policies to provide dependent coverage for children through age 26. They prohibit lifetime coverage limits, rescission of coverage except in cases of fraud, and imposing pre-existing condition exclusions on children. Many of these provisions will take effect in 2010. They may affect your benefits and how you administer your benefit programs.

The amount of information about the reform bills being released right now is staggering.  Keep in mind that the passage of this legislation is just the beginning point, and the implementation and regulatory processes surrounding these measures will take years.  The National Association of Health Underwriters (NAHU) has assembled two new charts to help explain the timeline for the implementation of the law.  The first is a very detailed chart that explains how all of the new health insurance reforms in both the Senate bill and the reconciliation bill will impact private health insurance organized by effective date.  The second chart is a simplified timeline that explains how both pieces of health care reform legislation will impact individuals and employers. 

Customized Benefit Solutions Can Help You Get Ready for Changes

Health care reform will almost certainly involve sweeping changes to the benefits you provide your employees and how you provide them. However, it will most likely affect each business differently. CBSI can review your company’s benefits to help you prepare for the changing landscape. We can work with you to maximize the value of your employee benefits and minimize your costs and risk. We will keep on top of developments regarding health care and keep you informed.

March 4th: Cobra Subsidy Eligibility Extended; North Jersey Coffee Talk       

COBRA Subsidy Eligibility Extended to March 31, 2010

An additional COBRA premium subsidy extension of 31 days was signed into law by President Obama on March 2 after being earlier approved by the Senate on a 78-19 vote.

Effective now, the government will continue to reimburse employers of health plans and subsidize 65 percent of the premium for workers who lose their jobs from March 1 through March 31, 2010. The extension is also available to employees who first lost group coverage due to reduced hours and were then laid off after March 1, pending to certain conditions.

Prior to the extension, employees laid off after Feb. 28, 2010, would have been ineligible for the subsidy.

The Senate will continue deliberation on legislation that would make the subsidy available to those laid off through Dec. 31, 2010, and would provide them with coverage for up to 12 months.

Of major concern regarding the changing legislation is the continued need for HR and benefits administrators to be knowledgeable on the extension. The Department of Labor will also have to issue new notices.  The Department of Labor's Employee Benefits Security Administration has updated the introduction on the COBRA webpage at www.dol.gov/COBRA to reflect the Temporary Extension Act of 2010 and has added a link to the law. EBSA is updating the fact sheet, FAQs and other materials on the COBRA webpage.

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Next CBSI Coffee Talk:  April 14th in Florham Park, NJ  

Coffee Talk is a complimentary seminar that features industry experts and is designed to educate, increase awareness, assist with compliance, and to provide an opportunity to network with other business professionals.  Next month's topic:     

HR:  What You’re NOT Doing, That You Should Be Doing Right Now!

And     

Strategic Employee Benefits Planning  

Sample Topics Covered:  NJ Paid Family Leave, Performance Management, Progressive Discipline, Employee Handbook Updates, CEPA, Sexual Harassment, Textual Harassment, Consumer Driven Health Plans, Wellness Programs, Total Compensation Statements.

For more information, click here.  You may also register online. 

 

February 17th: HIPAA HITECH Act's Impact on Brokers; CHIPRA Model Notices; NJ Autism Bill; Update- Continuum Health Partners' Network Participation 

HIPAA HITECH Act's Impact on Brokers

You will notice a change in the way we communicate with you in regards to protected health information (PHI).  PHI is any information about health status, provision of health care, or payment for health care that can be linked to a specific individual. This includes but is not limited to medical applications with health questions, claims documentation that contains identifying information about the patient (name, address, social security number, etc.), and general email correspondence containing individually identifiable health information. Any email correspondence that contains PHI will be sent securely using encryption technology.   

On February 17, 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act, was signed into law as part of the American Recovery and Reinvestment Act (ARRA). Among other things, the Act extended HIPAA privacy and security requirements to directly regulate business associates of covered entities and included stricter requirements for breach notifications.  Many of these changes will become effective on February 17, 2010.  

What does this mean for you?  The first time you are sent a "secure" email, you will need to select a password in order to retrieve the email.  Any future "secure" emails, you will continue to use your selected password.  We hope this will be an easy transition for everyone.  Please be assured that we will continue to treat with utmost care the confidential information entrusted to us and that we are prepared to comply with the requirements imposed upon business associates by the HITECH Act.

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DOL Model Notice for CHIPRA Premium Assistance Subsidies

The Children’s Health Insurance Program Reauthorization Act of 2009 created new notice requirements for some group health plans. The U.S. Department of Labor has now issued a new model notice that employers can use in complying with the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).  

-        If an employer’s group health plan covers residents in a state that provides a premium subsidy, the employer must send an annual notice about the available assistance to all employees residing in that state (the Employer CHIP Notice).  

-        The first Employer CHIP Notice must be sent by the first day of the first plan year beginning after February 4, 2010, or May 1, 2010, whichever is later.  For employers with calendar year plans, the notice must be sent by January 1, 2011.

  -        Employers that fail to send the required notices may be subject to penalties of $100 per day.

COMPLIANCE WITH CHIPRA

General CHIPRA Requirements

CHIPRA created additional special enrollment rules for group health plans, effective April 1, 2009. These rules permit employees and dependents to enroll in an employer’s group health plan when they lose eligibility under a Medicaid plan or CHIP or become eligible for a premium assistance subsidy under Medicaid or CHIP.

CHIPRA also added new notice requirements for employers that maintain group health plans in states that provide premium assistance subsidies under a Medicaid plan or CHIP. These employers must notify their employees in writing of the potential opportunities available for premium assistance. CHIPRA provides for civil penalties of up to $100 a day for failure to comply with the new requirements.

Premium Assistance Subsidies

States may offer eligible low-income children and their families a premium assistance subsidy to help pay for employer-sponsored coverage. These states may choose to pay the subsidy as a reimbursement to an employee for out-of-pocket expenses or directly to the employer. Employers may choose to opt out of being directly paid a premium assistance subsidy on behalf of an employee. As of January 22, 2010, 40 states offer some type of premium assistance subsidy. 

Using the Model Employer CHIP Notice

Employers may use the model notice as a national notice to meeting their obligations under CHIPRA. Employers could also choose to prepare their own notices, or modify the model notice. For example, an employer may want to provide more comprehensive information regarding states where it has a larger workforce or leave out information about states where no employees reside. Employers should be sure to include at least the minimum relevant state contact information for any employee residing in a state with premium assistance.

The information in the model notice is up to date as of January 22, 2010. The DOL will update the model each year to reflect any changes in the number of states offering premium assistance programs or the contact information for those states. 

Deadlines for Providing the Notice

The notice must be provided, free of charge, on an annual basis. The first notice must be provided by the first day of the first plan year after February 4, 2010, or May 1, 2010, whichever is later. This rule gives employers with plan years beginning in March or April some extra time to comply. Employers with calendar year plans will have to provide the notice by January 1, 2011.

Delivery of the Notice

The Employer CHIP Notice does not have to be provided in a separate mailing. Plans may combine the notice with other plan materials, such as open enrollment packets or summary plan descriptions, if:

• The materials are provided by the deadlines for providing the Employer CHIP Notice;
• The materials are provided to all employees entitled to receive the Employer CHIP Notice; and
• The Employer CHIP Notice is a separate document so that employees can appreciate its significance.

The notice must be provided in writing in a manner calculated to be understood by the average employee. It must be provided by first-class mail. Alternatively, it may be provided electronically if DOL electronic disclosure requirements are satisfied.

For a copy of the model notice, see www.dol.gov/ebsa/pdf/chipmodelnotice.pdf.

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UPDATE: Continuum Health Partners' Network Participation

UnitedHealthcare/Oxford and Continuum Health Partners (CHP) have provided notice to one another of their intent to terminate their agreement effective January 1, 2010. This termination will apply to UnitedHealthcare and Oxford commercial products, as well as the Medicare and Medicaid lines of business.

A two month, state-mandated cooling off period will apply to all fully-insured, commercial, Medicare and Medicaid members, which means that all fully-insured members will continue to have access to Continuum facilities on an in-network basis through February 28, 2010. Fully-insured commercial members and their employers who have visited a Continuum hospital in the past 12 months, as well as those who live in the area surrounding a Continuum hospital, will be notified of the termination. Medicare and Medicaid members who have received services from a Continuum hospital in the past 12 months also will be notified of the termination.

Notices began mailing to affected commercial group employers and members on Friday, January 15, 2010 to help them prepare for this change, as follows:

■ Fully Insured Commercial Employers (UnitedHealthcare; Oxford). Notice sent to employers with employees who have received services at a Continuum hospital in the past 12 months, and those that have employees who live near a Continuum hospital, advising that Continuum hospitals will be considered out-of-network for fully insured members as of March 1, 2010.
■ Fully Insured Commercial Members (UnitedHealthcare; Oxford). Notice sent to members who have received services at a Continuum hospital in the past 12 months and those who live near a Continuum hospital, advising that Continuum hospitals will be considered out-of-network for fully insured members as of March 1, 2010.

The cooling off period does not apply to commercial self-funded (ASO) employer groups and members. Notices were sent to affected commercial self-funded groups and members last month in advance of the contract expiration date of December 31, 2009, to give those groups and members proper notice of this change. As of January 1, 2010, all services rendered at Continuum hospitals to members of self-funded groups are being treated as out-of-network.

UnitedHealthcare and Oxford will continue to negotiate in good faith with Continuum Health System and will make every effort to reach a mutual agreement prior to the termination date of February 28, 2010, for fully-insured membership.

Hospitals in the Continuum Health System include:

• Beth Israel Medical Center
• Roosevelt Hospital
• St. Luke's Hospital
• Long Island College Hospital
• The New York Eye and Ear Infirmary
  

Below is a list of Neighboring Hospitals in UHC/Oxford's network:

Manhattan

• Bellevue Hospital
• Harlem Hospital
• Hospital for Special Surgery
• Lenox Hill Hospital
• Manhattan Eye, Ear & Throat Hospital
  Memorial Hospital for Cancer and Allied Diseases (also known as Memorial
  Sloan-Kettering)
• Metropolitan Hospital Center
• Mount Sinai Medical Center
• New York Downtown Hospital
• New York Presbyterian Hospital - Columbia University Medical Center
• New York Presbyterian Hospital - Weill Cornell Medical Center
• NYU Hospital for Joint Diseases
  
• NYU Hospitals Center (Rusk Institute & Tisch Hospital)
  
• St. Vincent’s Hospital & Medical Center

Neighboring Hospitals in Brooklyn

• Coney Island Hospital
  
• Kingsbrook Jewish Medical Center
  
• Kings County Hospital Center
  
• Lutheran Medical Center
  
• Maimonides Medical Center
  
• New York Community Hospital of Brooklyn
  
• The Brooklyn Hospital Center
  
• The New York Methodist Hospital
  
• University Hospital of Brooklyn
  
• Woodhull Medical and Mental Health Center
  
• Wyckoff Heights Medical Center

Impact on Physician Participation
At this time, there will be no physician terminations from any of our networks due to the termination of Continuum Health Partners. This is in compliance with a court ruling to allow those —1,200 providers who currently have sole admitting privileges to a Continuum hospital to remain participating in our network; pending the outcome of an arbitration ruling.

Impact on Benefit Payments
Members seeking care from providers who have admitting privileges at Continuum Health Partners in addition to another UnitedHealthcare participating facility: These providers have been notified that Continuum hospitals are non-participating as of March 1, 2010 and their patients' elective hospital admissions should be directed to the participating facility where they have privileges. Any emergency hospital admission to a Continuum hospital will continue to be reimbursed on an in-network basis.

For members receiving care from physicians with sole admitting privileges to a Continuum hospital: As a result of a recent judge ruling, elective hospital admissions for patients of physicians with sole admitting privileges to a Continuum hospital must receive services on an in-network basis. This policy will remain in effect until an arbitration ruling is rendered, at which time we will communicate the outcome to you. (Note: We do not have a date for this hearing at this time.)

Please keep in mind:

• UnitedHealthcare/Oxford will have transitional care guidelines in place so members who have scheduled or ongoing medical treatments at a Continuum hospital will continue to get care as appropriate.'
• Fully insured commercial, Medicare and Medicaid members will continue to have access to Continuum facilities on an in-network basis through the New York State cooling off period, which ends February 28, 2010.
• UnitedHealthcare/Oxford continue to negotiate in good faith with Continuum Health Partners and hope to reach an agreement with them in the near future.
• Members will not lose coverage as a result of this contract termination.

 

  

 

 

 

 

 

    

 

    

 

 

 

 

 

 

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