Common Summary Plan Description (SPD) Mistakes

Subject to ERISA (Employee Retirement Income Security Act) the SPD (Summary Plan Description) is one of the most important documents that participants under a health benefit plan must receive.  The Department of Labor has increased its company audits, and more often than not employers are failing to provide their employees an SPD. Some may consider the information distributed by their insurance carrier as sufficient evidence of coverage and benefits to satisfy their SPD distribution requirement.  Unfortunately, this is not the case, and the responsibility lies solely in the lap of the plans administrator (the employer that sponsors the group plan). Every employer that sponsors a group health plan must comply with this important ERISA requirement, or they run the risk of facing a hefty fine.  Penalties of up to $110/day per participant or beneficiary for failing to provide an SPD or plan document within 30 days of receiving a request.  The penalty accrues daily from the inception of the policy, not from the date of notification to furnish. It is considered a best practice to distribute the SPD to employees and maintain proper records that each beneficiary has in fact acknowledged receipt.  This can be accomplished by employing an online administration system that can track and organize specific notices, and ensure compliance under ERISA. To learn more about how we can assist your company reduce its risk of an audit, and eliminate the risk of arbitrary penalties -please contact us via telephone or...

AB339 Could Bring Relief to Those That Require Expensive Specialty Drugs

Many people that suffer from chronic conditions such as asthma, hepatitis C, Cancer, MS, rheumatoid arthritis and others are feeling discriminated against due to the high cost of the drugs that they need.  These drugs are referred to as Specialty Drugs.  The emergence of these very high cost specialty drugs has led health plans and insurers to impose high copays and coinsurance on these drugs.  Such drugs are often placed on the highest cost tier of a drug formulary (commonly known as the “fourth tier” or the “specialty tier”) with coinsurance of up to 20%, 30% or even 40% as opposed to a fixed co-payment.  As a result, Californians that suffer from chronic conditions can face high out-of-pocket costs and may even exhaust their annual out-of-pocket limit of $6,500 with a single prescription in the first month! Fortunately, Consumer Protection Bill AB339 is currently moving through the California Legislature.  The point of AB339 is to get the patient out of the middle of the fight between the health plans and the drug companies by providing basic consumer protections, including a cap of no more than $250 per monthly prescription for most coverage, or $500 for products in the bronze tier. The bill must be approved by the Legislature by Sept. 11 in order to go to Gov. Jerry Brown (D), who has until Oct. 11 to sign or veto...

How To Avoid The Painful Surprise of an Unexpected Medical Bill

It has happened to most of us, we visit the doctor, provide our health insurance ID card for services and then receive an unexpected bill a few weeks later.  Over the past two years, nearly one-third of privately insured Americans have received an unexpected medical bill where their health plan paid less than expected.  With Annual Out-of-Pocket Maximums now over $6000 for an individual, these balance bills are often extremely difficult to handle.  To make matters worse, whether you’re disputing the charge or simply can’t pay, medical debts are quick to reach collection status.  According to the Consumer Financial Protection Bureau, one in five consumers have an unpaid medical debt on their credit report. Here are a few small, but important steps that you can take to avoid unexpected medical bills.   Call your insurer ahead of a medical procedure as some procedures require pre-authorization.  Carriers like to make sure that certain expensive procedures are medically necessary and if you have the procedure without making sure that it is authorized, you could get stuck with the bill. Familiarize yourself with your health plan. Dig into plan specifics related to deductibles, coinsurance and maximum out-of-pocket costs.  Deductibles and coinsurance can be confusing if you do not know how they work on your specific health plan.  Also, many people can be caught off guard by the individual vs family deductible. A quick email to your broker can help refresh your memory on material covered in your benefit orientation. Don’t assume that because your doctor or hospital is in-network, that you’re all clear. Some insurers have tiered-service networks, reimbursing some in-network providers...

Blue Shield System Enhancements for Small Groups in CA

As part of Blue Shield’s commitment to improve the way they provide service to you, they are continuing to bring more customers onto our enhanced membership and claims system. Once the new system has been fully implemented, Blue Shield customers will be able to process and pay claims and enroll members faster and with greater efficiency. On June 1, Blue Shield is moving their small business clients with a July, August, and September 2014 renewal period onto the system. As of June 1, 2014, your clients will notice some changes. Changes for employers: Consolidated medical, dental, and vision* coverage billing with an improved format and a tear-off remittance slip. Customers will no longer receive separate bills for Dental HMO and/or vision* coverage they obtain through Blue Shield. New account number for billing purposes. New group contract number that replaces your current number. New subgroup billing number(s) that replaces your existing billing unit number(s). New employer service contact number. New payment mailing address. Access to our enhanced Employer Connection Plus online system for account management. Delayed June 2014 client bills. Please note: June 2014 Blue Shield bills will be mailed the last week of May, and they should receive them the first week in June. Our standard 30-day grace period for payment will extend from the date we actually produce their June bills. Clients’ June bill will be the first one generated by our newly enhanced system. The June bill will not reflect outstanding balances or adjustments from May, so please have them pay their May bill as usual. Our Producer Services team will work with you to resolve any open balances. For...

Understanding Anthem’s New Small Group Network Names

Anthem has 3 networks:  Full, Select and Priority Select. Anytime you see a plan without the word “Select” in it a member has access to the FULL network 60,0000 doctors and hospitals. If you see the word “Select” in the plan regardless if is it a Core, Essential, Preferred or a Premier plan a member would have the narrow “Select” network (which does not include any Sutter doctors). There is a total of about 40,000 doctors. The Priority Select is just for HMO and is slimmer than the “Select” Network. If Bedrosian & Associates can be of any assistance to help you find the medical insurance network that suits you and your family best please do not hesitate to contact...

SeeChange Anniversary Change Options Announced

Many SeeChange Health clients took advantage of their Early Renewal Program, locking in their 2013 coverage through November 30, 2014. I’m guessing not all of these groups are overly excited about having a December renewal. Here are the details of SeeChange’s Anniversary Change Options Program: The program is simple. All SeeChange groups that renewed at any time in 2013 (not just December) need only send SeeChange a letter on company stationery requesting the change at least one month prior to the 2014 renewal date they want. The letter must be signed by an officer of the company or the group administrator and, not surprisingly, needs to indicate which of our then-current plan(s) they’re enrolling in. No underwriting. No hassles. Technically SeeChange be canceling their 2013 SeeChange Health Insurance plan and enrolling them in a new 2014 plan at the rates in effect as of the group’s new anniversary date. This means clients can add (or remove) the HMO Combo Program and the Employee Option Program, implement an HRA or HSA, adjust their waiting period and the like. The Anniversary Change Program will be in force throughout 2014. SeeChange will be sending out details by separate email soon. And to state the obvious, this is a voluntary program. SeeChange just wants to give you more choices as they prepare to enter the new world of health care coverage. If Bedrosian & Associates can be of any further assistance please do not hesitate to contact...