CalCPA ProtectPlus

Banyan Consulting LLC has been providing us with beneficial information about different aspects of the Health Care Reform and how it affects us. Over the next months and years, employers will be faced with numerous changes, many of which require regulatory clarification. Banyan will continue to keep us up to date and on target with decisions that affect our plans. 

To view this article in PDF format, click here.

The following information is provided by Banyan Consulting LLC:

Another component of the Health Care Reform Act signed into law on 3/23/2010 is that beginning with the 2011 tax year, employers must report the aggregate cost of applicable employer-sponsored health insurance coverage on employees W-2 forms.  General information about this requirement has been provided, however, the Department of Labor (DOL) has not yet issued Interim Final Rules on this provision of the Health Care Reform Act.

1. When does an employer have to be ready to be in compliance with this new reporting requirement?

Employers must be prepared to accurately report this information on an employee’s 2011 W-2 form as early as February, 2011.  Although employers will be sending most of the 2011 W-2 forms to the employees in January, 2012, if an employee terminates employment in 2011, they do have the right to request an early 2011 W-2 form.  Employers must be prepared for this possibility. (continue reading…)

Non-Participating Pharmacy is a pharmacy which does not have a Participating Pharmacy Agreement in effect with the claims administrator at the time services are rendered. In most cases, you will be responsible for a larger portion of your pharmaceutical bill when you go to a non-participating pharmacy.

The following information is from Healthcare.gov:

How the Affordable Care Act will make Medicare stronger into the future

• The life of the Medicare Trust fund will be extended to at least 2029, a 12-year extension as a result of reducing waste, fraud and abuse, and slowing cost growth in Medicare. This will provide you with future cost savings on your premiums and coinsurance.
• Medicare will take strong action to reduce payment errors, waste, fraud, and abuse in Medicare. The President has made a commitment to reduce Medicare fraud 50 percent by 2012. The Affordable Care Act makes an historic, ten-year, $350 million investment to prevent, detect and fight fraud in Medicare, Medicaid and the Children’s Health Insurance Program—including criminal efforts to exploit the new law. Visit Stop Medicare Fraud for more information.
• In 2011, if you hit the prescription drug donut hole, you will get a 50% discount on brand-name drugs. Every year after, you will pay less for your prescription drugs in the donut hole until there’s complete coverage of the donut hole in 2020. Between now and then, you will get continuous Medicare coverage for your prescription drugs.
• The coordination of care between doctors and the overall quality of care will improve so that you will be less likely to experience preventable and harmful re-admissions to the hospital for the same condition.
• Hospitals will have new, strong incentives to improve your quality of care.
• Starting in 2014, the Affordable Care Act offers additional protections for Medicare Advantage Plan members by taking strong steps that limit the amount these plans spend on administrative costs, insurance company profits, and things other than health care.

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CalCPA Council recently nominated John Dodsworth, Charles Gielow, Jr., James McDonald and Daniel Thomas to serve three-year terms as trustees of the Group Insurance Trust. You can nominate any qualified individual for the fall election by submitting supporting petitions from at least 20 firms participating in one or more of the GIT’s group health and welfare plans by September 27, 2010. For more information, contact Judith Graziani at (800) 556-5771 x 2405 or Judith.graziani@calcpa.org.

Banyan Consulting LLC has been providing us with beneficial information about different aspects of the Health Care Reform and how it affects us. Over the next months and years, employers will be faced with numerous changes, many of which require regulatory clarification. Banyan will continue to keep us up to date and on target with decisions that affect our plans. 

To view this article in PDF format, click here.

The following information is provided by Banyan Consulting LLC:

One component of the Health Care Reform Act signed into law on 3/23/2010 requires minimum coverage, without employee cost-sharing, for services rated A or B by the US Preventive Services Task Force.  Beginning with the first day of the first plan year beginning on or after 9/23/2010, plans can no longer require a copay or apply a deductible or coinsurance to these services.  On 7/14/2010, the Department of Health & Human Services (HHS) released the list of A and B services determined by the US Preventive Services Task Force.

1.  Does this health care reform provision apply to “grandfathered” plans?

No, grandfathered plans do not need to comply with this provision.  If, in the future, your health plan loses its grandfathered status, this reform will apply to your plan.

2.  What are the A and B rated preventive services?

The A and B rated preventive services are segmented into 3 categories which are:

•  Adult Covered Preventive Services
•  Women (including Pregnant Women) Covered Preventive Services
•  Children Covered Preventive Services

There is still some debate on additional services for women that, most likely, will not be resolved until August, 2011.  There is lobbying from organizations such as Planned Parenthood, for example, who want birth control to be included in the preventive services category.  More information is sure to follow. (continue reading…)

The following information is provided by cdc.gov:

CDC urges women to take 400 mcg of folic acid every day, starting at least one month before getting pregnant, to help prevent major birth defects of the baby’s brain and spine.

About folic acid - Folic acid is a B vitamin. Our bodies use it to make new cells. Everyone needs folic acid.

Why folic acid is so important - Folic acid is very important because it can help prevent some major birth defects of the baby’s brain and spine (anencephaly and spina bifida) by 50% to 70%.

How much folic acid - a woman needs 400 micrograms (mcg) every day.

When to start taking folic acid- For folic acid to help prevent some major birth defects, a woman needs to start taking it at least one month before she becomes pregnant and while she is pregnant. Every woman needs folic acid every day, whether she’s planning to get pregnant or not, for the healthy new cells the body makes daily. Think about the skin, hair, and nails. These – and other parts of the body – make new cells each day.

How a woman can get enough folic acid- There are two easy ways to be sure to get enough folic acid each day:

1. Take a vitamin that has folic acid in it every day. Most multivitamins sold in the United States have the amount of folic acid women need each day. Women can also choose to take a small pill (supplement) that has only folic acid in it each day. Multivitamins and folic acid pills can be found at most local pharmacy, grocery, or discount stores. Check the label to be sure it contains 100% of the daily value (DV) of folic acid, which is 400 micrograms (mcg).

2. Eat a bowl of breakfast cereal that has 100% of the daily value of folic acid every day. Not every cereal has this amount. Check the label on the side of the box, and look for one that has “100%” next to folic acid.

Fact Sheet  - Download and print this fact sheet.

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Co-Payment is the amount payable by the member for office visits and certain other services. The prescription drug co-payments are fixed dollar amounts payable for prescription drugs. The term co-payment does not include the portion of covered expenses, expressed as a percentage, payable by the member for covered services.

If you are vacationing just over the state line, across the country, or elsewhere in the world and experience a medical problem, you will be glad to know that ProtectPlus has you covered. The Anthem Blue Cross card that identifies you as a ProtectPlus subscriber is not only good for network coverage in California, it also represents your membership in BlueCard®, a national program through the BlueCross BlueShield Association that enables members of one Blue company to obtain healthcare services while traveling in another Blue company’s service area.

Boasting an impressive reach, this coverage extends to all 50 states and Puerto Rico, plus more than 200 countries and territories worldwide. So, you can enjoy your vacation at ease knowing that covered healthcare is within easy reach. Here are a few guidelines for making use of your coverage with the least hassle.

Always carry your ID card wherever you are traveling, and in any emergency go to the nearest hospital. If you don’t need emergency care but do need to see a doctor or visit a hospital before you return home, call the “Coverage while traveling” number on the back of your Anthem Blue Cross ID card for help in locating the provider nearest to you, or referral authorization. For travel in the US, Puerto Rico and US Virgin Islands, you can also find participating provider information online (provider.bcbs.com).

Once at the hospital or doctor’s office, present your Anthem Blue Cross card. For services provided in the US, you shouldn’t have to complete claims forms or pay up-front for medical care other than your usual out-of-pocket expenses such as deductibles and copays. Anthem will send you a complete explanation of benefits.

If you are traveling out of the country and need emergency medical care, call, or have a family member or friend call the BlueCard Worldwide Service Center collect (1-804-673-1177) as soon as you are admitted to a hospital. If you need nonemergency care, the service center will help you make an appointment with a doctor or facilitate your hospitalization at a network hospital. The center can help obtain cash-less access for inpatient care except for your usual out-of-pocket expenses. For outpatient care and/or services from a non-network hospital you may have to pay the provider and submit a claim form.

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 Banyan Consulting LLC has been providing us with beneficial information about different aspects of the Health Care Reform and how it affects us. Over the next months and years, employers will be faced with numerous changes, many of which require regulatory clarification. Banyan will continue to keep us up to date and on target with decisions that affect our plans. 

The following information is provided by Banyan Consulting LLC:

With the passage of the Patient Protection and Affordable Care Act on March 23, 2010, effective January 1, 2011 over-the-counter (OTC) medicine will no longer be eligible for reimbursement from a Flexible Spending Account (FSA), Health Reimbursement Account (HRA) or Health Savings Account (HSA) unless accompanied by a prescription or medical necessity statement from a medical provider.  The new regulation only applies to OTC medicine so many OTC supplies that are, currently, eligible for reimbursement through an FSA, HRA or HSA will not be affected. To read more, click here.

Hospital is a facility which provides diagnosis, treatment and care of persons who need acute inpatient hospital care under the supervision of physicians. It must be licensed as a general acute care hospital according to state and local laws. It must also be registered as a general hospital by the American Hospital Association and meet accreditation standards of the Joint Commission on Accreditation of Health Care Organizations.

For the limited purpose of inpatient care for the acute phase of a mental or nervous disorder, severe mental disorder, or substance abuse, “hospital” also includes psychiatric health facilities.

The following article is from the San Francisco Chronicle:

By: Kathryn Roethel

Five of Nature’s Best Cancer-Fighting Foods 

As a veteran faculty member at the Stanford University Medical School, Dr. John Farquhar has seen thousands of patients try to beat cancer with aggressive chemotherapy treatments that “blast them with terrible side effects.” But, as the founder of Stanford’s Prevention Research Center, he believes he has helped other patients beat cancer before it starts using nature’s medicine: vegetables and fruits.

Farquhar has worked at the university for 30 years as a professor, a cardiologist and the co-founder of the Stanford Prevention Research Center. He co-teaches a popular course called “The Best Diet Ever,” (see box) in which he preaches the merits of five foods with strong anti-cancer agents: soy, onions, broccoli, tomatoes and blueberries.

“There’s still uncertainty about how important nutrition is in cancer prevention,” Farquhar said, “but I’ve found that if you deal with these specific foods, there’s evidence that they all have cancer-fighting nutrients. As opposed to genetics, nutrition is something that people can control.”

Joyce Hanna is the associate director of Stanford Prevention Research Center. A 19-year Stanford faculty member and former marathon runner, she teaches “The Best Diet Ever” class with Farquhar. Hanna also counsels clients who want to engage in healthier lifestyles and oversees a program that helps cancer patients exercise and eat well during and after treatments.

Beating disease back

“One of the biggest fears cancer patients have is that their cancers may come back,” Hanna said. “Other people haven’t been diagnosed with cancer, but they’re out of shape and their doctors have warned them about risk of disease. I try to help them take small steps to improve their lifestyles. Obesity increases cancer rates, and in a lot of these cases, lifestyles are more important than genetics.” (continue reading…)

5 Ways to Turn Back the Clock (www.prevention.com)

Nighttime is the right time to take years off your face

“Hormonal changes boost blood flow to the skin, brightening it overnight,” says Melvin Elson, MD, a clinical professor of dermatology at Vanderbilt School of Nursing. Skin temps are higher, too, so age-fighting potions seep deeper for better results. And even though you’re resting, your skin is hard at work. Studies show that cell turnover is 8 times faster at night, softening wrinkles.

On the flip side, as anyone who’s pulled an all-nighter can attest, the consequences—pasty-looking skin and dark circles—aren’t pretty. “Even worse, not getting the recommended 8 hours increases levels of the stress hormone cortisol, which may slow collagen production, promoting wrinkles,” says Jyotsna Sahni, MD, a sleep medicine doctor at Canyon Ranch in Tucson. To maximize your beauty sleep, follow this routine nightly to wake up with the complexion of your dreams.

Wake Up to Better Skin
Your complexion works hard to repair itself while you rest. Here’s how to take advantage of this natural healing process.
By Patricia Curtis

1. Keep It Clean

Washing your face plays two important roles: it removes damaging dirt and makes your night cream work harder
Removing makeup, oil, and other impurities helps keep pores tight and skin blemish free. Anti-aging treatments can also penetrate deeper on a clean surface. For dry skin, look for a creamy cleanser; for acne-prone or oily skin, a gel formula. If your skin is sensitive, wait 10 minutes after cleansing before applying anti-agers. (continue reading…)

Physician means:

1.  A doctor of medicine (M.D.) or doctor of osteopathy (D.O.) who is licensed to practice medicine or osteopathy where the care is provided; or
2. One of the following providers, but only when the provider is licensed to practice where the care is provided, is rendering a service within the scope of that license, is providing a service for which benefits are specified in this booklet, and when benefits would be payable if the services were provided by a physician as defined above:

a)       A dentist (D.D.S.)

b)      An optometrist (O.D.)

c)       A dispensing optician

d)      A podiatrist or chiropodist (D.P.M., D.S.P. or D.S.C.)

e)      A psychologist

f)        A chiropractor (D.C.)

g)      A certified registered nurse anesthetist

h)      An acupuncturist (A.C.)

i)        A clinical social worker (C.S.W. or L.C.S.W.)

j)        A marriage, family and child counselor (M.F.C.C.)

k)      A physical therapist (P.T. or R.P.T.)*

l)        A speech pathologist*

m)    An audiologist*

n)      An occupational therapist (O.T.R.)*

o)      A respiratory care practitioner (R.C.P.)*

p)      A psychiatric mental health nurse

q)      A Physician assistant*

r)       A nurse midwife**

s)       A registered dietitian (R.D.)* for the provision of diabetic medical nutrition therapy only

t)       A registered nurse practitioner

* Note. The providers indicated by asterisks (*) are covered only by referral of a physician as defined in 1 above.
** If there is no nurse midwife who is a participating provider in your area, you may call the Customer Service telephone number on your ID card for a referral to an OB/GYN.

Negotiated Rate is the amount participating providers agree to accept as payment in full for covered services. It is usually lower than their normal charge. Negotiated rates are determined by claims administrator’s Participating Provider Agreements. With respect to non-participating providers, the negotiated rate means the typical fee participating hospitals and participating physicians agree to accept as payment in full of covered services as determined by the claims administrator, as appropriate, in its discretion.