CalCPA ProtectPlus

Open Enrollment

It’s open enrollment season again and the Group Insurance Trust has taken the opportunity to strengthen its offerings with two new medical plans that give members even more flexibility in fine tuning their coverage through different levels of deductibles, co-pays, and premiums. Protect 40, a new co-pay plan, features a higher deductible and a higher $40 co-pay than the popular Protect 35 plan but lower than the Protect 45 copay plan. Protect HSA 3,500, a new HSA-eligible plan, features higher deductibles and lower member-paid coinsurance than the Protect 1500, 2500 and 2850 HSA plans with premiums approximating those of the Protect 45 copay plan.

As in previous years, the annual open enrollment period—continuing this year from November 1 through December 16—allows CalCPA-member firms a variety of options. Firms can offer employees the Trust medical, dental, and vision plans as a new benefit, while employees who had previously declined coverage can also enroll at this time. Current subscribers can take advantage of this opportunity to review their insurance needs, consider the new plans, and/or make any changes they have contemplated during the year. Finally, keep in mind that while most employers offer a single plan, your firm may elect to offer a combination of ProtectPlus co-pay, ProtectPlus HSA and Anthem Blue Cross HMO plans.

Choosing the Right Plan

While reviewing all the available choices might seem a daunting task, a new set of video presentations featured on the ProtectPlus website has just made it easier—even a little entertaining. Using the Video Toolbox feature on the homepage, you can get a video summary for each plan. The videos are segmented into topics such as coinsurance and deductibles so you don’t need to watch the whole presentation to get the information you are looking for. New videos are being added weekly, so be sure to check back frequently. Of course, you can still access plan information in written form. The 2012 EZ Guide is available online as an easy-to-read Summary Plan Benefits Comparison Chart. Once you’ve selected the plan or plans you’re interested in, you can get quotes based on the demographics of your firm using the Get a Quote Tool. If you have questions click on Ask the Expert and submit your query to the Trust staff. While they promise to get back to you within two days, you often receive an answer within the hour.

New Pharmacy Benefit Manager

Beginning January 1, 2012 ProtectPlus co-pay and HSA plan pharmacy benefits will be serviced by Medco rather than Express Scripts. (Please note that this change does not affect HMO participants.) Current subscribers who aren’t making any changes in their coverage should receive a welcome packet in the mail from Medco in the middle of December. Included in the mailing will be a welcome letter describing Medco services as well as your new pharmacy benefits ID card, which you will need to obtain your prescription drugs.

Between now and January 1, 2012 you can access the Medco open enrollment website to look up the cost of your prescription drugs pre- and post-deductible under the Medco pharmacy plan. After January 1, use your new Medco ID number to register at Medco.com to access the Medco mail order pharmacy and your personal prescription drug records. Although copays and coinsurance levels are not changing, differences between the old and new prescription drug formularies may result in an increase or decrease in your out-of-pocket costs.

Members who currently use specialty prescription medications for complex conditions will receive a letter introducing them to Accredo, Medco’s provider of specialty drugs. The letter will include information on contacting Accredo’s specialty pharmacists and nurses toll-free, 24 hours per day, 7 days a week. There is also an explanation of procedures for transitioning your specialty prescriptions and for scheduling regular deliveries.

While the population of the United States grew just 9 percent in the decade from 1999 to 2009, the number of prescriptions written increased 39 percent. During roughly the same period, the cost of prescription drugs grew 3.6 percent a year, and while these cost increases represent a considerable slackening from the double digit increases of the 1990s, pharmaceutical manufacturing continues to be one of the top three most profitable industries in the country.

Fortunately for consumers, the cost of prescription drugs still accounts for only 10 percent of healthcare spending nationwide. This is only good news because increases in the cost of hospital care and physician services have grown even faster, exceeding 5 percent annually.

Generic Counterparts

Nevertheless, several important factors have helped keep prescription costs in check. First and foremost, has been the introduction of generic alternatives when brand-name pharmaceuticals lose patent protection.

A report by the Kaiser Family Foundation points out that, “almost 80 percent of FDA-approved drugs have generic counterparts,” and explains that when there are two generic alternatives on the market, the generic price is usually about half the original price of the brand name drug. Moreover, when several competing generics are available, prices often plummet to 20 percent or less of the original brand cost.

The Value of a Formulary

In conjunction with cost-sharing techniques such as deductibles, copayments and co-insurance, another tool used by health insurers to keep prescription expenses down is the use of a formulary. Comprising a list of approved prescription drugs, formularies encourage the use of generics and lower-priced alternatives among their subscribers by creating a differentiated copayment schedule. Under such an arrangement, if you elect a brand-name drug when a generic equivalent is available, you will be responsible for a greater share of the cost. (continue reading…)

It’s been more than a year since the Group Insurance Trust contracted with Banyan Administrators, LLC for administrative services, and from early on, subscribers and Trust staff have been consistently pleased with Banyan’s expertise and responsiveness.

Staffed by a service center team where all members are fully licensed in California, three full-time and two part-time dedicated agents are on hand every day from 8 a.m. to 5 p.m. to handle member comments, inquiries, and billing. Two additional full-time staff members respond to incoming emails, faxes, and forms. Tom Zimmerman, Banyan’s Insurance Group Leader, provides a long list of issues that representatives commonly address, including “billing, coverage, claims, COBRA and CalCOBRA, enrollment, eligibility, forms, ID cards, open enrollment changes, quotes, plan changes, and underwriting.”

He adds that whenever the Banyan team is responding to members, they make secure handling of personal data a high priority. Banyan employs both a web encryption system and a password protected email system. The latter can be set up for incoming as well as outgoing emails, so if members need to supply vital information, they should contact Banyan before emailing the data to arrange for a secure transfer.

Performance Stats

As part of its contract with the Trust, Banyan is required to keep statistics on its performance in handling member calls, and the results are impressive. Since November 2009, the average phone response time has been 29 seconds and the average includes two open enrollment periods when calls were very heavy. Better still from a customer point of view, 95 percent of all email or telephone inquiries were resolved on the initial contact. In addition, Banyan’s average time to review and process incoming paperwork is less than two days with an accuracy rating of better than 99 percent on premium invoices and enrollment changes. (continue reading…)

The Group Insurance Trust operates the CalCPA-endorsed health and welfare plans, including CPA ProtectPlus medical plans, Delta Dental and Vision Service Plans. The Trust is governed by 12 trustees, and each year four are elected for three-year terms. Begining on January 1, 2011, John Dodsworth, Charles Gielow, Jr., James McDonald and Daniel Thomas were elected to serve a three-year term as trustees of the Group Insurance Trust. In addition to the four elected trustees mentioned above, Michael Allmon was appointed by the Chairman of the Board of Trustees to complete the term previously held by Pam Hunter who passed away in 2010.

CalCPA and its related entities are moving. Our offices will close at 5:00 pm on Friday December 17 and will reopen in our new headquarters on January 3, 2011. All direct phone extensions and fax numbers will change. All 800 numbers will remain the same. Please be aware that telephone and email services will be down from 12/20 – 12/22, but are expected to resume on 12/23. During the closure, please contact Banyan Administrators, LLC 877-480-7923 for assistance. Our new address is: 1800 Gateway Drive, Suite 201, San Mateo, CA 94404. Phone (800) 556-6771.

It’s often said, if you don’t know where you have been, you can’t know where you are going. So, as the Board of Trustees and staff of the Group Insurance Trust position themselves to meet the challenges ahead in 2011, looking back on 2010 will help set the course for the coming year.

A year of change began when the Trust transitioned to its new plan administrator, Banyan Administrators, LLC. When Banyan replaced the Trust’s prior long-time administrator Seabury & Smith, it was with the expectation that the Trust would soon be able to provide its members with modern, improved services. We have not been disappointed. Since Banyan assumed responsibility for managing the Trust’s group insurance plans, improvements have been apparent each passing month. This summer Banyan began rolling out online self-service management capabilities to participating firms. As firms are trained and comfortable with the self-management site, a new group of firms is then invited to take part. By the end of 2011 we expect that all firms wishing to manage common tasks (such as new hire enrollments, terminations, demographic changes, dependent adds and deletions and other tasks associated with benefit management) will be trained and actively managing their benefit programs. Participating firms may also have noticed the comprehensive and timely distribution of 2011 plan renewal information. (continue reading…)

Maintaining a successful health plan demands constant attention to changing conditions and regularly updating plan designs. It means responding to an evolving market, adapting to public policy initiatives, and taking advantage of new medical developments. That’s why there are always changes for the Group Insurance Trust to announce during the annual open enrollment period. This year, with the passage of the Patient Protection and Affordable Care Act (“health care reform”) the number of changes are greater than usual and carry a more serious financial impact.

Following is an outline of the most important plan modifications subscribers will see this year. Some are in response to health care reform but not all.

Health Care Reform Mandates

Beginning January 1, every health plan must comply with the following provisions:

• All dependents up to age 26 are eligible for coverage
• No cost-sharing for in-network preventive services
• No pre-existing limitations for children under 19
• Prior authorization or higher cost-sharing disallowed for out-of-network emergency services
• New rules for appeals process
• Removal of lifetime maximum limits (copay and HSA plans)
• Removal of lifetime limits for hospice care (copay and HSA plans)
• Removal of annual limits on durable medical equipment (HMO plans)

Premium Rates

Naturally, all these mandated changes come at a price. Over the past seven years, the Group Insurance Trust has delivered single digit increases that were well below national and regional trends. However, a thorough analysis of the costs associated with these mandated benefits, plus unusually high claims experience in 2009, resulted in an increase to CalCPA ProtectPlus medical plan rates that is significantly higher than that of previous years.

Because each firm’s rates are based on a combination of factors, each firm’s increase is unique. Renewal packets, including rate information specific to each firm, were mailed to participating firms on November 1. If you did not receive your renewal package please contact Banyan Administrators, LLC at (877) 480-7923 immediately. (continue reading…)

—A Note from Susan Young, Executive Director of the Group Insurance Trust of the California Society of CPAs

In addition to the quality medical care and competitive prices members have come to expect, when you subscribe to a CalCPA-endorsed ProtectPlus health plan, you get the added benefit of an administrative support team whose sole purpose is to make your insurance dealings clear, easy, and responsive. This is never more critical than when you find yourself facing a denied claim. If this should happen, here are the steps you can take to get an explanation and, at least sometimes, a decision reversed.

Begin by calling the Anthem member service phone number on the back of your medical ID card. You should have your EOB (explanation of benefits) in hand so that you can ask why a particular treatment was either denied or only partially paid. If the answer isn’t clear, or you feel the claim wasn’t handled properly, your next step should be to call the ProtectPlus service representatives at Banyan Administrators at (877) 480-7923. Every member of the Banyan team is a licensed agent and is there to serve you. Moreover, they are your advocates. Their job is to make sure you get the care you need as smoothly as possible, so you shouldn’t feel shy about asking. This is what your insurance plan is all about.

If the Banyan agent doesn’t solve the problem to your satisfaction, Banyan can walk you through the Anthem appeals process. Appeals are handled slightly differently depending on whether they concern completed care, treatments in progress, or future procedures. Anthem will provide a written response within 30 business days with the results of its decision.

At this point most disputes are resolved, but if you are still not satisfied you have the final option of filing for an Independent Medical Review (IMR). The IMR is provided by the California Department of Insurance (DOI). There is no charge to you for this service and the DOI’s decision is binding. Simply complete and submit the one-page application to request a review. Anthem will provide the applicable medical records and claims documentation required by the DOI and you can add any pertinent information in support of your claim. The Department will inform you of its determination in approximately 30 business days following submission of the IMR request.           

Because the ProtectPlus program is a Multiple Employer Welfare Arrangement (MEWA), ProtectPlus plan participants must submit their IMR application to the Department of Insurance which oversees MEWAs. IMR requests for many other healthcare plans in California are reviewed by the Department of Managed Care.  You can download the IMR application at http://www.insurance.ca.gov/0100-consumers/0020-health-related.

Few individuals have given as much for as long to CalCPA or been as intimately associated with its growth as John Dodsworth. Actively engaged in committee work since he joined in 1972, Dodsworth was appointed Director of Business Operations for CalCPA in 1984, a position that included responsibility for the financial aspects of the organization, continuing education, and the insurance program. A few years later he led in the creation of CAMICO—where he served as Director from 1986 until his retirement in 2009—and in expanding the Group Insurance Trust. Today he continues to serve on the boards of both CAMICO and the Trust.

Curiously, his first step toward this distinguished career began with a college job in the mail room at Union Carbide in San Francisco, and among his duties was delivering mail to the internal audit department. “I got to know some of the employees,” he recounts, “and they encouraged me to look into accounting as a profession.” As a math major he felt an affinity to the work they were doing. He recognized that “math is the language of accounting,” and saw that accounting offered something practical to do with the math he was studying.

After finishing college and a stint in the army, he went to work for the public firm of John F. Forbes & Co. “They were big in professional association involvement,” he comments, and so he joined CalCPA and became active in committee work for the San Francisco Chapter, eventually chairing the Accounting and Auditing Committee. During those years he was working his way up at Forbes. He made partner in 1977 and then opened an office for the firm in San Jose in 1981. When his firm won the engagement as auditor for CalCPA, he learned how the organization functioned, and he got to know its then executive director, Jim Kurtz. (continue reading…)

A.M. Best Co., a global credit rating agency and the leading provider of information in the insurance industry, has once again renewed its B++ rating for the Group Insurance Trust. While affirming the performance of the Trust and its insurance offerings, the rating also offers subscribers the reassurance that an outside evaluator has recognized the program’s consistent financial stability. When determining a rating, Best examines every aspect of an insurer, including its operations, financial data, governance, plan design, claims, and many other factors. Moreover, the Group Insurance Trust maintains the distinction as the first Multiple Employer Welfare Arrangement in the nation to receive a Best rating.

In previous years the Group Insurance Trust has provided all firms participating in one or more of its group insurance plans with a printed copy of the Trust’s annual report. In order to reduce costs and the environmental impact of printing and mailing several thousand copies of the report, the Trust will no longer distribute a printed version. Instead, members may view the 2009 Annual Report of the Group Insurance Trust online by clicking here.  Comments or questions regarding the Annual Report may be directed to focus_editor@calcpa.org.

The Group Insurance Trust operates the CalCPA-endorsed health and welfare plans, including CPA ProtectPlus medical plans, Delta Dental and Vision Service Plans. The Trust is governed by 12 trustees, and each year four are elected for three-year terms.

In order to ensure that the Trust continues to be governed by dedicated, knowledgeable members, it is expanding its pool of qualified future trustee candidates. Several appointed committee member positions are available to CalCPA members who are currently participating in a ProtectPlus medical plan. Due to the complicated nature of the Trust, ideal candidates are from firms with 15 or more employees, who can be reasonably expected to remain in active practice and serve the Trust for many years. Candidates are appointed for a two-year term and may be reappointed for a second two-year term. Appointed committee members sit on committees of the Board and attend four committee meetings and one board meeting per year. Appointed committee members are eligible for the same level of employer reimbursement compensation as trustees, and all out-of-pocket expenses are reimbursed.

If you are interested in applying, please send your resume with a cover letter of introduction to: Susan Young, executive director, The Group Insurance Trust, 1235 Radio Road, Redwood City, CA 94065-1217.

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.

A new COBRA administrator is now in place for CalCPA-member firms with employees enrolled in the Group Insurance Trust’s medical, dental and vision plans. As subscribers are probably aware, at the beginning of 2010, Banyan Administrators, LLC replaced Seabury & Smith as administrator of the Trust’s group insurance plans. Seabury previously had provided COBRA and CalCOBRA administration to CalCPA plan members. However, with the administrative transition, the Trust found it necessary to contract with a secondary administrator for these services. After a lengthy search, the Trust engaged Infinisource, a leader in COBRA and CalCOBRA administration, to provide member firms with these specialized services.

Founded in 1986 to help employers and insurance professionals navigate complex benefit-related federal regulations, Infinisource has streamlined the complex and time-consuming procedures that all firms must adhere to. Benefit managers and individual members will be pleased to find that the new online tracking capacities now available through Infinisource will make it easier both to track payments and comply with regulations.

Administrative Procedures

Firms with an average of 20 or more employees in the previous calendar year, and, thus subject to COBRA, must contract directly with Infinisource. These firms may, however, choose to contract directly with another COBRA administrator or to self-administer these benefits. The Trust will, however, absorb the costs of administration for firms selecting Infinisource as their provider. The Trust contracts directly with Infinisource on behalf of its CalCOBRA firms (i.e., those with 2–19 employees). Whether employees qualify for COBRA or CalCOBRA, firm administrators should communicate all qualifying event information to Banyan Administrators. (continue reading…)