CalCPA ProtectPlus

November 1^st through December 17^th marks open enrollment at CalCPA’s Group Insurance Trust. The Trust offers 12 medical plans that give firms the ability to fine tune their employee benefits via different levels of deductibles, co-pays, and premiums.

For firms already participating in the ProtectPlus program, the annual open enrollment period is the time to make important changes. Firms can add, delete or change plans, change the waiting period for new hires and change the number of hours required to qualify for benefits. This is also the time for employees who had previously waived coverage for themselves or their dependents to enroll. Open enrollment is the only time of year when firms can elect dental coverage, unless it is purchased at the same time the firm initially purchases a CPA ProtectPlus medical plan.

Starting November 1^st, make sure to visit the CalCPA ProtectPlus website to get all the details about open enrollment. On the website you can view the video presentations that summarize each plan. You also can get quotes based on the demographics of your firm by using the “Get a Quote Tool” and if you have questions, you can click on the “Ask the Expert” link and submit your question to Trust staff.

CalCPA ProtectPlus. Trusted Healthcare Plans for CPAs.

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.

Most people are used to reviewing their health insurance coverage and needs on an annual basis during their open enrollment period. After all, this is the one time during the year they are free to make changes in their health coverage to reflect changes in their lives. It may be they want to increase benefits or, conversely, opt for lower premiums. Or, not uncommonly in the current economic climate, they might want to add a dependent child to their plan who has moved back home after college. Under new health care regulations, some may even be adding an uninsured adult child under the age of 26.

Life Events

Beyond the options offered by the annual open enrollment period, health insurance subscribers may be unaware that a number of significant life events—a marriage or divorce, loss of eligibility under another plan, a child’s birth or adoption or placement for adoption—can also trigger a “special enrollment” opportunity outside their annual open enrollment period. This special enrollment window applies only to the individual(s) and event in question and can’t be used to make other plan changes.

Newly Acquired Dependents

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), coverage for a newborn child begins on the day of birth. You can also add coverage for a child while in the process of adoption once you have assumed full or partial financial responsibility for the child. In either case, you must notify the insurer within 30 days.

Coverage of a new spouse begins the first day of the month following the enrollment request. Covered individuals must notify insurers within 30 days to attain coverage for a new spouse. As with any new plan member, those individuals over age 19 who are eligible for a special enrollment period may be subject to preexisting condition exclusions, but prior creditable coverage can reduce or eliminate the exclusion period.

Loss of Other Coverage

Another sort of special enrollment opportunity arises when an employee who previously declined coverage through an employer’s group plan loses coverage from another source. This situation can arise because of a divorce or legal separation, the death of a spouse, or the loss of insurance through a spouse’s job loss. Under these circumstances employees can enroll in an offered plan under the same terms as any new employee. The employee can also apply for coverage of his or her spouse and dependents.

There are, however, some very important conditions to keep in mind. The employee must request enrollment within 30 days of loss of coverage and must have officially waived coverage at the time it was offered. Both employers and employees should keep the latter in mind because health plans have the right to require a copy of the waiver the employee signed when coverage was originally declined. An employee who hasn’t completed and signed a waiver of benefits may not qualify for a special enrollment opportunity later. Additionally, the California Health and Safety code requires employers to provide notice to employees of this requirement and the potential consequences of failing to complete the waiver.

As trusted financial advisors to millions of Californians, CPAs are in a position to know if their clients have uninsured children under the age of 19. According to a new state law (AB 2244) that took effect January 1, an important open enrollment window for obtaining individual insurance closes March 1. Applying for a child’s health insurance after that exposes families to much higher premiums.

While missing the window doesn’t mean children can’t be covered at a later date—they can enroll during their birthday month—but their premiums will be higher.

Authored by Assemblyman Mike Feuer, AB 2244 passed in response to the decision by California insurers late last year to stop selling individual policies to children under 19 years of age and was written as a defensive measure against insurance industry attempts to circumvent provisions in the federal health reform law.

Also keep in mind that the opportunity for parents to obtain individual coverage without regard to a child’s health status is here. Pre-existing condition clauses are no longer allowed. Low-income families may have good choices through Medi-Cal or the Healthy Families program. Information is available at 1-877-KIDS NOW.

While the new legislation doesn’t directly affect employer-based group plans, it is a good idea for employed parents to ask if their children under 19 can enroll and at what cost.

The California Department of Insurance has created a web page that explains how to take advantage of this time-limited opportunity. The message is: Act now to save money before the window closes on March 1 and premiums are raised.

Insurance Insider guest blog from Doug Hessel, CalCPA Protectplus Program Director, Ancillary Products at Hover Insurance Services – dhessel@hoverinsurance.com, (800) 805-9480, ext. 4

Disclaimer: Internal Revenue Service Circular 230 Disclosure

Please note that any discussion of or advice regarding United States or State of California tax matters contained herein (including any attachments hereto) does not meet the requirements necessary to be a “covered opinion” as defined in Internal Revenue Service Circular 230, and therefore, is not intended or written to be relied upon or used and cannot be relied upon or used for the purpose of avoiding federal or state tax penalties that may be imposed or for the purpose of promoting, marketing, or recommending any tax-related matters or advice to another party.

The following information is from www.healthcare.gov and is by Donald Berwick, MD, Administrator of the Centers for Medicare and Medicaid Services.

Today, November 15, Medicare’s Open Enrollment period begins, and runs it runs through December 31. Open Enrollment offers people with Medicare—-including those with Original Medicare—an opportunity to review their current health and prescription drug coverage; compare health and drug plan options available in their area, and choose coverage that best meets their needs.

Although this is an annual event, this year is an especially important time for people with Medicare to take advantage of the Open Enrollment period. The Affordable Care Act provides new benefits to most people with Medicare in 2011, including:

• A 50% discount on covered brand name drugs if you hit the prescription drug ‘donut hole,’
• A free annual wellness visit, and
• No co-pays for recommended preventive services

If you or someone you love has Medicare, checking out some options during Open Enrollment may result greater savings or even better coverage than you have this year.

For assistance during Open Enrollment, visit www.medicare.gov, consult your 2011 Medicare & You Handbook, or call 1-800-MEDICARE. You can also get one-on-one counseling assistance from your local State Health Insurance Assistance Program (SHIP).

Here at the Centers for Medicare and Medicaid Services (CMS), we are working hard each and every day to ensure that Medicare stays strong, and that people with Medicare have access to quality, affordable care. We encourage all seniors and people with disabilities in the program, to look at their current coverage, compare it to the options available, and decide which coverage best meets their needs during this Open Enrollment period.

Note: Remember—protect your personal information—don’t give out your Medicare number to anyone who arrives at your home uninvited, calls you and asks for it, or offers you free equipment or services in exchange for your Medicare number. Guard your Social Security and Medicare numbers like you would your credit cards. (Visit stopmedicarefraud.gov for more information.)

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