CalCPA ProtectPlus

COBRA

means the medical plan related provisions of the Consolidated Budget Reconciliation Act of 1985, as such provisions have been subsequently amended.

COBRA Administrator

means a COBRA participating employer or third party (not the Trustees or the plan administrator) appointed by the COBRA participating employer to act as the COBRA Administrator.

This article is a continuation of The Brown & Toland Medical Group in San Francisco will no longer be a part of UCSF’s Provider Network, Part 1 Published October 1st, 2009.

What if a member doesn’t want to change medical groups and prefers to select a new PCP within Brown & Toland Medical Group?

Members who choose to select another primary care physician within Brown & Toland Medical Group, or any other medical group within their service area, can use Provider Finder on anthem.com/ca to locate a new physician.  Members who need assistance in selecting a different PCP and/or medical group are encouraged to call Anthem Blue Cross’ Customer Service department at the toll-free number listed on their ID card.  Once the member knows  the PCP they would like to be reassigned to, they need to contact Customer Service at the toll-free number on their Anthem Blue Cross membership card prior to December 31, 2009 and provide information regarding their new selection in order to be reassigned.

Will HMO members who remain with their UCSF Medical Group primary care physicians (by switching to Hill Physicians Medical Group on January 1, 2010) still have access to the same specialty care physicians (orthopedics, cardiologists, surgeons, oncologists, etc.) who were available through Brown & Toland Medical Group?

Possibly.  Many specialty care physicians are members of both Brown & Toland Medical Group and Hill Physicians Medical Group, but it is important for each individual member to confirm that the specialty care physician(s) they see regularly are also part of Hill Physicians Medical Group network. (continue reading…)

These tips are provided by “We Connect”

Consider COBRA (but act fast)
If you lose job-based coverage, you only have a short window to make decisions that affect your health insurance options. The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) and state law (Cal-COBRA) give workers and their families the right to continue group health benefits for at least 18 months, but only if they enroll within 60 days of losing their health coverage.

The Federal Government May Partially Offset the Cost
Usually, you’d have to pay your premium share, your former employer’s share, and an administrative charge to keep coverage under COBRA or Cal-COBRA. But if you lost job-based coverage after September 2008, the federal government will pay 65 percent of the cost of COBRA continuation coverage through December 2009.
Get Connected

Local Community Health Centers and Clinics Can Help
If you can’t afford or qualify for coverage, care is available through community health centers and other safety-net providers, which are located in most California communities.
Get Connected to locate a clinic near you. (continue reading…)

UCSF Medical Group and Hill Physicians Medical Group formed a new contractual affiliation to serve the healthcare needs of HMO members whose primary care physician (PCP) is based in the San Francisco area. This new healthcare option becomes effective January 1, 2010.

UCSF Medical Center and UCSF Children’s Hospital will be in both Hill Physicians Medical Group and Brown & Toland Medical Group’s networks after January 1, 2010.

After January 1, 2010, only Hill Physicians Medical Group will market and have UCSF primary care physicians in their network. On that date, Brown & Toland Medical Group will no longer offer UCSF primary care physicians in their network and will begin a ‘referral-only’ type relationship with the specialists at UCSF Medical Group and UCSF Medical Center. All access to UCSF services for Brown & Toland members, will require prior authorization and administrative review. (continue reading…)

Medicare Secondary Payer (MSP) Reporting May 2009 Update, see UPDATES post for more information.

FREQUENTLY ASKED QUESTIONS

Q: What’s changing?
A: Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 replaces the voluntary data exchange agreement (VDEA) in which Anthem Blue Cross (Anthem) currently participates. Section 111 removes the voluntary label associated with the VDEA by requiring participation via the MSP reporting initiative. Mandatory participation for group health plan (GHP) enrollees coupled with requirements for social security numbers (SSN), group tax identification numbers (TIN), employer group size and penalties for noncompliance comprise the majority of the mandate.

Q: What is “MSP”?
A: “MSP” refers to “Medicare Secondary Payer.” According to Medicare law, there are situations in which another payer — primarily an insurance company or self-funded group health plan — must pay first (primary) for services rendered to a Medicare beneficiary before Medicare pays as “secondary”. The purpose of the law is to save Medicare money, since it will enable the Centers for Medicare and Medicaid Services (CMS) to pay claims accurately the first time by determining primary versus secondary payer responsibilities. When Medicare is “secondary payer,” it will only pay after the member’s “primary” payment has been exhausted or if it does not exist. (continue reading…)

The American Recovery and Reinvestment Act of 2009 (ARRA), signed into law in February, offers significant health insurance benefits to all those who are involuntarily terminated from a job between September 1, 2008 and December 31, 2009.

If you lose or have lost work during this period, you need to know about these provisions because they can save you money. Keep in mind, however, that if you voluntarily quit your job you don’t qualify. Moreover, individuals who were fired for negligence or misconduct don’t qualify either.

If you are an employer and let employees go during these 15 months, new rules under this law require action on your part. Among its many features, ARRA provides federal subsides that reduce premiums for nine months of COBRA or Cal-COBRA coverage.

During this nine-month period eligible individuals (and their qualified beneficiaries) are responsible for only 35 percent of their premiums. For COBRA recipients the remaining 65 percent must be paid by their former employer, while for Cal-COBRA recipients, the 65 percent portion must be paid by the insurer. Employer and insurer payments, however, are fully reimbursable through a tax credit.

Another provision of the new law allows COBRA recipients to switch their health coverage to a less expensive policy if that policy is available to all active employees of their former company.

Under the previous law, an eligible employee could only elect to continue coverage under the policy they had at the time they were terminated. To comply with ARRA, employers must amend their existing COBRA notice forms and distribute additional notices that include information about these benefits. (continue reading…)

ACS Announces ACS|Mellon HSA Solution Interest Rate Adjustment

The current economic climate and continued downward pressure on interest rates have made it necessary to decrease the interest rate we pay HSA account holders on the demand deposit checking account.

Effective July 1, 2009, the interest rate paid on our standard HSA product will be (APY) 0.100%.

While the reality of the current economic climate requires this action, we will continue to closely monitor interest rates and make responsive adjustments to our product.

This interest rate change will be reflected on the July HSA statements sent to all ACS|Mellon HSA Solution account holders in early August.

This is Part 3, of a three part article.  For Part 2, see Employers, What You Need to Know About the Federal Stimulus Package: Part 2.

This article was written by Connie Chuang and Gage C. Dungy, attorneys with the labor and employment law firm of Liebert Cassidy Whitmore.

In the beginning, some covered individuals may not become aware of the new federal subsidy and therefore continue to overpay their COBRA/Cal-COBRA premiums by paying the full premium amount.  In order to reimburse the covered employee in this situation, employers will have an initial choice of either providing a refund or a credit to be used against future premium  payments.  The credit option is only available if it is expected that the full credit will be used by the individual within 180 days of the date the full COBRA premium amount was paid. (continue reading…)

This is Part 2, of a three part article.  For Part 1, an introduction, see Employers, What You Need to Know About the Federal Stimulus Package: Part 1.

This article was written by Connie Chuang and Gage C. Dungy, attorneys with the labor and employment law firm of Liebert Cassidy Whitmore.

Qualified Individuals on COBRA/Cal-COBRA Can Now Receive a 65% Federal  Subsidy for Health Insurance Premiums for up to Nine Months.

Employees who were involuntarily terminated between September 1, 2008, through December 31, 2009, will be eligible for a 65% federal subsidy of their COBRA/Cal-COBRA health insurance premium payments.

For example, an employee who normally pays $1000/month in health insurance premiums under COBRA/Cal-COBRA, would only be required to pay $350/month (35%) because the other $650 (65%) would be covered by this federal subsidy.

The federal subsidy ends after one of the following circumstances occurs (whichever comes first):

• Nine months after the first receipt of the subsidy;
• The employee becomes eligible for coverage on another employer’s plan (or Medicare); or
• The maximum period of COBRA/Cal-COBRA coverage ends.

The subsidy plan became effective on the day the federal stimulus package was signed into law.  However, for individuals whose health insurance premium payments are paid on a monthly basis, the plan becomes effective on March 1, 2009.  Although the time period for qualification dates back to September 1, 2008, the federal subsidy does not apply retroactively before the effective date of the law. (continue reading…)

This article was written by Connie Chuang and Gage C. Dungy, attorneys with the labor and employment law firm of Liebert Cassidy Whitmore.

The Federal Stimulus Package Incorporates New Temporary Revisions to COBRA/Cal-COBRA, Including a Federal Subsidy for Qualified Individuals.

Federal law (COBRA – employers with 20 or more employees) and California law (Cal-COBRA – employers with 2-19 employees) provide individuals who have experienced a “qualifying event” the ability to continue their health insurance benefits for a period of up to 36 months by having the covered individual pay up to 102% of the full health insurance premium cost.

A “qualifying event” under COBRA/Cal-COBRA includes, among other reasons, voluntary termination of employment, involuntary termination of employment (except for gross misconduct), and a reduction in hours resulting in a loss of health benefits.

On February 17, 2009, President Barack Obama signed into law a federal stimulus package – also known as the “American Recovery and Reinvestment Act of 2009” – (or, visit Recovery.gov)in an attempt to address the current economic downturn in the United States. (continue reading…)

Hospital Facilities:

(continue reading…)

If You Continue to Work Past 65
For those who continue working beyond the age of 65, whether solo CPAs or in firms of fewer than 20 employees, the Group Insurance Trust strongly recommends subscribing to Medicare Parts B and D and purchasing a Medigap policy. Since Medicare will be your primary payer of claims, you will receive few if any benefits from retaining your group coverage.

However, if you are employed at a firm with more than 20 employees, the opposite generally holds true. Since your group plan qualifies as the primary payer, and thus is billed before Medicare, you should retain your group coverage. In this circumstance, you can also delay purchasing any optional Medicare and Medigap plans until you do finally retire. If your spouse has been covered on your group plan and you continue working, then for solo practitioners with ProtectPlus, the choice is simple. (continue reading…)

If You Retire at Age 65 For most people who retire on their 65th birthday, there are a set of choices to be made. Assuming you have contributed the minimum amount to qualify for Social Security, you will automatically receive hospitalization coverage under Medicare Part A.

Other medical expenses, such as doctors’ fees are covered under Medicare Part B. And though optional, subscribing to Medicare Part B is universally recommended.

The small premium for this coverage is automatically deducted from your Social Security payment, or will be billed to you if you have opted to delay collecting benefits. In addition to Medicare Parts A and B, the Social Security system gives you the opportunity to subscribe to prescription drug coverage under Medicare Part D. The complicated nature of this coverage has by now been well documented, so you should be sure to budget adequate time to determine the policy that will serve you best. (continue reading…)

(Originally published by Anthem Blue Cross April 24,2009)

The new CalCOBRA legislation, California Assembly Bill 23, is expected to be signed by the Governor by the end of this week. This bill will align the current CalCOBRA legislation with the Federal Subsidy as defined by ARRA (American Recovery and Reinvestment Act). The following are high-level details you should be aware of:

• This bill states that health plans and health insurers have 14 days from the date of enactment to provide proper notification to those individuals who may qualify for the Cal-COBRA subsidy. The Department of Labor (“DOL”) has agreed that the timeliness within which the state mini-COBRA programs must comply is to be determined by the states themselves. The DOL held a call with the California Department of Insurance (“CDI”) and the Department of Managed Health Care (“DMHC”) to assure this is understood by all three regulators.
• The mailing will go out to all individuals who had a qualifying event between Sept. 1, 2008, to the present, regardless of whether or not they had already elected CalCOBRA.
• The bill (AB23) currently states that California residents who were involuntarily terminated from their jobs between Sept. 1, 2008, and the present will qualify for the Cal-COBRA special election period.
• There is a notice letter being developed by Anthem in conjunction with the California Association of Health Plans (“CAHP”) and other health plans in this state. Once finalized, this notice will be deemed approved by both the CDI and DMHC. Anthem will send the notice as soon as possible following the enactment of AB 23.
• Once the bill is finalized and signed into law, Anthem will share a more detailed summary of the specific provisions of this law.

To continue reading “In the Interim“

Claims Procedures

Whether you have received treatment abroad in a hospital, clinic or doctor’s office, or filled a prescription, be sure to save your receipts. Also, try to get the doctor’s, or hospital’s, write-up in English. Anthem Blue Cross provides translation services, but having information about your treatment in English will speed your claim.

In addition, if you pay by credit card, the billing will be in dollars, making the process of reimbursement both simpler and at a better exchange rate.

Similar procedures apply for Delta Dental as well, plus Delta will make allowances for out-of-network treatment when abroad. When you return home, you can use the standard claims forms to get reimbursed.

Understanding the Medicare system that serves as the primary health insurer for almost everyone in this country who is 65 or older is vital in planning your health insurance needs. If you are approaching that age, you should start familiarizing yourself with the system before you retire.

You need to know how various parts of Medicare work, how they relate to the supplemental insurance policies (Medigap) and how they interact with your workplace group insurance plan.

In addition, understanding the relationship between Medicare and your group health policy becomes more important and more complicated if your spouse is covered under your plan at work. HIPAA, COBRA and CalCOBRA provisions may determine the availability of his or her coverage. (continue reading…)

It’s a haunting fear that most of us share in one form or another: You step off the curb in a foreign city, trip, and a sharp pain shoots up from your ankle. It might be broken. In another version, you’re enjoying a Caribbean cruise, and suddenly you have a high fever and feel nauseated. It could be something you ate or the flu, or it might be appendicitis. There are other scenarios too: you leave your carry-on bag with your prescription medicines in the taxi in Melbourne, or you crack a tooth chewing the ice in your drink in Puerto Vallarta.

All these scenarios share a common element—you’re abroad and you need medical help. Fortunately, friendly people guide you to the help you need. In addition, you are able to pay your bills with a credit card or a pile of traveler’s checks, or you arrange a wire transfer of funds from your bank. But now, you have a whole new set of concerns and questions: (continue reading…)