CalCPA ProtectPlus

January 2013

The Group Insurance Trust of the California Society of CPAs has helped California CPAs and their employees and families with health care insurance needs since 1959 and its operations have grown over the years. In 2012, the Trust offered self-insured medical, dental and vision plans and health savings arrangements with total premiums of approximately $50 million.

As we enter 2013, the Trust is watching developments on both the federal and state levels in health care reform. There has never been a time of greater uncertainty in the health care marketplace.

The Trust’s new CEO, Ron Lang, follows health care reform proposals closely and has identified a number of proposals that may affect the Trust and those it serves. His understanding of this complex subject is very impressive. He is backed in his efforts by our experienced staff and contractors and keeps the Board of Trustees up to date on developments. As proposals become more tangible, the Trust will continue to monitor developments and take appropriate actions.

December 2012 was a bitter sweet time for me personally since I retired at the end of the year as Chairman of the Board after 15 years in that role. I became Chairman of the Trust in 1997 right after finishing my term as President and Chairman of the Board of CalCPA. This month caps off over 30 years of leadership in CalCPA, including the last 15 with the Trust. I suspect I will miss it. Thank you for the opportunities you have provided to me.
The Trust is in good hands. The 12 CPAs who make up the Board of Trustees have experience with the Trust ranging from two to more than 40 years.

I wish you all good health and prosperity in 2013 and the years ahead.

Gale L. Case, CPA, CFE
Chairman of the Board
Group Insurance Trust of the
California Society of CPAs

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.

Losing a loved one is never easy, but for surviving family members, the loss can be even more overwhelming when faced with the loss of medical coverage. This is especially difficult for the surviving spouse and dependents of sole practitioners who are unlikely to qualify for COBRA or CalCOBRA. In order to provide some peace of mind to its members, ProtectPlus copay and HSA-eligible plans offer a unique benefit known as Rights of Survivorship to all ProtectPlus plan participants. Under Rights of Survivorship, the covered spouse and eligible dependents of a deceased plan member may retain their ProtectPlus medical coverage without going through underwriting. Survivor benefits begin after COBRA and CalCOBRA benefits have been exhausted, or if the surviving spouse does not qualify for COBRA or CalCOBRA, the extended coverage kicks in immediately.

Coverage continues until the earliest of the following events:

The date the individual(s) reaches age 65; b. The date the surviving spouse remarries; c. The date the individual(s) becomes covered under any other group health plan regardless of whether that coverage is less valuable; d. The date the individual(s) becomes entitled to Medicare; or e. The first of the month for which the surviving spouse or eligible child(ren) fails to make the required payment for the continuation coverage.

If you have any questions about the Rights of Survivorship benefit, or other questions about ProtectPlus copay and HSA plans, contact Banyan Administrators, managers for the CalCPA ProtectPlus programs, at (877) 480-7923.

Please note that Rights of Survivorship do not apply to Anthem Blue Cross HMO Participants.

We’ve been providing health and welfare benefits to California CPAs for over 50 years and we know how important it is for members to get fast, accurate answers to their health insurance questions. Now you can get answers even faster when you use the “Live Chat” feature on the www.cpaprotectplus.com website. CalCPA ProtectPlus strives to find new and better ways to make health insurance simple and understandable for CalCPA members. The addition of live chat is the perfect way to get help without picking up the phone!

Make sure to check it out! Look for this button on the top right of the website!

Here are some details about our new Live Chat feature:

• Chat is available M-F, 8:00 a.m. – 5:00 p.m. (PST)
• Chat online with the same Banyan representatives who have helped you in the past
• Fast response time
• Option to print transcript of chat
• No menu tree – you go straight to a representative that can help you

Pre-Existing Condition means an illness, injury or condition which existed during the six-month period immediately prior to either: (i) your effective date; or (ii) the first day of any waiting period, whichever is earlier. A condition is considered to have existed when you: (i) sought or received medical advice for that condition; (ii) received medical care or treatment for that condition; or (iii) received medical supplies, drugs or medicines for that condition.

To review more health care terms, click here to visit the ProtectPlus Medical Plan glossary.

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.

 by Doug Hessel

Most Americans are financially unprepared to endure a health problem that renders them incapable of working. Strangely, surveys on the subject show they actually know they are unprepared. Evidently there is a denial habit at work here intertwined with concerns about the cost of long-term disability (LTD) insurance.

It’s important to keep in mind when approaching the topic that while the probability of becoming disabled is small, the potential loss is extremely large. Self-insurance is not a reasonable option, and yet, most people don’t act in their own interests, or, equally problematic, when they do, they overreact. A 2005 study published by the National Bureau of Economic Research reports that when the typical consumer does confront the potential implications of a disabling condition, he or she is often willing to pay a premium that far exceeds the actual risk. If you share these denial and overreaction habits, here are some helpful facts and options to consider.

The good news for CPAs is that a fairly easy fix can be found close at hand. Relatively inexpensive individual and group LTD policies are available to CPAs and firms that can go a long way toward relieving the financial burden of not being able to earn a living due to a disabling condition. (continue reading…)

by Doug Hessel

Whether offered as an employee benefit through a group plan or purchased as an individual policy to help create a family safety net, long-term disability (LTD) insurance provides income when a policyholder suffers an injury or illness and can’t work. While most of us don’t believe, and can’t imagine, that we will ever need it, the value of such coverage is self-evident. Knowing it’s there certainly provides reassurance to policyholders and their families.

Like most things that seem self-evident, however, real life circumstances are often less than simple. If you’re in a coma, no one would suggest that you should come in to work anyway, but if you’re in pain, who decides if you’re in too much pain to work? Should your insurer take your word for it? Does it serve an insurance company to believe you, and if it disagrees, who is the final arbiter?

On September 9, the California state legislature unanimously passed SB 621 with the intent to take the ultimate decision-making authority for disability claims out of the hands of insurance companies and turn it over to the courts. The legislation is now awaiting the governor’s signature, which is considered almost certain. Originally authored by California’s new insurance commissioner Davey Jones when he was a state assemblyman, the bill continues many years of efforts to do away with “discretionary clauses” by which insurers reserve the right to make the final ruling on the legitimacy of disability claims.

For instance, you claim a back injury and your insurer decides that it is not disabling. At that point you appeal to your carrier. If they deny you again, and a discretionary clause is part of their policy, your options are extremely limited. Few courts would support your right to pursue a claim further. (continue reading…)

by Doug Hessel 

A popular feature in comprehensive benefits packages, long-term disability insurance provides replacement salaries for employees who suffer from an extended illness or injury. While many employers carry an inexpensive group LTD plan as a matter of course, only some take advantage of an IRS ruling that would allow disabled employees to receive their disability income tax free. This failure can prove costly for employees and represents a lost opportunity for savings by employers as well.

Maximizing Benefits

The IRS ruling in question (Revenue Ruling 2004-55) clarifies the distinction between before-tax and after-tax benefits as it applies to disability income, and it provides a mechanism for distinguishing between them. Simply stated, if an employer pays 100 percent of an employee’s premium, the salary replacement benefits to the employee are taxable. Conversely, if the employer increases an employee’s pay to cover the cost of LTD and then deducts the premium from the employee’s check, the benefits are tax free.

Of course, this change means that the employer and employee incur some extra expenses—an increased salary will mean increased FICA, SDI, and so forth—but these are relatively small expenses. Consider the difference in benefits. An employee who is earning $60,000 a year and is covered by an employer-paid LTD plan offering a two-thirds salary replacement, will receive $3,350 a month if disabled. Assuming he or she has a 16 percent effective tax rate, that net replacement salary is reduced to $2,814. That’s a cost of more than $500 a month as opposed to the few dollars a month that employer and employee would have paid in compensation-based taxes.

Moreover, employers who are looking for savings should note that a less expensive after-tax LTD plan—providing only 60 percent salary replacement rather than the two-thirds given in the example above—would net the employee $3,000 per month, an improvement of almost $200 a month. In other words, by offering the LTD as an after-tax benefit, employers can provide employees with larger benefits with less coverage and pay smaller premiums (as much as 20 percent with some carriers). The cliché of a win-win situation has rarely been so applicable.

Avoiding the Three-Year Look-Back Rule

If your firm is paying LTD premiums in pre-tax dollars and is ready to change, be sure to take advantage of a mechanism provided in IRS Ruling 2004-55 that allows benefits to be tax free from day one.

Ordinarily, the IRS applies a three-year look-back rule that considers benefits taxable in the proportion that they were paid for by before-tax premiums over the last three years. However, the IRS has provided a method that allows employees to qualify for tax-free benefits immediately after the change is made to paying with after-tax dollars. The workaround requires specific amendments to the plan description and a modified enrollment form that allows employees to elect for after-tax payment of the LTD insurance. (See below for information on obtaining sample forms.)

Employees can decide on an individual basis whether they want to have their LTD paid for in pre- or after-tax dollars, so firms can implement the program for employees who want to take advantage of this opportunity without forcing others to make any change in the way they have traditionally received benefits.

Doug Hessel is Program Director, CalCPA ProtectPlus Ancillary Products at Hover Insurance Services. For further information and sample forms email dhessel@hoverinsurance.com

Health Savings Account (HSA) – is a special tax-sheltered savings account that is similar to a traditional Individual Retirement Account (IRA), but designated for medical expenses. An HSA allows you to pay for current health expenses and save for future qualified medical and retiree health care expenses on a tax-free basis. Contributions, earnings, and distributions all are exempt from federal income and Social Security (FICA) taxes when used to pay for qualified medical expenses.

Banyan Administrators continue to provide us with beneficial information about several different aspects of the Health Care Reform and how it affects us as well as other interesting health care facts. 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 from Banyan Administrators, LLC:

Despite Potential PPACA Problems on the Horizon…HSA Enrollment Continues to Rise

Since health savings accounts (HSAs) were first authorized in January of 2004 as a tax-advantaged portal for medical savings, America’s Health Insurance Plans (AHIP), which is a trade association representing the health insurance industry, has conducted an annual survey of the HSA market. According the 2011 AHIP survey, HSA plan enrollment in the United States has almost doubled over the last three years, going from 6.1 million participants in 2008 to 11.4 million participants in 2011. From 2010 to 2011, the number of Americans covered by HSAs linked to high-deductible plans (HDHPs) increased by 14%.

Other key findings from the AHIP survey are:

• Large-group coverage was the fastest growing market for HSA plans between 2010 and 2011, with a growth of 26%.

• Individual market coverage was the second fastest growing market for HSA plans, with a growth of 15%.

• Over 6.3 million individuals were enrolled in HSA plans in the large-group market.

• Around 2.8 million individuals were enrolled in HSA plans in the small-group market.

• Approximately 2.4 million individuals were enrolled in HSA plans in the individual market.

The Impact Of The Patient Protection and Affordable Care Act On HSAs

As it relates to HSA plans, AHIP has noted that some of the provisions in the Patient Protection and Affordable Care Act (PPACA) could create some potential unintended consequences that might disrupt, if not limit, the availability of HSA plan coverage. Three of the main problems noted by AHIP include:

1. Medical loss ratio regulation.

This requires an insurer to spend 80% or more of a consumer’s premiums on direct, non-administrative patient care and improvements to such care’s quality. AHIP asserts that medical loss ratio regulations will be especially problematic for HSA-eligible HDHPs. Participating in a qualified HDHP is a requirement to participate in an HSA. HDHPs provide individuals with a low-premium, high-deductible alternative to traditional health plans. These plans might have lower benefit costs, but they certainly aren’t always cheaper to administer from a per-enrollee standpoint. As a result, they may naturally have lower medical loss ratios. (continue reading…)

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…)

The following information is from The ACS|BNY Mellon HSA Solution:

On May 1, 2011, The ACS|BNY Mellon HSA Solution “The HSA Solution” will offer a way for account holders to create and send one-time or recurring payments from their HSA ─ on demand ─ in five easy steps. 

Below we have put together a few of the Frequently Asked Questions (FAQs) regarding our Direct Pay HSA service:

How will account holders access the new Direct Pay HSA functionality?  

Account holders will be able to click on a “Direct Pay HSA” tab along the top navigation bar from their ACS|BNY Mellon HSA Solution Account Summary page; then click on “Access Direct Pay HSA”.

What are the necessary steps to create a payment request?

There are five basic steps to creating a payment online using Direct Pay HSA:

• Step #1: Click on the “Direct Pay HSA” tab from the Account Summary page
• Step #2: Click on “Access Direct Pay HSA”
• Step #3: Select “New Transaction” on the Direct Pay HSA home page
• Step #4: Click on “Send a Payment” and complete the payment information
• Step #5: Review and “Submit” the payment request for processing

What information will account holders need to know in order to create a payment using Direct Pay HSA?

• Payment amount
• Issue date
• Payee’s name
• Payee’s address including street address, city, state and ZIP code

Is there a charge to the account holder for creating a payment online using Direct Pay HSA?

Account holders do not incur transaction or postage fees with any payments they create using Direct Pay HSA.

What if I have additional questions?

The following training materials will be located on the “Direct Pay HSA” tab:

• Direct Pay HSA Frequently Asked Questions (FAQs)
• Direct Pay HSA flyer
• Direct Pay HSA online educational video

We thank you for your business and the opportunity to serve you!

The ACS|BNY Mellon HSA Solution

[Information Source] [Email Blast to Health Plans]

The following information is from The ACS|BNY Mellon HSA Solution. We hope you find it beneficial.

Combined tax forms 1099-SA and 5498-SA were mailed to The ACS|BNY Mellon HSA Solution account holders on January 29, 2011. The information on these forms will be submitted to the IRS. Account holders receive these combined tax forms for their records only. Account holders use the information on these forms to complete IRS Form 8889.  The 1099-SA and 5498-SA forms do not need to be attached to the account holder’s tax return.

Tax form 5498-SA: This form reports contributions made to an account holder’s Health Savings Account (HSA) by the account holder or by an eligible individual on the account holder’s behalf, as well as contributions made by their employer, if applicable. The IRS requires The ACS|BNY Mellon HSA Solution to issue form 5498-SA to every account holder who had any contribution activity in their HSA during the previous tax year (2010). Account holders can access this form by logging into their HSA account; click on the “Account Holders Services” tab then “View Tax Forms”.

Note: If an account holder makes a prior year (2010) contribution by April 18, 2011 they will receive an amended 5498-SA in May.

Tax form 1099-SA: This form reports distributions made from an account holder’s HSA. The IRS requires The ACS|BNY Mellon HSA Solution to issue Form 1099-SA if account holders took a distribution from their HSA during the previous tax year (2010). Account holders can also access this form by logging into their HSA account; click on “Account Holders Services” then “View Tax Forms”.

IRS form 8889: Account holders must obtain, complete and file IRS Form 8889 as part of the federal tax filing by April 18, 2011. It is downloadable from www.irs.gov or account holders can log into their HSA account and click on the “Account Holder Services” tab; then click “Useful Links”; then “Form 8889″. If both spouses have an HSA, then two forms are required (one for each account).

Additional HSA tax resources are available!

• Two online tax educational programs are now available. You may either click on the “watch video” links below or access the tax programs on our Web site at hsamember.com; click on the “Tools” section in the middle of the home page or by clicking on the “Resources” tab in the upper right corner of the home page.
   
  It’s Tax Time:
  Need tax filing information for HSAs?

Tax Guidelines for HSAs  Watch video
Information on HSA tax forms  Watch video

• Employers can log on to the hsamember.com Web site using their employer ID and view additional tax information in a presentation specifically designed for employers. To access this presentation, click on the “Reports” tab; then click on the PDF labeled “Tax Information for Employers”.

Do you have additional HSA tax questions?

For additional HSA tax questions, call the Employer Support Team at 866-712-4551, Monday through Friday, 8:00 a.m. to 8:00 p.m., Eastern time.
  

[Information Source, Image Source] 

Fluoride in drinking water has been one of the most successful ways to help prevent tooth decay in children during the 20^th century…so we thought. On January 7^th, the U.S. Department of Health and Human Services announced plans to lower the recommended level of fluoride in drinking water for the first time in nearly 50 years. These recommended levels have been reviewed by federal health officials and they say that many Americans are getting too much fluoride which is causing white marks on children’s teeth – a condition called fluorosis.

Not only are most children getting fluoride in their drinking water, but they are also getting it from toothpaste, mouthwash and some kids are even getting regular fluoride treatments when they have their teeth cleaned by their dentist.

In the report released last Friday by the Department of Health and Human Services, it was recommended to change the level of fluoride per liter of water to 0.7 milligrams which would replace the standard range since 1962 of 0.7 to 1.2 milligrams per liter.

Many parents may become concerned by this report, since we have all been told over the past years to let our children drink our tap water because of the health benefits of the fluoride. Now we will need to wait and see what further information the HHS comes back to us with by spring 2011 when they are expected to publish their final community water fluoridation report.

To read the full report from the HHS, click here. Also, for more information about fluorosis and young children’s intake of fluoride, check out this link from Delta Dental.

[Information Source]

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.

A powerful new tool recently added to the Anthem Online Services website now allows ProtectPlus subscribers to locate treatment facilities, compare prices and get other indicators about the expertise of the facility in a specific area of medicine. Though simple in use and appearance, this new function actually makes real a longstanding but elusive promise of modern healthcare—comparison shopping for medical services. With this information in hand, you can now decide whether one treatment facility is worth a lot more money than another and whether you are willing to go farther to save a little or a lot.

You can access these new tools by logging onto the Anthem Blue Cross website directly (www.anthem.com) or you can click through from the ProtectPlus site (www.cpaprotectplus.com). If you take the latter route, choose “Plan Members” then go to “My Plans” and click on “ProtectPlus (Anthem Blue Cross).” Please note that Anthem recently completed a major re-design of its website and you will be instructed to register, or re-register if you had an account on the earlier website, before accessing your account information. Once on your Anthem personal Account Summary page you will find several icons that you can click and drag onto your personal menu to customize your page.

Click on the “Facility Cost and Quality” icon to open the Anthem Care Comparison page. Once there click on “find a facility for a procedure or condition.” A drop-down list provides categories of treatment (e.g. cancer, lungs, orthopedic, or pediatric conditions). When you have chosen a category you can then choose from another list of procedures and diagnoses. You then put in your city or zip and the distance you are willing to travel. (continue reading…)

A group of new discount programs plus some important changes in two longstanding programs will begin delivering noticeable savings to many CalCPA members beginning October 1.

The first of these changes involves a new carrier for group life and long-term disability (LTD) insurance with lower rates and improved service. The second features a broad range of new options for purchasing individual life insurance and LTD policies that will make comparison shopping easier. Both of these changes have been negotiated through the combined efforts of the Group Insurance Trust, CalCPA management, and Hover Insurance Services, Inc. of Santa Rosa. Hover, a new provider to the Trust and CalCPA, will also be responsible for portions of program management. The third and final piece in this series of initiatives is a new money-saving discount program offered through CalCPA’s Affinity and Value Added Benefits Programs.

Group Life and LTD

Effective October 1, the Trust’s group life and LTD plans will move from The Hartford to Lincoln Financial Group. The switchover is automatic for currently enrolled firms. More good news will show up in the form of reduced premiums, which will vary according to firm size. In addition, billing for these policies will change from the current quarterly period to monthly. This means it will be easier to add new hires as they become eligible and to remove terminated employees without having to pay for a full quarter. You can keep your quarterly payment schedule, if you prefer, by simply paying for three months at a time. The credit will be applied to future invoices. If you have other insurance benefits through the Group Insurance Trust, you will have the added convenience of consolidated billing for all of your Trust policies.

In addition to the money savings and convenience offered by the Lincoln Financial group plans, the group life and LTD plans also come with valuable program enhancements. The group life plan features TravelConnect, offering a wide variety of travel-related services, and BeneficiaryConnect, with free grief counseling, memorial planning help, and other relevant services. EmployeeConnect, offered to those in the group LTD plan, is a confidential support program with in-person, phone, or online guidance and counseling. (continue reading…)

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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