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.

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.
  

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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.

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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…)

The VSP Member Vision Card has been updated and can be found on the VSP website.  The Member Vision Card replaces the current generic Member Reference Card found on the website. VSP’s enhanced Member Vision Card is perfect for those of us that would like our vision insurance card in our wallet to remind us of important information regarding our vision plan!

The purpose of the card is to reduce vision benefit questions you may have and it contains personalized information, such as:

• Member name
• Coverage type (i.e., Member Only, Family, etc)
• Client ID number
• Doctor network name
• Co-pays

Since the card is personalized, only members can log in and print their own card. This enhanced card is a convenience for members and is not required when you visit your eye doctor for an exam.

Protected Health Information (PHI), such as the member ID number and date of birth, is not included on the card because if it was, members would be put at risk of identity theft if the card were to be lost or stolen. VSP is committed to protecting the privacy and security of their members and their information.

Log on now to print out your enhanced Member Vision Card! Log in to to VSP, or create a new account if you don’t have one already. Under “My Benefits” go to “Benefit Resources” and click on “Member Vision Card”. You will be asked to confirm your state of residence and once you do that, your card will appear and will be ready to print!

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

Following is important information from ACS |BNY Mellon HSA Solution:

Protect our environment, go paperless. At ACS|BNY Mellon HSA Solution, we would like to do our part to protect the environment by reducing the amount of printed material we generate.

 If you are not already viewing your periodic HSA statement online; please “turn paper off” by following the four steps outlined below:

 Logon to your HSA Web site

• Select “Update Account Profile” on the left side of the screen
• Click on “Edit” under “Your Statement Delivery Option”
• Click on “Agree” to acknowledge and accept the terms

Beginning in September, any account holder receiving a paper HSA statement will be charged $0.75 each time one is generated.

A customer service enhancement for our account holders. Effective July 19, 2010, you will be able to log on to your HSA Web site or call the HSA Solution Contact Center and update your personal data (i.e., residential address, mailing address, e-mail address, and phone number). We will no longer accept personal data changes from another source.  We have changed the process to allow for direct owner­ship of personal information by the account owner.

HSA limits stay the same for 2011. For calendar year 2011, the maximum HSA contribution that can be made is $3,050 for employee-only coverage ($4,050 if you are age 55 or older and eligible to make catch-up contributions) and $6,150 for family coverage ($7,150 if you are age 55 or older and eligible to make catch-up contributions). The minimum deductible will stay at $1,200 for single coverage and $2,400 for family coverage. The maximum out-of-pocket employee expense, including deductibles, will stay at $5,950 for single coverage and $11,900 for family coverage. (IRS, 5/24/10)

Health care reform and HSAs. Outlined below are the health care reform changes with the most immediate impact on Health Savings Accounts:

• Amounts paid for over-the-counter drugs will no longer be qualified medical expenses eligible for reimbursement from an HAS unless the over-the-counter drug was prescribed by a doctor.  The prescription requirement only applies to over-the-counter drugs.     It does not apply to expenses for other over-the-counter items such as insulin and diabetic supplies, bandages, band-aids or contact lens supplies.  These items continue to be reimbursable from an HSA without a doctor’s prescription.  (Effective 1/1/2011)
• The penalty for reimbursements of nonqualified medical expenses from your HSA will increase from 10 to 20 percent. (Effective 1/1/2011)

NOTE: Do you have a dependent that is between the ages of 23 and 26? Parents who cover adult children via their employer’s high-deductible health plan option may be unable to use HSA funds to reimburse themselves on a tax-free basis for medical expenses incurred by those adult children.

If it weren’t a true story, you would have thought that a marketing person with a hand in the world of new media had made it up. Recently, a CalCPA member saw a “tweet” about ProtectPlus, and, wanting to know more, she followed a link to a ProtectPlus blog that gave some background on Group Insurance Trust health plans. She was intrigued enough to follow a link from the blog to the CPA ProtectPlus website (www.cpaprotectplus.com) and found herself thinking that there might be an opportunity to improve her firm’s health plans and reduce premiums. She wasn’t sure, however, if her firm met eligibility requirements, but seeing the linked phrase, “Ask our Sales Manager,” she clicked through, filled out the contact information, and typed in her question.

You’ve already guessed the ending, but the point of the story is to let CalCPA members know—whether or not they are ProtectPlus subscribers—that the Trust has a growing social media presence offering valuable health, medical, and insurance information that you can access at your computer or on your smart phone. At the bottom of the home page on the website, you will find a series of icons with links to our blog (http://cpaprotectplus.com/blog/), Twitter account (www.twitter.com/cpaprotectplus) and Facebook site (www.facebook.com/cpaprotectplus).

ProtectPlus has also created its own popular widget, the Daily Dose, which you can download from the home page. This useful desktop tool delivers top news items that refresh daily, including late-breaking news about health and medicine, stocks, sports, business and finance.

Though not mandated to go into effect until January 1, 2011, the Group Insurance Trust has chosen to adopt early the provisions of the Patient Protection and Affordable Care Act (“health care reform”) that affect young adults. Much in the news of late, these provisions are intended to provide wider coverage at lower cost to dependent adult children up to the age of 26 regardless of student status or income. Subscribers should be aware that these changes affect medical insurance only and have no bearing on either Delta Dental coverage or their Vision Service Plan.

Historically, ProtectPlus has offered subscribers coverage of student dependents until the age of 25, if students maintained a minimum of nine units. Under the new rules, those dependents who were covered as of May 31, 2010 can retain their coverage until the first day of the month following their 26th birthday. In addition, they will no longer have to verify their student status. Those who are currently 25 years old and who were not previously eligible, or who lost their eligibility will be allowed to enroll during a special enrollment period immediately preceding October 1, 2010. Further written notification of the special enrollment period will be mailed to subscriber firms in early August.

Under the old ProtectPlus rules, dependents over the age of 19 who were not students but were dependent on their parents for at least 50 percent of their support could enroll in ProtectPlus, but were charged the single employee premium rate. Those in this category have already been folded into their parents’ coverage at the subscriber and child(ren), or family rate. Banyan Administrators has already sent a notice to this effect to benefits managers at firms with affected employees and as of June 1, 2010 premiums were adjusted to reflect these changes.

Subscribers who have children between the ages of 19 and 26 should be proactive about letting their firm benefits administrator know that they have one or more dependents who will qualify under the new rules, especially if those dependents were not previously covered. Forms to enroll these dependents will be sent out in August, so be sure to watch for them, or check online (www.cpaprotectplus.com).

Recently the owner of a CalCPA-member firm contacted Banyan Administrators, LLC, managers of the CalCPA ProtectPlus health and welfare programs, about adding a new employee to his firm’s ProtectPlus medical plan. The new employee, it turned out, was a close relative, and the owner wanted to get him enrolled and covered as soon as possible—preferably, right away.

The fact that the new employee was related had, in fact, no bearing on how the matter was handled. What was relevant, however, was the firm’s written policy, clearly spelled out in its benefit plan subscription agreement (an employer’s master application and agreement with the Group Insurance Trust or other carrier), that new employees had to complete a two-month waiting period before being eligible for benefits. Naturally, the firm’s owner was disappointed that his relative would have to wait the same as any other new hire. Nevertheless, he was also appreciative that Banyan had helped him keep his firm in compliance with both HIPAA and ERISA rules. The Department of Labor (DOL) is concerned about fair treatment of employees and issues of discrimination immediately arise if employees are not treated equally.

Because Banyan service center representatives had the information at their fingertips in their computer system, they were able to provide an explanation to the firm’s owner on the phone. Even if the owner had not contacted Banyan proactively, Banyan would have flagged the employee’s enrollment form when it came in because it did not meet the employer’s established policy. An important feature of Banyan’s computerized recordkeeping is to help member firms prevent unintended regulatory violations.

At the same time, the Trust provides flexibility by offering member firms a broad range of options in setting their own policies. A firm can choose to add new hires to their existing plans on the first of the month following the day of hire or up to six months after, provided they are consistent. Existing rules are subject to change as the Patient Protection and Health Care Affordability Act (health care reform) is implemented and the specifics of the law are ironed out. The Trust and Banyan will continue to monitor evolving regulations and keep you informed as health care reforms solidify.

Generally, employers may change their benefit waiting period and other employee eligibility policies during the annual open enrollment period. It makes sense to review these policies each year to ensure that they are consistent with your firm’s hiring practices. If you are not sure about your company’s benefits eligibility policy as stated in your ProtectPlus Subscription Agreement, or if you are not sure whether the subscription agreement is consistent with your employee handbooks or other new-hire materials, call the Banyan Service Center at (877) 480-7923 or email cpaprotectplus@banyan-llc.com. A Banyan member service representative will be happy to answer your questions.