CalCPA ProtectPlus

CaliforniaHealthline.org  -  Friday, April 30, 2010

On Thursday, WellPoint officials announced that the company’s subsidiary, Anthem Blue Cross of California, has withdrawn its request to raise premium rates for individual policyholders by as much as 39%, the Los Angeles Times reports.

The increase would have taken effect on Saturday and affected as many as 800,000 of Anthem’s customers. California Insurance Commissioner Steve Poizner (R) confirmed the company’s decision (Helfand, Los Angeles Times, 4/30).

Background

In February, Poizner WellPoint to delay the rate hike, which originally would have taken effect on March 1.

Anthem officials later said they would delay the rate hike until May 1, pending the findings of an investigation by external actuaries hired by Poizner, the Sacramento Bee reports.

Report Pending

Although the complete report is expected to be released as soon as Tuesday, Poizner released a summary of the findings on Thursday (Caina Calvan, Sacramento Bee, 4/30).

Poizner said the actuarial firm had found “multiple, significant errors” with Anthem’s proposal, including its calculations of medical claims trends (Wilde Mathews, Wall Street Journal, 4/30).

The report — conducted by the actuarial consulting firm Axene Health Partners — found that among other errors, Anthem overstated medical costs by raising the effect of aging. The actuaries found that modifying those numbers could lower the average rate hike by 10.2% (Los Angeles Times, 4/30).

Those errors “would have led to massive and unjustified rate increases,” Poizner said, adding that Anthem was notified about the errors “and they admitted to the mistakes” (Sacramento Bee, 4/30). (continue reading…)

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The federal health care reform law will have a substantial impact on employers. Here are the main issues  that employers will want to be aware of:  

 1. Keeping the same coverage  

Employers will be able to avoid some of the law’s requirements by keeping their coverage the same after the law’s effective date (March 23, 2010). Unfortunately, it is very unclear at this time what kinds of minor changes will alter coverage, or keep it the same; this will be clarified in later regulation.  

 Changes that must be made to all plans include:  

• waiting periods for coverage must be less than 90 days; 
• no lifetime benefit maximum limits;
• dependent coverage for adult children up to age 26; and
• no annual limits on certain types of benefits (unless permitted by later-issued regulation).

2. New benefit and other plan changes If an employer does not keep its coverage the same, employers will need to make additional changes such as:  

• extending 100 percent coverage for preventive care;
• removing any prior authorization requirement or increased cost-sharing for emergency
• services (regardless of whether the services are provided in or out of network);
• no pre-existing limitation for children under age 19; and
• coverage of routine patient costs in clinical trials for life-threatening diseases.

3. FSA/HRA/HSA changes The law also will require changes to these types of accounts. In 2011, employees will no longer be able to receive pre-tax reimbursements from their FSA, HRA or HSA for non-prescribed over-the-counter medications, and the excise tax for nonqualified HSA withdrawals will increase from 10 percent to 20 percent. In 2013, employee contributions to FSAs will be capped at $2,500 annually, with the cap adjusted annually to the Consumer Price Index.  (continue reading…)

The following information if from Anthem Blue Cross and is quite helpful in guiding you to a healthier lifestyle.

Are you or a family member living with a chronic condition such as asthma, diabetes or heart disease? If so, we can help. 360˚ Health provides you with support to help you achieve your health goals. We’ll work with you, your doctor and other health care professionals to help you improve your health.

ConditionCare enhances your doctor’s plan of care through the use of a dedicated nurse plus a team of health professionals including dietitians, exercise physiologists, pharmacists and more. You can gain a better understanding of your health, receive help in following your doctor’s care plan and learn how to better manage your health. This program is designed to help members with chronic conditions such as asthma, diabetes, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD) and heart failure.

ConditionCare Support Programs complement our core ConditionCare programs. They assist members who are not managing a core chronic condition, such as asthma or diabetes, but need help with other conditions ranging from arthritis pain to high blood pressure. These programs include help with vascular at-risk conditions, low back pain, musculoskeletal conditions, and various types of cancer.

ConditionCare Kidney Disease is a program specifically designed to support members with chronic kidney disease. Nurses that specialize in renal care and the treatment of kidney disease provide education and support to help members manage their health.

ComplexCare provides help to those with multiple health concerns who may require high levels of collaborative care. Personalized nurses who specialize in treating multiple health conditions work with members to help improve their health.

Comprehensive Medical Management provides one-on-one expert assistance to help members find and receive the right services and care. The program includes a personal advocate to see that benefits are utilized effectively and that necessary medical interventions are appropriate and safe.

360° Health program offerings vary by state. Specific programs are included in your health plan and others are available for additional cost. Contact your human resources department or benefits administrator as appropriate for eligibility and further details.

Take your next step to better health. Choose a link:

• 360° Health Overview
• Improve Your Health
• Get Guidance

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Over the last few weeks the Group Insurance Trust has received a number of phone calls in response to headlines about significant premium increases recently proposed by Anthem Blue Cross. In fact, it turns out that Blue Cross is just one of many major insurers in California and throughout the nation who are contemplating big rate hikes. The good news, which Trust staff has repeated to these callers, is that ProtectPlus subscribers are not subject to the threatened rate increases that are so much in the news.

Since being licensed by the State of California as a Multiple Employer Welfare Arrangement (MEWA) in 1997, the Trust has acted as the insurer for the entire ProtectPlus medical, dental and vision plans, designing benefits to meet the needs of CalCPA members and setting its own rates.

The Trust’s executive director, Susan Young, notes, “The confusion may have arisen because the Trust contracts with Anthem Blue Cross for use of its Prudent Buyer Network and to adjudicate claims. The Trust has an administrative-services-only agreement for which it pays Anthem a negotiated fee per member, per month, for the services it provides.”  Young adds, “Although ProtectPlus members get the advantage of Anthem’s deep provider discounts, members should understand that it is the Trust that is responsible for setting ProtectPlus premium rates and benefits, which are based on our group’s claims experience. This is why the recent threatened increases by Anthem and others do not directly affect ProtectPlus members.”

For CalCPA members who are not yet taking advantage of the remarkable benefits found in the Trust program, this is an excellent time to see how their present plan stacks up against the ProtectPlus plans. Solo practitioners and members with small group plans who are facing big increases may well find that ProtectPlus offers them superior coverage at significantly lower rates. (continue reading…)

Many of us often have concerns about whether or not it is safe to take certain medications while taking other prescription or over-the-counter drugs. The effects of drug interactions may cause unexpected side effects such as allergies, heart palpitations or dizziness. It can make your other medication(s) less effective or it can also increase the effects of your medication(s) which can be harmful to your health – even life threatening.

You should make it a habit to read the label of prescription and over-the-counter medications – often times there are warnings of other medications that should not be taken at the same time. It is important that you learn about drug interactions which may be critical to your health and by having this knowledge you can reduce the risk of potentially harmful interactions and its side effects.

Anthem Blue Cross offers a great tool that allows you to search  for information on thousands of prescription and over-the-counter medications. [Click here to check it out.] Of course, this is an online tool that can help you get some general information - but you should always check with your doctor and pharmacist for detailed information and instructions. Make sure to them all of the medications you are taking – even vitamins and herbal supplements since those can interact with medications as well. Some people have more than one doctor, so remember to always inform them of what medications you are taking, or better yet, bring the bottle to the appointment. That way they can see the exact information including the dosage you are taking. These are very simple precautions that we can take to insure ourselves a healthier life!

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How To: Print a Temporary ID Cards

Via Anthem Blue Cross–If you have not yet received your permanent ID card and want to access health care services, you can print a temporary ID card online through anthem.com/ca.

It’s a simple four-step process:

1. Before starting, check with your employer to confirm your information has been added into Anthem’s system. Your name, date of birth and ZIP code must match exactly what is on file with Anthem.
2. Go to anthem.com/ca, click Members in the top-left corner and log in to the secure Member site. If you have not visited this site before, on “Register.” When you are asked for a member ID number during online registration, you may use your Social Security number if you do not yet have a member ID number.
3. Select the “Print Temporary ID Card” option under “Things You Can Do” and follow the instructions on how to create and print the temporary ID card.
4. You can print the ID card using your own printer and use the card at your next doctor’s appointment.

Your temporary ID card expires 30 days after its issue date and is not meant to replace your permanent ID card, which you will still receive. Take a look at a sample below.

Note: The temporary ID card may not include all of your benefit information. If you have any questions, a Customer Service number is on the temporary ID card.

If you’ve ever wanted to keep track of your health and health progress, now you can do it right inside your Anthem Blue Cross user profile using the new Health Tracker.

Here’s how you get started:
1.   Log in to MyAnthem
2.   Go to the 360º Health®tab
3.   Click MyHealth@Anthem > Health Trackers

The Trackers allow you to enter stats and track your health progress easily. Whether you’re focus is diet and exercise or blood pressure and heart rate, Health Trackers can track it for you. And you can create personalized trackers specific to your unique needs.

There are also charts & graphs so you don’t have to do any additional number crunching (since you do enough of that at work).

Check it out.

The end of the calendar year marks the ProtectPlus annual open enrollment period. It’s also the time to make plan changes. For employees who opted not to enroll in ProtectPlus for whatever reason, this is another chance to join. For current subscribers it’s an opportunity to make changes in their coverage.

Maintaining the longer open enrollment period adopted in 2007, the Group Insurance Trust has announced that open enrollment begins on November 2 and ends December 31.

CalCPA member firms that haven’t offered ProtectPlus plans to their employees can, of course, enroll in Group Insurance Trust plans at any time.

Firms can consider the full range of offerings for 2010 that include;

• 5 copay plans
• 3 HSA-eligible plans
• 2 Anthem Blue Cross HMO plans

This is also the time of year that the Trust announces plan changes and premium adjustments. As always, premium  increases are anticipated with concern, but the good news is:

The Trust has been able to maintain its single digit  premium increases for the seventh consecutive year.

This is a remarkable achievement when you consider that ProtectPlus also beat industry averages in each of these years.

Several benefit improvements will be implemented in 2010.

• All ProtectPlus copay plans will see a reduction in the copay amount for generic prescription drugs from $15 to $10.
• Improved coverage for mental health and substance abuse services on all copay, HSA-eligible, and Anthem Blue Cross HMO plans.
• Medical plans will now align all mental health and substance abuse member cost-sharing provisions with those offered for in-network and out-of-network medical services and remove any visit limitations (in accordance with the Mental Health Parity and Addiction Equity Act of 2008).

The Trust will also combine several copay plans for 2010.
Last year the Trust offered eight copay plans, including both regular and enhanced versions of:

• Protect 15
• Protect 25
• Protect 35

The enhanced versions of these plans—which waive the deductible for the first six in-network office visits—proved so popular that trustees were persuaded to include the enhanced benefits as standard features in the copay plans at these levels.

For 2010 the Protect 15, Protect 25 and Protect 35 plans will all feature the enhanced benefit of six office visits that are not subject to the plan’s deductible, while the Protect 10 and Protect 45 plans will retain their original structure.

Vision Service Plan and Delta Dental rates will be restructured for 2010.
Going forward, rates for both plans will be based on firm size in much the same way the medical plan rates are structured.

• Effective January 1, 2010, firms with two or more participants will see a reduction in VSP and Delta Dental rates while others will note a small increase.

Changes in Premiums
Some ProtectPlus members will see changes in their premiums next year that reflect altered geographical rate bands. Anthem Blue Cross has re-aligned several zip codes in rate areas one, two, and three, and the Trust has followed its lead in order stay consistent. For some, these changes will mean lower than average premium increases, while for others, unfortunately, it may mean an increase in excess of the average overall premium increase.

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You can simply call Anthem Blue Cross customer service at 888-209-7847 or login to Anthem Blue Cross and click on Search for a Provider outside of California.

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…)

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…)

Does your healthy lifestyle effect or inspire others?  Check out this micro site by Anthem to see what your health footprint is, and learn tips on how to improve your health and the health of those around you.  Here Anthem will lead you through a series of questions, done very interactively I might add, to calculate your health footprint. Check it out!

Care Comparison expands to cover all of California

All Anthem Blue Cross group members in California now have access to Anthem Care Comparison, our ground-breaking online tool that launched in 2008 to select geographic areas in the state. Care Comparison, provides total estimated costs associated will all aspects of nearly 40 specific mediacal procedures performed at local area hospitals and medical facilities.

Anthem Care Comparison is the only tool to bundle together related services and tests around a specific procedure typically costs.  And as our members will quickly see, one procedure can carry different price tags at different facitilites.  Those differences can increase or decrease members out-of-pocket costs. (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…)

In an effort to reduce Medicare costs, Congress passed the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) on December 29, 2007. Because Medicare has been unable to identify primary payers consistently, Section 111 of the new Act (MMSEA) imposes mandatory reporting requirements for fully insured and self-funded group health plans.

These requirements impose an obligation on primary payers to identify claimants entitled to Medicare and to report those claims to Medicare electronically.

As of July 1, 2009. Health plans are required to report specific member eligibility data for members who meet certain age or disability criteria. The reporting rules apply to covered individuals age 45 and older for groups with 20 or more full or part-time active employees. (continue reading…)

Having recently completed what looked like a paperwork endurance contest,  GIT staff and trustees were rewarded in  May when the Trust received a financial strength rating of B++ from insurance  company rating agency A.M. Best. In a press release announcing its positive evaluation, Best stated that the rating reflected the Trust’s “synergy with CalCPA, favorable level of capitalization and positive operating performance.”

The release went on to say that the Trust’s risk-adjusted capital position “remains favorable,” and is built upon “its historically positive operating results.” This gives a tremendous boost to all the GIT plans, affirming that they are as reliable as they are valuable.

Extended Rate Guarantee
On the heels of this good news, the Trust has announced that it will guarantee current 2009 premium rates for any newly enrolling firms through December 31, 2010. In terms of cost, there will never be a better time to switch to ProtectPlus than now. As CalCPA members you have available a variety of high quality health insurance plans that are already  competitively priced. By acting now, you and your employees can maintain current 2009 rates throughout 2010. Add to this the fact that ProtectPlus rate actions have averaged 7 percent over the past six years, which is significantly below average annual rate increases industry-wide,  and you should have all the incentives you need to enroll now. (continue reading…)

This year the Group Insurance Trust celebrates its 50th anniversary. Looking back, it’s a story of hard work and remarkable achievements. Whether you’ve been a long-time CalCPA member and can recall many of these events or have joined recently, a quick review of this history reveals the valuable service of CalCPA staff and board volunteers who have helped build this organization. This history also shows how CalCPA membership benefits have grown over the years. Consider these twelve milestones in the history of the GIT.

1. On December 4, 1959, the California Society of CPAs creates a trust for the maintenance of group insurance programs serving employer members, employees, and dependents. Over the course of the next 38 years, the terms of this trust will be amended and restated several times.
2. Between 1980 and 1983 two committees administer CalCPA insurance benefits. In 1983 the two committees separate. The Members Insurance Plans Committee is charged with the formation of CAMICO, while the Administrative Committee of the Group Insurance Trust (ACGIT) is given oversight of CalCPA’s health and welfare plans.
3. In 1981, with healthcare premiums escalating rapidly, the medical plan is put out for bid and moved from Pacific Mutual to Blue Cross. Despite a two-year rate guarantee period, when the plan loses $2 million in the first year Blue Cross requests and is denied an 82 percent premium rate increase. Eventually the Trust and Blue Cross agree on a rate increase of more than 40 percent and the creation of a rate stabilization fund to temper future rate increases. (continue reading…)

Ensure access to quality, affordable coverage

Congress has begun to debate how to reform our nation’s health care system, and it is important for them to hear from you. It is an historic opportunity to enact comprehensive reform that makes health care more affordable, improves quality and covers all Americans.

We strongly support reform that builds a strong, sustainable private-sector health care system – and strongly oppose creating a government-run health plan. We are urging our elected officials in Washington to take bipartisan action that will accomplish that. We are educating policymakers in Washington and working with our trade associations to encourage Congress to build on the current system and not disrupt the quality, affordable coverage on which our members depend.

Our elected officials need to hear from you

There is a role that you can play in this effort, too. As our elected officials debate health care, they need to hear directly from you. You understand the important role that private-sector health plans play in ensuring access to quality, affordable coverage.

Surveys show that the American people support a common-sense approach in which the public and private sectors work together to fix the health care system. We agree. Nonetheless, there are proposals in Washington that would threaten our ability to continue serving individuals, families and employers. We cannot allow that to happen.

That is why it is important for you to get involved in our grassroots effort. Here are some steps that you can take to get involved in the health care reform debate and to ask others to participate as well. (continue reading…)

If you want to find out if your doctor, or hospital is a participating provider, or you want to find a participating provider in your area.
You can use the Search for a Provider feature on the CPA ProtectPlus.com website or, login to Anthem Blue Cross. Then click on Search for a Provider.

You may view your EOBs, your contract benefits, and search for in-network providers by accessing member services on the Anthem Blue Cross website. Login to Anthem Blue Cross.