CalCPA ProtectPlus

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.

Protect HSA plans are self-funded High Deductible Healthcare Policies (HDHPs) offered through the Group Insurance Trust of the California Society of CPAs. The Protect HSA plans, when paired with a Health Savings Account offered through a bank, brokerage or other financial institution, provides security against catastrophic medical expenses, while allowing you to set aside pre-tax dollars to pay for qualified medical expenses. Detailed information on HSAs: official government site.

As with the ProtectPlus copay plans, the Protect HSA plans have contracted with Anthem Blue Cross of California to use its comprehensive provider network and to process our claims. You will have the freedom to choose virtually any health care provider and no physician referral is required. It’s up to you whether you go in-network and receive a higher benefit (after your deductible is satisfied) or go out-of-network and pay more. However, when you choose participating network providers, you will take advantage of negotiated rates, which lowers out-of-pocket expenses.

For more on CPA ProtectPlus HSA Plans

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

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

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

To continue reading “In the Interim“

Claims Procedures

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

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

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

If you need information regarding a claim submitted about your ProtectPlus coverage, simply contact Seabury & Smith at 800 824-1154. If you have received an Explanation of Benefits (EOB) from Anthem Blue Cross, please have that information available when you call.