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.

A series of scrolling panels link to some of the most highly regarded sources of health information on the Web, including Healthy Women; WebMD, The American Heart Association, The American Diabetes Association, and RealAge. Here is a sample of what you will find.

HealthyWomen

Sponsored by the nonprofit National Women’s Health Resource Center, HealthyWomen.org has a long history of providing unbiased and accurate health information. It was named one of the “Top 100 Websites for Women” by ForbesWoman. The site features information on a wide range of topics from pregnancy and reproductive health to diet, aging, and alternative medicine.

WebMD

One of the most popular health-oriented sites on the Internet, WebMD offers credible, in-depth medical news, features, reference material, and online community programs. Aiming to provide the most important and relevant health news each day, the site’s independent journalists draw upon medical journals, conferences, federal or state government actions, industry materials, and interviews with medical experts.

The American Heart Association

One of a group of sites created by the American Heart Association, Heart.org provides a wealth of information on cardiovascular diseases and stroke. In addition to explanations of heart-related health conditions, there are guidelines for caregivers and educators, resources for training in CPR and first aid, current research findings, and tips for healthy living.

American Diabetes Association

The official website of the American Diabetes Association, Diabetes.org offers a concise introduction to the basics of diabetes. It explains the differences between type 1 and type 2 diabetes, describes the symptoms, provides tips on prevention, and offers solid tools for living with the disease. Additionally, there are links to community resources, research, and advocacy measures.

RealAge

A highly praised commercial site, RealAge.com is dedicated to providing quality science-based health and lifestyle content available in a personalized, user-friendly, and easy-to-understand format. The editorial team is made up of health editors, writers, and researchers. Major categories address common issues around exercise, food, medical issues, and remedies. 

CLICK HERE to visit our new Wellness page

And More … Delivered to Your Desktop

For those who would like regular input or updates on health issues but need a reminder, RSS feeds are available from the American Heart Association and WebMD. The ProtectPlus website provides links to sign up for these, plus you can also sign up for an RSS feed of the ProtectPlus blog where Trust staff posts information on many topics of interest to members.

Finally, the Trust has contracted with HopeHealth for the semi-monthly delivery of a new eMagazine “The Healthy CPA.” You should have already received your first issue, with features and short squibs on health, diet, exercise, and even financial issues—information that you can put to use the day it arrives. If you didn’t receive it or overlooked it, here’s a link for retrieving it.

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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).

To access your account visit your plans login on the ProtectPlus website.

1. Next, you can select among medical, dental, and vision plans. When you click on “vision,” you will be taken to the VSP login page where you will need to register if you haven’t already done so.
2. Once you have logged in, you will see a page that lists each benefit with an entry that specifies if you are currently eligible or the date on which you will gain eligibility.
3. You can also view the online “savings statement” from your last vision appointment to see how much you saved by using your vision plan benefits.

Presentation Highlights:
•    Move Employees between health plans
•    Remove Life or Disability from all employees
•    Declare which health plans you will be offering (any combinations)

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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About this Change
Susan Young, executive director of the Group Insurance Trust commented,

In light of Seabury’s long service to the Trust, deciding to move our account wasn’t easy. However, in seeking the best possible service for our members, we wanted to take advantage of Banyan’s skills.

Starting November 1, 2009, Banyan will be responsible for the following:

• Customer service
• Billing
• Payment processing
• Record-keeping
• Marketing support
• Receiving and accounting for participant contributions
• Maintaining records of eligible participants
• Preparing financial reports for GIT staff and trustees
• Banyan will also process all enrollment and change applications
• Maintain an interface with Anthem Blue Cross
• Help new firms and new employees set up their accounts, and manage employee eligibility

For many ProtectPlus members, of course, the primary and often the only point of contact with the plan administrator is when they call or email with a question. Banyan brings to this customer service role a history of serving 220 organizations and group plans beginning in 1994, including other MEWAs (Multiple Employer Welfare Arrangements) in its home state of Pennsylvania that have similar needs and concerns as the Group Insurance Trust. Scott Fair, executive vice president of Banyan, is very clear about “how important customer service interactions are in presenting the face of an organization.”

Banyan Customer Service Center
The Banyan customer service center is staffed by Banyan representatives—all  are licensed brokers—who are there to answer your questions whether by phone or email. Moving all these services to a higher level, Banyan brings with it a high degree of technological sophistication, so that relevant information will be more quickly and easily accessible. For a benefits  administrator this can mean resolving an eligibility issue online, and for Trust staff, the ability to monitor plan performance more closely.

More Advanced Technology
“Banyan has the ability to track data and follow member questions in a way  that ensures questions and concerns are resolved in a timely fashion,” says Judy Graziani, director of marketing. “Additionally, the Banyan customer service system can quickly identify a returning caller, access historical case notes, and provide prompt assistance whether for a new or existing service inquiry. No more need to provide annoying repetition of the details of an on-going issue.”

Judy Graziani notes,

Another great feature of the Banyan system is that it gathers data on issues that arise frequently. This information will allow the Trust to make more informed decisions regarding plan benefits and service issues.

Improved Services
Fair emphasizes a number of new and/or improved services that will be implemented over the coming months including “both online, multi-media presentations and mailings to help members understand their choices.” Stressing his firm’s technical capacities, he also mentions that they will  be creating more online capabilities.

For instance, Banyan will be introducing web services that allow a benefits manager to access and update the firm’s account, and firms will even have the ability to transfer some of these responsibilities to individual employees if it so desires. As an added benefit to human resource departments, Banyan has contracted with the Bureau of National Affairs to make available a host of online reference and legal materials to participating ProtectPlus firms at no extra charge.

Starting November 2
You can contact Banyan Administrators with any questions regarding eligibility, billing, or customer service issues. In addition, Banyan Administrators customer service representatives will be available to answer any questions;

Customer Service: (877) 480-7923
Fax (877) 237-4519, or
Email: cpaprotectplus@banyan-llc.com.

Mailing Address:
Banyan Administrators, LLC, Program Manager for the CalCPA ProtectPlus Programs
1215 Manor Drive, Suite 200,
Mechanicsburg , PA 17055.

We will be launching a plan selector tool that will ease the process of selecting the right plan options for your firm. This tool will be in the form of a quick survey that will result in a recommendation of the three plans that are most likely to suit your needs. We are very excited about this new tool, and we think you will enjoy its ease of use as well!

Be sure to let us know what you think of it, once you’ve tried!

• Additional Web Features on CPAProtectPlus.com
• Brainshark Multimedia Online Presentation
• Detailed Administrative Guide Released
• Annual Enrollment Communications

The Trust is committed to continually improving the ProtectPlus member experience and the quality of the CalCPA ProtectPlus programs. The administrator transition will allow ProtectPlus program members to take advantage of a host of new and enhanced services, including:

• Simplified enrollment processes
• Improved program invoice design
• Enhanced communication capabilities – new web features; dynamic, multi-media presentations
• Streamlined administration leveraging web-based technology
• Online HR and Benefits reference materials

ProtectPlus Members
Your Annual Enrollment materials will be mailed to you on November 2, 2009 and will include new plan contact information.