CalCPA ProtectPlus

It’s been more than a year since the Group Insurance Trust contracted with Banyan Administrators, LLC for administrative services, and from early on, subscribers and Trust staff have been consistently pleased with Banyan’s expertise and responsiveness.

Staffed by a service center team where all members are fully licensed in California, three full-time and two part-time dedicated agents are on hand every day from 8 a.m. to 5 p.m. to handle member comments, inquiries, and billing. Two additional full-time staff members respond to incoming emails, faxes, and forms. Tom Zimmerman, Banyan’s Insurance Group Leader, provides a long list of issues that representatives commonly address, including “billing, coverage, claims, COBRA and CalCOBRA, enrollment, eligibility, forms, ID cards, open enrollment changes, quotes, plan changes, and underwriting.”

He adds that whenever the Banyan team is responding to members, they make secure handling of personal data a high priority. Banyan employs both a web encryption system and a password protected email system. The latter can be set up for incoming as well as outgoing emails, so if members need to supply vital information, they should contact Banyan before emailing the data to arrange for a secure transfer.

Performance Stats

As part of its contract with the Trust, Banyan is required to keep statistics on its performance in handling member calls, and the results are impressive. Since November 2009, the average phone response time has been 29 seconds and the average includes two open enrollment periods when calls were very heavy. Better still from a customer point of view, 95 percent of all email or telephone inquiries were resolved on the initial contact. In addition, Banyan’s average time to review and process incoming paperwork is less than two days with an accuracy rating of better than 99 percent on premium invoices and enrollment changes. (continue reading…)

The Group Insurance Trust operates the CalCPA-endorsed health and welfare plans, including CPA ProtectPlus medical plans, Delta Dental and Vision Service Plans. The Trust is governed by 12 trustees, and each year four are elected for three-year terms. Begining on January 1, 2011, John Dodsworth, Charles Gielow, Jr., James McDonald and Daniel Thomas were elected to serve a three-year term as trustees of the Group Insurance Trust. In addition to the four elected trustees mentioned above, Michael Allmon was appointed by the Chairman of the Board of Trustees to complete the term previously held by Pam Hunter who passed away in 2010.

CalCPA and its related entities are moving. Our offices will close at 5:00 pm on Friday December 17 and will reopen in our new headquarters on January 3, 2011. All direct phone extensions and fax numbers will change. All 800 numbers will remain the same. Please be aware that telephone and email services will be down from 12/20 – 12/22, but are expected to resume on 12/23. During the closure, please contact Banyan Administrators, LLC 877-480-7923 for assistance. Our new address is: 1800 Gateway Drive, Suite 201, San Mateo, CA 94404. Phone (800) 556-6771.

It’s often said, if you don’t know where you have been, you can’t know where you are going. So, as the Board of Trustees and staff of the Group Insurance Trust position themselves to meet the challenges ahead in 2011, looking back on 2010 will help set the course for the coming year.

A year of change began when the Trust transitioned to its new plan administrator, Banyan Administrators, LLC. When Banyan replaced the Trust’s prior long-time administrator Seabury & Smith, it was with the expectation that the Trust would soon be able to provide its members with modern, improved services. We have not been disappointed. Since Banyan assumed responsibility for managing the Trust’s group insurance plans, improvements have been apparent each passing month. This summer Banyan began rolling out online self-service management capabilities to participating firms. As firms are trained and comfortable with the self-management site, a new group of firms is then invited to take part. By the end of 2011 we expect that all firms wishing to manage common tasks (such as new hire enrollments, terminations, demographic changes, dependent adds and deletions and other tasks associated with benefit management) will be trained and actively managing their benefit programs. Participating firms may also have noticed the comprehensive and timely distribution of 2011 plan renewal information. (continue reading…)

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.

Few individuals have given as much for as long to CalCPA or been as intimately associated with its growth as John Dodsworth. Actively engaged in committee work since he joined in 1972, Dodsworth was appointed Director of Business Operations for CalCPA in 1984, a position that included responsibility for the financial aspects of the organization, continuing education, and the insurance program. A few years later he led in the creation of CAMICO—where he served as Director from 1986 until his retirement in 2009—and in expanding the Group Insurance Trust. Today he continues to serve on the boards of both CAMICO and the Trust.

Curiously, his first step toward this distinguished career began with a college job in the mail room at Union Carbide in San Francisco, and among his duties was delivering mail to the internal audit department. “I got to know some of the employees,” he recounts, “and they encouraged me to look into accounting as a profession.” As a math major he felt an affinity to the work they were doing. He recognized that “math is the language of accounting,” and saw that accounting offered something practical to do with the math he was studying.

After finishing college and a stint in the army, he went to work for the public firm of John F. Forbes & Co. “They were big in professional association involvement,” he comments, and so he joined CalCPA and became active in committee work for the San Francisco Chapter, eventually chairing the Accounting and Auditing Committee. During those years he was working his way up at Forbes. He made partner in 1977 and then opened an office for the firm in San Jose in 1981. When his firm won the engagement as auditor for CalCPA, he learned how the organization functioned, and he got to know its then executive director, Jim Kurtz. (continue reading…)

A.M. Best Co., a global credit rating agency and the leading provider of information in the insurance industry, has once again renewed its B++ rating for the Group Insurance Trust. While affirming the performance of the Trust and its insurance offerings, the rating also offers subscribers the reassurance that an outside evaluator has recognized the program’s consistent financial stability. When determining a rating, Best examines every aspect of an insurer, including its operations, financial data, governance, plan design, claims, and many other factors. Moreover, the Group Insurance Trust maintains the distinction as the first Multiple Employer Welfare Arrangement in the nation to receive a Best rating.

In previous years the Group Insurance Trust has provided all firms participating in one or more of its group insurance plans with a printed copy of the Trust’s annual report. In order to reduce costs and the environmental impact of printing and mailing several thousand copies of the report, the Trust will no longer distribute a printed version. Instead, members may view the 2009 Annual Report of the Group Insurance Trust online by clicking here.  Comments or questions regarding the Annual Report may be directed to focus_editor@calcpa.org.

The Group Insurance Trust operates the CalCPA-endorsed health and welfare plans, including CPA ProtectPlus medical plans, Delta Dental and Vision Service Plans. The Trust is governed by 12 trustees, and each year four are elected for three-year terms.

In order to ensure that the Trust continues to be governed by dedicated, knowledgeable members, it is expanding its pool of qualified future trustee candidates. Several appointed committee member positions are available to CalCPA members who are currently participating in a ProtectPlus medical plan. Due to the complicated nature of the Trust, ideal candidates are from firms with 15 or more employees, who can be reasonably expected to remain in active practice and serve the Trust for many years. Candidates are appointed for a two-year term and may be reappointed for a second two-year term. Appointed committee members sit on committees of the Board and attend four committee meetings and one board meeting per year. Appointed committee members are eligible for the same level of employer reimbursement compensation as trustees, and all out-of-pocket expenses are reimbursed.

If you are interested in applying, please send your resume with a cover letter of introduction to: Susan Young, executive director, The Group Insurance Trust, 1235 Radio Road, Redwood City, CA 94065-1217.

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…)

CalCPA Council recently nominated John Dodsworth, Charles Gielow, Jr., James McDonald and Daniel Thomas to serve three-year terms as trustees of the Group Insurance Trust. You can nominate any qualified individual for the fall election by submitting supporting petitions from at least 20 firms participating in one or more of the GIT’s group health and welfare plans by September 27, 2010. For more information, contact Judith Graziani at (800) 556-5771 x 2405 or Judith.graziani@calcpa.org.

It wouldn’t be quite fair to say that John Phillips was there in the beginning, but as the Group Insurance Trust’s longest-serving member and former Executive Director, he has been intimately involved in the evolution and growth of CalCPA’s insurance program for almost 40 years, including formation of the group health insurance program as a Multiple Employer Welfare Arrangement (MEWA).

Phillips joined CalCPA in 1968 shortly after receiving his CPA license. In 1972 he became a member of the Insurance Committee when Jim Kurtz, the long-time CEO of CalCPA, served as its Secretary. The Committee at that time was charged with overseeing all CalCPA-sponsored insurance plans and the Trust. This area of service also fit well with his professional responsibilities at Coopers & Lybrand in San Francisco where he  had become the first employee in what over many years would become a major human resource advisory group. One might say that Phillips was in the right place at the right time in respect to both his job and volunteer service, but that wouldn’t do justice to his enthusiasm for the work that engaged him over his long career. He has always found, he says, the precision of numbers to be “fun” and looked forward to his work every day—31 years with Coopers & Lybrand (now PricewaterhouseCoopers) and 10 years as executive director of the Trust.

After graduating from the University of California, Berkeley in 1962, serving in the military, and entering the workforce, Phillips soon saw, as he puts it, that “the language of business is accounting.” This insight inspired a return to Cal for an MBA with an accounting emphasis, which he earned in 1966, and then a stint at Golden Gate University at night for an MBA in taxation in 1972. (continue reading…)

A new COBRA administrator is now in place for CalCPA-member firms with employees enrolled in the Group Insurance Trust’s medical, dental and vision plans. As subscribers are probably aware, at the beginning of 2010, Banyan Administrators, LLC replaced Seabury & Smith as administrator of the Trust’s group insurance plans. Seabury previously had provided COBRA and CalCOBRA administration to CalCPA plan members. However, with the administrative transition, the Trust found it necessary to contract with a secondary administrator for these services. After a lengthy search, the Trust engaged Infinisource, a leader in COBRA and CalCOBRA administration, to provide member firms with these specialized services.

Founded in 1986 to help employers and insurance professionals navigate complex benefit-related federal regulations, Infinisource has streamlined the complex and time-consuming procedures that all firms must adhere to. Benefit managers and individual members will be pleased to find that the new online tracking capacities now available through Infinisource will make it easier both to track payments and comply with regulations.

Administrative Procedures

Firms with an average of 20 or more employees in the previous calendar year, and, thus subject to COBRA, must contract directly with Infinisource. These firms may, however, choose to contract directly with another COBRA administrator or to self-administer these benefits. The Trust will, however, absorb the costs of administration for firms selecting Infinisource as their provider. The Trust contracts directly with Infinisource on behalf of its CalCOBRA firms (i.e., those with 2–19 employees). Whether employees qualify for COBRA or CalCOBRA, firm administrators should communicate all qualifying event information to Banyan Administrators. (continue reading…)

The Group Insurance Trust has always made a priority of providing CalCPA  members the first-class service that they deserve. This goal is expressed in the quality benefit plans offered by the Trust, the range of choices, and the customer service that supports the use of those plans on a daily basis. Aiming to enhance this experience even further, the Trust has recently contracted with Banyan Administrators, LLC, to handle the administrative services formerly provided by Seabury & Smith.

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. (continue reading…)

CalCPA Council recently nominated Gale Case, John Phillips, James Malone and Nancy Chandler to serve three-year terms as trustees of the Group Insurance Trust. You can nominate any qualified individual for the fall election by submitting supporting petitions from at least 20 firms participating in one or more of the GIT’s group health and welfare plans by Sept. 25. For more information, contact Judith Graziani at (800) 556-5771 x 2405 or judith.graziani@calcpa.org.

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…)

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…)