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.

For the Trust, one of the great advantages of working with Banyan has been the company’s enhanced reporting capacities. Better information translates into the ability of the Trust to provide plans that conform as closely as possible to the needs and concerns of members.

In addition, the Trust and Banyan have collaborated to meet several significant challenges over the past year and a half. They have worked through all the initially mandated Health Care Reform changes and engaged in the process of updating ProtectPlus documents and forms, including enrollment forms and subscription agreements. More recently, partnering with Hover Insurance Services, Banyan has helped manage the transition of members covered by the group long-term disability and life insurance policies now offered through Lincoln Financial Group. As a result, subscribing member firms have seen significant reductions in their premiums.

Expanded Services

Another major step forward implemented by Banyan over the past six months has been the creation of an online benefits management system. Now available to all member firms on request, this resource allows a firm’s human resource team to access real-time benefit and demographic information about employees. Among other features, benefits administrators now can generate standard or customized reports on a recurring or one-time basis right from their desktops.

And, finally, Banyan offers member firms free access to the valuable online BNA human resource library with a vast selection of documents and solutions to a wide range of HR needs.

Speaking for Banyan, Tom Zimmerman concludes that “the level of plan customization in CalCPA ProtectPlus has given Banyan Administrators the opportunity to apply the range of flexibility built into our systems. This has been truly rewarding.”

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.

Other organizations also joined the Trust’s network of administrative providers including Infinisource, a recognized leader in COBRA and CalCOBRA management and Myers-Stevens & Toohey, the administrator for the ING Individual Term Life plans and The Hartford Personal Accident policy.

During the year the Trust also moved its long-term disability and group life insurance policies to Lincoln Financial Group. Existing subscribers are already seeing reduced rates and improved services. Monthly billing makes it easier to add new hires or remove terminated employees, plus the policies come with a set of valuable program enhancements.

The Trust also worked with CalCPA management to bring a new array of individual life and long-term disability options to members through the MiQuote platform of New Benefits, LTD, a system that instantly provides competitive individual life insurance quotes from several different carriers. Additionally, members can request quotes on individual long-term disability coverage through the MiQuotes website.

The Board of Trustees and Trust staff work hard to lower operating costs and improve the well-being of CalCPA members. In 2010 we reduced both the production costs and the environmental impact of printing and mailing thousands of copies of the Group Insurance Trust’s 2009 Annual Report by replacing the printed version of the report with an e-version. Members can download the report from the ProtectPlus website by clicking here. 

As the trend toward electronic communication continues, you may have noticed a series of short, informative videos produced by the Trust and distributed via email to CalCPA members. One series of these entertaining videos is aimed at benefits administrators and provides quick tips and useful shortcuts for managing ProtectPlus benefit plans. These videos are available on the CPAProtectPlus.com website under Firm Administrators/E-Presentations. Click here to view.

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.

Plan Design Changes

In addition to the mandated changes described above, for the 2011 calendar year the Trust is implementing changes specific to the ProtectPlus program. There are also changes specific to Anthem HMO plans.

Prescription Drug Formulary

A significant change to be implemented in the ProtectPlus copay and Anthem Blue Cross HMO plans in the coming year is the introduction of the Anthem Blue Cross formulary (preferred list of drugs). This list is updated quarterly by a committee of doctors and pharmacists who evaluate drugs on the basis of safety and effectiveness in the treatment of diseases. To view the list on www.cpaprotectplus.com, click on Forms/Prescription and select Anthem Blue Cross Formulary List.

The formulary list contains both brand name and generic drugs. In many cases when a generic is available for a brand name product, the brand name product will be considered non-formulary and only the generic equivalent will be on the formulary list, a practice endorsed by the FDA.

Beginning January 1, the copayment structure for ProtectPlus copay plans and Anthem Blue Cross HMO plans will be the same for a 30-day supply bought through an in-network retail pharmacy and a 60-day supply when ordered through Anthem’s Express Scripts mail order pharmacy.

• generics = $10 co-payment
• brand-name = $150 deductible per member
• brand-name/formulary = $25 co-payment
• brand-name/non-formulary = $45 co-payment
• self-injectables (excluding insulin) = 30 percent of prescription drug maximum amount

Administrative Updates

In addition to these rather significant changes in Trust plans, there are a couple of administrative issues that are important to note.

Anthem will be issuing new ID cards for all subscribers, regardless of whether they make an open enrollment change. This change is required by the National Blue Cross and Blue Shield Association, which is trying to standardize ID cards across all Blue plans. Please alert your employees to watch for an envelope from Anthem.

The Anthem Blue Cross HMO customer service phone number is now (888) 209-7847. This is the same customer service number that PPO and HSA subscribers currently use.

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.

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.

He left Forbes in 1984 after it had begun a couple of merges to become part of KPMG, but he says his years in public practice taught him a great deal about the kinds of issues that engage many CalCPA members. He “did a lot of auditing and business consulting for small to medium-size companies,” and he worked with a lot of startup-ups. He became familiar with the challenges of organizing a business and raising capital.

After leaving Forbes, he spent a short time in private accounting working for a developer. This experience broadened his outlook, but, he adds, when Jim Kurtz invited him to join the CalCPA staff, it seemed like a natural move. He was familiar with the organization and its goals.

Then in 1985 when the professional liability insurance market was going through a hard cycle, he found himself the lead person in the formation of CAMICO and later its CEO. With these new responsibilities he knew he had to let go of his leadership role in the Group Insurance Trust and turned this responsibility over to its first executive director, Ken Ashcraft.

The years since have witnessed major changes for both the Trust and CAMICO, but as one of the few individuals who have served on the two boards, Dodsworth sees parallels. Both CAMICO and the Trust he says, “have similar purposes and structure. They are member-owned, and they both have robust loss-prevention measures. Both provide real advocacy for members, and they stretch to provide services rather than limit their coverage.” He adds that the two organizations also provide resource support and information to each other.

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.