CalCPA ProtectPlus

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.

[Image Source]

Open enrollment is going on now through December 31st. See why so many CalCPA member firms choose CalCPA ProtectPlus. Each of our plans have been developed through research, member feedback, and collaboration with leading national service providers to deliver an attractive balance of benefits and savings. And because these are proprietary plans, we can provide them to our member firms at highly competitive group rates.

You may choose to offer your employees almost any combination of the CalCPA ProtectPlus plans. This exclusive coverage is a great enticement for attracting and retaining top-level talent to your firm.

Here is a quick look at our plans.

To find the plan that be fits your needs, please use our Plan Selector Tool.

• Protect 10 $10 copay, 10% coinsurance, 
individual deductible $250/Family $500. More details

• Protect 15 $15 copay, 20% coinsurance, Individual deductible $250/Family $500, the first 6 in-network office visits per calendar year are exempt from annual deductible. More details

• Protect 25 $25 copay, 30% coinsurance, Individual deductible $500/Family $1,000,the first 6 in-network office visits per calendar year are exempt from annual deductible. More details

• Protect 35 $35 copay, 40% coinsurance, Individual deductible $500/Family $1,000, the first 6 in-network office visits per calendar year are exempt from annual deductible. More details

• Protect 45 $45 copay, 50% coinsurance, no in-network deductible. More details

• Protect HSA 1500 $1,500 Individual deductible $1,500/Family $3,000, 30% coinsurance, $4,500 Individual out-of-pocket maximum. More details

• Protect HSA 2500 $2,500 Individual deductible $2,500/Family $5,000, -0- coinsurance, $2,500 Individual out-of-pocket maximum. More details

• Protect HSA 2850 $2,850 Individual deductible $2850/Family $5,650, 30% coinsurance, $5,500 Individual/ out-of-pocket maximum. More details

• HMO Value 80 $15 copay, no deductible, 20% coinsurance for most covered expenses. More details

• HMO Advantage 100 $10 copay, no deductible, no additional charge for most covered expenses. More details

Non-Participating Provider is one of the following providers which does NOT have a claims administrator’s Participating Provider Agreement in effect with the claims administrator at the time services are rendered:

1. A hospital;
2. A physician;
3. An ambulatory surgical center;
4. A home health agency;
5. A facility which provides diagnostic imaging services;
6. A durable medical equipment outlet;
7. A skilled nursing facility;
8. A clinical laboratory; or
9. A home infusion therapy provider.

They are not participating providers. Remember that only a portion of the amount which a non-participating provider charges for services may be treated as covered expense under this plan. See your medical benefits: how covered expense is determined.

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…)

Credible coverage is coverage under any individual or group plan that provides medical, hospital and surgical coverage, including continuation or conversion coverage, coverage under a publicly sponsored program such as Medicare or Medicaid, CHAMPUS, the Federal Employees Health Benefits Program, programs of the Indian Health Service or of a tribal organization, a state health benefits risk pool, or coverage through the Peace Corps.

Creditable coverage does not include accident only, credit, coverage for on-site medical clinics, disability income, coverage only for a specified disease or condition, hospital indemnity or other fixed indemnity insurance, Medicare supplement, long-term care insurance, dental, vision, workers’ compensation insurance, automobile insurance, no-fault insurance, or any medical coverage designed to supplement other private or governmental plans.

You are considered to have been covered under a creditable coverage if you:

1. Were covered under a creditable coverage on the date that coverage terminated;
2. Were in an eligible status under this plan within 63 days of termination of the creditable coverage; and
3. Properly enrolled for coverage within 31 days of the eligibility date. (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…)

As a solo practitioner, you’re in great company. When it comes to healthcare, being a solo practitioner doesn’t mean going it alone.

With ProtectPlus, you can take advantage of the comprehensive coverage and competitive rates of a group plan. We make it simple for solo practitioners to get superior healthcare with the ease of one-stop shopping for plans that include medical, dental, vision, disability and life insurance.

With ProtectPlus, your one-person firm can get exclusive programs and coverage ordinarily available only to large firms, with group plans that include the best doctors, hospitals and administrators available. Additionally, our staff is responsive and delivers personalized service you won’t get anywhere else. Since we offer programs only to CalCPA member firms, we understand the unique needs of your business. Our plans are specifically designed for CPAs, by CPAs, so you’ll find the perfect program that fits you. (continue reading…)

Out-of-Network describes services or visits rendered by non-participating hospitals, non-participating physicians and other non-participating providers, and with respect to services or visits covered on an in-network basis only if provided by COE, services or visits provided by any Provider other than a COE.

This Survey via Pew Internet & American Life Project

OVERVIEW

Americans’ pursuit of health takes place within a widening network of both online and offline sources. Whereas someone may have in the past called a health professional, their Mom, or a good friend, they now are also reading blogs, listening to podcasts, updating their social network profile, and posting comments. And many people, once they find health information online, talk with someone about it offline.

This Pew Internet/California HealthCare Foundation survey finds that technology is not an end, but a means to accelerate the pace of discovery, widen social networks, and sharpen the questions someone might ask when they do get to talk to a health professional. Technology can help to enable the human connection in health care and the internet is turning up the information network’s volume.

ABOUT THE SURVEY

The findings in this report come from a national phone survey done by the Pew Research Center’s Internet & American Life Project in partnership with the California HealthCare Foundation. Some 2,253 adults, age 18 and older, were interviewed in December 2008 about the social impact of the internet on health care. The interviews were conducted in English or Spanish and included 502 cell-phone interviews.

Read Full Report

Last Thursday, President Obama confronted the healthcare situation, here is a short clip from his speech.  See more videos, or this article from Associated Press Obama Confronts Critics on Health Care Overhaul.

Understanding the Medicare system that serves as the primary health insurer for almost everyone in this country who is 65 or older is vital in planning your health insurance needs. If you are approaching that age, you should start familiarizing yourself with the system before you retire.

You need to know how various parts of Medicare work, how they relate to the supplemental insurance policies (Medigap) and how they interact with your workplace group insurance plan.

In addition, understanding the relationship between Medicare and your group health policy becomes more important and more complicated if your spouse is covered under your plan at work. HIPAA, COBRA and CalCOBRA provisions may determine the availability of his or her coverage. (continue reading…)

Every day the news seems to bring a new story about how the nation’s healthcare system is under stress—a shortage of doctors, overworked medical personnel burdened by insurance paperwork, emergency rooms turning away ambulances—and everyone, it seems, has a complaint or horror story about their own medical treatment. The inescapable conclusion is that you have to play an active role in your own healthcare. When you’re helping someone else, the problems get even more complicated.

Helping another person with their healthcare and the maintenance of their finances involves issues that are both practical (making sure they take their medications) and legal (signing checks). If the person you are helping can handle the basics, then your role as a caregiver will fall on the practical side. You may need to accompany someone to a doctor’s appointment and take notes, make sure they get their meds on schedule, and keep a set of medical records for reference—medications, surgeries, allergies. (continue reading…)

For those of you who are not familiar with RSS, or Real Simple Syndication here is a short and entertaining video that will help you understand.  We offer RSS for our latest posts, so you can keep up to date on health care and ProtectPlus news, announcements & tips.

Subscribe to ProtectPlus RSS