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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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

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.

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.

Quality information is also included so members cn access information regarding the number of patients treated, complication rates, average length of stay and mortality rates.

All of the information provided is easy to find and easy to understand.

Members can become engaged health care consumers when they use Antheme Care Comparison as well as the Zagat Health Survey, whihc allows members to view or sublmit feedback on their experiences with physicians on the following four categories:

1. Trust: Confidence in physician’s approach, integrity and recommendations
2. Communication: Physician’s bedside manner, responsiveness and rapport with patients.
3. Availability: Convenient appointments, physician’s punctuality and face-to-face time.
4. Environment: Office condition, staff quality, atmosphere and amenities.

Anthem Care Comparison and Zagat Health Survey are two of the many online tools available when you visit anthem.com/ca and login into member services.

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.

You are also considered to have been covered under a creditable coverage if your employment ended, the availability of medical coverage offered through employment or sponsored by an employer terminated, or an employer’s contribution toward medical coverage terminated, provided that you:

1. Were covered under a creditable coverage on the date that coverage terminated;
2. Were in an eligible status under this plan within 180 days of termination of the creditable coverage; and
3. Properly enrolled for coverage within 31 days of the eligibility date

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.

Getting involved is easy

There are several easy opportunities to make your voice heard:

1. Go to healthactionnetwork and sign up to be a part of our grassroots campaign. When you register you will learn who your federal representatives are.
2. Write a letter. Once you register on the Health Action Network, you will have the opportunity to send an email to your elected officials.
3. Make a toll-free phone call to share your views with your federal lawmakers.  After you have registered on the Health Action Network site, you will have the opportunity to take part in a phone alert in which you will be presented with a toll-free number and a PIN to enter once you have dialed in. Your PIN will enable us to patch you through to the offices of your U.S. Senators and your U.S. Representative.
4. Post information on your Facebook page. Simply click the Facebook button provided on the Health Action Network and follow the instructions. The information will be published on your Facebook profile. Also, please be sure to become a fan of the Health Action Network on Facebook and encourage your friends and family to do the same!
5. Tell a friend. Once you have emailed your elected officials, you will have the opportunity to spread the word to family and friends by using our “Tell a Friend” feature.

The private-sector health care community is actively engaged in support of reform across the country. This effort gives all of us a chance to have our voices heard in Washington.

Thank you for your ongoing efforts in maintaining and enhancing the private-sector health care marketplace.

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.

Best of all, you won’t waste valuable, billable hours shopping for the best coverage or managing a lot of administrative details. So you can stay focused on your core business, ProtectPlus provides back office services that include:

• Help with completing forms
• Answering questions about plan benefits
• Facilitating claims resolution

When it comes to healthcare, we take care of our own. Get comprehensive coverage from the people that understand the needs of solo practitioners. Get an instant, no-obligation quote now. Solo practitioners are subject to underwriting and may be denied coverage based on health history.

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.