To review more health care terms, click here to visit the ProtectPlus Medical Plan glossary.

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.

The old idiom with the words, “two is company,” was reinforced at a recent CalCPA member event. A ProtectPlus staff member was chatting with an accountant who described himself as a sole practitioner while mentioning that he had an assistant. He subscribed to ProtectPlus as a sole practitioner, he said, because the person who helped him already had medical coverage through her spouse’s employer, and she wanted to keep that coverage.

Alerted to a possible misunderstanding, the ProtectPlus representative responded by pointing out that under ProtectPlus rules even if his employee waived coverage, the accountant qualified for the lower premiums of firms with 2 to 14 employees. In addition, if the firm ever moved to another carrier, it would not be subject to underwriting to qualify for coverage. Moreover, simply having that employee on staff is enough to qualify for the lower rates as long as the employee is working a minimum of 20 or 30 hours a week. Even if the employee waives the benefit—whether because he or she has other group insurance coverage or a Kaiser plan—the CPA still qualifies for coverage at the two-member firm rate.

ProtectPlus subscribers should keep in mind that the same rules apply to a CPA sole practitioner who employs his or her spouse. As long as the spouse works at least 20 hours per week and is compensated as an employee, the CPA firm is defined as a group of two. The CPA can purchase a ProtectPlus policy at the lower rate, forego underwriting, and choose whether to include the spouse as a dependent on his or her policy, or cover the spouse as an employee under their own policy. However, in firms where the only other employee is the spouse, the Trust requires documentation (W-2, payroll records, income tax returns, etc.).

For CalCPA members—especially sole practitioners and small firms—one of the greatest benefits of the Group Insurance Plans is access to high quality medical insurance at prices that are competitive to those usually offered to large firms. While true sole practitioners are subject to underwriting, the ProtectPlus policies available to them will for the most part be miles ahead of anything they can purchase on the individual market. And even those who don’t qualify for coverage due to their medical history may qualify for a ProtectPlus HIPAA option. For more information please contact Banyan Administrators (877) 480-7923.

Via Anthem Blue Cross–If you have not yet received your permanent ID card and want to access health care services, you can print a temporary ID card online through anthem.com/ca.

It’s a simple four-step process:

1. Before starting, check with your employer to confirm your information has been added into Anthem’s system. Your name, date of birth and ZIP code must match exactly what is on file with Anthem.
2. Go to anthem.com/ca, click Members in the top-left corner and log in to the secure Member site. If you have not visited this site before, on “Register.” When you are asked for a member ID number during online registration, you may use your Social Security number if you do not yet have a member ID number.
3. Select the “Print Temporary ID Card” option under “Things You Can Do” and follow the instructions on how to create and print the temporary ID card.
4. You can print the ID card using your own printer and use the card at your next doctor’s appointment.

Your temporary ID card expires 30 days after its issue date and is not meant to replace your permanent ID card, which you will still receive. Take a look at a sample below.

Note: The temporary ID card may not include all of your benefit information. If you have any questions, a Customer Service number is on the temporary ID card.

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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