CalCPA ProtectPlus

Firms participating in the Group Insurance Trust of the California Society of CPAs elected Gregory M. Burke, Patricia Cochran, John B. Phillips and Ricardo R. Rosario to serve  three-year terms beginning January 1, 2013. The Trust is governed by 12 trustees and each year four nominees are elected for three-year terms. As of January 1, 2013, Charles H. Gielow replaced Gale Case who retired in December 2012, as Chair of the Board of Trustees.

CalCPAs’ Group Insurance Trust, has been dedicated to providing quality health and welfare benefits to CalCPA member firms since 1959, including CPA ProtectPlus medical plans, Delta Dental and Vision Service Plans.

November 1^st through December 17^th marks open enrollment at CalCPA’s Group Insurance Trust. The Trust offers 12 medical plans that give firms the ability to fine tune their employee benefits via different levels of deductibles, co-pays, and premiums.

For firms already participating in the ProtectPlus program, the annual open enrollment period is the time to make important changes. Firms can add, delete or change plans, change the waiting period for new hires and change the number of hours required to qualify for benefits. This is also the time for employees who had previously waived coverage for themselves or their dependents to enroll. Open enrollment is the only time of year when firms can elect dental coverage, unless it is purchased at the same time the firm initially purchases a CPA ProtectPlus medical plan.

Starting November 1^st, make sure to visit the CalCPA ProtectPlus website to get all the details about open enrollment. On the website you can view the video presentations that summarize each plan. You also can get quotes based on the demographics of your firm by using the “Get a Quote Tool” and if you have questions, you can click on the “Ask the Expert” link and submit your question to Trust staff.

CalCPA ProtectPlus. Trusted Healthcare Plans for CPAs.

Losing a loved one is never easy, but for surviving family members, the loss can be even more overwhelming when faced with the loss of medical coverage. This is especially difficult for the surviving spouse and dependents of sole practitioners who are unlikely to qualify for COBRA or CalCOBRA. In order to provide some peace of mind to its members, ProtectPlus copay and HSA-eligible plans offer a unique benefit known as Rights of Survivorship to all ProtectPlus plan participants. Under Rights of Survivorship, the covered spouse and eligible dependents of a deceased plan member may retain their ProtectPlus medical coverage without going through underwriting. Survivor benefits begin after COBRA and CalCOBRA benefits have been exhausted, or if the surviving spouse does not qualify for COBRA or CalCOBRA, the extended coverage kicks in immediately.

Coverage continues until the earliest of the following events:

The date the individual(s) reaches age 65; b. The date the surviving spouse remarries; c. The date the individual(s) becomes covered under any other group health plan regardless of whether that coverage is less valuable; d. The date the individual(s) becomes entitled to Medicare; or e. The first of the month for which the surviving spouse or eligible child(ren) fails to make the required payment for the continuation coverage.

If you have any questions about the Rights of Survivorship benefit, or other questions about ProtectPlus copay and HSA plans, contact Banyan Administrators, managers for the CalCPA ProtectPlus programs, at (877) 480-7923.

Please note that Rights of Survivorship do not apply to Anthem Blue Cross HMO Participants.

Open Enrollment

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.

by Doug Hessel

Whether offered as an employee benefit through a group plan or purchased as an individual policy to help create a family safety net, long-term disability (LTD) insurance provides income when a policyholder suffers an injury or illness and can’t work. While most of us don’t believe, and can’t imagine, that we will ever need it, the value of such coverage is self-evident. Knowing it’s there certainly provides reassurance to policyholders and their families.

Like most things that seem self-evident, however, real life circumstances are often less than simple. If you’re in a coma, no one would suggest that you should come in to work anyway, but if you’re in pain, who decides if you’re in too much pain to work? Should your insurer take your word for it? Does it serve an insurance company to believe you, and if it disagrees, who is the final arbiter?

On September 9, the California state legislature unanimously passed SB 621 with the intent to take the ultimate decision-making authority for disability claims out of the hands of insurance companies and turn it over to the courts. The legislation is now awaiting the governor’s signature, which is considered almost certain. Originally authored by California’s new insurance commissioner Davey Jones when he was a state assemblyman, the bill continues many years of efforts to do away with “discretionary clauses” by which insurers reserve the right to make the final ruling on the legitimacy of disability claims.

For instance, you claim a back injury and your insurer decides that it is not disabling. At that point you appeal to your carrier. If they deny you again, and a discretionary clause is part of their policy, your options are extremely limited. Few courts would support your right to pursue a claim further. (continue reading…)

While the population of the United States grew just 9 percent in the decade from 1999 to 2009, the number of prescriptions written increased 39 percent. During roughly the same period, the cost of prescription drugs grew 3.6 percent a year, and while these cost increases represent a considerable slackening from the double digit increases of the 1990s, pharmaceutical manufacturing continues to be one of the top three most profitable industries in the country.

Fortunately for consumers, the cost of prescription drugs still accounts for only 10 percent of healthcare spending nationwide. This is only good news because increases in the cost of hospital care and physician services have grown even faster, exceeding 5 percent annually.

Generic Counterparts

Nevertheless, several important factors have helped keep prescription costs in check. First and foremost, has been the introduction of generic alternatives when brand-name pharmaceuticals lose patent protection.

A report by the Kaiser Family Foundation points out that, “almost 80 percent of FDA-approved drugs have generic counterparts,” and explains that when there are two generic alternatives on the market, the generic price is usually about half the original price of the brand name drug. Moreover, when several competing generics are available, prices often plummet to 20 percent or less of the original brand cost.

The Value of a Formulary

In conjunction with cost-sharing techniques such as deductibles, copayments and co-insurance, another tool used by health insurers to keep prescription expenses down is the use of a formulary. Comprising a list of approved prescription drugs, formularies encourage the use of generics and lower-priced alternatives among their subscribers by creating a differentiated copayment schedule. Under such an arrangement, if you elect a brand-name drug when a generic equivalent is available, you will be responsible for a greater share of the cost. (continue reading…)

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.

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.

A powerful new tool recently added to the Anthem Online Services website now allows ProtectPlus subscribers to locate treatment facilities, compare prices and get other indicators about the expertise of the facility in a specific area of medicine. Though simple in use and appearance, this new function actually makes real a longstanding but elusive promise of modern healthcare—comparison shopping for medical services. With this information in hand, you can now decide whether one treatment facility is worth a lot more money than another and whether you are willing to go farther to save a little or a lot.

You can access these new tools by logging onto the Anthem Blue Cross website directly (www.anthem.com) or you can click through from the ProtectPlus site (www.cpaprotectplus.com). If you take the latter route, choose “Plan Members” then go to “My Plans” and click on “ProtectPlus (Anthem Blue Cross).” Please note that Anthem recently completed a major re-design of its website and you will be instructed to register, or re-register if you had an account on the earlier website, before accessing your account information. Once on your Anthem personal Account Summary page you will find several icons that you can click and drag onto your personal menu to customize your page.

Click on the “Facility Cost and Quality” icon to open the Anthem Care Comparison page. Once there click on “find a facility for a procedure or condition.” A drop-down list provides categories of treatment (e.g. cancer, lungs, orthopedic, or pediatric conditions). When you have chosen a category you can then choose from another list of procedures and diagnoses. You then put in your city or zip and the distance you are willing to travel. (continue reading…)

If you are vacationing just over the state line, across the country, or elsewhere in the world and experience a medical problem, you will be glad to know that ProtectPlus has you covered. The Anthem Blue Cross card that identifies you as a ProtectPlus subscriber is not only good for network coverage in California, it also represents your membership in BlueCard®, a national program through the BlueCross BlueShield Association that enables members of one Blue company to obtain healthcare services while traveling in another Blue company’s service area.

Boasting an impressive reach, this coverage extends to all 50 states and Puerto Rico, plus more than 200 countries and territories worldwide. So, you can enjoy your vacation at ease knowing that covered healthcare is within easy reach. Here are a few guidelines for making use of your coverage with the least hassle.

Always carry your ID card wherever you are traveling, and in any emergency go to the nearest hospital. If you don’t need emergency care but do need to see a doctor or visit a hospital before you return home, call the “Coverage while traveling” number on the back of your Anthem Blue Cross ID card for help in locating the provider nearest to you, or referral authorization. For travel in the US, Puerto Rico and US Virgin Islands, you can also find participating provider information online (provider.bcbs.com).

Once at the hospital or doctor’s office, present your Anthem Blue Cross card. For services provided in the US, you shouldn’t have to complete claims forms or pay up-front for medical care other than your usual out-of-pocket expenses such as deductibles and copays. Anthem will send you a complete explanation of benefits.

If you are traveling out of the country and need emergency medical care, call, or have a family member or friend call the BlueCard Worldwide Service Center collect (1-804-673-1177) as soon as you are admitted to a hospital. If you need nonemergency care, the service center will help you make an appointment with a doctor or facilitate your hospitalization at a network hospital. The center can help obtain cash-less access for inpatient care except for your usual out-of-pocket expenses. For outpatient care and/or services from a non-network hospital you may have to pay the provider and submit a claim form.

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Recently the owner of a CalCPA-member firm contacted Banyan Administrators, LLC, managers of the CalCPA ProtectPlus health and welfare programs, about adding a new employee to his firm’s ProtectPlus medical plan. The new employee, it turned out, was a close relative, and the owner wanted to get him enrolled and covered as soon as possible—preferably, right away.

The fact that the new employee was related had, in fact, no bearing on how the matter was handled. What was relevant, however, was the firm’s written policy, clearly spelled out in its benefit plan subscription agreement (an employer’s master application and agreement with the Group Insurance Trust or other carrier), that new employees had to complete a two-month waiting period before being eligible for benefits. Naturally, the firm’s owner was disappointed that his relative would have to wait the same as any other new hire. Nevertheless, he was also appreciative that Banyan had helped him keep his firm in compliance with both HIPAA and ERISA rules. The Department of Labor (DOL) is concerned about fair treatment of employees and issues of discrimination immediately arise if employees are not treated equally.

Because Banyan service center representatives had the information at their fingertips in their computer system, they were able to provide an explanation to the firm’s owner on the phone. Even if the owner had not contacted Banyan proactively, Banyan would have flagged the employee’s enrollment form when it came in because it did not meet the employer’s established policy. An important feature of Banyan’s computerized recordkeeping is to help member firms prevent unintended regulatory violations.

At the same time, the Trust provides flexibility by offering member firms a broad range of options in setting their own policies. A firm can choose to add new hires to their existing plans on the first of the month following the day of hire or up to six months after, provided they are consistent. Existing rules are subject to change as the Patient Protection and Health Care Affordability Act (health care reform) is implemented and the specifics of the law are ironed out. The Trust and Banyan will continue to monitor evolving regulations and keep you informed as health care reforms solidify.

Generally, employers may change their benefit waiting period and other employee eligibility policies during the annual open enrollment period. It makes sense to review these policies each year to ensure that they are consistent with your firm’s hiring practices. If you are not sure about your company’s benefits eligibility policy as stated in your ProtectPlus Subscription Agreement, or if you are not sure whether the subscription agreement is consistent with your employee handbooks or other new-hire materials, call the Banyan Service Center at (877) 480-7923 or email cpaprotectplus@banyan-llc.com. A Banyan member service representative will be happy to answer your questions.

Over the last few weeks the Group Insurance Trust has received a number of phone calls in response to headlines about significant premium increases recently proposed by Anthem Blue Cross. In fact, it turns out that Blue Cross is just one of many major insurers in California and throughout the nation who are contemplating big rate hikes. The good news, which Trust staff has repeated to these callers, is that ProtectPlus subscribers are not subject to the threatened rate increases that are so much in the news.

Since being licensed by the State of California as a Multiple Employer Welfare Arrangement (MEWA) in 1997, the Trust has acted as the insurer for the entire ProtectPlus medical, dental and vision plans, designing benefits to meet the needs of CalCPA members and setting its own rates.

The Trust’s executive director, Susan Young, notes, “The confusion may have arisen because the Trust contracts with Anthem Blue Cross for use of its Prudent Buyer Network and to adjudicate claims. The Trust has an administrative-services-only agreement for which it pays Anthem a negotiated fee per member, per month, for the services it provides.”  Young adds, “Although ProtectPlus members get the advantage of Anthem’s deep provider discounts, members should understand that it is the Trust that is responsible for setting ProtectPlus premium rates and benefits, which are based on our group’s claims experience. This is why the recent threatened increases by Anthem and others do not directly affect ProtectPlus members.”

For CalCPA members who are not yet taking advantage of the remarkable benefits found in the Trust program, this is an excellent time to see how their present plan stacks up against the ProtectPlus plans. Solo practitioners and members with small group plans who are facing big increases may well find that ProtectPlus offers them superior coverage at significantly lower rates. (continue reading…)

“It may be a cliché,” says Stu Weinstein, chair of the Group Insurance Trust Claims and Plan Design Committee, “but I have gotten a lot out of my relationship with CalCPA as member, and so serving as a trustee, and finding products and services that benefit members, is a great way to give  back.” To this he adds, “Its enjoyable to be associated with something as successful as the Group Insurance Trust has been.”

In addition to his spirit of service, Weinstein also embodies a broad range of professional experience that helps him understand the circumstances of different members. Having graduated with a degree in accounting from the University of California, Berkeley in the late 1960s, Weinstein started his career with a large regional accounting firm where he served until receiving his license. From there he moved to a consulting firm and then to a job as controller in McKesson Corporation’s International Division.

He comments that this experience was a unique opportunity

“to observe the  inside of a business from the client’s perspective, something that many CPAs don’t get a chance to do.”

He was fascinated to see how an enterprise is built, how people are responsible for the bottom line, and how they report to others. He was also engaged by the process of building appropriate controls. At the end of the day, however, he found the work repetitive, and he turned back to public accounting with renewed interest.

He joined his father, who had been working as a solo CPA, in forming Weinstein & Company, where he stayed until 1999. At that point he found himself ready for a more corporate structure and moved to Rooney, Ida, Nolt and Ahern, which had just opened a San Francisco office. He liked the fact that they had separate departments with specialties and that clients were shared.

This structure also meant that his clients had a place to stay as he transitioned into retirement during the years from 2005 to 2007. Currently he still provides occasional services as a consultant and also continues as a director of CAMICO Mutual Insurance Company. (continue reading…)

If you’re looking ahead toward a big birthday this year—one of those marked by a round number, a party, and jokes about getting older—then among the surprises that may await you is an increase in your health insurance rates.

This unwelcome gift—in addition to the seemingly inevitable yearly rate increase that everyone gets—comes in the form of a higher premium and marks your status in having moved to another age rate band.

You’re probably aware that older people pay more for their health insurance and younger people less, and you may have already experienced such an increase.

Nevertheless, in these lean times, its not something you want to come as a surprise. “Happy birthday! Blow out the candles! Your premium just went up $100 a month!” ProtectPlus uses a range of age bands that are common in health insurance plans:

• under 30
• 30–39
• 40–49
• 50–54
• 55–60
• 60–64
• 65 and older

If you’re with another insurer, you should check to see where the bands fall on your policy. You can’t avoid getting older, of course, but if a higher premium will create a financial burden, you can switch to a less expensive plan during open enrollment (November 2 to December 31). Otherwise, you will have to live with the higher rates for your newly attained age until the next year.

Keep in mind that the rates for your spouse and dependents are dependent on your age band, so their big birthdays don’t count in terms of premiums. You can celebrate as you see fit, and not have to worry about higher rates on their birthdays.

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Easy-to-use, clear, and helpful, the redesigned CPA ProtectPlus website offers a wide variety of new tools addressing the insurance needs and benefits questions of CalCPA members.

Give these new features a try!

Plan Selector Tool. Analyzing your responses to a short series of questions, this new selector tool identifies three health plans suited to your needs. You can click through to each of the selected plans and view a description of its benefits. In addition, the tool displays a graph comparing the relative premiums of all available ProtectPlus plans.

Member Satisfaction Survey. Whether you are a current or former ProtectPlus plan participant, we want your feedback, and we’ve made it easy for you. Just click on the member satisfaction tab to let us know about your experience and what is important to you.

Firm Administrator’s Tab. For firms that wish to manage some of their own ProtectPlus account functions, this tab will soon be the portal to the firm’s own self-management site. It already features a series of important links, including a twelve-page PDF Administrative Guide with contact information, payment information, rules and recent changes. The tab also provides links to a host of PDF forms (enrollment forms, claims forms, the new 2010 rate sheets, HIPAA information, prescription drug preauthorization forms, plan descriptions, brochures, and the 2010 ProtectPlus EZ Guide). A series of multi-media E-Presentations give administrators information on how the ProtectPlus program operates. Finally, a Contact Information option has links to an insurance glossary and FAQs, as well as a list of companies, institutions, and people who can help with your insurance needs.

Blog, Twitter, and Facebook Links. Expand your network while making sure you get the news from CalCPA as it happens. ProtectPlus is blogging, tweeting, and networked.

Ask the Sales Manager Link. Too busy to pick up the phone? Want a quote? Have a question but it’s too complicated to leave in a phone message? Just fill in the online form and CalCPA sales manager Tom Kowalski will get back to you ASAP.

The CalCPA Daily Dose Widget link brings you top news items that refresh daily. You’ll receive late-breaking news about health and medicine, stocks, sports, business and finance.

Revised Quote Tool. You can now choose to get a quote as a guest, or you can create an account. If you choose to create an account, the system automatically saves each quote you request so you can return at any time to view prior quotes. On each visit you can get  a detailed quote with the cost for each employee, or you can get a “quick view” premium summary.

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

In the next several weeks, please be on the lookout for important announcements pertaining to the CalCPA ProtectPlus programs. We are making changes that will lead to improvements in program billing, customer service and technology usage.  Information will be distributed via the CalCPA ProtectPlus website, CPA eFocus newsletter, Twitter, direct mailings, Brainshark multi-media presentations and other communication resources.  Stay tuned for more information!

A note from Susan Young, Executive Director

Trust staff are frequently asked “why should I choose ProtectPlus?”  The short answer is, “because these plans provide valuable features you just aren’t going to find elsewhere.” At the top of the list is the claims advocacy that members get from the Seabury & Smith staff exclusively dedicated to serving Group Insurance Trust plan subscribers.

The Seabury staff usually resolves disputes and claims issues fast, despite the fact that they are often dealing with complicated issues. In an age when computer-processed claims are tossed out because they don’t fit the formula, having a live person to resolve problems can be a huge time saver.

A second, immensely important feature of ProtectPlus is the right of survivors to continue coverage. In plain terms this means that if a member dies, his or her dependents can continue their health coverage as long as they need it—either until they qualify for Medicare, remarry, or get other coverage through an employer.

Finally, ProtectPlus allows college students between the ages of 19 and 25 to remain on their parents’ plans if they carry a minimum of nine units. The industry standard for this benefit is 12 units. Additionally, dependents between the ages of 19 and 25 who may be taking time off from school or serving on a HSAsreligious mission may remain in the plan as “single-subscribers” billed at their own age rate, until they once again qualify as a dependent student, become independent of their parents, or turn age 25.

Comprehensive healthcare, with simple administration.  We know that your time is limited and you have enough to do just keeping your firm running smoothly. The last thing you need standing between you and billable hours is more work shopping for healthcare options and then investing even more time administering a plan. But, there’s an easier way to provide your firm with quality healthcare at affordable rates.

ProtectPlus, makes it simple for small firms to provide comprehensive healthcare to their employees with easy one-stop shopping for plans that include medical, dental, vision, disability and life insurance. And, we make it even easier by providing back office assistance–so administration of your benefits is a breeze.

With ProtectPlus, your CalCPA firm can get exclusive programs and coverage ordinarily available only to larger firms. Our group plans include the best doctors, hospitals and administrators available at competitive rates. 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 just for CPAs, so you’ll find the perfect program for your business.

And if you thought you needed more staff to administer a healthcare plan, think again. So you can stay focused on your core business, ProtectPlus provides back office services that include:

• CalCobra administration and billing
• Employee eligibility assistance
• Help with completing forms
• Billing and collection of premiums
• Answering employee’s questions about plan benefits
• Facilitating claims resolution

Get comprehensive coverage for your firm from the people that know your needs and understand your business. Click here to receive an instant, no-obligation quote now.