CalCPA ProtectPlus

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.

Responding to the growing popularity of Health Savings Account eligible medical insurance plans (commonly referred to as HSAs), the Group Insurance Trust (CPA ProtectPlus) has expanded its current offerings with a third such plan, Protect HSA $2,500.

With premiums approaching the lower end of ProtectPlus co-pay plans, the new plan offers significantly greater benefits than the two already established Protect HSA plans.

As with all HSA-eligible plans, Protect HSA$2,500 features a high annual deductible that must be satisfied before benefits are paid by the plan. For the new plan the deductible is $2,500 per individual and $5,000 per family.

Though not greatly different from HSA $2,850 in respect to the deductible, the difference in benefits is large indeed.

After the deductible is met HSA $2,500 provides 100 percent coverage for all in-network office visits, professional services, emergency and in-patient hospitalization, hospital and outpatient surgery, lab costs and more.

It also pays 70 percent of the negotiated fee for all these services when provided out-of-network. In contrast, HSA $1,500 and $2,850 pay 70 percent of negotiated fees for in-network services and 50 percent of negotiated fees out-of-network. (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.

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