A year of change began when the Trust transitioned to its new plan administrator, Banyan Administrators, LLC. When Banyan replaced the Trust’s prior long-time administrator Seabury & Smith, it was with the expectation that the Trust would soon be able to provide its members with modern, improved services. We have not been disappointed. Since Banyan assumed responsibility for managing the Trust’s group insurance plans, improvements have been apparent each passing month. This summer Banyan began rolling out online self-service management capabilities to participating firms. As firms are trained and comfortable with the self-management site, a new group of firms is then invited to take part. By the end of 2011 we expect that all firms wishing to manage common tasks (such as new hire enrollments, terminations, demographic changes, dependent adds and deletions and other tasks associated with benefit management) will be trained and actively managing their benefit programs. Participating firms may also have noticed the comprehensive and timely distribution of 2011 plan renewal information.

Other organizations also joined the Trust’s network of administrative providers including Infinisource, a recognized leader in COBRA and CalCOBRA management and Myers-Stevens & Toohey, the administrator for the ING Individual Term Life plans and The Hartford Personal Accident policy.

During the year the Trust also moved its long-term disability and group life insurance policies to Lincoln Financial Group. Existing subscribers are already seeing reduced rates and improved services. Monthly billing makes it easier to add new hires or remove terminated employees, plus the policies come with a set of valuable program enhancements.

The Trust also worked with CalCPA management to bring a new array of individual life and long-term disability options to members through the MiQuote platform of New Benefits, LTD, a system that instantly provides competitive individual life insurance quotes from several different carriers. Additionally, members can request quotes on individual long-term disability coverage through the MiQuotes website.

The Board of Trustees and Trust staff work hard to lower operating costs and improve the well-being of CalCPA members. In 2010 we reduced both the production costs and the environmental impact of printing and mailing thousands of copies of the Group Insurance Trust’s 2009 Annual Report by replacing the printed version of the report with an e-version. Members can download the report from the ProtectPlus website by clicking here. 

As the trend toward electronic communication continues, you may have noticed a series of short, informative videos produced by the Trust and distributed via email to CalCPA members. One series of these entertaining videos is aimed at benefits administrators and provides quick tips and useful shortcuts for managing ProtectPlus benefit plans. These videos are available on the CPAProtectPlus.com website under Firm Administrators/E-Presentations. Click here to view.

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.

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.