New Employer Requirements

Our Financial Library (6/23/14)

Health Reform - A Guide for Employers (8/12/13 - Source: Word & Brown)

Anthem Blue Cross Members' Cost for Ancillary Services Could Change (9/12/12 - Source: MyAnthem News eBulletin)

Is your doctor's lab considered "in-network"? Members' out-of-pocket costs could change for independent clinical labs, specialty pharmacies, and durable/home medical equipment and supplies beginning October 14, 2012. To be considered in network, ancillary providers must participate with the local Blue Cross and Blue Shield Plan where the services are rendered, even if the member is out of town.

Here's an example: A member goes to a doctor in the member's home state. The doctor takes a blood sample in his office but sends it to a lab out of state. For the blood test to be covered in network, the out-of-state lab must belong to the network in the home state.

If the ancillary provider or service does not participate in the local Blue Plan, members may have to pay more. So the member should tell their doctor if they want to use only in-network ancillary providers. Members can also click on Find a Doctor on the member website and then choose Pharmacy>Lab/Pathology/Radiology or Medical Equipment. Members can also call the phone number on the back of their ID card and ask Member Services to check if the provider is in network.

Members will be advised of this change in the Healthy Solutions newsletter, scheduled to go out the week of September 17.

Note: Other ancillary provider types, including home infusion therapy providers, are not included in this change.

Medical Loss Ratio (MLR) Rebate Checks

Many people are wondering about getting these "rebate" checks from their group's insurance company. There's information provided about this on my blog if you're interested. The bottom line, though, is: Did you get a rebate check?! If so, you can use this MLR Calculator to see about distributing the rebate check appropriately. Also, check out our MLR FAQs page to answer common questions about what can and cannot be done with this money.

Sept. 23, 2012: Summary of Benefits and Coverage Info

What does the health care reform (HCR) law say about summary of benefits and coverage (SBCs)? The Affordable Care Act (or health care reform requires that all members of fully insured plans receive an SBC. Why? The SBC helps members understand their benefits and coverage by using simple language and a consistent format.

This requirement applies to all group plans, whether they are offered through an exchange or not. Plans must also provide an SBC to COBRA-qualified beneficiaries.

The key date to remember is September 23, 2012. To read more about this upcoming change, click here.

Creditable Coverage for Employees Age 65 or Older

Prior to Medicare's Open Enrollment season, which starts on October 15, 2012, employers are required to inform employees who are 65 or older whether their group health plan is Creditable or Non-Creditable. If the employer's group health plan provides prescription drug coverage equal to or better than Medicare Part D prescription drug coverage, it is deemed to be Creditable coverage.

Employees who choose to stay enrolled in their employer-sponsored group health plan with Non-Creditable coverage will likely incur a penalty for not having Creditable coverage. If, instead, they choose to enroll in a Medicare Part D prescription drug plan, they will not be assessed this penalty.

Employees turning 65 are to be advised of their group health plan status prior to turning 65 years of age.

View the guideline for Anthem Blue Cross' group health plans.

Health Care Reform Articles

Walgreens Becomes In-Network Retail Pharmacy - NEW (7-26-12) - Effective Sept. 15, 2012, Anthem members will be able to use their pharmacy benfits at Walgreens stores. Express Scripts and Walgreens have finally reached an agreement, making Walgreens an in-network retail pharmacy. Other Walgreens-owned pharmacies will also be considered in-network. Stores such as Duane Reed and Happy Harry's.

Health Reform Guide - NEW (7-17-12) - Easy-to-read brochure. Offers simple answers to complex issues facing every employer in America. (9 pgs.)

Health Coverage During Pregnancy Leave - (10-12-11) - Existing law prohibits an employer from refusing to allow a female employee disabled by pregnancy, childbirth, or a related medical condition to take a leave for a reasonable time of up to 4 months before returning to work. SB 299, commencing Jan. 1, 2012, would also prohibit an employer from refusing to maintain and pay for coverage under a group health plan for an employee who takes that leave, as specified. CA SB 299 (Evans)

Medicare Eligibility Age Needs to Rise to 67, Health CEOs Say -(9-14-11)

How Long Can We Avoid Long-Term Care? - (10-30-11)

Republicans to HHS: What Did You Do with the CLASS Office? - (9-26-11) - Congressional Republicans are demanding clarification on what the Obama Administration is doing about implementation - or non-implementation - of the Community Living Assistance Services and Supports (CLASS) Act long term care (LTC) insurance program.

States Head to DC with Questions about Health Insurance Exchanges - (9-19-11)

What a Healthcare Ruling Could Mean to the Supreme Court - (10-4-11)

Threshold Raised for HRA Reporting - (10-15-11) - Medicare Secondary Payer: Centers for Medicare & Medicaid Services (CMS) announces that the $1,000 threshold increases to $5,000, effective Oct. 3, 2011. Thus, only HRA coverage with an annual benefit level of $5,000 or more is required to be reported.

More Lawsuits, Anyone? - (10-4-11) - Supreme Court Justices worry a California Medicaid case could unleash a flood of new lawsuits

The Broccoli Case - (9-29-11) - Can the government force us to buy health insurance any more than they can make us buy broccoli? The Obama Administration, PPACA Opponents ask the Supreme Court to Rule.

Maternity Coverage for ALL Plans - Mandated - (10-12-11) - SB 222, commencing July 1, 2012, would require every individual health insurance policy to provide coverage for maternity services for all insureds covered under the policy. This bill would become operative only if AB 210 of the 2011-12 Regular Session is also enacted.

CA Could Pose Problem for Obama's HCR - (9-15-11) - CA was supposed ot be a model that showed the law's promise. But, the state is emerging as 1 of the biggest headaches for the White House.

Hospitals Face Big Medicare Fight Under HCR - (10-1-11) - New Medicare penalties for re-admitting too many patients soon after they are discharged 

Will HCR Survive the Courts? - (8-20-11) - The legal battle over the constitutionality of the HCR law.

Appeals Court Strikes Health Insurance Requirement - (8-12-2011) - 11th Circuit Court of Appeals struck down the so-called individual mandate, siding with 26 states that sued to block the law. However, the panel didn't go as far as the lower court.... 

Republicans Bring Out the Grandfathers - (9-2-2011) - House Republicans plan to craft a bill that could loosen the current rules governing when an existing health plan can keep grandfathered status.

AB 52 Faces Growing Opposition - (8-18-2011) - The bill would allow government to reject or modify proposed health insurance rate increases.

CA Health Benefit Exchange Receives $39 Million Federal Grant - (8-12-2011) - Well, who else did you think was going to pay for this?!

HHS Grants 106 New Healthcare Waivers - (8-19-2011) - And this bring the total to 1,472 waivers.

Compare Health Benefits "In Plain English" - (8-19-2011) - New health insurance rules would let consumers compare plans, "like reading the 'Nutrition Facts' on the package label." The government has saved us again!

The Individual Mandate Cheat Sheet - (8-31-2011) - Your guide to the Affordable Care Act's (ACA's) most controversial provision.

How Medicare Curbs will Affect Prescription Drugs - (8-19-2011) - Will the Independent Payment Advisory Board really help to alleviate the Medicare crisis? Could the panel make it worse?

How is CA Going to Deal with the Impact of HCR? - (8-11-2011)

CA Attorney General Files Brief in Support of HCR - (8-22-2011)

Health Care Reform Timeline 1 - A one-page document that points out key provisions of Health Care Reform due to transpire over the next several years.

Health Care Reform Timeline 2 - Another 1-pg. document.

Health Care Reform Rules on Dependent Coverage of Children Up to Age 26 - (Legislative Brief) This answers questions about adding dependent children (who are up to age 26) to your new or existing health insurance plan.

Payroll Stuffer - Adding Dependent Children (up to Age 26) to your Health Insurance - FREEBIE FOR EMPLOYERS!!! Use this payroll stuffer to inform your employees that they can add their dependent children to their employer-sponsored health insurance plan.

Early Retiree Reinsurance Program - (Legislative Brief) Key information for large businesses (those with over 51 employees).

Congress Repeals 1099 Reporting Requirements - (Legislative Brief) HOORAY! It's official. You DO NOT have to send a 1099 to every business you send over $600 after all!

Other News

Social Security Disability Payments in Peril by 2017 - NEW (8-21-11)

Advocates for Disabled Urge Feds to Reject Cuts to Medi-Cal - NEW (8-25-11)

Poll: Americans Hit the Roof Over Debt Ceiling Debate - NEW (8-10-11) - Americans' confidence in government is down

Medicare Says Competitive Pricing Will Save $28B - NEW (8-20-11)

Ruling May Broaden Insurance Plans' Coverage for Medical Illness - NEW (8-28-11)

6th Circuit: Congress Has the Authority to Make People... Buy Health Insurance?

IRS Further Delays Form W2 Reporting Requirement

IRS Increases 2011 Mileage Rate


Type of Reimbursement 



January 1 - June 30, 2011 



Effective July 1, 2011 



Business Mileage 



51 cents per mile 



55.5 cents per mile 



Medical and Moving Mileage 



19 cents per mile 



23.5 cents per mile 



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