Bernard Health

If you have a group health insurance plan, you know that you have a renewal date each year for your group benefits. Sometimes, companies get questions from employees or ideas throughout the year to add new lines of coverage to their insurance benefits.

Recently, a Bernard Health client came to me asking if they could add Dental and Vision group insurance coverage as of January 1, 2012. The answer, of course, is yes!  

The second part of that question is if the new Dental and Vision benefits could renew alongside their other company Medical insurance benefits at their renewal date of 7/1. Again, the answer is yes!  

Most of the time insurance companies can put a benefit in place at a certain date and have it renew on a different date.  There is usually more paperwork involved but we've found with our experience it's worth it to renew all your benefits at one time instead of having two different open enrollment periods for separate benefits.

I hope everyone had a wonderful Thanksgiving!  It was nice to catch up on family and reflect on all the things that I am thankful for this year.  I have to admit, coming back to work Monday was difficult. ;)

As I get back into my daily routine here at Bernard Health HQ in Nashville, Tennessee, I've been thinking about some new insurance information that I've learned recently.  The saying goes "You learn something new everyday" and that is so true with my job.  I get excited everytime I learn something new and can't wait to share!

Recently, I was presenting to a large group here in Nashville, Tennesee and the following question came up.

Question:  Can I use my Health Savings Account money to pay for a previous medical expense from a prior plan that was not HSA eligible?

Answer:  No, unfortunately prior insurance expenses incurred while on a Copay plan (non-HSA eligble) can not be paid for out of your HSA.

This was a GREAT question and a new answer that I had learned after doing some research.

Yesterday I met with a woman at the Bernard Health store in Nashville, Tennesee (let's call her Sally). Sally's husband recently left his job with his previous employer, through which his family was insured,  to start his own business. A couple weeks later, Sally received a packet in the mail detailing her family's option to continue receiving their health insurance benefits through COBRA. COBRA provides certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health insurance coverage at group health insurance rates. This coverage, however, is only available when coverage is lost due to certain events (e.g. leaving a job), and for a specific amount of time (in this situation, 18 months).

For Sally, the coverage was not the issue -- the issue was the high price of the monthly health insurance premiums. Sally was used to paying only a portion of what she was now being charged due to the fact that her husband's former employer was fitting the rest of the bill. Through COBRA, the premiums for the same health insurance plan would now be closer to 102 percent of the total cost.  Furthermore, there is no longer an employer paying part of the premiums.

That being said, Sally wanted Bernard Health's help in evaluating alternatives -- her family was healthy and she simply felt that they could do better. In fact, after running a complete analysis Sally and her family were able to enroll in a health savings account (HSA) based plan with almost identical out of pocket maximums for nearly $700 per month in savings.
Without sacrificing coverage or increasing her family's financial exposure -- Sally was able to save $8,240/ year.

If you or someone you know recently lost employer sponsored group coverage -- it may be in your best interst to evaluate your healthcare options. Whether you want to replace your COBRA health insurance plan before the coverage expires, or you want help figuring out what to do once it has -- we can help. The first consultation is free and we're always happy to answer questions. It just might save you a small fortune.

                                             

I provide Customer Service to Bernard Health clients and members, so I answer questions about group health insurance and health savings accounts.  Here are few I answered last week:

• How much will I be spending on medical services and prescriptions since I no longer have a copay?
  • You will pay more than the typical copay for services and prescriptions.
  • When going to in-network providers, you will receive the "network discount" for these services and prescriptions.
  • When you reach your in-network deductible, then services are covered according to the coinsurance schedule of your group health plan.
  • When you reach your in-network out-of-pocket maximum, services and prescriptions are covered 100%.

• Why would I want to change from a copay plan to an HSA plan?
  
  • An HSA plan will cap your costs for the year.
  • With a copay plan, the copays (for services and prescriptions) don't count towards your deductible or out-of-pocket maximum, so the amount of copays you pay are unlimited.
  • If your employer contributes money into your HSA account, then you could be missing out on free (and tax-free) money that you would not receive by participating in a copay plan.

• What happens to my HSA annual contribution if I change coverage type mid-year?
  • HSA contributions are calculated by the number of months you had each type of coverage.
  • Figure out the monthly contribution for each type of coverage.
  • Multiply the number of months by the monthly contribution for each type of coverage.
  • Add the totals for your annual contribution amount.

Retired healthcare executive Richard Cherrin recently said the Delaware needs a "dramatic, bold, paradigm shift" in the way it provides healthcare to its poorest residents -- those on Medicaid. In a plan laid out during a meeting of the Commission on Medicaid Cost/ Health Care Containment, which he chairs, Cherrin urged moving to "consumer-driven" health savings accounts (HSAs) for Medicaid recipients.

According to the , "state officials are looking for some way to escape the unsustainable trend that now has about 25 percent of Delawareans enrolled in Medicaid, thousands more expected in the next year and the cost of that care tipping toward $1.5 billion for fiscal year 2012."

Cherrin goes on to point out that the average cost of Medicaid, in federal and state money, is approx. $7K per person in his state - and if alternative medical insurance options were available, such as HSAs, that incentivize having something left over each year -- money would be used more efficiently. 

It's too soon to tell just what's in store for Delaware, or whether Health Savings Accounts will part of the plan or not. The commission has a December 15 deadline to submit its recommendations to the governor and legislators -- they'll meet again Nov. 30th.

Every new year, we always stride to start the beginning of the year on the right foot.  In the case of HSA contributions, this is no different.  It's so important to save money on taxes by contributing to your Health Savings Account on a regular basis through payroll.

In 2011, Health Savings Accounts have a contribution limit of $3050 for individuals and $6150 for families.  If you are age 55 or older you can put in an additional $1000 "catch up" contribution.

Great news!  The contribution limits are going up in 2012 to $3100 for individuals and $6250 for families.  There also continues to be a "catch up" contribution of $1000 for those 55 or older.

It's never to early to start thinking about your 2012 budget goals!

I recently helped a Bernard Health client figure out how Provider Administered Specialty Drugs are handled by their group health insurance.  In this particular case, their provider had written a prescription to the member.  The member had dropped it off at the pharmacy, but it had not yet been filled since she wanted to find out how the benefits worked first.  Very good idea!!

Here is my reply to her after talking to the health insurance company.

1. This is on your group health insurance carrier's Specialty Drug List.
2. It is under the name "X" and does not need prior authorization.
3. However, it must be ordered by the Provider's office or it will not be covered.
4. You should not have it filled at a pharmacy.
5. The "Provider Administered Specialty Drugs" are excluded from your "pharmacy benefits" because they are covered under the "medical benefits".
6. This means that your doctor should be getting the injection for you.
7. All you have to do is go to their office and have them administer it.
8. Please make sure your provider is in-network so you can take advantage of the your group health insurance carrier's network discount.
9. Charges will apply towards your deductible, but the provider will file the claim with your group health insurance carrier for you.

Luckily they asked BEFORE and NOT AFTER getting the prescription filled.  She was able go back to her provider and discuss this and the provider took care it on their end.

                                                   

Recently, I've been working with a new large group health insurance client here in Nashville, Tennessee on their benefits renewal for January 1, 2012.  They have several locations, including a location in California.  

For 2012, this Bernard client decided to offer Voluntary Long Term Disability, which is a new offering to all employees.  It was brought to my attention that the employees who work in California are already provided a state disability policy, paid for with state taxes.  

In this situation, one may ask, "How does the state disability work if I enroll in the Voluntary Long Term Disability option?"

This is a great insurance question!  The answer is, depending on when the LTD insurance policy kicks in, the LTD plan will fill the difference between the state plan and 60% (depending again on the LTD plan benefits) of employees earnings.

Here at Bernard Health, we blog about what we do for our clients.  There are a few posts regarding Preventive Care.

• What is Preventive Care?
• Preventive Care is Free, Hurray!!!
• Healthcare Reform and Screening Colonoscopies

But what happens when a test performed as part of your annual "preventive care" turns out not to be free?  If you are a Bernard Health client, you call us to find out why.  Last week, one member did just that.

She received a bill for almost $400 for her annual mammogram.  Mammograms are covered 100% as Preventive Care for women age 40 and over, and for younger women with a family history of breast cancer.  She sent me her Monthly Claims Statement from her group health insurance carrier.  This showed that her mammogram was performed by an out-of-network provider.  Oh no!

For her group health insurance plan, Preventive Care is covered 100% for in-network providers only.  I asked her if her doctor who performed her annual exam was in-network.  She said he was AND the doctor who read the mammogram was too.  This was the answer I was hoping for!

Because an in-network provider sent her to an out-of-network facility for the test, it is covered as in-network.  It also helped that the provider reading the test was also in-network.  I contacted the group insurance company and they are reprocessing her claim as in-network so it will be covered 100%.  

Another Bernard Health customer is happy to have us on their side to help with the complicated world of group health insurance! 


                                                                 

One reason why so many companies offer group health insurance to their employees is because they can offer these benefits in Tennessee, Indiana and in other states pre-tax.

While health insurance premiums (yes, even Health Savings Account-based plans to an extent) continue to increase every year, The Affordable Care Act has created a tax credit for qualifying small businesses and tax-exempt organziations, so that they can continue to offer benefits.  

Trouble is... how much is this credit worth, and how can your company qualify?  Qualifying depends on: 

1. Total number of Full Time Employees
2. Total annual hours worked by part-time staff
3. Total annual wages
4. Total employer premium contribution (health, dental, vision)

If you can come up with the above information then plug it into this insurance company's calculater and get an estimate of what your company stands to save.

I ran across an interesting article this afternoon entitled, Traditional Plans Losing Traction, the overall gist is that more and more individuals are moving away from traditional, copay based health insurance plans, and alternatively enrolling in consumer-driven Health Savings Account based health insurance plans .

Notably, in Indianapolis, Indiana, more than 20,000 state employees have signed on to this type of health insurance plan. It goes on to say, "state officials expect the number to rise further..."

A consumer-driven health plan that works in conjunction with a Health Savings Account (HSA), saves money in premiums while also allowing employees to contribute to the account out of their paychecks before taxes. Employees can use the company HSA to offset the costs for healthcare before their annual deductible is met. "Health savings accounts empower employees to make decisions over their health care. They can choose their doctors, shop for good prices, and question whether procedures are need", says Indiana Gov. Mitch Daniels.

As more and more employers are offering different types of health plans to choose from during annual open enrollment, individuals can become easily overwhelmed with their options.  If you'd like help evaluation the best healthcare strategy for you and your family or would just like to learn more about consumer-driven health plans -- give us a call or check us out online.

Like I've said before, health insurance renewal season is here with a lot of Bernard Health group health insurance clients renewing their benefits at the beginning of the new year, January 1st.

I look at health insurance renewals on a daily basis, and a question that I often get is, "How is my renewal determined?"  If you are a small group, you are pooled with other small groups within your carriers specific book of business.  If you are a larger group, your renewal is based on only your groups insurance claims experience for that year.

Small groups are what I currently specialize in, and there are many difference factors that go into a renewal for a small company.  Just to name a few of those factors:

1. Trend: The cost of the carriers responsibility to pay medical and pharmacy claims and utilization.  All small groups receive the same trend increase/decrease. 
2. Base rate: This factor includes plan design, group size changes, network, etc.
3. Risk Adjustment:  Groups specific change in health claims/risk.  If your group had a good year of claims or bad year of claims, it would be reflected in this category.
4. SIC Code: Changes in your industry's specific code.  Sometimes their can be a change in cost or utilization for your specific industry.
5. Demographic:  This one is a biggie!  This factor is based on your groups enrollment mix.  Specially, if you had someone change age bands (example: aging from 44 to 45 or 39 to 40) or if you have fewer employees on your plan then you had last year.
6. Reform:  This is changes in any state regulations

I hope this helps provide some insight as what is taken into consideration for a group's health insurance renewal.  Happy renewal season!

Wow!  I can not tell you how excited I was Sunday when I got my Tennesseean newspaper!  (Yes, I still walk out to my driveway and pick up and read a real newspaper).  I was looking through the Publix sale paper to find some grocery bargains and instead found a prescription bargain!!!!  I saw the words:
 
Well that got my attention!  I have recommended this medication hundreds of times because it is a tried and true $4 generic.  Who knew it would get better?  Wow Publix.... Free Lisinopril, Metformin and free antibiotics... You rock!

While we are on the topic of free medication, do not forget about free diabetic medication at Harris Teeter!


This deal is great for anyone!  HSA health plan or traditional co-pay health insurance, either way free is free!  If you switch from a $4 generic pharmacy to this free offer you can have an extra $48 in your Health Savings Account every year!  Publix and Harris Teeter are both in several locations in Nashville Tennessee.  Our Bernard Health Tennessee group and individual clients should take advantage of these offers.

Most people are accustomed to filing taxes every spring.  Likewise, there is a window each year when Medicare beneficiaries can evaluate their Medicare options and, when appropriate, switch plans.  This window is called the Medicare Annual Enrollment Period.  In 2011, the Annual Enrollment Period runs from October 15 – December 7.  

Though rare, there are times when enrolling in Medicare Part A may not be the best strategy even though the benefits are often free.  If you want to disenroll from Medicare Part A, you can fill out CMS Form 1763 (available by contacting Bernard Health) and mail it to your local Social Security Administration office. 

To disenroll after turning 65, you are required to pay back all of the money you may have received from Social Security as well as any Medicare benefits paid.  You can re-enroll at any time by calling Social Security at 1-800-772-1213 or by visiting your local Social Security Administration office.

If you turn down Medicare Part B when you’re first eligible and don’t have other coverage through an employer, but later decide you want Part B coverage, you can only enroll during from January 1 – March 31 of the following year. 

Your Part B benefits will not be effective until July 1 of that year.  You may also be required to pay a late enrollment penalty of 10% of the current Part B premium for each 12 month period you delayed in enrollment.

 

The list of prescription drugs covered by a Medicare Part D plan can vary from plan to plan.  However, every therapeutic category of prescription drugs will be covered by any one plan.  Medicare Part D plans must cover the following types of drugs: antidepressants, antipsychotics, anticonvulsants, antiretrovirals (AIDS treatment), immunosuppressants, and anticancer.

Within those categories, Medicare Part D plans establish their own lists of approved drugs.  These lists are called formularies.  Most Medicare Part D plan formularies are divided into four or five tiers, and each tier is assigned a different copay amount. 

Some types of prescription drugs are excluded from Medicare Part D.  They include certain types of anti-anxiety and anti-seizure drugs, Barbiturates, Benzodiazepines, prescription vitamins and minerals, and prescription drugs used for anorexia, weight loss or weight gain, fertility, cosmetic purposes or hair growth, and relief of cold symptoms. 

If you don’t join a Medicare drug plan when you are first eligible for Part A, and you go without  prescription drug coverage* for 63 continuous days or more, you may have to pay a late-enrollment penalty to join a plan later.  The penalty amount changes each year, and you will have to pay it for as long as you have Medicare prescription drug coverage.

Now, we realize that no one likes to pay a penalty, but if you find out that you do owe a penalty, know that the penalty for late enrollment in 2012 will be ~$.40 per month for each month that enrollment was delayed.  For example, if you delayed Part D enrollment by 10 months, you would owe an extra ~$4.00 each month, or $48 each year.

*Even if you have prescription drug coverage through your employer, you’ll want to make sure that the prescription benefit counts as “creditable”.  If it doesn’t, be sure to sign up for a Part D plan to avoid a late enrollment penalty! 

Medicare Advantage Plans are health plan options that are part of the Medicare program.  If you join one of these plans, you generally get all of your Medicare-covered healthcare through that plan.  This coverage can include prescription drug coverage.  Medicare Advantage Plans include: