| Issue: # 14 |
March 18, 2008 |
Greetings!
Keeping you informed of the latest developments in the employee benefit marketplace.
If you have any questions, e-mail Bill or Vanessa. To learn more about Advantage Benefits, click here. Many of our clients have found these newsletters to be quite helpful and we have now set up a link to hold all the archived newsletters on-line that can be accessed at anytime.
If you know anyone, who may find this information of interest, please forward them this newsletter (there is a link on the bottom), and they can subscribe themselves.
Sincerely,
Bill Randell, CLU, CHFC Vanessa Costa, CLU,CHFC
Advantage Benefits Group, Inc. |
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Fallon Health Plans
Expanding Outside Central Mass
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Typically, we tell clients the network for Tufts, Harvard/Pilgrim and Blue Cross are very similar and extend throughout the entire state. On the other hand, there are plans that are stong in specific areas, like Health New England in Springfield. and Fallon in Central Mass.
Recently, however, Fallon has expanded significantly in the last 6 months. We have implemented Fallon for businesses in Attleboro, Westboro & Acton. It is also now available in Berkshire County. If a doctor does not accept Fallon, we can enroll the subscriber in their National PPO Plan. This is the same PPO network that both harvard & Tufts use, it is called Private HealthCare Systems ( PHCS ).
Fallon calls it their Triple Product Solution, you write 1 plan design and offer 3 networks:
- Direct (HMO): 696 Primary Care Doctors, 2585 Specialists and 32 Hospitals
- Select (HMO): 2396 Primary Care Doctors, 5541 Specialists and 58 Hospitals
- PHCS (PPO): nationwide and quite extensive
The Fallon Direct is appoximately 13% less then Fallon Select and the PPO is typically 17% more then Select. The nice part about this "triple product solution" is that all employees have the same co-pays & you only get one bill to administer. It creates uniformity and consistency.
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| Removing a Dependent
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Recently, a client questioned whether an employee could remove her spouse from her family pla,n without spousal consent. The employee had seperated from her spouse, and wanted to change to a single plan to save money.
Can this be done or does something have to be done legally?
We learned that since there was nothing legally binding; for eample, a divorce decree or separation agreement, the employee was able to make the change!
Bottom line: An employee can terminate coverage at anytime for themself or a dependent, unless they are legally bound not retain coverage. Please note, an employee can only add dependents or themselves back during the annual open enrollment or if there is a qualifying event.
In addition, in this example, the employee's spouse may now be eligible for COBRA!!
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| CommonwealthCare Renewal
Connector Authority Not Happy |
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Last newsletter we reviewed the Advantage Benefits Group health insurance renewal, this time the Commonwealth of Massachusetts Connector Board received their renewal rates for CommonwealthCare from the Insurance Companies. Upon review the Board expressed the renewal rates "were not satisfactory.' Click here for the full story the February 28th board meeting was delayed. The basis of the Connector Authority's unhappiness was a rumored average 14% increase from the insurance carriers, click here for another story.
Items under consideration are to increase premiums for someone making 150 percent of the federal poverty level, or $15,135 a year, to $40 per month, up from $35. At the same time a subscriber making 300 percent, or $30,630 a year, would pay $120 a month, up from $105. A range of copays would likewise increase. A visit to a primary care doctor for lower cost plans would go from $5 to $10, while a trip to a specialist would go from $10 to $20, and the patient's share of prescriptions would also go up, doubling for most drugs.
The Connector Authority needs to lower eligibility for CommonwealthCare down from 300% to either 150% or 200% of the Federal Poverty Limit and add an Asset Means Test to lower the pool of potential insureds before this gets any worse.
How many times have you looked at your renewal and commented "not satisfactory." .
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