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Issue: # 62November 10, 2010 
vets day
 
Dear

Year end is fast approaching and unfortunately it has been another year of health insurance increases.  New products have been introduced for 2011 and we will keep you posted on pricing and plan design options that may make sense for your business.    For an idea of what the future may hold, read this story in the Boston Globe.   

If you have any questions email Bill or Vanessa.  We hope you find these newsletters helpful, please forward to anyone who may find this of interest, by using the forward link at the bottom of this e-mail.   Thank you for your referrals.

To learn more about us, click here.   In addition, do not forget to take advantage of the physical fitness reimbursement!  All the reimbursement forms, by carrier, may be found at our Forms Library at our website.

Sincerely,


Bill Randell CLU,CHFC,        Vanessa Costa CLU,CHFC,
Advantage Benefits Group,
Dependent coverage to age 26 
What should you be doing?
National Health Reform has resulted in many changes, although not many that effect employers in Massachusetts.  Many of the reforms adopted on the Federal level were based on the Massachusetts model.    Under current rules, an employee in Massachusetts could keep a dependent on their family plan to age 26 if they were:
  1. Full-time student
  2. Dependent on their tax return
  3. A period of up to two years after they are no longer a dependent on the tax return.

National Health Reform makes student or tax-filing status irrelevant.  This has been estimated to increase corporate health costs by 3% according to a story in Society for Human Resource Management.  

 
At your next renewal employers need to notify employees of this change in the event there was a dependent who may not have been eligible previously, but now may be.   Blue Cross has a great explanation, click here, and a model notice that you should pass out to your employees. 

Preventive (Routine) vs. Diagnostic

You need to be careful

As deductible plans become more popular, this issue becomes more important.  Traditionally, co-payment plans would cover most services (lab tests, x-rays) performed at a doctor's office with your co-payment.  The deductible plan will only cover annual, ROUTINE preventive tests.  All diagnostic tests will apply towards your  deductible.   Example:
 
  • Preventive- deductible does not apply.  Annual physical exams, gynecological and mammogram.  When you have no symptoms and no reason to suspect you might not be healthy.
    • 
  • Diagnostic- deductible does apply.    Any office visit, that you may or may not initiate, to diagnose or treat a condition or symptom.     
     
Recently, a client had a routine physical exam.  They, however, received a $150 bill for one of their blood tests.   Upon calling the insurer, the physician's office coded this test as Diagnostic (low vitamin D).  We advised the client to call his physician and explain that this was part of annual, routine exam and coded incorrectly.  The test was changed to Preventive, resubmitted and covered by the insurer. 
The issue with how a claim is submitted (coding) happens frequently.  You must be diligent to review any bills you receive for accuracy.


This is also an example of how Advantage Benefits can help you. Today's Health Insurance Broker does more than just give you rates once a year. It is an ongoing process of service
to assist through an everchanging health insurance marketplace at both the State and Federal level.