Employee Benefits updates
Employee benefits today      
September 6, 2016
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Dear 
:

We are in the middle of 4th quarter renewals... All of which are not too bad, however, we are seeing unusually high renewals with Harvard Pilgrim.  This has become a reality and it does appear will continue into 1st quarter 2017.

The issue stems from the Affordable Care Act and the Risk Adjustment Factor. Harvard had to payout in excess of $ 40 million dollars due to this requirement.  Harvard is reviewing their product portfolio and has announced some plan designs will be discontinued.  If you currently have Harvard for your carrier it is suggested to get an early start on the renewal - this applies to both under 50 employees and over 50 employees.  WE are not experiencing any coverage issues with our Harvard clients.  It appears to be more of a "temporary phase" they  will have to work through.

If you have any questions please send us an e-mail.   We would really appreciate if you would forward this newsletter to anyone else you know who owns a business.
 
 
Sincerely,


Urgent Care facilities do not have contracts with all plans


We have spent a lot of time talking about ways to reduce healthcare costs.  The carriers have started programs to make consumers more aware of where and how they are receiving services.  
A hot topic is the volume of urgent care centers opening up all over the country.  Urgent care centers are a cheaper and more convenient alternative to the Emergency Rooms.  Members do not need a referral and usually an office visit co-payment.

We are on board with the use of Urgent Care centers, and recommend you educate employees on how this more affordable alternative works. We have run into a few complications/issues using these facilities, mostly stemming from out of state use.  Just like anything new, there are always some problems at first and this is no different.

We are finding out that not all facilities have contracts with our Massachusetts HMO's.  Here is our word of caution, before you go to one of these facilities:

  1. Call your health carrier
  2. Give them your ID number
  3. Tell them the name of the facility that you want to attend
  4. Make sure that they are accepted by your plan
In some cases, you may not be able to make that call before hand, but please try to reach out to the carrier afterwards.  In addition, we have been told that a referral may be necessary, which can be done after the visit.  Just reach out to your primary shortly after.
 
To avoid any surprises - call you carrier either before or after.
The main urgent care centers like CVS MinuteClinic and ReadyMed are fine....  Again these issues have occurred for out of state situations. 
 
CVS Minute Clinic: 
 
Our daughter's ear was throbbing on Saturday so we decided to try the local CVS Minute Clinic. When we arrived there was a computer to check in.  It showed in detail who was ahead of you and what the projected wait time was.  Our wait time was 1 hour and 45 minutes. 
 
The clinic asks for your mobile phone number to text you 30 minutes prior to when your appointment.  This worked out great, as we left CVS ran some errands and then promptly returned upon receipt of the text.
The process was smooth, affordable and convenient.
 
Please keep in mind these options !
 
Follow up- Update to Our Minute Clinic Visit as of today:
After 5 days of antibiotics our daughter still had ear pain so we decided to see her pediatrician.  Turns out the minute clinic diagnosis was incorrect and she needed specific ear drops rather than the antibiotic.
 
Although it was a convenient alternative, we still ended up at the doctors office.
 
Please share your stories with us - any positive or negative feedback from urgent care?  Email us now. 
 
 
  
 
Federal Health Exchange is failing

  
There are articles everywhere about the failures of  The Federal Exchange. In some parts of the country only one health plan may be offered since many carriers have pulled out of the exchange. There is now the distinct possibility that some areas may actually have no plans to offer!
 
Seems like yesterday we heard President Obama saying:
 
"This exchange will allow you to one-stop shop for a health-care plan, compare benefits and prices, and choose a plan that's best for you and your family," Obama said in a speech in 2009. "You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package."
 
What he failed to understand was that healthy people would rather pay a $600 penalty then pay the monthly premium for health insurance.   
 
As a result, many of the "new " people who signed up were mainly bad risks.   As a result claims were much higher then expected and the insurance companies lost money.  
 
Aetna reported Obamacare losses of $200 million in just the second quarter and more than $430 million since January of 2014. They expect full-year exchange losses of $320 million in 2016 alone.    Instead of trying to get large rates increase approvals through the exchanges they have opted to just withdraw.
 
It was all actually pretty predictable. Truthfully the only way to save the exchanges would be to increase the penalty to a more significant number, like $6,000 per year.  The pool needs the healthy insureds to participate, but, at this point that's highly unlikely.  We don't see any way to save the Federal Health Exchange from this death spiral. 

Blue Cross Paperless Billing 
 
 
In their continued efforts to reduce overhead, Blue Cross now requires mandatory paperless bills for any new customers.  In addition, they are transitioning existing customers as well into the new system.  Some of our groups we were not very happy about this since it is very easy to overlook a bill that is e-mailed.

Since Blue Cross gives you no choice there is not much we can do.  WE also anticipate that the other carriers will also follow suit in the near future. With that in mind here is a good FAQ on the billing system and a link to some videos that should help you with this new system from Blue Cross.  
 
Flexible Spending Accounts, again! (FSA)

We remember over 20 years ago educating our clients about Section 125 Pre tax Deductions for medical and dental,  and showing how both Employees and Employers save money.  Many of the payroll companies would implement the plan and would give detail to employees about their Federal, State and FICA tax savings.  Also, there was focus on how much the employer would save in FICA.  
 
Flash forward 20 years and now everyone has a Section 125 especially since employers do not pay 100% of the premiums anymore. Today we feel the same way about the FSA as we did 20 years ago about the Section 125 Plan.  
 
The FSA is really perfect fit:
  1. Costs to administer have dropped dramatically 
  2. Employees with debit cards take all the administration out of the plan
  3. Un-reimbursed medical costs have increased dramatically as employers have shifted to plans with higher deductibles.
  4. Roll-over provision eliminates the "use it or lose it" issues.
  5. The FSA Store provides a convenient way to male allowable and authorized purchases.
  6. It has all the same tax savings as the Section 125 plan

To get an exact quote send us an

 

 

 

  Advantage Benefits Group       
78 Pleasant St Worcester MA 01609
     800-426-2413 (Bill)                508-798-0887 (Vanessa)
 508 4-14-8305  (Bill cell)          508-494-8303 (Vanessa cell)
Bill@AdvantageBenefits.com     Vanessa@AdvantageBenefits.com
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