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In This Issue

Group Health Selects Swedish as Contracted Provider

Harrison Medical Center Terminated From Regence Network

Regence - Additional Preventive Care Benefits Available Sept. 1, 2014

United HealthcareWill Cover Certain Breast Cancer Drugs Without Cost-Share

CMS Explains When Individuals With Medicare May (and May Not) Enroll for Coverage Through Exchanges

ACA Reporting Requirement Update: Draft Instructions

Backpack Safety: Is Your Child Overloaded?

Key Facts About Seasonal Flu Vaccine

Question of the Week

Do HIPAA's portability rules apply to our company's dental benefits; and do these benefits have to comply with health care reform's various requirements?

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INSURANCE SPOTLIGHT

Septemer 3, 2014

Carrier News

Group Health Selects Swedish as Contracted Provider of Seattle -Based Hospital Services Starting February 2016

Group Health announced that it has signed a Letter of Intent for Swedish Health Services to provide its Seattle-based hospital services starting in February 2016. News release

Harrison Medical Center Terminated From Regence

Network As Of August 22nd

hospital After several months of contract negotiations, Regence and Harrison Medical Center could not agree on a fair reimbursement schedule. Effective August 22, 2014 Harrison Health Partners is no longer participating in the Regence BlueShield network. Read more

Regence - Additional Preventive Care Benefits Available Sept. 1, 2014

Regence has added preventive care benefits based on recent recommendations from the United States Preventive Services Task Force (USPSTF):

BRCA Screening to include Family History of Tubal or Peritoneal Cancer
Gestational Diabetes Mellitus in Asymptomatic Pregnant Women after 24 Weeks of Gestation
Lung Cancer Screening for Adults Ages 55-80
Medications for Risk Reduction of Primary Breast Cancer in Women: anastrozole, letrozole, exemestane, raloxifene, tamoxifen.

The updated preventive care brochure and covered medications list show benefits and drugs covered as preventive starting Sept. 1, 2014, regardless of renewal date. They'll be posted to our website once they're effective. Members may be required to meet certain criteria to be eligible for these benefits.

United Healthcare - Effective September 2, 2014 United Healthcare Will Cover Certain Breast Cancer Drugs Without Cost-Share

The benefit applies to women who meet certain criteria and is subject to reasonable medical management. This requirement is effective for plan or policy years beginning on or after Sept. 24, 2014, and is based on the U.S. Preventive Services Task Force (USPSTF) B recommendation issued in September 2013.

The USPSTF recommends that clinicians engage in shared, informed decision-making about medication options with women who are at increased risk for breast cancer. The USPSTF also recommends that clinicians should offer to prescribe risk-reducing medications, such as tamoxifen or raloxifene, to women at increased risk for breast cancer but are low risk for adverse medication effects. More information

Federal & State News

CMS Explains When Individuals With Medicare May (and May Not) Enroll for Coverage Through Exchanges

CMS has released FAQs that explain when individ

uals with Medicare may and may not enroll for coverage through the Exchanges. The FAQs also explain that employers purchasing coverage through a SHOP Exchange are exempt from the duplicate coverage prohibition, which does not apply to employer-sponsored coverage. Thus, Medicare beneficiaries who are active employees may also be enrolled in SHOP coverage. Full article

ACA Reporting Requirement Update: Draft Instructions

Earlier this month we provided you with an overview of the ACA reporting requirements with links to draft forms that will be required to filed at the beginning of 2016. On August 28, 2014, the Internal Revenue Service (IRS) released draft instructions for these draft forms.

The IRS is hosting a webinar on September 9, 2014, at 2:00 p.m. Eastern Time (11:00 a.m. PST) to describe how to report on minimum essential health coverage, effective in 2015. The IRS presenters will cover:

Internal Revenue Code Section 6055
Who is required to report
What elements are required to be reported
How do government entities designate reporting

Employers interested in attending must sign up on the IRS Webinar Registration site.

Health & Wellness

Backpack Safety: Is Your Child Overloaded?

Of all the physical burdens children must shoulder, their backpacks are probably the heaviest. Crammed with everything from lunches to laptops, bags can cause stiff necks, sore shoulders and aching backs. The Consumer Product Safety Commission found that every year more than 10,000 children ages 5 to 14 see doctors with backpack-related complaints.

"The extra stress placed on the spine and shoulder from heavy loads is causing children to develop adult-like back problems," said Dr. Christine Ho, a pediatric orthopedic specialist at Children's Medical Center and assistant professor of Orthopedic Surgery at UT Southwestern Medical Center. "The most common injuries are muscle strains and, in extreme cases, slipped discs. Some injuries could lead to long term conditions if not avoided."

Recommendations for backpacks and injury prevention

Key Facts About Seasonal Flu Vaccine

The Center for Disease Control and Prevention has all the Flu Shots facts about flu vaccination; the who, what, where and why. Please see their site on Flu vaccination and why it is important to be vaccinated every year. For the most part, carriers cover the flu shot in full.

Regence BlueShield has a list of visiting nurses who will come to your office, at no charge in most cases, for covered Regence enrollees.

If you have any questions about the articles contained in this newsletter, please give us a call or e-mail us:

Doug Evans

Marjorie Harwood

Becky Kaczor