OFFERING SOUND FINANCIAL ADVICE FOR OVER 40 YEARS

In This Issue

Two South Puget Sound Network Additions Round Out Group Health's Access PPO

Regence - New Preventive Care Benefits

EEOC Proposes Long Awaited Wellness Regulations

Cadillac Tax

May is Mental Health Awareness Month

Question of the Week

Are self-insured plans required to provide Essential Health Benefits?

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INSURANCE SPOTLIGHT

May 7, 2015

Carrier News

Two South Puget Sound Network Additions Round Out Group Health's Access PPO

GHC Logo A new addition to the Group Health Access PPO network gives Group Health's PPO product a comprehensive contracted network coverage. Earlier in April, providers and facilities within the MultiCare Health System were added to the Access PPO network. That follows the addition of CHI Franciscan Health in January. These two additions mean that the Access PPO offers extensive contracted network coverage throughout their service area. Read more

Regence- New Preventive Care Benefits

As of May 1, 2015 Regence added preventive care benefits based on recent recommendations from the United States Preventive Services Task Force (USPSTF):

Fluoride treatment for children from the first primary tooth up to 5 years of age
Hepatitis B screening for individuals at increased risk and pregnant women
Aspirin use for the prevention of preeclampsia.
Healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: Behavioral counseling
One-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men ages 65 to 75 years who have ever smoked
Intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs)
Screening for chlamydia and gonorrhea in sexually active women age 24 years and younger and in older women who are at increased risk for infection

Regence released an updated preventive care brochure and covered preventive medications list These changes went into effect May 1, 2015, regardless of renewal date.

Federal & State News

EEOC Proposes Long-Awaited Wellness Regulations

Proposed rules on the use of financial incentives within workplace wellness programs were published by the Equal Employment Opportunity Commission (EEOC) on April 16, 2015. These rules align the wellness provisions of the ACA and HIPAA with the nondiscrimination rules of the Americans with Disabilities Act (ADA). The rules amend the ADA regulations to provide guidance on the extent to which employers may use incentives to encourage employees to participate in wellness programs that include disability related inquiries or medical examinations. Read more

In addition, other agencies have released FAQ guidance covering related topics.

CMS: ACA and Wellness Programs

HHS: HIPAA and Wellness

CMS: Insurance Market Reforms and Wellness Program

Cadillac Tax

To review, as one of the financing mechanisms of the health reform law, beginning in 2018 there will be a 40% excise tax on health benefits companies provide to their workers if the cost for those benefits is above a certain threshold. In 2018, the tax will hit employer-sponsored plans valued at more than $10,200 for singles and $27,500 for families and the threshold amount will rise each year...but the cost-index is not explicitly tied to medical inflation. This requirement will apply to all employer group plans, including those that are self-funded and fully insured.

In February, the IRS issued a guidance which begins the process of laying out some of the tax's implementation issues. Clarifying these issues ahead of time will be crucial for employers who work in contracted plan situations that require advance planning and can be negotiated years ahead of time. The guidance does not contain many answers but does review the statute and attempt to clarify and does seek comments.

Identified issues from the guidance include:

How the employee contribution to the account based plans like HSA's, FSA's and HRA's may be valued
How self-funded vision and dental plans will be valued
How will the IRS determine the applicable coverage costs? The IRS is leaning towards the use of a variation on the COBRA rate calculation formula. However, the law allows for adjustments for the various ages of people on the plans, which could pose problems given the current limitations on composite rates, particularly for smaller groups.

We will keep you posted as we learn more.

Health & Wellness

May is Mental Health Awareness Month

For over 65 years, Mental Health America-MHA and their affiliates across the country have led the observance of May as Mental Health Month to raise awareness about mental health and mental illness. Addressing mental health before Stage 4, this year's theme for the month calls attention to the importance addressing mental health symptoms early, identifying potential underlying diseases, and planning an appropriate course of action on a path towards overall health. Full article

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