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What records does ERISA require us to maintain for our employee welfare benefit plans, and for how long
 

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INSURANCE SPOTLIGHT

December 14, 2015

Carrier News

Moda Health Pulling Out of Washington State
Moda Health will no longer market individual and group products in Washington effective January 1, 2016. Moda Health has been notifying covered members in their Individual plans that they will need to enroll in other carrier plans effective January 1, 2016.
 
In addition, Moda will no longer sell or renew group fully funded business in the state of Washington. Companies who have renewed or enrolled as new groups with Moda Health for 2015 effective dates and who have signed group master applications prior to 10/31/15 will be honored. Moda will continue those contracts through their 12 month contract period. Moda Health will not be selling new group insured plans for effective dates on or after January 1, 2016. All Group purchasers and members will receive notification from Moda Health to inform them as to when their coverage will terminate.  Press Release
 
Group Health Updates
GHC Signs Agreement to be Acquired by Kaiser Permanente
Group Health Cooperative announced that it has signed an agreement to be acquired by Kaiser Permanente subject to Group Health's voting membership and regulatory approval.

The acquisition process may take a year or more to complete, during which time business will continue as usual. The process will not affect the health plans and rates they've filed and are offering for 2016. Upon joining Kaiser, Group Health will maintain local clinics, care teams, health plans, staff, services and operations that serve Washington families every day. Press release and FAQ.
 
HMO Plans Moving Forward for Transition to Swedish
Beginning in January 2016, many of Group Health's Seattle area HMO members who require hospital admission will get care at the Swedish Hospital First Hill and Cherry Hill campuses, rather than at Virginia Mason Hospital. It was approximately a year ago that Group Health Cooperative announced a new relationship with Swedish Health Services to provide hospital services to Seattle area members. Since then, plans have moved forward with teams at Swedish and Group Health working together on transition planning. Read more
 
New ID Cards
Group Health has changed its pharmacy benefit manager (PBM) from MedImpact to OptumRx. OptumRx will take over this function beginning on Jan. 1, 2016, for our large group, small group, individual and family. Affected members can expect new cards prior to Jan. 1, 2016. Read more
 
UnitedHealthcare - New Prior Authorization Requirement
Effective Oct. 1, in an effort to provide UnitedHealthcare members with the most cost-effective place of service, there will be a Prior Authorization requirement for certain outpatient surgical procedures performed in outpatient hospital settings. This requirement, which applies to new and existing UnitedHealthcare fully insured commercial plan members, is due in large part to the high costs to members when these procedures take place in a hospital outpatient facility versus a less expensive ambulatory surgery center. 
 
For some UnitedHealthcare members, requests for select procedures being performed in a hospital outpatient facility may be subject to Medical Necessity review. As a result, the provider may be required to perform select procedures at an ambulatory surgery center instead of a hospital outpatient facility to continue benefit coverage. A full list of these select outpatient surgical procedures is included in the FAQ.

First Choice Health NetworkFirst Choice Healht
FCHN is pleased to let you know that Harrison Medica l Center will be remaining in the First Choice network. The two parties agreed to a new 3 year contract effective October 1, 2015. There will be no lapse in network access for members who utilize hospital services at Harrison Medical Center. 


Federal & State News

1095 Reporting Requirement - Important!
IRS LogoIn order to enforce certain aspects of the Affordable Care Act, the IRS will require that Applicable Large Employers provide employees, and the IRS, a 1095 form by the end of January 2016. If you are a fully insured employer, that does not meet the definition of an Applicable Large Employer (see ALE definition), your insurer will handle all filing requirements for you.  If you have questions about whether you are required to file these forms, call us.

If you are an ALE or have a self-funded plan, you are responsible for providing a 1095 to your employees, and you must file copies of these with the IRS by the end of February.  The information on these forms detail offers of coverage made by employers, and whether it met Minimum Value, Minimum Essential Coverage and Affordability requirements.  If you partially self-fund your medical benefits, you must also detail who was covered by the plan and for which months they were covered.  At this point we believe we have reached out to all of our clients impacted by this new requirement.  Should you have any questions, please contact your consultant. 

The IRS Increases PCORI Fee
PCORI IRS Notice 2015-60 announces that the adjusted applicable dollar amount for PCORI fees for plan and policy years ending on or after October 1, 2015 and before October 1, 2016 is $2.17. This is a $.09 increase from the amount in effect for plan and policy years ending on or after October 1, 2014 and before October 1, 2015. PCORI fees are payable by insurers and sponsors of self-insured plans, and are calculated by multiplying the applicable dollar amount for the year by the average number of covered lives. 
 
Legislation Impacts the Definition of Small Groups
On Oct. 7, 2015, President Obama signed the Protecting Affordable Coverage for Employees (PACE) Act. The PACE Act amends the Affordable Care Act (ACA) to classify employers with 51 to 100 employees as large employers for purposes of health insurance markets. States have the option to treat these employers as small employers. Previously under the ACA, employers with 51 to 100 employees were defined as small employers, but before Jan. 1, 2016, states had the option to treat them as large employers.

Under the ACA, health insurance offered in the small group market must meet certain requirements that do not apply to the large group market. This includes adjusted community rating, no medical underwriting and the requirement to cover all 10 categories of essential health benefits. Each state will have to determine whether it wants to default to the revised Federal definition of Small Business (1 to 50) or move to a 1 to 100 definition. Washington State defaults to the Federal definition of Small Business (1-50). 
 
Health & Wellness
5 Myths About the Flu
Cold or flu Nearly everyone knows something about the flu-but not everyone knows the whole truth about the flu.

Influenza, commonly known as "the flu," is a respiratory viral illness that can cause sickness and death. It's extremely common in the United States in fall and winter, yet it's also commonly misunderstood. Here are the facts behind five common (and persistent!) myths about the flu.
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