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In This Issue


Premera Reaches Agreement With CellNetix










Question of the Month

Our Company offers a High Deductible Health Plan with a Health Savings Account (HSA). Can employees contribute to the HSA once they have turned 65? I have a number of such employees who want to enroll in the HDHP and participate in the HSA

  
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INSURANCE SPOTLIGHT

April 14, 2016

Carrier News

Regence Announces July 1 Formulary Changes
On July 1, 2016, several formulary changes will be made Pill Rx that directly affect about 13,000 members across all Regence plans. The majority of affected members, about 9,000, will be affected by the exclusion of non-FDA-approved drugs from coverage. These include fluoride toothpaste, hemorrhoid medications, acne products, and prenatal vitamins, many of which can be purchased over the counter. Other changes include new pre-authorization requirements and tier changes. 

Premera Reaches Agreement With CellNetix 
Premera is pleased to announce they have reached an agreement with CellNetix.  Effective February 15, 2016 CellNetix Labs LLC and CellNetix Pathology PLLC are back in-network.
 
Group Health Voting Membership Approves Plan of Member Substitution
Group Health has an important update to share with you about the proposal for Group Health to join Kaiser Permanente. At the Special Meeting of the Membership on Saturday, March 12, 2016 Group Health announced that their voting members approved the Plan of Member Substitution, the resolution supporting Kaiser Permanente's acquisition of Group Health. The merger is now before the Office of the Insurance Commissioner for regulatory review.
 
 

Federal & State News

Health Insurance Industry Fee
CMS Logo The Centers for Medicare and Medicaid Services (CMS) issued an FAQ that clarified the suspension of the 2017 Health Insurance Industry Fee. The moratorium will apply to the Health Insurance Industry Fee that would have been due in the 2017 calendar year based on 2016 data.

Non-Grandfathered Plan Extension to December 31, 2017
CMS issued a bulletin announcing that non-grandfathered individual policies and small group plans may extend their exemption from certain ACA provisions under the previously announced transitional relief.  If the applicable state permits, an extension may be granted through December 31, 2017. As of January 1, 2018, these policies and plans will need to comply with all ACA requirements. Earlier guidance had required these policies and plans to end by October 1, 2017. 

New Summary of Benefits and Coverage
The Affordable Care Act requires SBCs as a means to provide individuals with standard information so they can better understand and compare medical plan offerings. Final regulations implementing SBC requirements were issued in June 2015, but release of final documents had been delayed. 

On April 6, the Department of Labor (DOL) issued final regulations on the new Summary of Benefits and Coverage (SBC) template and related documents, intended for use as of April 1, 2017. Final documents and a completed sample SBC are available on the DOL website. Changes to the template include:
  • Streamlined content, e.g., removal of Q&A about coverage examples, which reduced the template to 5 pages (SBC limit remains 8 pages/4 double-sided pages)
  • An additional cost example for a foot fracture treated in an emergency room
  • Updated claims/pricing data for the coverage example calculator
  • New minimum essential coverage and minimum value language, as well as new continuation and appeals/grievance rights language
  • Revised language for some sections of the template
  • An updated Uniform Glossary
Use of the new materials will be required starting with the first day of the first open enrollment period that begins on or after April 1, 2017. 

Health & Wellness
What Causes Asthma?
Asthma affects 8% of American adults-nearly 19 million people. Almost 7 million children have asthma, too, according to the Centers for Disease Control and Prevention (CDC).

No one knows with absolute certainty what causes some people to develop asthma, but as the Asthm cold_woman.jpg a and Allergy Foundation of America notes, the condition does run in the family. Certain people with a family history of asthma and allergies seem predisposed to developing this chronic inflammation of the lungs, suggesting that heredity plays a role. Most experts believe a combination of genetic and environmental influences are responsible. Additionally, some people develop asthma in adulthood. You could be 40, 50 or even 60 years old and still develop asthma. Many cases of adult-onset asthma are linked to allergies-allergies to pets, cigarette smoke, mold and other substances are often triggers for these cases. Other cases are linked to obesity and various illnesses such as influenza. Women are also at greater risk of developing asthma as adults-some research suggests that hormonal fluctuations may play a role. 

While we don't know exactly why asthma develops, we do know common triggers that can make symptoms worse. Asthma is different in everyone, which is why it's important to identify your specific triggers so you can avoid them.  Full article

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