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INSURANCE SPOTLIGHT

July 26, 2016

Carrier News

Premera Network Change for Schumacher Clinical Partners              
Starting July 1, 2016, Schumacher Clinical Partners (Schumacher) decided to terminate their contract and will no longer be in the Premera network of contracted doctors and hospitals. This change includes Washington Emergency Physician Partners and Sterling Emergency Services of Washington. These groups supply emergency room (ER) staff to the following hospitals. 

*  Deaconess Hospital, Spokane     
*  Valley Hospital, Spokane  
*  Yakima Regional Medical & Cardiac Center, Yakima 
*  Toppenish Community Hospital, Yakima


New Regence iPhone App 
Regence has launched their new iPhone app! Available now from the Apple Store, the app gives Regence members convenient on-the-go access to their health information, including claims status, benefits and coverage information, provider search, and Touch ID sign-on for newer iPhone models. Flyer and FAQ

UnitedHealthcare - Network Termination of Seattle Pain Center 
Effective immediately, Seattle Pain Center (SPC) will no longer participate in UnitedHealthcare's networks, which means any providers working out of SPC are also out of network. This impacts SPCs' eight clinics across Washington (Everett, Seattle, Renton, Tacoma, Poulsbo, Olympia, Vancouver, and Spokane). Read more

Federal & State News

2016 Comparative Effectiveness Research Fee (CERF) Payment Due July 31st
The Affordable Care Act (ACA) includes a Comparative Reminder Effectiveness Research Fee (CERF) for insurers and self-funded plans to fund research that determines the effectiveness of various forms of medical treatment. CERF is effective through 2019 with fee amounts indexed annually. Fact Sheet

The fee is based on the average covered lives for the applicable 12-month policy or plan year, and is paid using IRS form 720 by July 31 each year for the plan year that ended in the preceding calendar year. The fees for 2016 are:

Plan Year Start Date
Fee Per Average Covered Life
Feb. 1, 2014-Oct. 1, 2014
$2.08
Nov. 1, 2014-Jan. 1, 2015
$2.17
 
Proof of Mailing COBRA Election Notice Defeats Claim of Non-Receipt
As part of a larger employment discrimination lawsuit, a former employee claimed that her employer failed to provide a COBRA election notice upon her resignation. The employer argued that it had notified its third-party administrator (TPA) of the employee's termination and that the TPA had sent the notice in a timely manner. As evidence, the TPA produced an electronic copy of the notice along with computer records showing the dates on which the notice was created and mailed, supported by an affidavit from a TPA employee responsible for delivery of COBRA notices as directed by this employer. The court ruled that the employer met its obligation by having the notice mailed to the employee and noted that the employee's claim of non-receipt did not mean the employer failed to comply with COBRA. Full article
Perkins v. Rock-Tenn Services, Inc.
, 2016 WL 3135709 (W.D. Mich. 
Health & Wellness
The Dangers of Pokemon Go
One writer explains some of the biggest safety obstacles that Pokemon GO players must learn to manage in order to stay safe while trying to catch 'em all.
 
Just a few days after launch, Pokemon GO has already proven itself to be a national (and soon worldwide) phenomenon. It's nearly impossible to walk down any street in supported cities without seeing dozens of people catching Pokemon or capturing gyms. Although the game is doing a fantastic job getting gamers out into the world to explore and be social, there are also some serious safety issues to consider. I only had to play the game for a day or two to see dozens of people putting themselves at risk while playing. Continue reading
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