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TPA Briefing: October 2010
In this issue: Update on PPACA Early Retiree Insurance Program
The Early Retiree Insurance Program, enacted as part of the Patient Protection and Affordable Care Act (PPACA), was intended to help offset the costs of health insurance coverage for early retirees. The program will provide $5 billion in payouts to be awarded on a first-come, first-served basis.
The program began accepting applications this summer and the U.S. Department of Health and Human Services recently released a list of employers whose applications were approved. A number of Alliance members have been accepted, including Foley & Lardner, LLP., CUNA Mutual Group, Webcrafters, Inc., WEA Insurance Trust, and Wipfli, LLP. The list, which is being added to daily, can be found here.
To receive assistance, plans must apply, document and submit claims. They must also have in place a new or existing program or procedures to generate cost savings for chronic and high-cost conditions.
Payments will cover up to 80 percent of costs for medical, surgical, mental health, hospital or prescription drug coverage, minus negotiated price concessions, for net health claims between $15,000 and $90,000 that occur after June 1, 2010.
For more information about the program, our Legislative Brief, and links to application materials, visit our PPACA Updates page.
If you know of a mutual client that has applied, let us know about their experience, how long it took to complete the application, and how quickly they received a response.
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Documents Released Providing Clarification on PPACA
The Patient Protection and Affordable Care Act (PPACA) is officially six months old and a number of regulations are now in effect for any new plan year. Federal agencies recently issued several documents clarifying certain PPACA requirements. The following summarizes information is that most notable for self-funded plans:
- The DOL has issued a list of Frequently Asked Questions about PPACA implementation. The following have been addressed in the FAQ:
- Although not legally binding, the FAQ states that the Department is not taking a “punitive” approach in enforcing PPACA compliance. As long as plans make good-faith efforts to comply with requirements DOL will attempt to help plans understand compliance requirements and not penalize them for violations.
- Guidance will be issued shortly on ways a group plan may retain grandfather status and change carriers.
- The definition of “child” for the purposes of adult dependent coverage has been clarified to mirror the IRS code 152(f)(1) definition, which includes a son, daughter, stepchild, adopted child or foster child. Plans may impose additional conditions on eligibility for health coverage of an individual not described in the IRS code, such as a grandchild or niece, for example requiring that the individual be a dependent for income tax purposes.
- Regarding external appeals requirements for non-grandfathered plans, a third-party administrator (TPA) may hold contracts with independent review organizations (IROs), instead of the plan sponsor, in order to comply with the safe harbor procedure described in Technical Release 2010-01.
- The DOL issued Technical Release 2010-02 last week regarding internal claims and appeals requirements. It provides a grace period for certain new appeals procedure requirements to give plans more time to bring IT systems up-to-date, and has issued a revised model notice for adverse benefit determinations.
- HHS has issued a memorandum that describes changes made to HIPAA opt-out provisions for non-governmental self-funded plans as a result of PPACA.
- The IRS is asking for comments about the extension of non-discrimination rules to the fully-insured market. Notice 2010-63 also explains the difference in penalties between self-funded plans and fully-insured plans for violating non-discrimination rules. Comments will be accepted until November 4.
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Massage Therapy Added to Healthy Living Discounts
Members’ employees and family members can now receive discounts on massage through the Healthy Living Discounts program. Discounts have been added at massage providers in the Madison area, Portage, Fennimore, Baraboo, Watertown, and Lake Geneva.
As with other providers, discounts vary and members need only show their medical ID card with The Alliance logo to receive them. We will continue to solicit other massage therapists to participate in the program, but if you have a suggestion for a business you’d like to see added, contact Tierney Jensen, 800.223.4139 x 6642.
In addition to massage therapy, savings are offered on a wide variety of services, including:
- Health and fitness centers
- Hearing aid centers
- Yoga practitioners
- Nutrition and weight-loss centers
- Karate studios
For a complete list and more information, view complete program details.
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BabyLove is Easy
Helping employees get started with a healthy pregnancy is easy with BabyLove, a free benefit of Alliance membership. BabyLove is a free service that Alliance members’ employees and their family members can access by calling 608.276.7584.
The program includes:
- A free, confidential health risk screening, conducted by a registered nurse.
- General self-care information to promote good health during pregnancy.
- A free copy of What to Expect When You’re Expecting or What to Expect—The First Year or What to Expect the Toddler Years.
To let individuals know, members simply send them to the BabyLove toolkit on our website. They may also print out this flyer and hang up at their worksite.
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Foremost Farms Wins WELCOA Well Workplace Award
Congratulations to Alliance member Foremost Farms USA who was recently awarded a Gold Well Workplace Award from the Wellness Council of America. The Well Workplace Award recognizes quality and excellence in worksite health promotion. The gold designation is awarded to organizations developing a comprehensive program that is producing results and that are a strategic and integral part of the business.
To learn more about the Well Workplace Awards as well as access free resources about structuring your wellness program, visit WELCOA’s website.
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Free Case Study from WisconsinRx for Alliance Members
The Alliance offers a preferred relationship for members with WisconsinRx/National CooperativeRx. This not-for-profit, member-owned cooperative of employers and organizations provides more than just prescription benefit management, going the extra mile, testing clinical effectiveness and bringing significant financial return.
WisconsinRx/National CooperativeRx is offering Alliance members a free case study showing how its Drug Savings Review program saved members about 6 percent on their total drug spend. The program, which helps manage utilization by ensuring the right drugs are prescribed for the right duration, is offered at no charge to members.
To request the case study, contact Chris Ralston, WisconsinRx/National CooperativeRx sales manager, 608.204.9479 x 223 or at 866.679.9479 x 223. You can learn more about WisconsinRx/National CooperativeRx here.
To learn more about Alliance preferred pricing from WisconsinRx/National CooperativeRx, contact Bobbi Jones, product management specialist, 800.223.4139 x 6638.
Did you know The Alliance was one of three groups to found WisconsinRx? It's number 14 on our list of 20 accomplishments for 20 years. Read them all, and learn more about our beginnings here.
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Onsite Flu Shot Clinic Information
As part of Alliance membership, members can access discounts at a number of local providers that offer onsite flu clinics.
To see the complete list of vendors, services offered, fees, and Alliance employer preferred discounts members may visit our 2010 flu shot page at the Employer Resource Center, under the Employee Health and Education tab. They will need to log-in first. If they are unsure how to do so, they may contact Tierney Jensen.
We will also add any information to this page we receive from the CDC on flu or H1NI as it becomes available throughout the flu season.
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Welcome Kelly Davit
Kelly Davit has joined The Alliance as southern region manager. In this position, Kelly will be heading up our efforts to expand member access to additional providers in the northern Illinois area. Kelly has a great deal of experience in contracting with health care providers and working with employers on health benefit strategy in the greater-Rockford area.
Kelly’s position has been added at the request of many members with employees who receive or would like to receive care from providers in that area.
Please join us in welcoming Kelly, 800.223.4139 x 6649.
If you have perspectives or insights on how we can best address the needs of our mutual clients in this area of Illinois, please contact Kelly.
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Breast Cancer Awareness at Work
Unless you have been living under a rock, you know that October is Breast Cancer Awareness Month. But you may be asking yourself, “Why is breast cancer month so highly promoted?”
It might have something to do with the fact that 1 out of 8 women will have breast cancer in their lifetime and it’s hard to find someone who does not have a close friend or family member that has been affected.
The good news is that although the incidence of new cases of breast cancer has increased, the mortality rate has decreased, largely in part due to the extensive research that has been done to find a cure. Not only are there ways to support breast cancer awareness on an individual level, such as increasing awareness, fundraising, wearing a pink ribbon or participating in awareness walks, there are also activities that can be done on an organizational level. Below are some breast cancer awareness opportunities that can be implemented at member organizations:
- Breast Cancer Awareness Day: Each employee can donate at least a $5 donation to be able to wear jeans and a pink shirt to work on a designated day. All the money collected could be donated by the organization to Susan G. Komen for the Cure or another breast cancer research organization.
- Breast Cancer Bake Sale: Employees can volunteer to make pink treats to sell for donation to a breast cancer research organization.
- Distribute pink awareness ribbons to all employees: Challenge all to wear their ribbon each day of the month. All employees who wear their ribbon 20 days out of the month could be entered into a drawing for a breast cancer awareness giveaway.
- Educate on preventive screenings and how to perform a self-breast exam: Send information via e-mail, post flyers on bulletin boards or high traffic areas, even add information on mammogram insurance coverage to the meeting agenda.
- Ask someone in the organization that has been affected by breast cancer to speak about their experience.
- Pink Potluck: Organize a healthy potluck where foods can either be pink in theme or high in cancer fighting foods (like fruits and vegetables).
- Gather a group of employees to participate in a locate run/walk for the cure.
Health Solutions Ltd® can help provide education about breast cancer and other preventive screenings for Alliance members. For more information about breast cancer awareness, Health Solutions Ltd®, or about their partnership with The Alliance, contact Bobbi Jones, product management specialist, 800.223.4139 x 6638.
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Alliance Provider Update
The Alliance encourages employers to distribute the monthly Provider Update listing to their employees.
Just a reminder: Always check the online provider directory for the most current provider information!
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QualityCounts™ for Employees
The Alliance encourages employers to distribute the monthly QualityCounts for Employees informational piece to their employees.
This month, as with last month, we continue to bring you this piece in a new form. We’ve included a newsletter article that tells individuals about the report and how to access it. Members can simply print out and make copies. Get your copy here. Members can also find the complete QualityCounts toolkit in the Employer Resource Center under Employer Tools. They will need to log in first. If they do not know their log-in, they may contact Tierney Jensen.
The Alliance is available to come and give a presentation to our members’ employees about QualityCounts. For information, contact Bobbi Jones, 800.223.4139 x 6638.
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News You Can Use
Each month, The Alliance highlights health care and benefit management news for employers in News You Can Use, with a link to take you to the original story or report.
This month we look at a Mercer study that examines cost through the lens of grandfather status.
You may also be interested in reading Purchasing High Performance, a quarterly bulletin from the National Business Coalition on Health and the Commonwealth Fund. This issue includes a note from Secretary Sebelius to Employers about Health Reform and an article about September 23 PPACA changes featuring President & CEO Cheryl DeMars.
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About The Alliance TPA Briefing
Each month, The Alliance TPA Briefing delivers the latest news to third-party administrators about Alliance services, programs and events as well as information on health benefit trends, issues and ideas of interest to our mutual clients.
Subscriptions are available on a complimentary basis. To subscribe, please send an e-mail with your name, title and organization to the marketing and member services department.
Reader comments, suggestions and topics are always welcome.
Cathy Lanser, Editor
Tierney Jensen, Design
Carlene Boehmer, Manager of Claims & Customer Service
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