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CMS Issues Final Rule on MLR Requirements for Medicare Advantage and Medicare Prescription Drug Program; Updates Reporting Deadline to December
CMS Issues Final Rule on MLR Requirements for the Medicare Advantage and Medicare Prescription Drug Program; Updates Reporting Deadline to December
On May 17, 2013, the CMS released a final rule that implements new medical loss ratio (MLR) requirements for the Medicare Advantage Program and the Medicare Prescription Drug Benefit Program (Part D) established under the Affordable Care Act. The MLR represents the percentage of revenue used for patient care, rather than administrative expenses or profit. Under the final rule, Medicare Advantage and Part D sponsors are subject to financial and other penalties for failing to meet an MLR of at least 85%. The final rule primarily follows the proposed rule released in February 2013. However, CMS did agree with commenters on the proposed rule who recommended that the reporting deadline should be December, not July. In the final rule, CMS states that “We agree with the commenters that the best balance between beneficiary protection and calculating MLRs based on the most complete data is to require that, in general, MLR reporting for a contract year will occur in the December following the contract year, on a date and in a manner specified by CMS.” The final rule becomes effective on July 22, 2013. --AON Hewitt
CMS Releases Frequently Asked Questions on Health Insurance Exchanges
On May 14, 2013, the Centers for Medicare and Medicaid Services (CMS) released frequently asked questions (FAQs) on health insurance Exchanges (marketplaces). The federal and state Exchanges are to become operational in 2014 and are intended to provide individuals and small businesses with the opportunity to purchase affordable, quality health insurance options, as part of the Patient Protection and Affordable Care Act (Affordable Care Act). The FAQs address:
- The oversight of premium stabilization programs, advance payments of the premium tax credit, and cost-sharing reductions;
- Issuers’ ongoing compliance with Exchange-specific standards and oversight;
- State-based Exchange reporting requirements;
- Privacy and security standards for state-based Exchanges and non-Exchange entities (e.g., Navigators, agents, brokers, etc.);
- Cost-sharing reductions and health savings accounts (HSAs);
- Eligibility and enrollment; and
- Issuer withdrawal from the small group or large group market. -- AON Hewitt
Your Pharmacy Immunization Program Makes Getting Your Flu Shot Easy and Convenient!
Your employees can get their flu and pneumonia shots fast and easy through their Pharmacy Immunization Program, included in your prescription drug benefit through our health plan.
The best part of getting a flu shot from your pharmacist is the convenience. Your employees can avoid having to schedule their shots at the doctor's office and instead go directly to a participating retail pharmacy that offers the shots. Many are open after hours or on the weekends with no appointment necessary. Your employees simply choose the location and pick a time that works best. Most are usually close by.
The coverage is the same as at the doctor's office. Your employees simply present their health plan ID card at the pharmacy and then receive the shot. No prescription is necessary. And in many cases, there may be no copay. Not all pharmacies offer flu shots, so the best way to find out is to visit a pharmacy and ask.
Not all plans include the option of receiving flu shots at a retail pharmacy, so your employees should call the Customer Service number on the back of their member ID card for details.
You'll find more details in this flier that your employees may find helpful. Or, contact your Pharmacy account manager for more details about the Pharmacy Immunization Program.
Finding the right one for your company can be a daunting task. Here's a great way to figure out which one will work for you:
- Provider Network - One should first determine that their dental provider accepts the dental plan they are looking to purchase. Dental carriers have multiple dental plans and providers may pick and choose which ones they will accept. It is a common mistake to assume that a dental provider accepts all plans from a particular carrier. Typically, dental providers choose plans that command a high reimbursement rate.
- Plan Waiting Period - Some dental plans place restrictions on major services such as orthodontics, root canals, bridges, etc. Sometimes this waiting period can last from no waiting period to up to 12 months before major services will be rendered.
- Rollover benefits - As an enticement for members to seek preventative care, some dental plans roll over additional preventative care benefits to a member as an incentive. For example, if a member has a $ 1,500 dental benefit and the member uses at least $750 for preventative care, the carrier will roll over the remaining $750 of the unused benefit to the following calendar year. Ultimately, this raises the maximum benefit level to $2,250 rather than $1,500.
The federal health care reform law changed the way health plans and issuers approach rescissions in both the group and individual markets. Group health plans are affected whether they are insured or self-insured.
It's important to understand what constitutes a "rescission" for federal health care reform, as opposed to another type of coverage termination. A rescission is broadly defined as a retroactive termination of a member's coverage.
However, there are some important exceptions from this broad definition. For example, termination of coverage because of nonpayment of premium or contribution (either by the group or the member) is not a rescission. It is not considered a "rescission" when the member's coverage is retroactively canceled to the last paid-to date if the member pays no premiums or contribution for periods of time after termination of employment or eligibility. The member's coverage can be retroactively canceled to the last paid-to date.
For information on the restrictions on rescissions and clarification on which coverage terminations qualify as rescissions, refer to the Affordable Care Act Implementation FAQs - Part 2.
Are you looking for a quick and easy way to see whether they're eligible for the new health insurance tax credit?*
Look no further!
As you know the new health reform law is now allowing an unprecedented tax credit of up to 35% on health coverage for qualifying small groups.
And it rises to 50% in 2014!
Blue Shield just launched a new website for you that features a tax estimator powered by H&R Block.** Use this new tool to help estimate how tax credits could mean big savings for you.
Visit bscataxcredit.com to calculate your potential savings today!
Small businesses may be eligible this year for a tax credit up to 35 percent of the cost of providing health insurance for their employees."
Don't Leave Money on the Table!
There's a lot of discussion about how and when the health law is going to be taking effect. If you missed it, it's already started to roll out. And if your business is not getting on track wtih what tax subsidies and provisions there are that have ALREADY kicked in, you could be leaving MILLIONS of dollars on the table!
According to a January 4th article put out by Reuters, "Here are some of the law's major provisions and when they were implemented or are set to take effect:
- Several consumer protection rules took effect in September, including allowing children to stay on their parents' health insurance plan until age 26, banning lifetime coverage limits and ending denial of coverage for children because of pre-existing health conditions.
- A temporary insurance program was created to help provide coverage to "high risk" patients with pre-existing conditions.
- A phase-in of tax credits began for certain small businesses that provide health insurance to workers."
And even more provisions kick in during 2011! For a full list of what is coming up and what you need to know at a glance,click here to download this Provisions Timetable.
We've been hearing about Health Care Reform for some time. Most business, both big and small, are confused and concerned about what the changes will mean to them. The following are some of the ways health care reform will begin to impact your business, you, and your family:
- Adult children on your policy.
- Pre-existing conditions.
- “Grandfathering” for all policies.
- Changes to Health Care Savings Accounts.
- Subsidies for employers with Health Care plans.
How do you know what to expect? Where do you turn? Well, look no further! Vanasek Insurance Services has just released Reform Readiness Review™. This is a proprietary, complimentary, and no obligation service. Your personalized Reform Readiness Review™should take no longer than 3-5 minutes to complete. Once we recieve your information, we will be contacting you within 2-3 business days to review your Health Care Reform report customized for you and your company.
Information is Power! Know your rights! Find out exactly how this reform wil be impacing you, your business, and your family TODAY!
Follow this link to start your Reform Readiness Review™: http://www.reformreadinessreview.com
The new healthcare reform law gives a tax credit to certain small employers that provide healthcare coverage to their employees, effective with tax years beginning 2010.
The IRS has released a simple, 3-step worksheet for employers to use to determine if they qualify for the Small Business Health Care Tax Credit.
We believe this is good information for you to share with your clients and could prove to be a valuable prospecting tool as well.
Click here to visit the Warner Pacific website. The worksheet can be found in the article titled Small Business Health Care Tax Credit, located under "News & Updates."
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- May 23, 2013
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