Anthem's Radiology Shopper Program

Recently, Anthem launched a new Radiology Imaging Shopper Program for the following counties in Ohio:

Belmont, Butler, Carroll, Clark, Clermont, Clinton, Columbiana, Cuyahoga, Delaware, Erie, Fairfield, Franklin, Fulton, Geaga, Greene, Hamilton, Hancock, Holmes, Huron, Jefferson, Lake, Licking, Lorain, Lucas, Madiosn, Mahoning, Medina, Miami, Montgomery, Muskingum, Pickaway, Portage, Richland, Ross, Stark, Summit, Trumbull, Tuscarawas, Union, Warren, and Wood.

With this tool, members can compare costs for the same procedure at multiple locations in their area. For more information on this program and how if can help to keep your health costs down, check out this flier from Anthem!

Top 5: Causes of Changing Prescription Costs #1

1. How often your prescription plan carrier reviews the pricing of medications

The price of prescription medications is constantly changing based on a variety of factors. Anthem has compared the rise and fall of prices to gas or hotel rooms. The frequency that your insurance carrier audits the cost of prescriptions can mean significant impact for you.

For instance, some carriers only check the price of medications on a bi-annual basis while others check on a monthly basis. As a member, this can impact the total out of pocket throughout the year.

	Prescription Cost	Price to Member with bi-annual review	Price to member with monthly review
January	50	50	50
February	75	50	75
March	100	50	100
April	100	50	100
May	100	50	100
June	100	50	100
July *biannual review month	100	100	100
August	75	100	75
September	25	100	25
October	25	100	25
November	25	100	25
December	25	100	25
Total Cost		950	800

In this example, the member on the bi-annual plan has more consistency in their cost, but their final year out of pocket is $950. The member on the monthly review plan has costs all over the place, but their final year out of pocket is only $800. This can go either way for the member, but the frequency that the plan reviews this cost can impact the consistency of the prescription pricing as well as the out of pocket cost to the member.

For more examples of the causes of changing prescription costs, check out our Top 5: Causes of Changing Prescription Costs and check back often for articles explaining further each of these examples.

Top 5: Causes of Changing Prescription Costs

One of the more common questions that our team receives from our clients is: I just went to the pharmacy, and the cost of my medication nearly doubled from last month; what is going on?

Many factors can play into the cost of a prescription, but over the next few weeks, our team will be looking into what we see as the Top 5 Causes of Changing Prescription Costs. Keep checking in over the next few weeks for articles elaborating on the following causes:

1. How often your prescription plan carrier reviews the pricing of medications

2. Patents on medications and patent extensions

3. The availability of and introduction of generic medications

4. FDA approved uses of prescriptions

5. Manufacturer rebates and the net cost of a prescription to your plan

In the meantime, you can also check out the nice article that Anthem put together explaining some of these causes.

Tax Excise Chart

As a follow up to our last article regarding COBRA/FMLA compliance, today we are sharing a great excise tax chart created by Christine Roberts of Mullen & Henzell. Ms. Roberts has a fantastic blog, E is for ERISA, that I encourage you to reference for employee benefits update information.

The chart created by Ms. Roberts explains how failure to comply with COBRA, HIPAA, GINA, Mental health parity, Insured plan nondiscrimination rules, internal claims and appeal requirements, and/or external review procedure can result in excise taxes for the employer, insurer, HMO, and/or TPA. You can check it out here for a better understanding of what non compliance could mean for your group.

COBRA/FMLA Compliance

Recently, a court case ruled on the how FMLA, STD, and COBRA work.

The Family and Medical Leave Act (FMLA) ‘provides certain employees with up to 12 weeks of unpaid, job-protected leave per year. It also requires that their group health benefits be maintained during the leave.’ This act ‘applies to all public agencies, all public and private elementary and secondary schools, and companies with 50 or more employees. These employers must provide an eligible employee with up to 12 weeks of unpaid leave each year for any of the following reasons:

·         for the birth and care of the newborn child of an employee;

·         for placement with the employee of a child for adoption or foster care;

·         to care for an immediate family member (spouse, child, or parent) with a serious health condition; or

·         to take medical leave when the employee is unable to work because of a serious health condition.

Employees are eligible for leave if they have worked for their employer at least 12 months, at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles. Whether an employee has worked the minimum 1,250 hours of service is determined according to FLSA principles for determining compensable hours or work.’

In the court case, an employee went on FMLA. Once FMLA had run out, their employer put them on STD without offering them COBRA coverage. At the end of STD, the employer offered the employee COBRA coverage. However, the carrier refused to reimburse the employer for medical expenses incurred during the employee’s STD coverage. The employer argued that the requirement to be on FMLA, work 40 hours a week, or be on COBRA was only a condition for initial eligibility, but the court ruled in favor of the carrier, and the carrier was not responsible for reimbursing the employer for the employee’s medical expenses incurred while on STD.

For more information on this case, check out Plan Sponsor. For more information of FMLA, check out the United States Department of Labor.

Get to Know Your Anthem Plan

Just getting started with a new Anthem plan - or want to know more about your existing plan? Then Anthem's interactive video tutorial is a great resource for you! Here you can get a deeper understanding of your plan based on the type of benefits (HSA, HRA, PPO, HMO, EPO)and coverage (individual or family) you have elected!

You can find this video tutorial by going to www.anthem.com/basics, or it can always be accessed on our Video Tutorial page. Make sure to check out our other videos while you are there, too! From e-service tutorials to McGohan Brabender made Anthem application step by step videos to help your new hires or open enrollment employees, we try to ensure that you have the links to everything in one place.

Want to see more of the videos produced by the McGohan Brabender team? Check out the MB Studio page to see some of our team's projects!

New Women's Preventive Services

Recently it was announced that the Affordable Care Act has been expanded to include additional prevention coverage for women's health and well being. Under the act, originally signed into law in March 2010, it is required that health plans cover preventive services without cost share, such as copays or coinsurance, when going to an in network provider. Coverage included preventive services like mammograms, colonoscopies, and immunizations.

On August 1, 2011, the Affordable Care Act was expanded to include well-woman visits, screening for gestational daibetes, HPV testing, counseling for STIs, counseling and screening for HIV, contraceptive methods and counseling (except when group exclusions apply), breast feeding support/counseling and supplies, and screening and counseling for interpersonal and domestic violence. For an outline of the guidelines, check out the US Department of Health and Human Services site.

Please note that these guideline are effective August 1, 2011, but non-grandfathered plan and issuers are not required to provider coverage without cost sharing consistent with the guidelines of the act until the first plan year that begins on or after August 1, 2012. As always, it is beneficial to contact your member services line with your insurance carrier to verify what all is covered (and how it will pay!) under your benefit plan.

Controlling the Cost of Healthcare – for the Employer

The cost of healthcare seems to always be on the rise, both for employees and their employers. Various plans have been introduced throughout the years to help control these costs – from front end deductibles to high deductible/HSA plans. Recently, United Healthcare and McGohan Brabender partnered to launch a new, innovative program and product to help employers earn significant trend and rate adjustments for their renewals call Bend the Trend.

The easiest way to understand how the program works is to break the program down into Years 1 and 2.

Year 1 establishes the foundation for the Bend the Trend Program at the employer level. To "get on the field to play," employers agree to some basic strategic commitments in the following categories: wellness, optimal plan components, outcomes-based plan design, diabetes prevention/control. Don't worry, it sounds a lot more complicated than it actually is -- and chances are good that you're probably already doing some of it or all of it already. If you are an existing UHC customer, you can go ahead and start at year 2.

For meeting each employer strategic commitment, points are awarded Click Here to Download PDF Chart . The more commitments you meet, the more points you earn. Thus, the greater the premium discounts.

Beginning with your Year 1 start date, the Year 2 clock begins ticking. Now we need your employees to get involved. Do you remember those four strategic buckets we started with at the employer level? Well, we take those same four buckets and add some employee activities to them. Some are very simple, and others may require a little more effort – but that's ok. Our goal is to get your employees to own their health care plan…not rent it!

Just as with the employer commitment, employees earn points. Some of the points are awarded for participation while others are based on outcomes.

At the end of Year 1, your Year 2 rate adjustments are determined. This is done by adding up your earned Year 1 and Year 2 points. The greater your points, the greater your rate adjustment.

Want to know more about this program? Check out the Bend the Trend website for a potential financial impact calculator, wellVibe trailer, and a contact form!