Shirazi Notice – September 2013

 open book

IN THIS ISSUE:

Legislative Alerts

Alert: Deadlines Ahead

Health Care Reform

Partners in Covering Coloradans
Tax Credit Resource Brochure
Health Insurance Plans & Rates for 2014
FAQs About the Affordable Care Act Implementation (Part XII)

Carrier Updates

Cigna Preventive and Physical & Occupational Therapy Changes
New 2014 Individual Plans for Rocky Mountain Health Plans
Cigna 2013-2014 Flu Shot Program
Anthem 2013-2014 Flu Shot Program

 

LEGISLATIVE ALERTS:

Alert: Deadlines Ahead

Just a short time remains to prepare for and comply with upcoming federal reporting and employee notice requirements. The below chart highlights upcoming deadlines, what size of businesses they apply to and clickable links to get more information.

Reporting Requirement
Deadline
Employer Applicability
Purpose How to Comply
EEO-1 Report September 30th, 2013

100+ employees, under 100 employees if affiliated with another company with 100+ employees, federal contractors with 50+ employees.

Collect annual data about from covered private employers and federal contractors about their minority and female workforce.
File the survey online.
Exchange & Updated COBRA Notices October 1st, 2013 and to each new employee at the time of hiring beginning October 1st, 2013 All employers

Notifies employees and qualified beneficiaries of other coverage options available in the Marketplace.

Read:

Sample notice for employers who DO offer a health plan. EnglishSpanish

Sample notice for employers who do NOT offer a health plan. EnglishSpanish

COBRA model election notice: EnglishSpanish
HIPAA Privacy Final Rule September 23rd, 2013 Applies to business associates who performed or assisted in any activity involving the use or disclosure of individually identifiable health information. Business associate status is triggered when a vendor “creates, receives, maintains or transmits” personal health information (PHI).

Employers must update their health information disclosure policies and retrain their employees to ensure compliance.

Read: Final Rule

Employers should review and revise their Business Associate Agreements (BAAs) to ensure compliance with the security rule, review and revise (or create) breach-notification procedures and train employees who have access to PHI.

 

Medicare Part D Annual Notice
October 15th, 2013 and when a Medicare eligible individual joins the plan. Must also be provided to that individuals dependents and any retirees and their dependents.
Employers whose health insurance policies include prescription drug coverage.

Notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage.

Read:

Read:

Must provide written notice to all Medicare eligible individuals annually who are covered under its prescription drug plan.

Model Creditable Coverage Disclosure Notice: EnglishSpanish

Model Non-Creditable Coverage Disclosure Notice: EnglishSpanish
Summary of Benefits/Coverage (SBC)

Plan years upcoming open enrollment.

Material modifications affecting the SBC content would require advance notice (no later than 60 days prior to the date that the change will become effective).

All employers who offer group health coverage. Informs employees whether the plan or coverage provides minimum essential coverage (MEC) and minimum value (MV).

Plans will not be required to use the new template for the second year of applicability so long as they provide a cover letter or disclosure statement with the SBC stating whether the plan provides MEC and MV.

SBC template: English – Spanish

 

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HEALTH CARE REFORM:

Partners in Covering Coloradans

The following is a fact sheet that may help you guide your employees on what coverage options will be available to them in Colorado, including benefits through Medicaid and Connect for Health Colorado.

Download the Partners in Covering Coloradans fact sheet.

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Tax Credit Resource Brochure

A new brochure from Connect for Health Colorado is now available to help Coloradans learn more about how the advance premium tax credit will work and information to help use it, if eligible.

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Health Insurance Plans & Rates for 2014

Information on plans and rates for 2014 approved by the Division of Insurance are now available on the Department of Regulatory Agencies (DORA) website. The information is for plans insurance carriers want to offer on Connect for Health Colorado, Colorado’s exchange, as well as plans not for the exchange.

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FAQs About the Affordable Care Act Implementation (Part XII)

The Departments of Labor, Health and Human Services (HHS) and the Treasury have jointly prepared a set of additional Frequently Asked Questions (FAQs) regarding implementation of various provisions of the Affordable Care Act. These FAQs help answer questions from stakeholders to help people understand the new law and benefit from it, as intended.

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CARRIER UPDATES:

Cigna Preventive and Physical & Occupational Therapy Changes

Effective January 1, 2014, services on Cigna’s preventive care list will continue to be paid at 100%. Some services that are commonly ordered by primary care physicians during preventive care visits but which are not universally recommended as preventive for all individuals will also be covered at the preventive level (100%) when provided in conjunction with a routine annual preventive care visit and appropriately coded by the physician as a preventive service or screening test. Examples include:

  • Urinalysis
  • General Health, Basic and Comprehensive Metabolic Panels
  • Vitamin D testing
  • Thyroid testing

Several coding edits for Physical and Occupational Therapy were implemented January 1, 2014 as well. You can review the full changes here, as shown in the sample client letter you should have already received in the mail.

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New 2014 Individual Plans for Rocky Mountain Health Plans

Rocky Mountain Health Plans (RMHP) has recently sent notification to all SOLO members introducing their new 2014 plans and rates. The member letter and attachments provide benefit information and premiums, specific to each member and family, as well as step-by-step guidance on how to enroll in a new RMHP Individual health plan effective January 1, 2014.

It is important to note that Individual members MUST choose a new individual/family health plan to maintain their coverage. If RMHP does not receive acknowledgement from the member on their new plan choice, coverage will be terminated effective December 31, 2013.

Individual members can go online to www.individualrenewal.com to review and select a new plan, add or delete dependents and update their address. Members can also complete the Plan Change Form. However, we would encourage that Individual members contact our office at 970.356.5151 to help in finding comparable coverage and make the transition to a new plan as smooth as possible.

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Cigna 2013-2014 Flu Shot Program

Cigna Onsite Flu Clinics – how they work
Cigna is offering an onsite flu clinic program with services delivered by Summit Health to help their clients’ employees fight the flu. Licensed professionals will come to the worksite and administer flu shots to your employees. A minimum of 30 injections per site is required to hold a clinic, and both Cigna and non-Cigna customers that are over 18 years old and who are not pregnant or nursing are eligible to participate. Pricing is $25 per injection. Injections for Cigna customers will be processed as a claim when the client’s plan covers immunizations at 100% in-network under adult preventive care with no copay, no deductible and no maximum. For complete details, view the Onsite Flu Fact Sheet and the Onsite Flu Pricing Sheet.

Cigna Seasonal Flu Vaccine Pharmacy Directory
Cigna customers may also be able to receive the seasonal flu vaccine, as well as other select vaccines, at several retail pharmacy locations. These vaccines can be administered at the following pharmacies and will be billed through the Cigna medical benefit. Your medical benefit will determine if there is a cost to you or if these vaccines are available for zero dollars.

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Anthem 2013-2014 Flu Shot Program

Anthem Onsite Flu Clinics – how they work
Anthem will provide flu shots clinics for existing large groups, covering all Anthem members at 100%. Minimum participation of 20 participants per location must be met or the balance will be charged directly to the employer. Anthem members will be invoiced directly to Anthem and any non-Anthem members can be invoiced to the company or they can pay out of pocket via cash, Visa or MasterCard. Anthem uses a third-party vendor to conduct the clinics and you can contact Jamie Dennis in our office if you would like more information about getting this set-up for your company.

Anthem Seasonal Flu Vaccine Pharmacy Directory
Pharmacies in our Pharmacy Immunization Program may give you vaccines for the flu, pneumonia and shingles. Anthem members can go to a pharmacy that’s part of the program and offers shots. Check the list, or call a pharmacy to make sure it’s in the program. You have the same coverage for when you get a shot at your doctor’s office. If you want to check your coverage, call Customer Service at the number on your ID card or call our office at 970.356.5151 for assistance.

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