Regional Training - Benefits Program July 2010 NEW MEXICO PUBLIC SCHOOLS INSURANCE AUTHORITY 1
Christy Edwards, NMPSIA 800 -548 -3724 800 -233 -3164 mquintana@santafe. cserisa. com 800 -947 -4722 christy. edwards@state. nm. us mchb. grievance@state. nm. us Martha Quintana, ERISA Managed Health Care Bureau Julie Garcia, Poms & Associates • 800 -898 -6236 JGarcia@pomsassoc. com 2
Spring Benefits Fund Balance FY 10 Fund Balance July 2009 ($8, 848, 728) September 2009 ($8, 079, 069) August 2009 October 2009 November 2009 December 2009 January 2010 February 2010 ($10, 727, 703) ($6, 511, 653) ($4, 357, 466) ($3, 102, 810) ($1, 352, 357) $2, 700, 000
Self – Insured Coverage Began FY 09 with an $8 million deficit No Premium Increases allowed in FY 10 legislative budget process Current fund balance is a positive$7 million 4
Premiums October 2010 Blue Cross Medical: Presbyterian Medical: UCCI Dental: +6. 4% Davis Vision: The Standard Life: The Standard LTD: No Change 5
Carrier Contact Information now on inside covers References to Healthy Vistas deleted New Employer Plan Matrix & Rates Medco Pages 33 and 34 Correction of maximum on Non-Network High Option Dental 6
Infusion Therapy In-office Sterilization Maternity handout) Benefits (see 7
Two Recent NMPSIA Notices CHIPRA Mental Health Parity Opt Out 8
Medco ID cards and welcome kits mailed June 22 Temporary ID card can be printed from “medco. com” Alternate ID number same as it was with Catalyst Mail order prescription number same as it was with Catalyst 9
Medco Catalyst Formulary Status grandfathered until January 1, 2011 NMPSIA and ERISA have access to Client Website allows view of claims and changes to eligibility real-time Important for members to register on “medco. com” 10
Medco Specialty drug are filled by Accredo (separate division of Medco). Retail fills limited to 2 x. Immunization program to continue. Diabetes Pilot Program will probably expand this fall or early 2011. 11
Some new acronyms & headaches PPACA – Patient Protection and Affordable Care Act HCERA = Health Care and Reconciliation Act (aka “budget reconciliation bill” Combined form, they form Federal Health Care Reform 12
Reform from 50, 000 feet By 2014 everyone must have minimum essential healthcare or pay a tax. Employer obligations dovetail with programs for low paid persons who cannot afford coverage Low paid means employee household income of 100% to 400% of Federal Poverty Level 13
Federal Poverty Level 14
Minimum Essential Coverage Specific plan design – yet to be determined Bronze (60%), Silver (70%) Gold (80%) and Platinum (90%) Must cover ambulatory patient service, emergency services, hospitalization, maternity & newborn care, mental health & substance abuse, prescription drugs, Rehab services, lab services, wellness & preventive services, chronic disease management, pediatric services 15
Vouchers Begin January 1, 2014 Avoid $2, 000 penalty per employee by offering plan to all full-time employees Avoid $3, 000 penalty by offering a voucher to anyone who is low income and would pay between 8 – 9. 8 % of income for group plan Tax deductible voucher: a contribution to plan to which employer pays greatest proportion of costs (not highest dollar amount of contribution). 16
Voucher Example for Low Income Household income $15, 000 Current BCBS premium: $458. 40 (single EE < $15, 000) EE contribution 25% or $114. 60 per month, $1375 annually, or 9. 1% of $15, 000 income If EE declines NMPSIA coverage, employer issues voucher to EE for employer share of $343. 80 month 17
Impact to NMPSIA Plan year after October 1, 2010: no annual and lifetime caps except on “non-essential benefits” Children covered until age 26 (including married children) effective 7/1/11 (first plan year after October 2010) 2011 must include cost of employer sponsored benefits on employee’s W-2 July 1, 2014, pre-ex exclusion eliminated, automatic enrollment required 18
The Standard Life Insurance coverage also includes MEDEX assistance Pre-trip Assistance (visa, inoculation requirements, health hazards, etc. ) Emergency evacuation and repatriation when 100 or more miles away from home or out of country Coordinates with any medical coverage Benefits for companion or children transportation 19
ARRA is an acronym for? (a) Accounts Receivable’s Receivable Accounts (b) Aggravating Rules and Regulations Activities (c) American Recovery and Reinvestment Act 20
July 2, 2010 News from the Hill “Prospects for congressional approval of another extension of the COBRA subsidy are dim. The subsidy was first authorized in last year’s stimulus bill and has already been extended twice. However, the 15 -month subsidy was not available after June 1. An extension of the subsidy was included in House jobs bill but conservative Democrats and Republicans forced Democratic leaders to jettison it over cost concerns. The provision was never in the Senate bill. Sens. Sherrod Brown, D-Ohio, and Bob Casey, DPenn. , want to reinstate the subsidy as an amendment to the bill if it again reaches the Senate floor. But since reconsideration of the bill seems unlikely, a spokeswoman for Brown said the senators are pushing for the COBRA subsidy as a separate piece of legislation, and pay for it by eliminating a tax break. The Senate proposal would, be retroactive, giving people laid off since June 1 six months (through 11/30/2010) of the federal subsidy instead of the 15 months that earlier law had provided. “
Encouraged for Employer Transactions: ◦ Basic Life Enrollment ◦ Update EE and Dependent Information (like employee address or dependent SSN) ◦ Cancel All Enrollment ◦ Log on to districts. nmpsia. com and click on Online Enrollment Encouraged for Employee ◦ ◦ View and confirm enrollment Update address, phone or add email address Switch Enrollment Go to nmpsia. com “Members” tab and click on Employee Online Enrollment System
Warning on Possible Rule Change August Board discussion of no longer allowing 1 penalty waiver per rolling 12 months Staff recommendation because of additional work involved in penalty waiver research and accounting 23
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Any More Questions? Comments? Thanks! Let’s Break for Lunch 25
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