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It’s time to reassess your insurance plan

The year 2015 is coming to a close, which means it’s time for business owners to think about renewing or purchasing a health insurance plan for the coming year. NRHA’s health insurance expert Bob Chiesa, president of Custom Benefits Insurance Group of Michigan, provides insight to some important questions employers should ask. Next month, stay tuned towww.nrha.org for our “Ask the Expert” video featuring Chiesa and Brett Slama, account executive from Member Insurance, for more helpful advice.

Is my current plan Affordable Care Act (ACA) compliant?
In recent years, many new health insurance requirements have been introduced. While some carriers have taken a lead role in transitioning their groups and clients, ultimately, it is the employer’s responsibility to determine compliance. Business owners should be aware of two major changes that went into effect this year. A full-time employee is now defined under ACA as anyone working 30 or more hours per week. Additionally, the waiting period to offer employees medical insurance has been capped at 90 days. Due to these changes, many employers will have to offer coverage much sooner and to employees they may not have previously insured.

Do I need to comply with the Employer Mandate?
Under ACA, employers with over 100 employees had to comply with the Employer Mandate in 2015. Beginning in 2016, employers of more than 50 employees will be required to comply. This requires all businesses of this size to offer a medical plan and requires employers to charge no more than 9.5 percent of the employee’s gross household income as the employee contribution. A unique strategy for employers who fall into this category is to offer base and buy-up plans. Under ACA, an employer is only required not to exceed the 9.5 percent rule for the lowest ACA compliant plan. Many employers are offering a base plan that costs much less. If the employees want to choose
a buy-up plan, then they pay the difference while still keeping the employer in compliance.

Does my plan offer a composite rate or do rates vary by age?
Consider this: You have two equally qualified candidates for a job, but one is 32 years old and the other is 55 years old. As an employer, you’re put in an awkward situation knowing that hiring the younger employee could save you money on health insurance if rates vary by age, but you’re risking age discrimination if you consider that in your decision making. Due to health care reform, the majority of health insurance carriers for groups of fewer than 50 employees only offer rates by age. Moving forward, this will also affect groups of less than 100 employees. Consider how the type of rates offered by your carrier impacts your accounting and human resource departments.

Are the ACA and PCORI Fees and reinsurance fees included in the base rate?
The Patient-Centered Outcomes Research Institute Fees, or PCORI Fees, are due once per year in July, and then an initial reinsurance fee is due in December. For 2016, the PCORI Fees increased from $2.00 to $2.08 per insured member. However, the reinsurance fee was reduced significantly from $63 down to $44 per insured member. It is important to note that these fees are per person, so for a family of four the rates would be multiplied times four. There are a small number of carriers that are building these rates into the base rate, yet many are not and several carriers are itemizing these fees at the bottom of your invoice. The key is to be familiar with these fees and to take them into consideration when comparing carriers.

NRHA currently offers a complete range of health care coverage available to retailers and their employees. If you have additional questions about health insurance related issues or would like more information on NRHA’s health insurance options, please contact Bob Chiesa at 888-201-7408 or visit www.cbigi.com/nrha-program.

Source: Hardwareretailing.com – Written by: Hilary Welter

Parents: Take the 2×2+20 Challenge for Healthy Smiles and Mind

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How many times should children brush their teeth each day and how long should they brush? Chances are many parents might not know. The Ad Council recently kicked off its newest 2min2x campaign (www.2min2x.org) to help educate parents and guide kids toward brushing their teeth for two minutes, twice per day.

We applaud the Ad Council’s approach. Our recently-launched Brighter Futures initiative also focuses on the advancement of kid’s oral health and aligns perfectly with the 2min2x effort. As an added component to our strategy, we’ve incorporated the importance of literacy into the mix.”

“We’d like to challenge parents and caregivers to add a new variable to the 2×2 equation – read with or to your children for 20 minutes each day.According to The Reading Foundation, “Just 20 minutes of reading aloud each day with young children strengthens relationships, encourages listening and language skills, promotes attention and curiosity, and establishes a strong education foundation.” These skills are pivotal to success in school and in life.A study recently conducted by the Ostrow School of Dentistry at the University of Southern California linked low school grades to poor oral health. It sounds elementary, but the connection may be more common than you might think. According to the study, children without access to dental care were nearly four times more likely to have a lower grade point average than those with access. Further, the U.S. Department of Health and Human Service estimates that 51 million hours of school are missed annually among school-aged children because of oral health issues.Healthy, well-educated children are our most valuable resource. Today’s youth will be tomorrow’s dentists, doctors, scientists, teachers, business innovators and political leaders. With so much at stake, we must make sure that children show up for school every day healthy and ready to learn. Building good oral health and reading habits early can make a difference in a child’s ability to read, learn and achieve.

So take the 2×2+20 challenge. Brush for two minutes, twice per day and read with your child 20 minutes each day. That’s just 24 minutes of time in 24 hours making it easy math for a healthy body and mind—not a lot to ask to help ensure brighter futures for kids! “

Sources:

Deltal Dental http://bit.ly/YrfYW1

Reading Foundation http://www.readingfoundation.org/more.jsp
PubMed http://www.ncbi.nlm.nih.gov/pubmed/22813093

It’s Almost Time to Win by Losing

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Keep up with your New Years’ resolution to make healthy lifestyle changes!

Blue Cross Blue Shield is preparing to kick off the next round of Win by Losing, their weight-loss challenge designed specifically for BCBSM group customers. Since fall 2009, and throughout six rounds of the Win by Losing competition, participants from across the state of Michigan have discovered the benefits of taking personal responsibility for their health. Collectively, the teams have lost more than 46,000 pounds, more than 23 tons.

The eighth round of competition begins on Feb. 25, with registration opening on Feb. 18. In the next few weeks, BCBSM will be contacting group customers about the contest and providing them with all of the details they’ll need to know to register and get their team started.

Get involved! Check out bcbsm.com/yourhealth for Win by Losing contest details (PDF) and information.

BCBS of Michigan and St. John Providence Partner for Outcome-Based Hospital Payment Model

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First health system in Michigan to commit to performance-based reimbursement; The Physician Alliance also a key partner

St. John Providence Health System (SJPHS), and its five acute care hospitals across southeast Michigan, is the first health system in the state to partner with Blue Cross Blue Shield of Michigan on a new performance-based reimbursement model.

Under the agreement, the SJPHS hospitals will commit to achieving mutually-designed standards for successful patient outcomes in exchange for higher reimbursement. The agreement enables an organized system of health care by including The Physician Alliance as a key partner. The Physician Alliance is a 2,300-member physician organization that recently joined with SJPHS to form Partners in Care, a physician-health system entity created to manage the health of populations in the future.

Moving away from the traditional fee-for-service approach that is behind the huge growth of health care costs over the last decade, the agreement between BCBSM and St. John Providence on pay-for-performance contracting sets a new standard for how Michigan hospitals are paid by insurers.

This agreement truly breaks new ground. It leverages health insurance dollars not to encourage high volumes of services but rather high quality of care as measured by the successful treatment of hospital patients, said Susan Barkell, BCBSM senior vice president for Health Care Value. This is the first outcomes-based reimbursement arrangement between Blue Cross and a major Michigan hospital system. We recognize the leadership and foresight of St. John Providence for partnering with Blue Cross on it.

This kind of partnership with Blue Cross Blue Shield is exactly what we envisioned when St. John Providence Health System and The Physician Alliance formed Partners in Care in October, said Patricia Maryland, president and CEO of SJPHS. We are pleased that Blue Cross Blue Shield endorses the commitment we and our physician partners have made to a new era in health care that focuses on helping patients manage a lifetime of healthy choices and fewer episodes of illness.

Under the agreement, BCBSM will support the funding of infrastructure improvements necessary to better integrate care services between The Physician Alliance and the five hospitals under Partners in Care. Milestones will be established jointly between St. John Providence and BCBSM to ensure infrastructure work continues along with funding until 2013, when St. John Providence will include a performance-based reimbursement model in its next contract with BCBSM.

The agreement recognizes St. John Providence Partners in Care as a leading, innovative and clinically integrated health care organization that will be accountable for the delivery of patient-centric, coordinated, high-quality and compassionate health care.

This agreement integrates physician organizations and hospitals in ways that create a better system of health care that has the patient front-and-center throughout the care process, said Dr. Thomas Simmer, BCBSM senior vice president and Chief Medical Officer. We are building the future of Michigan health care with our partners at St. John Providence, and we encourage other hospital systems and physician groups to join us.

St. John Providence is part of Ascension Health, the nation’s largest Catholic and nonprofit health system. St. John Providence’s five acute-care hospitals include:

Providence Hospital, Southfield
Providence Hospital, Novi
St. John Hospital and Medical Center, Detroit
St. John Macomb-Oakland Hospital, Madison Heights and Warren
St. John River District Hospital, East China Township

Source:

Contact:
BCBSM, 313-549-9884
newsroom@bcbsm.com

St. John Providence, 586-753-1154
Maureen.petrella@stjohn.org

Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.

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