New Small Group Rate for Blue Shield in July 2011

New Small Group Rate for Blue Shield in July 2011

Blue Shield Group Rate ChangeThank you for your continued support of Blue Shield. Now more than ever, Health Plans Online is committed to helping you manage and grow your business. To help you prepare for the third quarter renewal period, we’ve outlined below some key details:

  • February 18  a rate pass for new second quarter business. In addition, Blue Shield offered renewal date change options for your second and third quarter new and renewing groups.
  • The second and third quarter renewing groups may choose between two specific medical contract/policy (“contract”) terms. New business has contract term choices as well.
  • For the July 2011 rate cycle, your small group rates will increase, however, the average increases are lower than previous cycles with rate actions. Below are some highlights of this quarter’s rate increases1 :
Plan Rate increase
PPO (other than HSA-compatible)
HMO
Dental, vision or life2
1.1%
0%
0%
  • Detailed rates can be found obtained by contacting Health Plans Online.
  • By popular demand,  the RAF program is extended until December 15, 2011.
  • There will be no new benefit changes to medical or specialty products for third quarter 2011.

For the latest information on our July 2011 rate cycle, please contact your Health Plans Online.

1099 Reporting Requirement Repealed

Legislation that would repeal the 1099 tax reporting requirement for businesses included in the Affordable Care Act (or the health care reform law) was signed by President Barack Obama today.  This now cancels the reporting requirement that  would have required businesses to file a 1099 form with the Internal Revenue Service every time they spent more than $600 a year with another business.  To offset the revenue losses by the repeal of this provision, the repeal legislation requires eligible individuals to repay the subsidies they are eligible for under the health care reform law if their income rises above 400% of the federal poverty level. Passage of the 1099 repeal legislation is considered a victory for business groups that have expressed opposition to the provision since the health care reform law’s passage last year, but this also represents the first time the health care reform law has been successfully changed.

Preventive Services Covered under the Affordable Care Act

If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider. 

Covered Preventive Services for Adults

  • Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  • Alcohol Misuse screening and counseling
  • Aspirin use for men and women of certain ages
  • Blood Pressure screening for all adults
  • Cholesterol screening for adults of certain ages or at higher risk
  • Colorectal Cancer screening for adults over 50
  • Depression screening for adults
  • Type 2 Diabetes screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • HIV screening for all adults at higher risk
  • Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
    • Hepatitis A
    • Hepatitis B
    • Herpes Zoster
    • Human Papillomavirus
    • Influenza
    • Measles, Mumps, Rubella
    • Meningococcal
    • Pneumococcal
    • Tetanus, Diphtheria, Pertussis
    • Varicella
  • Obesity screening and counseling for all adults
  • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  • Tobacco Use screening for all adults and cessation interventions for tobacco users
  • Syphilis screening for all adults at higher risk

Covered Preventive Services for Women, Including Pregnant Women

  • Anemia screening on a routine basis for pregnant women
  • Bacteriuria urinary tract or other infection screening for pregnant women
  • BRCA counseling about genetic testing for women at higher risk
  • Breast Cancer Mammography screenings every 1 to 2 years for women over 40
  • Breast Cancer Chemoprevention counseling for women at higher risk
  • Breast Feeding interventions to support and promote breast feeding
  • Cervical Cancer screening for sexually active women
  • Chlamydia Infection screening for younger women and other women at higher risk
  • Folic Acid supplements for women who may become pregnant
  • Gonorrhea screening for all women at higher risk
  • Hepatitis B screening for pregnant women at their first prenatal visit
  • Osteoporosis screening for women over age 60 depending on risk factors
  • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  • Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  • Syphilis screening for all pregnant women or other women at increased risk

Covered Preventive Services for Children

  • Alcohol and Drug Use assessments for adolescents
  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children of all ages
  • Blood Pressure screening for children
  • Cervical Dysplasia screening for sexually active females
  • Congenital Hypothyroidism screening for newborns
  • Depression screening for adolescents at higher risk
  • Developmental screening for children under age 3, and surveillance throughout childhood
  • Dyslipidemia screening for children at higher risk of lipid disorders
  • Fluoride Chemoprevention supplements for children without fluoride in their water source
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screening for all newborns
  • Height, Weight and Body Mass Index measurements for children
  • Hematocrit or Hemoglobin screening for children
  • Hemoglobinopathies or sickle cell screening for newborns
  • HIV screening for adolescents at higher risk
  • Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
    • Diphtheria, Tetanus, Pertussis
    • Haemophilus influenzae type b
    • Hepatitis A
    • Hepatitis B
    • Human Papillomavirus
    • Inactivated Poliovirus
    • Influenza
    • Measles, Mumps, Rubella
    • Meningococcal
    • Pneumococcal
    • Rotavirus
    • Varicella
  • Iron supplements for children ages 6 to 12 months at risk for anemia
  • Lead screening for children at risk of exposure
  • Medical History for all children throughout development
  • Obesity screening and counseling
  • Oral Health risk assessment for young children
  • Phenylketonuria (PKU) screening for this genetic disorder in newborns
  • Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
  • Tuberculin testing for children at higher risk of tuberculosis
  • Vision screening for all children

While it’s easy to simply say that preventive care is covered at 100%, the actual administration of this benefit is exceedingly complex. Here are some common concerns and things you can do now to address them:

* Eligible expenses. Some items on the list of covered services are not currently covered under most medical plans, such as aspirin, fluoride and iron supplements.   We recommend providing the list of covered items to your insurer early and ask them about their plan to address these types of items. If they do not yet have a plan of action, request semi-annual updates on the status.

* Participant confusion. Finding a clear definition of the difference between preventive and routine care, and educating your participants, is also key.  Many services that a participant considers preventive are not, such as screening for skin cancer, follow-up care and colon cancer screenings for individuals under age 50.  We recommend requesting a list from your insurance company of the items considered preventive care and make this easily available internally to assist with minimizing confusion.

As a precaution, we recommend contacting either your carrier or insurance broker to determine how any of the above items will be covered by your insurance carrier.

W-2 Reporting Rules for Small Employer Groups Under PPACA

One of the provisions of the PPACA law that is worrisome to small employer groups is the requirement that the cost of employer-sponsored group health plan coverage be included on an employee’s Form W-2.

This requirement was originally scheduled to be effective for taxable years beginning on or after Jan, 1, 2011, however, the IRS granted a one year extension in late 2010 so that the requirement now applies beginning with the 2012 Forms W-2.

While the general rule is that all employers that provide employer-sponsored group health plan coverage during a calendar year are subject to the enhanced Form W-2 reporting requirement, a limited exception now exists for small employers.

Specifically, in the case of the 2012 Form W-2 (which must be delivered to employees on or before Jan. 31, 2013), an employer is not subject to the enhanced reporting requirement for any calendar year if the employer was required to file fewer than 250 Forms W-2 for the preceding calendar year.

Consequently, if an employer files fewer than 250 2011 Forms W-2, the employer would not be subject to the enhanced reporting requirement for the 2012 Forms W-2.

This exception will be very helpful to those employers that do not reach the 250 Forms W-2 threshold. In addition, while the exception specifically applies with respect to the 2012 Form W-2, the exception is available until the issuance of further guidance.

Therefore, it is possible that this exception will be extended into later taxable years.

In any event, the earliest that such small employers would be required to comply is the 2013 Forms W-2 in January 2014. While the exception applies with respect to the 2012 Forms W-2, the determination of whether the 250 Form W-2 threshold has been reached is based on the prior year (i.e., 2011).

However, it is important that employers who may be eligible for this small employer exception in 2012 are aware of the exception throughout 2011.

Guidance on implementation is available in the IRS notice 2011-28 avaiable onthe IRS website.  Employers should consult with their employee benefits counsel and tax advisors to determine the impact that this guidance will have on their reporting obligations.