Agents are Your Groups Looking to have Control of their Billing and Extend their Cash Flow? New BCBS eBilling is now Available!

 

Starting June 12, 2012, if you or any of your customers require support with accessing or using eBilling or requests for training, you must complete the eBilling support request form (ZIP) and submit it to eBillingSupport@bcbsm.com. Include any supporting screenshots if applicable.

 

Also effective June 12, BCBSM will no longer accept any eBilling support inquiries to the MOS Command Center email box. All eBilling support requests must be submitted via the request form.

 

Groups currently on the Michigan Operating System platform have access to eBilling, an application that allows them to view and print billing information. Please Note: Groups that are billed directly by BCBS instead of a third party administrator can also pay their invoices online using eBilling.

 

You can view and print billing information using eBilling for your book of business currently available in MOS.

 

Upcoming eBilling webinars:

BCBS scheduled several question-and-answer webinars for you and your customers. Subject matter experts will be on hand to answer your questions.

 

You can register for a session at MOS_News_BCBSM@bcbsm.com. You’ll receive a confirmation email with the call-in information. The webinars also will cover information on the new membership system, eMVP.

Health care reform expands ERISA’s disclosure requirements by requiring that a “summary of benefits and coverage” be provided to applicants and enrollees before enrollment or re-enrollment. The summary (referred to as the SBC) must accurately describe the “benefits and coverage under the applicable plan or coverage.” The SBC requirement applies in addition to ERISA’s SPDs.

 

The initial SBC must be distributed to participants and beneficiaries who enroll ore re-enroll during an open enrollment period that begins on or after September 23, 2012. For newly hired employees and special enrollees who enroll in coverage other than during an open enrollment period, the SBC must be distributed on the first day of the plan year that begins on or after September 23, 2012.

 

What Types of Plans Must Distribute a Summary of Benefits and Coverage?
The obligation to furnish an SBC applies to a group health plans and insurers. A plan that offers “excepted benefits” is not required to distribute an SBC. This would generally include a standalone dental or vision plan and most health flexible spending arrangements.

• Grandfathered group health plans must comply.
• Disclosures for a health FSA that is not an excepted benefit depend on whether it is integrated with other major medical coverage. If the health FSA is integrated with other major medical coverage, features of the health FSA can be included in the SBC for the major medical coverage. If the health FSA is not integrated with major medical coverage then it is required to furnish an SBC.
• A health reimbursement account (HRA) must comply.
• A health savings account (HSA) is not a group health plan and is not required to furnish an SBC. However an SBC for a high deductible health plan can mention the effects of any employer contributions to an HAS that can be used for deductibles, copayments, coinsurance or other services not covered by the high deductible health plan.

 

Who Must Provide the SBC?
Both the health insurance issuer and the plan administrator of a group plan are required to furnish an SBC to plan participants.

• If the group health plan is self-insured, the obligation to provide an SBC lies solely with the plan administrator.
• If the plan is fully insured, the obligation to timely provide an SBC lies both with the plan administrator and the insured.

 

When Must the SBC be Distributed?
A health insurance issuer that offers group health insurance must provide an SBC to the plan or plan sponsor as follows:

• Within 7 business days after receipt of an application for health coverage.
• By the first day of coverage; if there are any changes in the initial SBC.
• If written application for renewal is required, no later than the date the written application materials are distributed.
• If renewal is automatic, at least 30 days before the beginning of the new plan or policy year.

 

What Types of Information Must be Included in the Summary of Benefits and Coverage?

• Uniform definitions of standard insurance and medical terms so that consumers may compare health coverage and understand the terms of their coverage.
• A description of the coverage, including cost-sharing, for each category of benefits identified by the agencies.
• Exceptions, reductions and limitations on coverage.
• Cost-sharing provisions, including deductible, co-insurance and co-payment obligations.
• Renewability and continuation of coverage provisions.
• Coverage examples.
• Contact information for questions and obtaining a copy of the plan document or policy.
• An internet address for obtaining a list of network providers and information on the prescription drug formulary.
• An Internet address for obtaining the glossary of health coverage and medical terms.

 

Is the Summary of Benefits and Coverage Required to be Provided in a Uniform Format?
Yes. The SBC must be provided in the form issued by the Departments using prescribed language. The information must be presented in the order shown in the SBC template, must be in 12-point font and cannot exceed for pages. The template, instructions, the information necessary for the coverage examples, the uniform glossary and a sample completed SBC are available at: www.dol.gov/ebsa/healthreform or http://cciio.cms.gov/resources/other

<p><img width=”160″ vspace=”15″ hspace=”15″ height=”68″ align=”right” src=”/Portals/3/Logos/Basic.png” alt=”” />The MBPA &amp; MFBA can provide you and your clients state-of-the-art COBRA administration through <strong>BASIC</strong>, a Michigan-based award winning company providing a wide-range of HR Solutions for businesses. Best of all, the Associations’ COBRA Administration program is open to all members – <strong>starting at $25.00 per month!</strong></p> <p>&#160;</p> <p>Our COBRA Administration program with BASIC reduces your clients’ risk and frees up valuable time and resources, allowing your clients time to focus on their active employees and business operations. With BASIC COBRA, your clients will be relieved to know that their COBRA administration is being handled consistently and accurately by experts.</p> <p>&#160;</p> <p><strong>As a friendly reminder </strong>the MBPA &amp; MFBA also provides the following BASIC products:</p> <ul> <li>Discounted FMLA Administration</li> <li>Flexible Spending Account Program</li> <li>Guru – HR Online Benefits Management Software Solution</li> <li>Discounted HRA Administration</li> <li>Payroll Service Program</li> </ul> <p>&#160;</p> <p><em>If you have questions or need assistance, please contact our Membership Services Team at 1-888-277-6464 or 1-586-393-8800.</em><br /> &#160;</p>

The Michigan Business and Professional Association (MBPA), along with its sister group, the Michigan Food and Beverage Association (MFBA), want to keep you up to date on the federal healthcare law and how it will affect you and your clients.

 

On March 12, 2012 the federal government released a final rule on Healthcare Exchanges. State Exchanges will allow individuals and small businesses to view all options, compare, and enroll in the plan that best meets their needs. As you are aware, in order for Michigan to operate its own Exchange beginning Jan. 1, 2014, our state must receive approval from the federal Department of Health and Human Services by Jan. 1, 2013. If a state is not running its own Exchange, HHS will step in and run the Exchange in that state, as federally mandated. States can receive funding from HHS to assist with Exchange development, but no federal funds will be provided after Jan 1, 2015.

 

Final Rule Updates

HHS is no longer requiring that states run their own reinsurance program in order to run a state-based Exchange. States also no longer need to announce user fees to issuers prior to the start of the plan year–HHS indicated that it wanted to give states more flexibility regarding fee assessment and notification. When a state seeks to make changes to its state-based Exchange, HHS has up to 90 days to approve or reject the changes to its Exchange Blueprint (the new name for the documentation states must file with HHS to receive state Exchange approval).

 

Individual market Exchange enrollment periods

The final rule changed initial open enrollment from Oct. 1, 2013, through Feb. 28, 2014, to Oct. 1, 2013, through March 31, 2014 and moved the initial coverage effective dates such that, now:

• If enrolled on or before Dec. 15, coverage effective Jan. 1
• If enrolled Dec. 16 to Jan. 15, coverage effective Feb. 1
• If enrolled Jan. 16 to Feb. 15, coverage effective March 1
• If enrolled Feb. 16 to March 15, coverage effective April 1
• If enrolled March 16 to March 31, coverage effective May 1

 

States may elect an earlier effective date than those listed above, but only if all qualified health plan issuers agree. Annual open enrollment period in subsequent years remains Oct. 15 to Dec. 7, with coverage effective Jan. 1.

 

Special enrollment periods

The final rule removes the requirement in the proposed rule that would have restricted recipients of a special enrollment period to selecting a QHP in the same metal level.

 

Roles for Navigators/Agents

1. Navigators

The final rule establishes that at least one Navigator entity must be a community-and-consumer-focused non-profit group. At least one navigator must also come from one of eight prescribed categories. Navigators are prohibited from receiving direct compensation from issuers for enrollment in plans inside or outside of the Exchange. In addition, a Navigator must not be a health insurance issuer, a subsidiary of a health insurance issuer, or an association that includes members of, or lobbies on behalf of the insurance industry.

 

The Exchange must develop a set of training standards to ensure expertise in the needs of underserved and vulnerable populations, eligibility and enrollment rules, the range of QHP options and insurance affordability plans, and privacy and security standards.

 

2. Agents

The final rule establishes participation standards for agents and brokers to facilitate QHP selection through the agent’s or broker’s website. In these cases, the agent’s or broker’s website must:

• Provide consumers the ability to view all QHPs offered through the Exchange
• Not provide financial incentives, such as rebates or giveaways
• Display all QHP data provided by the Exchange
• Provide consumers with the ability to withdraw from the process and use the Exchange website at any time

 

The final rule expands its regulations on agents and brokers with the inclusion of language outlining how an agent or broker may assist an individual in enrolling on the Exchange as well as requirements for an agreement between an agent/broker and the Exchange before the agent/broker may assist individuals in enrollment.

 

SHOP

HHS re-asserts that in order to be on the SHOP an employer must have at least one common law employee. This means that sole proprietors, 2 percent S-corporation shareholders and certain family members of sole proprietors or 2 percent S-corporation shareholders are not included in employee count. If a business does not have a common law employee it cannot constitute a group health plan and therefore cannot purchase coverage in the small group market. In these situations, Exchange coverage must be purchased on the individual market.

 

The proposed rule specifically excluded the SHOP from the requirement to provide a premium calculator that applies to the individual market Exchange. The final rule removes this exclusion and requires the SHOP to provide a premium calculator that compares the price of available QHPs after the application of any employer contribution.

 

QHP standards

New language requires QHP issuers to ensure that the provider network of each QHP maintains a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance abuse services. The rule includes an alternate standard for a QHP issuer that provides a majority of covered professional services through physicians employed by the issuer through a single contracted medical group, such as through a staff-model HMO. To guarantee compliance, these QHP issuers must have an adequate number and geographic distribution of employed providers and hospital facilities to ensure reasonable and timely access to such providers.

 

Dental Plans

The final rule guarantees that the Exchange doesn’t overload a single dental insurance issuer by adding a “sufficient capacity” provision. The Exchange must consider the collective capacity of stand-alone dental plans during certification to ensure sufficient access to pediatric dental coverage.

 

The Exchange may allow standalone dental plans to be offered independently or in conjunction with a QHP. The rule clarifies that standalone dental plans offered through an Exchange must offer the pediatric dental essential benefits without annual or lifetime dollar limits. If standalone dental options that cover the pediatric dental essential benefits are available on the Exchange, then a health insurance product does not need to cover pediatric dental essential benefits in order to receive QHP certification.

 

Multi-state plans or CO-OPs

The Exchange must recognize the ACA established multi-state plans and plans offered by issuers through the Consumer Operated and Oriented Plan program. Multi-state plans are immune from many Exchange certification standards. HHS notes that OPM is required to ensure that multi-state plans adhere to QHP certification standards, so HHS finds it unnecessary to require each Exchange to certify the OPM-contracted plans. For many requirements, the final rule explicitly provides that, rather than the Exchange, OPM will assess whether the multi-state plans are achieving the appropriate standard.

 

Who is eligible?

The final rule no longer permits eligibility based on intent to reside in an Exchange service area. In addition, a new provision specifies that when multiple tax households are covered on a single policy, the Exchange will apply cost-sharing reductions such that the lowest level of cost-sharing reductions will be provided to the combined households (the household with the highest FPL determines cost sharing eligibility).

 

An interim final rule requires Exchanges to “determine eligibility promptly and without undue delay.” Notification of eligibility determinations must now be made in writing.

 

MBPA/MFBA will continue to keep you up to date. As always, please contact us with any questions or comments. We enjoy your feedback.

 

Please visit our website for more and detailed information. Contact our Government Relations Team with questions/comments at: bbochniak@michbusiness.org or by phone at: 517-374-9128.

To help your clients reduce their employee benefit costs, the Associations are providing complimentary services such as Summary Plan Descriptions and Section 125 Plan documents to all dues paying members.

 

Summary Plan Descriptions (SPDs)
ALERT: The Employer Retirement Income Security Act (ERISA) guidelines make it mandatory for all businesses with 2 or more employees to provide employees with a Summary Plan Description (SPD).

 

We continue to take a leading role in informing and helping our members meet their obligations under ERISA. We offer SPDs at no charge to our members. Types of benefits covered by Summary Plan Descriptions include: Medical, Long Term Disability, Short Term Disability, Life and AD&D and freestanding Dental/Vision.

 

The adoption agreement is a compliant document reflecting ALL the Health Care Reform Law changes as of January 2012. The Benefits SPD adoption agreement is one compliant document rather than 5 different forms. These documents are FREE to our members. NOTE: The cost for non-members will be $50 effective May 1st.

 

Let us complete your All-Inclusive SPDs for your clients:

 

To request an SPD:

• Simply contact our office and our team will work with you or your client
• Download the documents from our secured Agent Pavilion, complete, and return to the Association office.
• The completed Agreement should be emailed in WORD format to info@michbusiness.org for processing.
• The Association will send the completed agreement to you or your client.

 

Section 125s
To request your Section 125 for your clients:

• Simply contact our office and our team will work with you or your client.
• The Section 125 Plan has a separate adoption agreement.
• Please follow the same submission instructions as with a SPD.
• The completed Section 125 Plan and supporting documents are normally returned in 2-5 business days.

 

If you have questions or need assistance, please contact our Membership Services Team at 1-888-277-6464 or 1-586-393-8800.