The Centers for Medicare and Medicaid Services (CMS) has issued a new “special enrollment period” for individuals who attest they first learned of the individual mandate to have health insurance after the open enrollment had concluded and they learned of the tax upon completion of their taxes.

The individual mandate applies to all people with incomes above the federal poverty level and that they must enroll in health coverage or face a penalty of $325 per person, or 2% of household income, whichever is larger.

The new “special enrollment period” runs from March 15th, 2015-April 30th, 2015. A projected 44% of uninsured people who are expected to be penalized for not having coverage have heard nothing, or only a little, about the tax penalties, according to research by the Urban Institute and the Robert Wood Johnson Foundation. It also revealed 65% of those expected to pay the penalty had either not known about the health care exchanges, didn’t know the date of the open enrollment deadline, or assumed it was in March.

Those individuals taking advantage of the new enrollment period will still owe a fee for the months they were uninsured and didn’t receive an exemption in 2014 and 2015. This “special enrollment period” is designed to grant these people the chance to get covered for the rest of the year and elude additional fees for 2015.

The federal government website, HealthCare.gov has added a new tool to help people determine whether they are eligible for a hardship exemption from the requirement to have insurance. 

As always, please reach out to our government relations team with any questions.  We always welcome your feedback!  Email: bbochniak@michbusiness.org  (888) 277-6464.

New-to-Blue Group Incentive:

Agents are eligible to receive incentives for selling medical plans to non-Blue Cross® Blue Shield® of Michigan and Blue Care Network (BCBSM and BCN) group customers with 50 to 99 enrolled contracts.

Enroll a New-to-Blue group with 50-99 BCBSM or BCN contracts and earn an extra $2,500 on top of your commissions.

Guidelines and Information:
• Applies to groups with an effective date of Jan. 1 through Dec. 31, 2015.
• All contracted agents are eligible to participate in the program.
• BCBSM and BCN commissionable groups are eligible. Non-commissionable groups are excluded.
• Applies to all groups with 50 to 99 enrolled contracts.
• The number of enrolled contracts will be determined at the end of the enrollment month.
• One-time payout amounts will be calculated and paid approximately 60 days after the quarter is finalized.
• Groups must be active at the end of the quarter to qualify.
• A group is considered new-to-Blue if it has not had Blues coverage for at least 12 months.
• The incentive program is in addition to the standard commission schedule and the Blue Rewards program.

Blue DentalSM and Blue VisionSM Incentives
Agents are eligible to receive incentives for selling Blue DentalSM and Blue VisionSM to non-Blues customers and to existing Blues customers who don’t have dental or vision coverage with the Blues.  Add Blue Dental to a group of 50 to 99 enrolled contracts and you will receive a $600 bonus.  Add Blue Vision to a group of 50-99 and you will receive a $300 bonus.  

Add both Blue Dental and Blue Vision to a group and you will receive a $1,200 bonus.

Guidelines and information
• Applies to groups with an effective date of Jan. 1 through Dec. 31, 2015.
• All contracted agents are eligible to participate in the program.
• BCBSM and BCN commissionable groups are eligible. Non-commissionable groups are excluded.
• Applies to all groups with 50 to 99 enrolled contracts.
• Number of enrolled contracts will be determined at the end of the enrollment month.
• One-time payout amounts will be calculated and paid quarterly.
• Groups must be active at the end of the quarter to qualify.
• A group is considered new-to-Blue if it has not had Blues coverage for at least 12 months. Incentive program is in addition to the standard commission schedule and the Blue Rewards program.

ERS 50 to 99 Group Retention Program
In 2015, you will also be eligible to receive incentives for renewing customers with ERS coverage who have 50 to 99 enrolled contracts with BCBSM.

Retain 95% or higher of your ERS 50 to 99 book of business and receive $1,200 per group.

Guidelines and information
• All contracted agents are eligible to participate in the program.
• BCBSM and BCN commissionable groups are eligible. Non-commissionable groups are excluded.
• Applies only to ERS 50 to 99 rated groups.
• One-time payout amounts will be calculated and paid approximately 60 days after year-end is finalized.
• Groups must be active at the end of the year to qualify.
• The incentive program is in addition to the standard commission schedule and the Blue Rewards program.

Pharmacy Incentive Program*
For 2015, agents can receive $12 per contract for ASC and ERS (50-99 enrolled) groups with new 3- or 5-tier prescriptions plans with the Custom Select Drug List. This includes new-to-BCBSM (medical and Rx) groups, as well as existing groups that either add a 3- or 5-tier plan with the Custom Select Drug List or switch into one.

Receive $12 per contract for ASC and ERS (50-99 enrolled) groups with new 3- or 5-tier prescription plans with the Custom Select Drug List.

Guidelines and information
• This program gives a one-time quarterly payment based on the number of enrolled contracts at the end of the bonus period.
• The pharmacy incentive program applies to groups with effective dates of Jan. 1, 2015, through Dec. 31, 2015.
• To qualify, groups must be active at the end of the quarter.
• All Blues-contracted agents are eligible to participate, as are all commissionable BCBSM groups.
• Non-commissionable and BCN groups are excluded.
• A group is considered new-to-BCBSM if it hasn’t had Blues coverage for at least six months.
• The program is in addition to the standard commission schedule and the Blue Rewards program.

*All pharmacy incentives exclude groups with fewer than 51 full-time equivalent employees.

Total enrollment in the Healthy Michigan Medicaid expansion plan has hit 533,110 people, according to figures released by the Department of Community Health, more than 4,000 more people than was expected for the entire program.

The state also hit its total enrollment goal in slightly more than eight months. Open enrollment in Healthy Michigan began on April 1 and the state had anticipated hitting its projection of 477,000 enrollees by the end of 2015.

Community Health Director Nick Lyon said, in a release, that along with nearly 500,000 Michigan residents now having health insurance, the state has seen those recipients get more than 315,000 primary and preventative care visits to a physician.
Those recipients have also gotten 22,900 mammograms and 10,900 colonoscopies – considered critical to detect early indications of cancer – among the exams and visits they have had since acquiring health insurance.

The Healthy Michigan plan was adopted by the Legislature in 2013 following an intense legislative effort. It expands the availability of Medicaid to lower-middle income individuals.

Along with the state announcing the number of people who had enrolled in the plan, it also said the University of Michigan Institute for Healthcare Policy and Innovation had been given a five-year contract to evaluate the program and how well it is meeting its overall goals.

That assessment is required by the federal Centers for Medicare and Medicaid Services.

Originally, the federal Patient Protection and Affordable Care Act required all states to expand Medicaid to those populations but the U.S. Supreme Court ruled in 2012 that was unconstitutional. Michigan is one of the few states with a Republican governor and Republican-controlled Legislature to expand Medicaid to that population.

Michigan officials initially anticipated some 300,000 people would sign up for the program in 2014, but met that goal in July.

The state then exceeded 400,000 enrollees in September.

Hitting the enrollment goals means “Michigan residents are stepping up to take preventative measures that will improve their long-term health and well-being,” Mr. Lyon said.

As the program continues, Mr. Lyon said the state’s focus “will be on ensuring that beneficiaries not only have the necessary health resources they need, but also understand how to use them.”

Ultimately, the state will see a population in the program of more than 500,000. The growth in the program has slowed in recent months, but has not yet hit a stable position.

The federal government will pay the full cost of the additional Medicaid population for the first three years, and beginning in the 2017 fiscal year, the state will pay 10 percent of the cost, which Mr. Lyon said will be about $100 million.
But the state is also seeing budget savings as the federal government is now covering behavioral health services.

The fact that so many people signed up for coverage in such a short time “shows there was a real demand for coverage,” Mr. Lyon said, “and that people saw the need for health insurance for themselves and their families.”

The Blues hope this will clear up any confusion regarding the similarities between the Rate Renewal Certification and Medical Loss Ratio surveys.
 
Rate Renewal Certification (RRC) Surveys have begun to go out to groups renewing in December 2015 and January 2016.  RRC surveys for groups renewing in February 2016 will be mailed beginning on April 17, 2015. Last year, these groups received their RRC Survey at approximately the same time as their Medical Loss Ratio (MLR) Survey.  Because the surveys ask for similar information, many groups assumed they were the same survey and only submitted one.  
 
In an effort to alleviate the confusion this year, Blue Cross® Blue Shield® of Michigan and Blue Care Network made the decision to send RRC surveys out earlier than usual for groups that renew in December, January, and February.  These groups will receive the RRC surveys in April, and their MLR surveys in May.
 
The completed December RRCs must be submitted by June 10, 2015, January 2016 RRCs must be submitted by July 8, 2015, and February RRCs must be submitted by August 12, 2015.  You can check the status of your groups’ RRC surveys under Renewal Status at www.actionbenefits.com. Action Benefits has not yet received a due date for the MLR survey, but they are expected to be mailed to groups at the beginning of May.  As additional details become available, we will be sure to forward them on to our agent partners.
 
If you have any questions, please contact a member of the Action Benefits Rate Renewal Certification Team at 248-356-8585.
 
Action Benefits is an Authorized Managing Agent for Blue Cross® Blue Shield® of Michigan and Blue Care Network. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.

Summary Plan Descriptions (SPDs)
The Employee Retirement Income Security Act (ERISA) guidelines make it mandatory for all businesses with two or more employees to provide their employees with a compliant Summary Plan Description. The MBPA continues to take a leading role in informing and helping our members meet their obligations under ERISA.

The types of benefits covered by Summary Plan Descriptions include: Medical, Long Term Disability (LTD), Short Term Disability (STD), Life and AD&D and freestanding Dental/Vision.

These documents have been reviewed and are certified as being compliant with all applicable laws, including health care reform to date.

How to Complete an SPD for a Client:
• Log into MBPA’s secured Agent Pavilion via our website www.michbusiness.org. Complete the adoption agreement online for an existing member and immediately receive a customized SPD.

• Contact our office and our Client Services Department will work directly with you or your client(s) to help you through the process and assist with your questions. (See back of flyer for our Quick SPD checklist).
– The completed form should be e-mailed in WORD format to info@michbusiness.org for processing.

• Our Client Services Department will send the processed document to you or your client within two business days.

• If your client is NOT a member of MBPA, a $200.00 fee to attain an SPD applies. Contact our Office for more details: 888.277.6464

CLICK HERE for a checklist of information needed to complete an SPD.