New Rx Riders now available on HNE Direct Online Quoting portal! January 27, 2012
Posted by eharlow in : InsideHNE Broker , add a commentBased on your feedback, the new pharmacy riders are now available in the HNE Direct for Brokers online quoting portal!
HNE is excited to offer these two cost effective Pharmacy rider options: $10/$50/$100 and $15/$50/$100.
The copays reflect member responsibility for covered drugs in Generic / Name Brand / Name Brand Non-Formulary categories. The riders are available for all HNE plans except the HDHP Wise products.
Not registered for HNE Direct for Brokers? Click here to register now!: https://www.hnedirect.com/login/index.aspx
We hope you find that these new riders will offer additional solutions to your clients’ healthcare needs.
Please contact your HNE Sales representative for additional information.
HNE Sales Department (413)233-3535
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
HNE invites you to an important business forum on: Getting at Health Care Costs – Monday, Feb. 13 from 8:00 a.m. – 10:30 a.m. at the Westin Waltham January 25, 2012
Posted by eharlow in : InsideHNE Broker , add a commentWe at Health New England (HNE) would like to invite you to an important business forum on Monday, February 13, 2012 in Waltham to discuss one of the most important issues facing us in Massachusetts: health care costs.
To register for the forum, please call 617-646-1365 or visit
www.coalitionforaffordablehealthcare.org/list_events.php
Federal Healthcare Reform – 2012 Requirements January 19, 2012
Posted by eharlow in : InsideHNE Broker , add a commentIn October 2011, HNE provided the information below to HNE Employer Groups. It has since come to our attention that we may not have provided this information to all of our Brokers, as is our standard practice. We apologize for this oversight on our part. HNE has updated the previous letter to reflect the delayed implementation for the Summary of Benefits and Coverage.
————————————————————————–
RE: Federal Healthcare Reform – 2012 Requirements
As your business partner, HNE is committed to keeping you informed of changes to the healthcare industry, particularly those which could have an impact on your business. This letter describes three new provisions of the federal healthcare reform law that may impact your group health plan and also provides an update regarding the delayed effective date for Employer W-2 reporting.
- Comparative Effectiveness Research Fees
- Summary of Benefits and Coverage
- Preventive Services for Women
- W-2 Reporting (Update)
Comparative Effectiveness Research Fees
The Treasury Department and the Internal Revenue Service (IRS) issued Notice 2011-35 (http://www.irs.gov/pub/irs-drop/n-11-35.pdf), as “potential guidance” that the IRS expects to propose, and requested public comments on a new tax added by the Affordable Care Act: “comparative effectiveness research fees”. There are a number of open questions and items that require clarification. The IRS will issue implementing rules at a later date.
These fees will be paid by carriers and by plan sponsors of self-insured group health plans. This essentially is a new tax on both insured and self-insured plans. In the first year it applies, the fee will amount to $1 multiplied by the average number of lives covered under the plan (including dependents). In subsequent years, the multiplier is $2 times the average number of covered lives.
The Notice says that the “fees are effective for policy and plan years ending after September 30, 2012. If the policy year were the calendar year, the fee would apply to calendar policy years 2012 through 2018.” The fees do not apply to plan years ending after September 30, 2019.
Since we are not familiar with how your Plan is organized for tax purposes, it is also not clear how this potential “tax” will impact your Plan. HNE plans to follow up with our self funded groups after the comment period had ended and additional guidance is available.
| Quick Summary: Comparative Effectiveness Research Fees
Q: What are they? A: A new tax added by the Affordable Care Act. Q: Who is responsible to pay them? A: Insurance carriers and plan sponsors of self-insured group health plans. Q: How much are they? A: Year 1: $1 multiplied by the average number of lives covered under the plan (including dependents) After Year 1: $2 multiplied by the average number of covered lives. Q: When does it take effect? A: Plan years ending after September 30, 2012. |
Summary of Benefits and Coverage
On August 27, 2011 the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury proposed new rules under the federal healthcare about uniform plan disclosures. The new rules require carriers and group health plan sponsors to provide a four-page summary of benefits and coverage (with print in 12-point font or larger). The summary must describe the benefits, exceptions, or limits on coverage, and cost-sharing provisions. Carriers and group health plan sponsors must provide these summaries to plan participants beginning March 23, 2012. However, on November 18, 2011, the Departments issued new information that delayed the implementation date. It is not yet clear how long the Departments will delay the applicability date. Employers and trade associations have asked the Departments to delay the applicability date until the 2014 plan year or at least 18 months following the issuance of the final regulations. HNE will update you as new information becomes available.
Sample uniform disclosure models are available on the National Association of Insurance Commissioners (NAIC) website and additional information is available at www.HealthCare.gov and www.dol.gov/ebsa/healthreform/. HNE will prepare this summary for your plan on group anniversary dates following the March 23, 2012 effective date.
| Quick Summary: Summary of Benefits and Coverage (SBC)
Q: What are they? A: A four-page summary of plan benefits and coverage. Q: When is the requirement effective? A: Implementation was delayed by the Departments until further notice. Q: Who will prepare and distribute the SBC? A: HNE will prepare and distribute this summary for your plan. |
New Preventive Requirements for Women
As you know, Federal healthcare reform requires non-grandfathered group health plans to provide a variety of preventive services without cost sharing when those services are obtained from a network provider. On August 1, 2011, the Departments of Health and Human Services (HHS), Labor (DOL) and Treasury released guidance on new preventive care requirements related to women. The new requirements apply to non-grandfathered plans beginning on or after August 1, 2012 Plans may use reasonable medical management to help define the nature of the covered service applied to women’s preventive services. Plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost-sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use.
Preventive Services for Women
The latest requirements expand on the requirements for non-grandfathered plans that already apply to women. The new services for which coverage is required are:
- Well-woman visits
- Screening for gestational diabetes
- Human papillomavirus (HPV) testing every three years beginning at age 30
- Counseling for sexually transmitted infections (STIs) for all sexually active women
- Counseling and screening for human immunodeficiency virus (HIV) for all sexually active women
- Contraceptive methods and counseling for all FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity (except for employees of “religious employers,” which are exempt from this requirement, as discussed in the next section
- Breastfeeding support, supplies, rental of equipment and counseling
- Screening and counseling for interpersonal and domestic violence.
HNE will be prepared to meet these new requirements by the effective date.
Religious Employer Exemption
The agencies also issued an interim final regulation that would exempt “religious employers” from the requirement to provide contraceptive services under the group health plans they maintain. The agencies state in the regulations’ preamble that the religious employer exemption is consistent with religious accommodation policies maintained by States that require contraceptive services coverage. However, there is a question about the definition of religious employer and HHS has requested comments on this issue. HNE expects further guidance regarding the definition of religious employer and will update our church plans when additional guidance is issued.
Quick Summary: New Preventive Requirements for Women
|
W-2 Reporting -Update
Federal healthcare reform requires employers to report the aggregate cost of coverage under employer-sponsored group health plan coverage on employees’ W-2 forms. This is simply a reporting requirement; employees would not pay income or payroll taxes on that amount. In Notice 2010-69, the Internal Revenue Service (IRS) delayed the effective date of this requirement so that it now applies to coverage provided during 2012. IRS Notice 2011-28 provided further relief for smaller employers filing fewer than 250 W-2 forms by making the reporting requirement optional for them at least for 2012 and continuing this optional treatment for smaller employers until further guidance is issued. The aggregate cost of coverage will be determined under rules similar to those that apply to calculating rates for continuation coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). The IRS has promised guidance will be forthcoming in 2011. The IRS encourages employers to work with their payroll system providers to understand how this will affect their W-2 reporting. For more information, see the 2011 Form W-2, IR-2011-31, Notice 2010-69, Notice 2011-28 and frequently asked questions at http://www.irs.gov/newsroom/article/0,,id=220809,00.html.
| Quick Summary: W-2 Reporting
Q: What is it? A: Employers will be required to report the aggregate cost of coverage under employer-sponsored group health plan coverage on employees’ W-2 forms. Q: When is the requirement effective? A: For W-2 forms reflecting 2012 coverage – usually January 2013, but earlier if requested by an employee who leaves a job during 2012 Q: Does this apply to small businesses, too? A: For smaller employers (those who file fewer than 250 W-2 forms) the reporting requirement is optional, at least for 2012 Q: How do I determine the aggregate cost of coverage? A: Using rules similar to those that apply to calculating rates for continuation coverage under COBRA. The IRS has promised guidance will be forthcoming in 2011. Q: How will this affect my W-2 Reporting? A: The IRS encourages employers to work with their payroll system providers to determine this. ———————————————————————– |
HNE rates for First Quarter 2012 are now available. November 8, 2011
Posted by eharlow in : InsideHNE Broker , add a commentHNE is pleased to announce that rates for the First Quarter 2012 are approved by the DOI and available for quoting. We look forward to providing you with new business quotes for January, February and March effective dates.
Renewal letters for existing HNE groups are being sent out this week for January renewals. Please contact your Existing Business Account Executive if you have questions about a specific group.
Please note: First Quarter rates are not yet available through HNE’s online New Business quoting service. The service is currently being updated. In the meantime, please forward quote requests directly to the HNE Sales Department.
Please call 413-233-3535 for assistance.
.
Announcing HNE Mobile App for Members to Access Health-Care Information Quickly and Easily via Smartphones and Tablets September 6, 2011
Posted by eharlow in : InsideHNE Broker , add a commentFeedHenry and Court Square Partner to Deliver First Cloud-Powered HIPAA Compliant Mobile App to Health New England Members
Secure Cloud Environment Gives Mobile App to HNE Members to Access Health-Care Information Quickly and Easily via Smartphones and Tablets
Press Release: Springfield, MA – Sept. 7, 2011 – FeedHenry (www.feedhenry.com) the cloud solutions provider for mobile healthcare applications and Court Square Group (www.courtsquaregroup.com), providers of enterprise business solutions and private clouds for regulated industries, announced a joint collaboration to develop and deliver the first fully HIPAA-compliant mobile app solution, powered by the cloud, to Health New England (www.hne.com) (HNE). With this mobile app, HNE a managed care organization, majority owned by Baystate Health, will be able to provide its members with a provider directory and member ID application 24/7 from any smartphone or tablet. Members will also be able to trigger directions from their current location, call a provider or access ID cards, which provide policy numbers, member numbers and various co-pay and deductible amounts.
Developed on the FeedHenry mobile application platform, the mobile app integrates securely with HNE member information systems by storing and caching member details and logic in the Court Square private cloud. HIPAA compliance is ensured through FeedHenry’s end-to-end security framework from mobile device to internal system endpoints and through the deployment in Court Square’s cloud, enabling HNE to have a fully HIPAA-compliant and privately-hosted mobile solution. The partnership combines enterprise-grade mobility and cloud expertise, giving a secure and scalable cloud solution for healthcare and life science organizations to take advantage of the growth in mobile health apps.
“HNE is an innovative and service oriented organization. We believe that this is an opportunity to provide our members with an even higher level of service at their fingertips. We chose the Member ID Card and the Provider Search because these are the highest traffic areas on our website: www.hne.com. We anticipate that this will be the first of many mobile applications that we will provide to our customers, members, employers, brokers and providers,” said Phil LaCombe, VP of IT, Health New England, “Court Square and FeedHenry worked closely with our team to deliver this app which we believe is the first truly HIPAA compliant cloud-based mhealth app to be deployed across multiple mobile devices from the same code base.”
“Court Square has been working with virtual networks and cloud technology in regulated environments for many years and understands the special requirements necessary to comply with HIPAA, FDA and other regulated environments. FeedHenry’s fully cloud-based development and server-side architecture meant we could quickly build the app for HNE and fully integrate with backend systems via the Court Square regulated cloud which manages storage, caching, business logic, app management and security.” said Court Square CEO, Keith Parent.
HNE anticipates release of the mobile app during the third quarter of 2011. The app will be free of charge to any smartphone, tablet or web-enabled mobile user.
For more information, contact Lynn Ostrowski HNE’s Director, Brand & Corporate Relations at lostrowski@hne.com; 413-233-3383
HNE, the Only Health Plan in the State, Files for a Decrease in Premium Rates August 17, 2011
Posted by eharlow in : InsideHNE Broker , add a commentHealth New England filed for a decrease in rates effective October 1, 2011. HNE is the only plan in the state to have filed for a decrease. According to State House News Service, “the rate hikes – filed for July 1 and due to take effect on October 1 – average no more than a 5.9% increase for any Massachusetts insurer, and one insurer, Health New England, actually sought a decrease in premium rates.”
Juan Campbell, Vice President of Sales, explained that over the last 16 months we’ve experienced a slowing in the rate of increase in costs and lower utilization of services which has lowered the overall medical trend. This is important because medical trend drives approximately 90% of costs. The other 10% covers administrative costs and HNE continues to work diligently to manage these costs. We are pleased to be in a position to pass on a reduction to individuals and employers.
HNE, a provider sponsored plan, is unique in Massachusetts. HNE is majority owned by Baystate Health (approximately 97%) and the remaining 3% is held by independent practicing physicians in Western Massachusetts. HNE has a long history of working collaboratively with providers and investing with them to deliver efficient use of the right services in the right place. “Providers have taken to heart all the scrutiny with pricing and are organizing themselves to do better. They are proactively retooling how they deliver care with Patient Centered Medical Homes and the use of electronic medical records (EMR’s). HNE is very proud of our role of working in tandem with the providers. We believe to be successful in controlling health care costs requires a partnership between the health plan, the health care delivery system, and engagement with the member/patient.” said Peter Straley, HNE President & CEO.
New HNE Pharmacy riders are now available for quoting! July 12, 2011
Posted by eharlow in : InsideHNE Broker , add a commentHNE is excited to offer two new Pharmacy rider options beginning with an August 1, 2011 effective date. The new riders are: $10/$50/$100 and $15/$50/$100.
The copays reflect member responsibility for covered drugs in Generic / Name Brand / Name Brand Non-Formulary categories. The riders are available for all HNE plans except; Connector, HDHP and some specialized Large Group renewals.
Please contact your HNE Sales representative for quoting opportunities as these riders are not yet available through HNE Direct Online Quoting, or on standard rate proposals.
We hope you find that these new riders will offer additional solutions to your clients’ healthcare needs.
HNE Sales Department (413)233-3535
Help Support Health Insurance Rate Review Provisions July 7, 2011
Posted by eharlow in : InsideHNE Broker , add a commentThe Massachusetts Association of Health Plans (MAHP) is working with MassAHU to send a letter to Governor Patrick in support of the rate review provisions in the budget and we need your help. Please send the attached letter to the Governor as soon as possible.
The letter can be emailed to the Governor’s Office at: http://www.mass.gov/?pageID=gov3utilities&sid=Agov3&U=Agov3_contact_us
If you have any questions, please contact Lynn Ostrowski, HNE’s Director of Brand & Corporate Relations, at 413-233-3383 or cell 413-538-1564.
~~~~~~~~~~~~SAMPLE LETTER~~~~~~~~~~COPY AND PASTE~~~~~~~
July 2011
Re: Actuarial Soundness of Rates – Support Sections 107 & 108
His Excellency Deval Patrick, Governor
Commonwealth of Massachusetts
State House, Room 360
Boston, MA 02133
Dear Governor Patrick:
On behalf of hundreds brokers that work with thousands of small businesses across the Commonwealth, we are writing to express our support for provisions included in the House and Senate FY12 Conference Committee report that will provide stability and certainty for Massachusetts employers and brokers around the applicable rates for health benefit plans.
Sections 107 and 108 amend section 29 of Chapter 288 of the Acts of 2010 (Chapter 288) to establish more specific standards for the Division of Insurance (the Division) when disapproving proposed premium rates and ensure that health plans have sufficient time to give employers and brokers the information they need on premium rates. Section 107 retains the current standard established by Chapter 288 for rate approvals, including maintaining the nation’s strictest medical loss ratio standards and limits on health plan profits and the rate of increase for administrative expenses, but requires that the Division utilize sound actuarial principles in disapproving rates.
Section 108 would require that the Division notify the health plan 60 days prior to the effective date of the proposed rates if it intends to disapprove the rate, rather than the current 45 days. Additionally, Section 108 further requires that if the Division failed to notify the health plan within 60 days that it was disapproving the proposed rate, the rate would be deemed approved. This provision would help to minimize the risk of confusion for employers and brokers as to what rates apply and minimize any potential delays in making rates available to them. Further, it will provide Massachusetts businesses with more time than they currently have to review rates among carriers in determining the coverage that best meets the needs of their employees and is consistent with the rate review process other states, including Maine and New Hampshire, have taken.
For all these reasons, we urge that you support sections 107 and 108 in the final version of the FY12 state budget.
Sincerely,
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Support Amendment 225 May 24, 2011
Posted by eharlow in : InsideHNE Broker , add a commentFrom the Desk of:
Lynn Ostrowski
Health New England
Director, Brand & Corporate Relations
SUBJECT: Help us Ensure Sound Rates & Time to Get the Rates to You and Your Accounts!
Support Amendment 225
This week, the Massachusetts Senate will debate the state budget. The $30.5 billion spending bill includes a number of targeted cuts to close the projected $1.9 billion gap between spending priorities and available revenues and draws $209 million from the state’s rainy day fund. Nearly 600 amendments to the budget were filed including several that require our attention.
We need your help to pass an amendment that would provide stability and certainty for Massachusetts employers and brokers around the applicable rates for health benefit plans. Amendment 225, filed by Senator Anthony Petruccelli of East Boston, would require that the Division of Insurance (DOI) utilize sound actuarial principles in disapproving rates. If DOI intends to disapprove the rates, the amendment would require that it notify the health plan 60 days prior to the effective date of the proposed rates, rather than the current 45 days. If DOI does not notify the plan, then the rates would be deemed approved.
Amendment 225 would ensure that there is actuarially support for any rate disapprovals and would ensure that health plans have sufficient time to give employers and brokers the information they need on premium rates.
Please contact your State Senator today and urge them to support Amendment 225 by clicking on the link below or by calling Jennifer Willis at 617-259-2774 and she can help you find your senator.
Click Here to Support Amendment 225.
HNE is expanding enrollment guidelines! Beginning July 1, 2011 employers can cover more subscribers. May 20, 2011
Posted by eharlow in : InsideHNE Broker , add a commentNEW HNE Enrollment Area Policy
All HNE Commercial HMO, POS and PPO products:
As we hope you know, HNE’s vision is to be “the most trusted and valued health plan in the communities we serve”. We are committed to offering health care to everyone located in the four counties of Western MA.
Effective July 1, 2011 HNE has expanded our enrollment guidelines. Employers located in HNE’s service area will be able to have up to 70% of the eligible and participating subscribers living within the HNE service area. Therefore, HNE will allow up to 30% of the enrolled subscribers to reside outside of the HNE service area. By enhancing our enrollment policy HNE will provide more options to employers located in our service area!
Please contact me, Eric Harlow HNE Broker Relations Manager, for more information about this exciting change!
(413)233-3378 or eharlow@hne.com