All services provided by Southern Regional Medical Center after May 15, except emergency services, will be considered out-of-network for United Healthcare members. United Healthcare members have access to several other local network hospitals in the Riverdale area, including Piedmont Henry Medical Center, Piedmont Fayette in Newnan, and South Fulton Medical Center.

United Healthcare will work with patients and their physicians on a Transition of Care plan to ensure continuity of care for members receiving ongoing medical treatment at Southern Regional Medical Center. Members with pre-planned services at SRMC or one of its affiliates may be eligible for network benefits for these services during a transition period. Members should call the customer care number listed on their ID cards to determine eligibility.

HSAs are savings accounts that allow an eligible individual to contribute (or have contributed on his/her behalf) amounts on a tax-favored basis to pay for certain medical expenses. In order to be eligible to participate in an HSA, an individual must be enrolled in a HDHP.

2013 contribution limit:

• Self-only HDHP coverage: $3,250 (up $150 from 2012)

• Family HDHP coverage: $6,450 (up $200 from 2012)

• Catch-up contribution limit for HSA-eligible individuals who are age 55 or older: $1,000 (unchanged from 2012)

2013 deductible limit:

• Self-only: Not less than $1,250

• Family: Not less than $2,500

2013 out-of-pocket maximum:

• Self-only: Not more than $6,250 (up $200 from 2012)

• Family: Not more than $12,500 (up $400 from 2012)

Remember, it’s never too soon to start thinking about next year’s medical plan offerings and cost saving strategies. If your firm is not currently offering an HSA/HDHP plan, contact your A.I. Group Representative to learn about these cost saving solutions.

On December 7, 2011, HHS issued final rules on the calculation and payment of MLR rebates. Depending on how the premiums were paid by the employee, a rebate received whether it is a cash payment or premium reduction, may or may not be considered taxable income. Generally, if the participant paid the premiums with pre-tax dollars (Section 125) or has deducted them from their income taxes, then the rebates are taxable income. If the participant paid for the premiums with after tax dollars then the rebate would not be taxable income. Additional scenarios are covered in the IRS FAQ.

We expect medical carriers to notify their employer groups of any potential rebates during the second quarter of 2012.

Currently, outpatient radiology/x-ray claims for members who use non-network facilities and providers are typically reimbursed based on the network status of the referring physician. United Healthcare believes that this reimbursement change will encourage members to participate in the decision-making process by promoting in-network utilization. By using in-network providers members will experience lower co-payments and co-insurance obligations, as well as avoid the potential for being balance-billed for amounts in excess of the UHC usual and customary payments.

United Healthcare members can find in-network providers, including radiologists, via www.myuhc.com. Members should communicate with the provider to ensure that the radiologist who reads the x-ray is also an in-network provider.

The rule requires that insurers and health plans provide a standardized Summary of Benefits and Coverage (SBC) and Uniform Glossary to consumers “when shopping for coverage, enrolling in coverage, at each new plan year, and within seven (7) business days of requesting a copy from their health insurer or group health plan.”

 The SBC will describe health plan benefits in easy to understand terms; it will include what the plan will cover, what limitations or conditions will apply, and coverage examples. These examples are a key feature of the SBC, illustrating how much coverage the plan would provide in an event such as having a baby or managing Type II diabetes. These examples are designed to help consumers understand and compare what they would have to pay under each plan that they are considering.

For group health plans, the SBC must be provided to participants enrolling or reenrolling prior to the first day of open enrollment beginning on or after 9/23/2012. For newly eligible participants or special enrollees, the SBC must be provided on the first day of the plan year following 9/23/2012. If plan changes are made other than at renewal, individuals must be informed in writing 60 days ahead of any significant plan changes.

The law is very specific regarding the format of the SBC: It cannot exceed four double-sides pages in length and must not include print smaller than a 12-point font. In addition, it must include a phone number and internet address for questions and copies of plan documents. The SBC may be provided in paper or electronic form under current ERISA electronic distribution rules and while it can be included with other documents (e.g. summary plan description) it must be prominently displayed at the beginning of the document.

For fully insured groups, the SBC will be provided by the insurance carrier. For self-funded groups we will work with carriers to obtain SBCs.

Click here to view the template for the Summary of Benefits and Coverage and the glossary.

BCBS GA members who have question about this change should call the customer service number on the back of their ID cards.

Due to the agreement reached late yesterday, Blue Cross Blue Shield of Georgia HMO, POS, PPO, and Indemnity members can continue to utilize Tenet facilities as in-network providers and there will be no break in their network participation.

The agreement reached between BCBS GA and Tenet covers Tenet’s five acute care hospitals in Georgia (Atlanta Medical Center, North Fulton Hospital, South Fulton Medical Center, Spalding Regional Medical Center, and Sylvan Grove Hospital) as well as freestanding outpatient centers and physicians who are employed by Tenet subsidiaries.

Tenet facilities include: Atlanta Medical Center, North Fulton Hospital, South Fulton Medical Center, Spalding Regional Medical Center, and Sylvan Grove Hospital. All BCBS GA health plans will be affected by Tenet’s contract termination, including the Blue Distinction program (bariatric surgery at Atlanta Medical Center and the spine surgery program at North Fulton Hospital).

BCBS GA recommends the following alternative hospitals:

The termination also affects Tenet employed physicians who only admit to Tenet hospitals and do not have admitting privileges to other participating hospitals. To check the network status of a physician, go to www.bcbsga.com and click “Find a Doctor” or call the customer service number found on the back of BCBS GA ID cards.

If you are an inpatient at one of the above Tenet facilities on February 1, Tenet must continue to honor the in-network reimbursement rate until you are discharged from the hospital. Your claim will be paid at the in-network level of benefits. If you currently receive care from a Tenet physician who is terminating on February 1, you may be eligible for continuity of care benefits. Eligibility is based on active treatment for a specific medical condition. You can obtain the required form for continuity of care at www.bcbsga.com or by calling the customer service number found on the back of BCBS GA ID cards. All other services rendered by Tenet facilities on or after February 1, 2012, will be paid at the out-of-network benefit rate.

Walgreens Leaves BCBS and Express Scripts Network
As expected, Walgreens terminated their contract with BCBS and Express Scripts on December 31, 2011. In order to limit disruption and inconvenience to members, BCBS GA is making automated calls to members who visit a Walgreens on or after January 1, 2012 and members who use Walgreens, are on maintenance medications, and are approaching or have missed their refill date. The automated call campaign will run through February and will assist members in moving their prescriptions to in-network pharmacies. Members can also visit www.bcbsga.com and click “How to Find an In-Network Pharmacy” in the bottom right corner of the home page.

Employers who will issue 250 or more W-2s for the 2011 tax year are required to required to report coverage for the 2012 tax year; W-2s for 2012 must be issued in January 2013. (Note: the employer requirement is not based on the number of covered employees, but on the number of W-2s issued by an employer, including those issued to active, terminated, full-time, part-time, and seasonal employees.) Transitional relief has been given to “small” employers, those who issue fewer than 250 W-2s until further guidance is issued. When guidance is issued, it will apply prospectively and will not apply to any calendar year beginning within 6 months of the date guidance is issued.

Employers must report on an employee’s Form W-2 for the year 2012, in Box 12, Code DD, the (calendar year) cost of major medical insurance, mini-med plans, on-site clinics, wellness programs, and executive reimbursement plans. The IRS emphasizes that both the employer and employee contributions are to be reported. The reportable cost includes the cost of coverage for the employee and any person covered by the plan because of a relationship to the employee. (For example, coverage for spouses, domestic partners, dependent children, etc.) The reportable cost of coverage can be calculated by using the premium charged method, the COBRA applicable premium method (less the 2% COBRA admin fee), or the modified COBRA premium method. The employer may choose any of these methods but should be consistent in their reporting. If the cost of coverage changes during the year, the reportable amount must reflect any increases or decreases in cost.

Excluded from the reporting requirement are contributions to Archer Medical Savings Accounts, HSAs, HRAs, employee contributions to FSAs, costs for Long Term Care insurance, and stand-alone dental and vision insurance coverage.

The mandated W-2 reporting is for informational purposes only. It does not cause excludable employer-sponsored health coverage to become taxable to the employee. The purpose of the reporting requirement is to educate and inform employees about the true cost of their health coverage.

Further, as part of the transitional relief, employers are not required to report the cost of coverage on Form W-2 to a terminated employee who requests their W-2 before the end of the year.

This summary is intended to provide a general overview of the W-2 reporting requirement. Additional information can be found on the IRS website.

On November 17, 2011 the Department of Labor (DOL) responded to concerns regarding the timeframe and lack of final regulations. The notice stated “until final regulations are issued and applicable, plans and issuers are not required to comply with section 2715 of the Public Service Act” and that the final rules and guidance will be issued “as soon as possible.”

The DOL also commented that once the final regulations are issued they will also provide a date the regulations will apply that allows health plans and insurers sufficient time to comply.

The Regulations that have yet to be issued by the Department of Health and Human Services will provide additional guidance regarding the implementation of the following requirements:

• A glossary of standard medical and insurance terms
• A four-page Summary of Benefits and Coverage describing plan benefits, cost sharing and limitations
• Coverage examples illustrating customer costs based on the specific plan’s benefits for common medical scenarios, currently identified as: maternity, breast cancer treatment and diabetes management
• Online availability of documents including Certificates, Summary Plan Descriptions (SPDs) and policies
• Notification of material modifications at least 60 days before their effective date
• Failure to provide the required information will result in a fine of not more than $1,000 per enrollee.

If you would like to read the DOL’s complete response click here.