Broker Edge
September 2011, Vol. 10, No. 3
A newsletter dedicated to informing brokers affiliated with Fallon Community Health Plan
In this issue:
Municipal health insurance spotlighted in FCHP seminar
Massachusetts recently passed into law municipal health insurance reforms that give cities and towns new options for making health plan changes.
“The municipal market will be undergoing significant changes. FCHP is well positioned with individual cities and towns, as well as with our largest corporate customer, the GIC, to continue giving our current and future customers excellent health insurance solutions,” notes Dave Przesiek, FCHP Senior Vice President, Sales and Marketing.
On August 16, we shared our expertise in this area when the FCHP Municipal Advisory Group presented a complimentary seminar in Westborough, called Massachusetts Municipal Health Reform: What does this mean for you and your community?
This was an exciting opportunity for FCHP to connect with municipalities. We shared and learned a lot—and received very positive feedback about this program and our innovative health plan offerings.
The well-attended program included guest speakers Patrick Farrell, J.D., FCHP Regulatory Affairs Manager; Kathleen Johnson, Human Resources Director, City of Worcester; and Marc Waldman, Treasurer/Collector, Town of Wellesley. Also offering insights and answering questions were Dolores Mitchell, Executive Director, Group Insurance Commission, and Demitrios M. Moschos, J.D., labor attorney with Mirick O’Connell. Program facilitator was Dan Morgado, Town Manager, Shrewsbury.
About the law
Broadly, the law gives cities and towns more flexibility under an expedited collective bargaining process to make changes in copayments, deductibles and other cost-sharing plan design features. These features cannot be higher than those offered by the Group Insurance Commission (GIC). On the other hand, municipalities may transfer employees to the GIC if doing so would result in at least 5% more savings than could be achieved through using the above process to make cost-sharing changes to an existing local health care plan. In the expedited collective bargaining process, if a municipality and the Public Employee Committee (union reps) don’t reach an agreement within 30 days, the case goes to a three-person review panel for a binding resolution within 10 days.
The law also reduces the PEC vote from 70% to a simple majority (51%), for coalition bargaining. In addition, it’s now mandatory under the law to move subscribers who are eligible for Medicare coverage into Medicare plans.
For details, you’ll find most of the law at: malegislature.gov/Laws/SessionLaws/Acts/2011/Chapter69, and the Medicare provisions at malegislature.gov/Laws/SessionLaws/Acts/2011/Chapter68 (Sections 52 through 56 only).
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Network news
♦ FCHP Direct Care welcomes Saint Vincent Medical Group
While Saint Vincent Hospital in Worcester has long participated in the FCHP Direct Care network, we were pleased to also welcome earlier this year the Saint Vincent Medical Group (SVMG) as a participating physician group.
That means that SVMG, a multi-specialty group of more than 20 physicians at 10 locations in Worcester and the surrounding communities, now accepts members with our Direct Care health insurance, as well as Select Care, Preferred Care (PPO), Major Medical and NaviCare® HMO SNP. For more information and a list of physicians, go to the group’s Web site at stvmg.com.
FCHP Direct Care is a limited provider network. This plan provides access to a network that is smaller than FCHP Select Care. In this plan, members have access to network benefits only from the providers in FCHP Direct Care. Please consult the FCHP Direct Care provider directory—a paper copy can be requested by calling our Customer Service Department at 1-800-868-5200—or visit the provider search tool at fchp.org to determine which providers are included in FCHP Direct Care.
♦ Fallon Clinic has new affiliation, name
Fallon Clinic, a large multi-specialty medical group practice in Central Massachusetts, announced a new affiliation with Atrius Health, an alliance of medical groups in Massachusetts, and is changing its name in October to Reliant Medical Group. FCHP will continue its long-standing, positive partnership with the physicians and professionals of Reliant Medical Group, which will continue to accept Fallon Community Health Plan insurance.
The name change allows the former Fallon Clinic to shed public misperceptions about its identity; it is often confused to be part of Fallon Community Health Plan, an insurance company. Name confusion with our health plan has been pervasive since FCHP, and the former Fallon Clinic became separate organizations in 2004.
♦ Update on paying non-contracted providers
We discussed in our June issue how FCHP generally partners with network providers who have agreed to our negotiated rates for their service, which helps us keep quality health care as affordable as possible.
When certain providers are not contracted with us, as in the case of certain emergency room providers, FCHP pays them the reasonable and customary cost for that service in the community, minus any copayment/coinsurance the member has. Some providers may bill the member for the difference between what they charged and the amount paid by FCHP.
For other non-contracted providers, such as certain ambulance providers and specialists in pathology, anesthesiology and radiology, FCHP now directly reimburses the member the entire billed amount for services, minus any copayment/coinsurance the member has. The member, in turn, will be responsible for directly paying the provider’s bill.
Know that FCHP wants to have contracts in place with as many providers as possible, and pursues that at every opportunity. If you have questions, please contact your account executive through our dedicated broker line, 1-888-746-4823.
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Anticipated 2012 changes under reform law
Fallon Community Health Plan currently anticipates only one plan design change for 2012 related to the Patient Protection and Affordable Care Act (PPACA). That change is implementation of the new guidelines for coverage of preventive health services for women.
These guidelines are part of PPACA’s preventive care mandate. Though referenced in the original text of PPACA, they did not exist at the time PPACA was enacted. The guidelines were only recently adopted by federal regulators. They are effective on first renewal on or after August 1, 2012, and apply to group plans (insured and self-insured) and individual policies. Coverage is with no member cost-sharing.
FCHP is currently analyzing the requirements to determine what changes may be necessary. We already cover some services consistent with the mandate, but not all.
A sample of what the guidelines include under preventive health services is well-woman visits and contraception, screening for gestational diabetes, sexually transmitted infection counseling, breastfeeding supplies and counseling, and domestic violence screening and counseling.
FCHP currently anticipates administrative changes in 2012 in response to PPACA in at least three areas.
- Certain requirements around the appeals process will become effective on first renewal on or after January 1, 2012. Based on recently released regulatory guidance, the impact of these requirements will not be as great as originally anticipated; the recent guidance has pulled back the scope of a number of requirements. Details about possible changes to the state external review process, in response to new federal requirements, are not yet known.
- Requirements around uniform coverage documents are expected to become effective on or before March 23, 2012. Regulations were recently released, and FCHP has begun analyzing the impact of the proposed requirements. The regulations appear to leave many details open.
- Federal requirements around medical loss ratio become effective for calendar year 2011. This will require filings and the possible implementation of a refund process in 2012. Regulations have been issued, and FCHP is working to implement the necessary processes.
We’ll continue to watch for any further regulations or guidance that may be released related to PPACA, and will take any required action to ensure that the plans that we administer stay in compliance. Watch for relevant updates in the coming year.
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Medicare creditable coverage disclosure soon due
Employers who currently provide prescription drug coverage to Part D eligible individuals must by law disclose whether or not their coverage is “creditable prescription drug coverage.” Broadly, an employer’s coverage is creditable if its actuarial value is the same or better than that of the standard prescription drug coverage under the Medicare prescription drug benefit.
As a service to our customers, FCHP will notify employers of any prescription drug plans they offer which do not meet creditable coverage guidelines.
Employers are required to make a two-prong notification: (1) to individuals and (2) to the Centers for Medicare & Medicaid Services (CMS).
- Disclosure is required to active and retired employees (and their covered dependents) who are Part D eligible individuals and covered under the company’s prescription drug coverage. These individuals must receive a notice at initial enrollment and annually prior to the Medicare annual election period. Beginning this year, the election time frame is earlier–from October 15 through December 7. Therefore, the 2011 disclosure must be sent prior to October 15.
- Disclosure to CMS must be made annually and upon any change that affects creditable coverage status. The annual notice must be provided within 60 days of the beginning of the plan year.
Guidance, model notice letters and CMS disclosure forms are available on the CMS Web site at cms.gov/CreditableCoverage.
Please note that it is the employer, not Fallon Community Health Plan, who must manage the disclosure process. If you need additional information, feel free to call your account executive through our dedicated broker line, 1-888-746-4823.
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Time’s up for COBRA subsidy
The COBRA premium subsidy program, first passed by Congress in February 2009 and extended several times, expired at the end of August. The federal government paid 65% of COBRA premiums for involuntarily terminated employees for up to 15 months. The last extension in April 2010 approved the subsidy for individuals let go through May 31, 2010, with a 15-month end date of August 31, 2011.
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More user-friendly formats in FCHP materials
♦ Coverage information standardized
FCHP employers and members are beginning to see a new and more user-friendly format for our Member Handbooks/ Evidence of Coverage and Summary of Benefits. We are in the process of converting these to a letter-sized (full-page) format that is easier to read and store. This approach also allows us to include this information in our newly enhanced member welcome package, which now has all the key benefits, programs and access information members need to know in one publication.
♦ ID cards get a makeover
In our last issue, we reported that FCHP has totally reformatted its ID cards and will be issuing them to members joining the plan or members whose benefits change upon renewal. (We are not doing a total replacement of ID cards.)
FCHP has partnered with a vendor, Clarity Software Solutions, Inc. (Clarity), to streamline our membership ID card print and distribution process. This allowed us to redesign our ID cards to be easier to read for our members and to help clarify network differences for our providers. To simplify information, we have spelled out the benefits, color-coded the cards by network and increased font sizes. To see a sample of the new cards, go to fchp.org/members/news-announcements/new-ID-cards.aspx.
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Medicare Advantage election begins earlier; FCHP expertise grows
This year, the annual election period for our Fallon Senior Plan HMO individual members is earlier—from October 15 to December 7 for plan coverage effective January 1, 2012. (It used to be November 15 to December 31 of each year.)
During this time, anyone wishing to make a change in how they get Medicare may do so—including joining or switching Medicare Advantage plans. Fallon Senior Plan HMO members don’t have to do anything if they want to stay in their current plan. FCHP now also offers Medicare Supplement (Medigap) insurance plans that further diversify our non-group senior-product portfolio.
The FCHP difference in senior care services
FCHP offers its customers a unique expertise in the field of senior care services with several programs that provide care and support for an older loved one. These include:
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Summit ElderCare®, our Program of All-inclusive Care for the Elderly Elderly for people 55 and older, which offers coordinated medical, insurance and social supports all in one comprehensive program.
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NaviCare®, our Senior Care Options program for people 65 and older, which combines all benefits and services that are covered by Medicare and MassHealth Standard. Effective January 1, 2012, we are expanding our NaviCare network, now in Worcester County, to include all of Hampden County and portions of Franklin, Hampshire, Middlesex and Norfolk counties. The expanded service area will include cities such as Springfield, Holyoke, Lowell, Framingham, Natick, Milford and Franklin.
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Home Staff, LLC, our joint venture with VNA Care Network & Hospice, which provides home, hospice and respite care and specialized companion services from three locations in Massachusetts.
You’ll find more information at fchp.org/about-fchp/senior-care-services.aspx. Feel free to contact your sales executive through our dedicated broker line, 1-888-746-4823, to learn more about how we can help.
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Your checklist for open enrollment success
Autumn is around the corner and a busy open enrollment season is upon us!
FCHP can help your clients maximize their time and be responsive to their employees. The first step is to give us a call. We’re here to help you in any way we can. Need a presence at health fairs? Member information and plan materials? Wellness programs? Problem-solving help? Just ask—call your FCHP sales executive through our dedicated broker line, 1-888-746-4823. We’ll be happy to give you personalized service.
Here is a checklist for helping your clients move through open enrollment successfully.
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Give everyone plenty of notice with flyers, payroll stuffers or intranet notices.
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Simplify enrollment materials. Prepare comparison charts for benefits and rates. Clearly explain your clients’ plan options (e.g., copayment versus deductible).
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Make enrollment meetings mandatory so that employees have an opportunity to review plan options and ask questions of HR/health plan reps.
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Entice employees to attend with snacks, sought-after giveaways and a health fair lineup.
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Make it easy. Present each employee with a prepackaged folder with his/her name on it that includes a list of current benefits and forms. Keep materials simple and customized to the employer’s offering.
- Provide a benefits hotline if possible.
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Do a follow-up survey of employees and representatives to get feedback about what you did well and how you might improve.
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Remember, please let us help. Call your FCHP sales executive through our dedicated broker line, 1-888-746-4823.
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Taking wellness to the next level
Fallon Community Health Plan recently welcomed Karen Gagliastre as Manager of Health Promotions. She most recently served as Health & Wellness Director at the YMCA of Central Massachusetts, Central Community Branch.
FCHP currently has an active Wellness Works program that brings programs and educational materials to our employer customers. Karen would like to take this outreach to the next level.
“I’d like to enhance our offerings to include weight management, fitness/exercise classes and wellness challenges that will help employers to engage their employees in strategies to become healthier,” Karen says. “I’m looking forward to building lasting relationships that will facilitate and sustain change in our member/client base—and to offer them support as they make major lifestyle changes to manage their own health.”
If you have questions or suggestions for our Health Promotions Department, please contact Karen at 508-368-9786 or karen.gagliastre@fchp.org.
Karen recommends checking out FCHP’s health and wellness blog, Well Now—, particularly the posting on “mini office workouts”!
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In our corner
♦ President and CEO Pat Hughes tackles tough market
FCHP President and CEO Patrick Hughes answered some interesting questions recently in an interview by the Boston Sunday Globe, “Fallon chief tackles tough market.” Hughes discusses the challenges of doing business in the current health care environment and FCHP’s past and future position in the marketplace. If you missed the original article, you can still read it on our Web site at fchp.org/news/fchp-in-the-media.aspx.
♦ David Jachimiak settling in as Chief Information Officer
FCHP this summer appointed David M. Jachimiak as Chief Information Officer. He is providing strategic leadership in planning, developing, implementing and maintaining technology and information systems that support FCHP’s business goals and our customers.
Jachimiak recently announced a reorganization of the health plan’s IT Department around Centers of Excellence that encourage teams to work collaboratively and use best practices. “This new structure better positions FCHP to leverage its investments in technology and create the type of world-class IT organization that will support FCHP’s success and best serve our customers,” he noted.
Most recently, Jachimiak was Vice President of Information Systems at LifeNet Health, a leading life sciences organization located in Virginia Beach, Virginia, and previously served in similar positions at First Boston Pharma in Gloucester and Allmerica Financial in Worcester.
♦ Vision and values set high standards
After formulating a three-year (2011-2013) strategic plan, FCHP took a closer look at who we are, what we value and what are goals are for the future. We confirmed our mission of making our communities healthy, and we refocused our vision, which now is extraordinary innovation, quality, health care.
It is our values, however, that we believe our customers most care about and that make us unique. They are the guiding principles and behaviors that embody how FCHP and all of its employees think and act. We are member-driven. Innovative. Accountable. And a team.
“For our employees who serve you, these aren’t just words—they are everyday actions,” emphasizes President and CEO Patrick Hughes. “Team FCHP is dedicated to supporting you, as an FCHP customer, and caring and advocating for our members as they navigate through the complexities of the health care system.”
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FCHP business and community support
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On September 10, we are proud to sponsor the 5th annual FCHP Canal Diggers 5km Road Race and one-mile fitness walk—one of the premier fitness events in the region. The race, held this year in partnership with Central Mass Striders, helps to launch Worcester’s Blackstone Canalfest. FCHP members may be reimbursed for race fees with our It Fits! benefit. For more information, visit canaldiggers.org.
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FCHP will hold its annual fundraising event, Golf FORE a Goal, on September 19, 2011. We’ve again asked community partners to join us in supporting food pantries and hunger relief programs throughout our service area. Last year, we donated to more than 90 programs. In the history of this event, we’ve raised more than $670,000. This initiative strongly supports our mission of making our communities healthy. Thank you for your support!
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Fallon Community Health Plan will participate in, and sponsor the luncheon program for, Benefest 2011, the Massachusetts Association of Health Underwriters’ 9th Annual Statewide Conference & Trade Show. Benefest 2011 will be held September 28 at the DoubleTree Hotel in Westborough. The conference features educational programs, networking opportunities and a premier showcase of exhibitors.
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FCHP is a presenting sponsor of the 2011 New England Business Expo to be held at the DCU Center in Worcester on November 3. It’s the 25th anniversary of this event, presented by the Worcester Regional Chamber of Commerce. We also are separately sponsoring the event’s Breakfast Club, which will feature Dave Kurlan, a successful entrepreneur and sales development industry pioneer. FCHP will be among the many area businesses on hand to showcase our products and services. See you there!
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Fallon Senior Plan™ is the presenting sponsor of the Senior Spectacular 2011 for seniors and caregivers. This year’s expo will be held October 20 at the DCU Center in Worcester and November 1 at the Basketball Hall of Fame in Springfield. This free and well-attended event includes workshops, health screenings, seminars, exhibits and entertainment. Visit our booth to learn more about our products for the Medicare-eligible population.
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Save these important numbers
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FCHP’s dedicated broker line: 1-888-746-4823
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Sales fax: 1-508-368-9565
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Enrollment & Billing fax: 1-508-831-1136
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Billing & Enrollment phone: 1-800-333-2535, ext. 69322
Press option 1 for Billing, option 2 for Enrollment
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FCHP’s dedicated broker line: 1-888-746-4823
Broker Edge is published quarterly to provide the broker community with the latest Fallon Community Health Plan news and product facts, health care trends and marketplace information. fchp.org/brokers