Broker Edge
March 2012, Vol. 11, No. 1
A newsletter dedicated to informing brokers affiliated with Fallon Community Health Plan
In this issue:
Product news
♦ FCHP is a smart choice
We thank you for partnering with us for April 1 enrollments. We’ve made minimal changes to our diverse and competitive product portfolio for small groups and individual consumers, effective April 1, 2012, upon anniversary.
The best news is that FCHP has a very low premium trend for April 1, 2012. We’ve also made regional adjustments to our product portfolio and offer new network and plan design options—making FCHP an even smarter choice this open enrollment season. For example, for our small group PPO, we made increment changes from 20% to 12% for MetroWest, North Shore, Merrimack Valley, Southeastern and South Coast. Be sure to ask us for plan specifics.
Overview of changes
- We’ve expanded our It Fits! program to include reimbursement for cardiovascular home fitness equipment. We’ve made the richest fitness benefit in Massachusetts even better! For details, please see the It Fits! article under the “Benefits news” section below.
- We’ve introduced a Premium Saver 1000 Classic plan design for Direct Care, Select Care and Fallon Preferred Care, rounding out the popular PS 1500 and 2000 Classic plan designs we introduced last year.
- For all of our Classic plan designs, diagnostic lab services for office visits and same-day surgery are covered in full and no longer accumulate towards the deductible! This differentiates us from most competitors and will be a popular benefit with Premium Saver Classic members.
- For our PPO, we’re introducing two closed-formulary plans, Preferred Care Premium Saver II and Preferred Care Premium Saver 2000/500 II, which will allow you to offer the triple option when discussing closed formulary plans with clients.
For details, call your sales executive at FCHP’s dedicated broker line,
1-888-746-4823.
♦ FCHP Steward Community Care: a limited-network with big savings
Fallon Community Health Plan, in an exciting new partnership, has introduced FCHP Steward Community Care—a limited network HMO plan that saves employers significantly on their health care costs, while maintaining the highest level of care for their employees.
We are offering FCHP Steward Community Care to employers at a 20% cost differential from FCHP Select Care.
Available throughout Eastern Massachusetts, the plan network includes all of the Steward Health Care system community doctors and hospitals. Members also have access to two premier Boston hospitals, Brigham and Women’s Hospital and Massachusetts General Hospital, for medically necessary services that are not available at a Steward facility.
The Retailers Association of Massachusetts, which serves more than 3,500 stores and restaurants, announced that FCHP Steward Community Care will be the primary offering of the association’s newly-approved group purchasing cooperative, one of the first in the state.
Why choose FCHP Steward Community Care?
- Our plan combines the innovation and experience of FCHP with the strengths and expertise of the Steward Health Care System.
- You can offer all the same flexible plan designs as FCHP Direct Care and FCHP Select Care. From traditional copayment plans to qualified high-deductible options with HRA, HSA or FSA integration, we have it all.
- It’s an easier sell with all the comprehensive benefits and extras that FCHP members have long enjoyed, including our rich It Fits! reimbursement program, $0 wellness visits and eye exams, and other valuable member discounts.
- It’s part of our “quad” option. To meet employer needs, you can offer Steward Community Care in tandem with FCHP Select Care, FCHP Direct Care and Fallon Preferred Care.
Steward Health Care: An innovative partner
Steward Health Care is earning a reputation for delivering quality, affordable health care at the community level. Steward serves more than one million patients annually in 85 communities in Massachusetts. This past year, Steward hospitals have received a dozen independent awards recognizing the quality of their services. For more information, go to fchp.org/steward.
Call your sales executive for more details at FCHP’s dedicated broker line, 1-888-746-4823.
♦ Introducing FCHP Tiered Choice: more savings, more options
Fallon Community Health Plan is proud to offer another innovative plan option, FCHP Tiered Choice, effective March 1, 2012.
FCHP Tiered Choice—a 3-tier network plan with three plan design options—is currently available in Berkshire, Hampden and Worcester counties, and will continue to expand throughout Massachusetts.
With FCHP Tiered Choice, employers save on premium—at a 7% cost differential from FCHP Select Care. At the same time, employees are empowered to pay more or less for their care based on the network doctors and hospitals they choose. If members seek care from a Tier 1 provider, they will pay less than if they see a Tier 3 provider.
The three plan designs with FCHP Tiered Choice are:
- Tiered Choice $0 Deductible
- Tiered Choice $1,000 Deductible
- Tiered Choice $0/$1,000 Deductible (Tier 1 has $0 deductible.)
Deductibles apply only to high-tech imaging, same-day surgery and inpatient care.
What makes FCHP Tiered Choice stand out?
- Lab, X-ray and pathology are covered in full with all three plan designs.
- Premier hospitals including UMass Memorial, Saint Vincent Hospital and Berkshire Medical Center are all in Tier 1.
- We offer a plan design that does not tier PCPs and specialists.
- We tier on total medical expense, not unit cost.
- All three plan designs include It Fits!, the richest fitness reimbursement program in the state, and Oh Baby!, our popular program for new and expecting parents.
Call us today at 1-800-333-2535 for all the details about FCHP Tiered Choice! Or visit us at fchp.org/tieredchoice.
♦ Fallon Companion Care now pays!
FCHP is now paying broker commissions for our competitive Companion Care group option: $100 one-time payment per group and $16 per member per month. We significantly improved both the pricing and positioning of Companion Care last year to make it one of the richest and most affordable retiree products in the market.
Companion Care is a coast-to-coast health care coverage solution for Medicare eligible retirees and a great product to sell.
- Retirees can use any provider who accepts Medicare (nationwide).
- Members have little out-of-pocket costs.
- The plan includes It Fits! ($200 fitness reimbursement).
Also, for retirees who live in and around Central and Western Mass., don’t forget our popular and affordable Medicare Advantage group plan, called Fallon Senior Plan Premier HMO. It enriches Original Medicare benefits and includes prescription drug coverage.
Plus, we’ve expanded the network for Fallon Senior Plan Premier HMO to include Central Massachusetts Independent Physician Association (CMIPA), Tri-County Medical and Health Alliance Medical Group. Other quality providers already in this network include UMass Memorial Health Care, Reliant Medical Group (formerly Fallon Clinic), Heywood Hospital and physicians, and Hampden County Physician Associates and their affiliates, among many others.
Call today! For more information or to receive a competitive quote on your retiree business, please call Medicare Group Sales Executive Brian Guagnini directly at 1-508-368-9578.
♦ FCHP has strong presence at muni trade show
FCHP’s ongoing outreach to municipalities included our participation as major exhibitors in January at the the 33rd Massachusetts Municipal Association (MMA) Annual Meeting and Trade Show held at the Hynes Convention Center in Boston— the ultimate networking and educational event for cities and towns.
Many FCHP Sales & Marketing representatives interacted with municipal officials who stopped at our exhibit throughout the weekend. FCHP continues to promote its expertise in providing affordable health insurance solutions for the municipal market.
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FSA/HRA solutions with UltraBenefits
Reminder: Participants in flexible spending accounts (FSAs) should take time to ensure that all eligible 2011 expenses are accounted for—they must be submitted by March 31.
A Flexible Spending Account, which gives employees a tax break, is one way that employers can minimize the impact of higher-deductible plans that help them manage premium costs. An FSA through FCHP’s subsidiary, UltraBenefits, can be offered in conjunction with any FCHP plan design option. Any UltraBenefits FSA uses Benny™, the Prepaid Benefits Card to access the FSA funds, making the process faster, easier and more convenient.
Employers also may choose through UltraBenefits to partially fund a Health Reimbursement Account for their employees to reimburse certain qualified medical expenses on a tax-free basis. When combined with a high-deductible health plan, an HRA can save employers a significant amount of money on their employee benefit plans.
Given FCHP’s integration with UltraBenefits, employers enjoy the benefits of bundling their medical, HRA and FSA administration into one resource. Also, reimbursement is easy with our direct claims feed, so there’s little or no paperwork for either employer or employee. It’s a great solution.
To learn more about UltraBenefits’s cost-management solutions, contact our on-site liaison Molly Hebert at 1-866-858-7223.
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Online quoting with Quick Quote
Get your quotes quickly and easily. By using our online Quick Quote tool, you can create custom proposals for your new business prospects, manage group census data and more!
As an FCHP broker, registering for Quick Quote is easy!
- Download the Quick Quote registration form. (pdf)
- Fax or mail the completed form to FCHP.
- After we've received and processed your form, we'll contact you with your username and password for Quick Quote. When you're ready to start using the tool, just return to the Broker section on fchp.org and log in!
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Network news
♦ FCHP Direct Care new option in southeastern Mass.
We expanded our FCHP Direct Care limited network in January to include the hospitals (St. Luke’s, Tobey and Charlton Memorial) and physicians of the Southcoast Health System and Jordan Hospital and its physician group.
We’re offering FCHP Direct Care in the region for at least a 12% price differential compared to the base premium for our broad-based HMO Select Care network. Members of Direct Care may use our Peace of Mind Program™ to receive a second opinion and treatment for specialty services at several Boston medical centers.
Direct Care may be offered as the centerpiece of a defined-contribution approach or part of our triple-network choice, which positions our two HMO networks—FCHP Direct Care and FCHP Select Care—alongside Fallon Preferred Care (our PPO) at designated price points.
We look forward to partnering with you in developing new business in the southeast region. Check our rates on Quick Quote or call your sales executive on our dedicated broker line, 1-888-746-4823.
FCHP Direct Care 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 1-800-858-5200—or visit the provider search tool at fchp.org to determine which providers are included in FCHP Direct Care.
♦ BI Deaconess now “in-network” for Select Care
Reminder: FCHP Select Care members may now use Beth Israel Deaconess Medical Center in Boston as an in-network medical facility and have in-network access to providers in the Beth Israel Deaconess Physician Organization. Currently, BIDPO has over 450 primary care physicians and 1,300 specialists in the physician organization.
Our FCHP Direct Care members continue to have access to Beth Israel Deaconess through our Peace of Mind Program™ to receive a second opinion and treatment for specialty services.
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Benefit news
♦ It Fits! now covers home fitness equipment
We’ve expanded our It Fits! program to include reimbursement for certain home fitness equipment. We’ve made the richest fitness benefit in Massachusetts even better! The equipment must be new and purchased at a retail or online store, and must provide a cardiovascular/muscular total-body workout. (Some examples are: treadmills, stationary cycles, stair climbing/elliptical or rowing machines, and home gyms.)
The standard reimbursement for families is $400 (individuals $200) each year for all kinds of healthy activities, like memberships at any gym, sports programs for kids and adults, yoga classes, and even ski lessons and ski passes.
New for January 2012: Commercial plan members now may sign up directly with Weight Watchers® for either group meetings or online programs and be reimbursed through It Fits! And, as a new addition, members may be reimbursed for registration costs for Jenny Craig® or the membership fee for TOPS® (Take Off Pounds Sensibly).
Reminder: It Fits! reimbursement requests must be made no later than 3 months following a benefit year. That means March 31 is the deadline for members who have a benefit year of January 1 through December 31. No reimbursement claims for eligible 2011 activities will be accepted beyond that deadline.
For details about It Fits!, see our online flyer—or call us at our dedicated broker line, 1-888-746-4823.
Weight Watchers® is a registered trademark of Weight Watchers International, Inc.
Program eligibility and benefits may vary by employer, plan and product.
♦ Extras add up to more FCHP value
Our members love the It Fits! program, but also look to FCHP for other programs and services that make their lives healthier. Here are a few:
- FCHP’s Family Fun program continues in 2012. Right now, look for special coupons for local ski areas like Wachusett Mountain, Nashoba Valley Ski Area, Jiminy Peak Mountain Resort and Ski Ward. FCHP members also save when visiting many attractions throughout our service area. Our partners in the program have donated these discounts, with no cost to FCHP or our members.
- $0 copayments. FCHP pioneered $0 wellness copayments for certain preventive services now required by law. And, though not required, last year we added $0 copayments for annual preventive vision screenings.
- Oh Baby! We deliver for free some of the “little things” for parents-to-be, such as childbirth classes, prenatal vitamins, a child care or sibling rivalry book, a home safety kit and even a free car seat!
- CVS ExtraCare Card. Members can use their FCHP CVS Caremark ExtraCare Health Card at over 7,100 CVS stores nationwide! With this card, they get a 20% discount on over 1,500 CVS/pharmacy brand health-related products.
- Nurse Connect. Free 24/7 member access to registered nurses and other health care professionals who can respond to medical questions.
- Customized care management programs for members with health issues such as asthma, diabetes or heart disease.
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FCHP gives its members tools for healthier living
Fallon Community Health Plan’s Health Promotions and Disease Management departments in Care Services are working together to expand their outreach to our employer groups and the community.
To raise awareness about potential health issues, the departments conduct screenings and lunch ‘n learns that focus on health education and disease prevention. The screenings include blood pressure, body composition (BMI and body fat percentage), DermaView to look for skin damage, grip strength and carbon monoxide testing.
Educational flyers offer tips and information on many topics such as exercise and nutrition, and explain resources such as FCHP’s Quit to Win smoking cessation program. Additionally, we promote well visits, vaccinations and routine screenings (skin cancer, colorectal and breast) and encourage referral to FCHP’s Disease Management program.
In Disease Management, Health Educators/Nurses do telephonic health coaching for members with asthma, diabetes and heart disease. The program empowers members with chronic health conditions to self-manage their disease and control it the best they can.
Our program strives to slow the progress of disease, prolong periods of health and improve quality of life. We do this by focusing on action steps for healthier living. The Health Educators/Nurses guide participating members in making lifestyle behavioral changes, such as diet, exercise, stress management and quitting smoking. The program also sends members disease-specific self-management tools and quarterly newsletters, and other educational materials.
The Health Promotions and Disease Management staff is available to employer and other groups for group educational sessions
To learn how you can take advantage of these FCHP’s programs, please contact Karen Gagliastre, M.Ed., CHES, Manager of Health Promotions, at 1-800-868-5200, ext. 69786, or by e-mail at karen.gagliastre@fchp.org.
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Growing our support for seniors and caregivers
♦ Summit Eldercare® soon in Springfield
FCHP has begun construction on its 6th Summit ElderCare site, to be located in Springfield (on Wason Ave.). We project the building will be completed in late 2012. This milestone is another step in growing FCHP’s Senior Care Services.
The Summit ElderCare building serves as an adult day health center where participants can receive medical care and get involved in social activities. As a Program of All-Inclusive Care for the Elderly, Summit ElderCare is a medical, insurance, and social support program for persons age 55 and older who meet eligibility criteria.
A team of professionals coordinate each participant’s medical care and other geriatric services. The program offers comprehensive benefits such as home health care and personal care assistance, as well as caregiver support. To learn more, call 1-800-698-7566, or go to summiteldercare.org.
♦ NaviCare® membership tops 1,000
Our NaviCare program, begun in 2010, recently reached the milestone of serving over 1,000 members! We also expanded the NaviCare service area for 2012 from Worcester County alone to include all of Hampden County and parts of Franklin, Hampshire, Middlesex and Norfolk counties.
NaviCare is a unique product for eligible seniors, which combines in one package all Medicare and MassHealth Standard benefits, services and items. A Navigator works with members and caregivers to coordinate the care and services needed, which can include community-based home and personal care services such as adult day health, home-delivered meals or help with bathing and dressing needs. For more information, call 1-877-255-710 or visit our NaviCare Web site.
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In our corner
♦ New VP appointments announced
Todd M. Bailey recently was appointed Vice President of Senior Care Services at FCHP. In this role, Todd is responsible for all of FCHP’s product lines within its Senior Care Services division, including all Fallon Senior Plan products, Summit ElderCare® and NaviCare®. Todd, who has been with FCHP since 1999, was most recently Vice President of Underwriting and Actuarial Services.
Taking Todd’s place as Vice President of Underwriting and Actuarial Services is Kevin J. Grozio, who recently served as Vice President of Actuarial Services at ConnectiCare, Inc. & Affiliates in Farmington, Conn. Prior to that, he was an Actuarial Analyst for United HealthCare and also Aetna Health Plans. Kevin is an Associate of the Society of Actuaries and a member of the American Academy of Actuaries.
♦ Billboards reflect new FCHP ad campaign
If you travel the major roads of Massachusetts these days, you’ll likely see an FCHP billboard introducing our new ad/marketing theme, “More New Thinking,” which also appears in our TV, radio and print advertising.
We have more than a dozen boards highly visible throughout the state, including Pittsfield, Springfield, Methuen, New Bedford and Fall River—as well as two along I-290 in the Worcester area. See if you can spot one!
♦ An extraordinary milestone
This is a milestone year for Fallon Community Health Plan—we celebrate our 35th anniversary! From our humble beginnings as a part of the former Fallon Clinic in 1977, FCHP has become an independent and innovative health care services company with a strong presence in the Massachusetts marketplace and beyond. We’re proud of our many accomplishments—and have set our sights on many more. Thank you for being an important partner with us on this journey!
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Wellness watch
♦ Spring in your step
You’re ready to put winter behind you and get out on the athletic field, onto the golf course or back to your jogging or biking routine.
As you get back into the game, you want to avoid injuries to muscles, bones and joints. The first thing to remember is to increase your exercise level gradually. Don’t be a “weekend warrior,” packing a week’s worth of activity into a couple of days.
Other things to consider:
- Make warm-ups part of your routine even when participating in less-vigorous activities like golf.
- Learn to use proper form for your fitness activity to reduce the risk of “overuse” injuries.
- Exercise at a comfortable pace that allows you to carry on a conversation while you’re exercising.
- Cool down after vigorous sports so that your pulse comes down gradually.
- Don’t play when you are tired or in pain. It’s never a good idea to “work through” the pain.
Always check with your doctor before beginning any exercise program, especially if you’re over 40 or have cardiovascular risk factors. Otherwise, have fun!
If you have questions about FCHP’s Wellness Works program, please contact Manager of Health Promotions Karen Gagliastre at 1-508-368-9786 or karen.gagliastre@fchp.org.
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Reporting fraud, waste and abuse
Fraud, waste and abuse affect everyone. Combating fraud, waste and abuse is essential to maintaining strong and affordable health care.
- Fraud can be defined as an intentional misrepresentation that causes a victim to part with something of value, and is considered a criminal act.
- Waste is generally categorized as an act that causes a company to pay unnecessarily for a service.
- Abuse occurs when an individual or entity “works the system,” so as to be paid (or paid more) for a service to which he/she would not otherwise be entitled.
Fallon Community Health Plan is committed to detecting, investigating and resolving instances of error, fraud, waste and abuse.
If you suspect fraud, waste or abuse, please be sure to report the activity to Phil Benvenuti, FCHP Senior Director of Internal Audit, at 1-508-368-9412. You also may call FCHP’s Compliance Hotline anonymously at 1-888-203-5295.
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Procedural notes
- FCHP mailed out 1099-MISC tax forms in January to all brokers who are not incorporated, indicating the amount of money we paid in commissions between January 1, 2011, and December 31, 2011. If you received a 1099-MISC and think the information on the form is incorrect, please call FCHP Accounting Manager Karen Millay at 1-508-368-9344.
- Please note: FCHP sends out broker commission statements on the 15th of every month—or the business day closest to the 15th if it falls on a weekend.
- In our effort to provide you and your clients with great service, it’s important that we have not only your address and e-mail, but the current e-mails and names of your associates. That way we can keep you and each of your partners connected to FCHP through Broker Edge Flash e-mails, the most recent editions of Broker Edge and other FCHP communications that all of you will value. Please send your e-mail information to mark.depatsy@fchp.org or call Mark at 1-508-368-9498.
- Fallon Community Health Plan is required to have your current Commonwealth of Massachusetts broker’s license on file. If you’ve renewed your producer’s license in the recent past and haven’t sent us a copy, please do so now. We need your most current Massachusetts license to issue commissions and do business with you. Please send a copy of the license via fax at 1-508-368-9565, attention Ursula Arello, Manager of Sales Operations, or via e-mail to Ursula.Arello@fchp.org.
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Save these important numbers
- FCHP’s dedicated broker line: 1-888-746-4823
- Sales fax: 1-508-368-9565
- Enrollment & Billing fax: 1-508-831-1136
- 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