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Our value-based benefit approach rewards members who take steps to improve and manage their health. We’ll now contribute $500 to the Health Incentive Account for employees who complete their Preventive Health Actions—and another $500 when their spouse or domestic partner completes theirs. Premier dentists are considered Out-of-Network for all PPO and PPO plus Premier plans, and are considered In-Network for Premier plans. If a Delta Dental member goes to a Non-contracted dentist, charges are reimbursed at the lesser of the submitted charge OR the fee that satisfies a majority of dentists with the same training and geographical area.
Lowered their health risks:  CDHP customers lowered their risk of developing or worsening a chronic condition.
Reduced total medical costs:  CDHP medical cost trend was 16 percent lower than traditional plans during the first year.
Were more engaged in health improvement: Through proper plan design plan and the use of incentives,  CDHP customers were more likely to have completed a health risk assessment and participated in their health coaching program than those enrolled in a traditional plan.
Were more savvy consumers of health care:  CDHP customers enrolled in their pharmacy management program were more likely to choose generic medications and had 14 percent lower pharmacy costs compared to those in a traditional plan.
Preventive health care–including annual physical exams, screenings, and immunizations–is essential to good health.
The Affordable Care Act (health care reform) attempts to address this problem by requiring all new group and individual health insurance plans as of September 23, 2010 to pay 100% of the costs for preventive care services ranked A and B by the U.S.
If your health plan qualifies, you can take advantage of a wide range of preventive care services to help you avoid illness and improve your health–at no cost to you, so long as you receive these services from a health care provider within your health plan’s network of doctors and hospitals. You won’t have to pay a copayment at the office visit, and not a penny toward coinsurance or your deductible. Note: Services marked with an asterisk (*) must be covered with no cost–sharing in plan years starting on or after August 1, 2012. It’s important to keep in mind that while the health plan cannot charge you a copayment, deductible, or coinsurance when the primary purpose of the office visit is the recommended preventive care service and the service is NOT billed separately from the office visit, you may be required to share some of the costs if the preventive service is not the primary purpose of the office visit. This change is due to the addition of atorvastatin, a new generic for the brand name Lipitor, on their covered drug list.
This change impacts all of the commercial and individual business in California and New York. Benefit and eligibility information must be provided to eligible participants or be made available at their request.
Please remember that failure to follow the rules can be costly.  For example, the fine for failure to file the 5500 report is $1,000 PER DAY. If we may be of any assistance to you or can help you organize a compliance process, please contact Gary Whiddon at (888)474-6627.
The new plans were designed to help employers and employees save on health care costs while getting a plan that meets their needs. Plan sponsors can set their contribution rates on the lowest priced plan, and their employees can “buy up” to different plans if they wish to do so. IMPORTANT PLAN CHANGES: In addition to introducing new plans, some changes were made to existing plans.
As of March 2012, an employer can obtain a new employee’s member ID right in the on-line enrollment tool as soon as the enrollment has been processed. A pioneer in the creation of tailored networks, Health Net is evolving its Bronze plans and network into Health Net SmartCare.
Health Net SmartCare is the health care solution that employers can afford, employees will use, and both will value. Effective March 1, 2012, Health Net will no longer offer Bronze or Bronze Choice to new groups.


Offered the option to choose any one or more of the new SmartCare plans (six for SBG, five for Large), or any other Health Net group plan. If a group wants to keep their plan design exactly as it is under their Bronze plan, they may do so by pairing those benefits with Health Net’s full HMO or Silver network.
Health Net has the Health Net SmartCare broker guide including a crosswalk and plan overviews available to support you and your brokers in client conversations.
In conjunction with introducing SmartCare in San Diego (region 7), Health Net is also lowering rates for its PPO Advantage plans.
Health Net is expanding its Salud network with the addition of IPA Hispanic Physicians, which has eight PCPs and 74 specialists. SeeChange Health offers value-based benefit design solutions to meet the needs of businesses of all sizes. The PPO plans within the Small Group EmployeeElect Portfolio will see a new business average increase of approximately 3.2%*. Groups with 6 or more enrolling in our BeneFitsplan portfolio will also receive an automatic .90 RAF -There will be no qualifying renewal RAF required on those groups.
On January 3, 2012, the IRS issued additional interim guidance on the W-2 reporting requirement that is part of health care reform.
Additionally, the release indicates that specialty coverage, if included with medical benefits, must be reported. The guidance reaffirms that this is a reporting requirement only and does not impact employees’ taxable wages. 3.Employers may begin to  use social media to reinforce healthy behaviors, such as  losing weight, exercising more and  becoming healthier. 4.In spite of the economic downturn, one-third of employers plan to increase their  spending on wellness programs  in order to reduce overall premium expenditures.
Groups with more than 49% of the eligible employees employed outside the state of California are considered non-guaranteed issue in California.
Underwriting will approve or decline these groups in accordance with the underwriting guidelines.
This could impact rates for specific groups whose employees reside in a different rating area than the one in which they work.
That’s a total of $1,000 per couple, up from the $200 per person contribution we make today.
Non-contracted dentist charges are reimbursed at the lesser of the submitted charge OR the fee that satisfies a majority of dentists with the same training and geographical area.
According to the study, when employers fully transitioned to offering only a CDHP option, individuals improved their health risk profile by 10 percent in the first year compared to customers in a traditional plan option. Over five years, cumulative cost savings averaged $9,700 per employee enrolled in a CDHP compared to employees who remained in a traditional health plan. In addition, CDHP customers used the emergency room at a 13 percent lower rate than individuals enrolled in HMO and PPO plans. Yet many Americans don’t receive the regular preventive care they need, despite the fact that chronic diseases, which are responsible for 7 of 10 deaths among Americans each year and account for 75% of the country’s health care spending–are often preventable. And remember, preventive services are covered at 100% only when received from health care providers within the health plan’s network. The insurer said the approach should cut down on some of the priciest forms of medical care, emergency room visits and hospital admissions. SmartCare is built to flex over time with planned expansions for 2012 (and beyond) in geographic coverage, prominent participating provider groups and other resources to match evolving employer and employee needs. The expansion makes Salud HMO y Mas and Salud Mexico available to groups – both SBG and Large – in parts of Kern county effective March 1, 2012.


SeeChange Health Insurance provides value-based benefit plans to fully insured employer groups in California and is the first to bring this unique approach to small and midsize companies. In this guidance, the IRS confirms that employers filing fewer than 250 W-2s are not required to report the value of health benefits. Employers may require that employees pass biometric screenings to receive discounts on their health insurance premiums.
More employers may use the services of a health care advisor to teach employees how to make better treatment choices, find quality providers and make better use of their employers’ health management programs, thereby reducing health care costs.
Employers filing fewer than 250 Forms W-2 for the preceding calendar year are not required to report the aggregate cost of coverage.
The Notice clarifies that the standard for determining whether the cost of coverage under a dental plan or vision plan is included in the aggregate cost is the same standard for determining whether such coverage is an excepted benefit under HIPAA.
The reporting requirement does not apply to the cost of coverage includible in income under Section 105(h) of the Internal Revenue Code, or payments or reimbursements of health insurance premiums for a 2% shareholder-employee of an S corporation that is required to include the premium payments in gross income. An employer that does not charge a premium for an EAP, wellness program or on-site medical clinic to COBRA-qualifying beneficiaries is not required to include the cost of such coverage in the aggregate reportable cost.
The aggregate reportable cost for a calendar year reported on a Form W-2 may be based on the information available to the employer as of December 31 of the calendar year, without regard to any election or notification made or provided in a subsequent calendar year that has a retroactive effect on a previous year’s coverage. The Notice provides employers with various options for reporting the aggregate reportable cost for a payroll period that spans two taxable years. Employers are required to include the cost of coverage in the aggregate reportable cost on Form W-2 if the employer makes any contribution to the cost of coverage that is excluded from the employee’s income, or if the employee purchases a policy on a pre-tax basis under a cafeteria plan. The aggregate reportable cost is not required to be reported on a Form W-2 furnished by a third-party sick pay provider.
Cost reductions were achieved without employers shifting out-of-pocket health expenses to their employees. Please note: There are changes to every plan — so it is important for you to review the changes.
SeeChange Health Insurance is now the fastest-growing health plan in the market, as brokers and employers alike are embracing the value-based model. Those who don’t meet the necessary biometric levels would have to enroll in a wellness program and after achieving a healthy body mass index and other biometric numbers, would then be eligible for the discounts.
Thus, certain stand-alone dental and vision plans may be exempt from the reporting requirement.
For arrangements that are not subject to any federal continuation coverage requirements (such as church plans), the employer is not required to include the cost of such coverage on the Form W-2. However, if the employer provides the opportunity for employees to purchase an independent, non-coordinated fixed indemnity policy and the employee pays the full amount of the premium with after-tax dollars, the cost of coverage provided under that policy is not required to be reported on Form W-2. However, a Form W-2 furnished by the employer to an employee must include the aggregate reportable cost, regardless of whether that Form W-2 includes sick pay, or whether a third-party sick pay provider isfurnishing a separate Form W-2 to report sick pay.
Essentially, preventive care becomes ‘free’ for the policyholder, greatly increasing the incentive to take advantage of these services. The following lists outline the preventive care services covered by these rules for adults, women, and children.



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