IMPORTANT: New Medicare Part D Reporting Requirement for Employers
The new Medicare prescription drug program requires employers to file a Creditable Coverage Disclosure Notice with the Centers for Medicare and Medicaid Services (CMS). The Notice is intended to disclose to CMS whether or not the prescription coverage offered by the employer to Medicare Part D eligible individuals is creditable or non-creditable. The Notice must be filed online no later than Friday, March 31, 2006. To access the online form, go to:
http://www.cms.hhs.gov/apps/ccdisclosure/default.asp
To access CMS' Creditable Coverage Notice to CMS Guidance brochure, go to:
http://www.cms.hhs.gov/CreditableCoverage/Downloads/Disclosure2CMSGdnc.pdf
Should you have any questions about this Notice or how to file, please contact your Thesco Account Executive.
United Healthcare & Oxford Health Plans Announce New Out-of-Network Claim Payment Policy
United Healthcare and Oxford Health Plans have released the following announcement:
Oxford and United are committed to helping make healthcare costs more affordable to their customers. One way to do this is to provide more information to Members about the costs of medical services and their liabilities when they receive care from non-participating providers. As a part of this effort, Oxford and United are changing the way they direct claim payments for services rendered by non-participating providers.
Effective April 1, 2006 if a Member receives services from a facility or physician who does not participate in the Oxford or United network of providers, claim payment may be made directly to the covered employee instead of the non-participating provider. In accordance with the provisions outlined in the Member Certificate of Coverage, the carrier may refuse assignment of benefits for out-of-network claims. In such cases, the following process will be followed:
- The non-participating provider will be instructed to bill the covered employee (Subscriber) for services rendered.
- The reimbursement check the Subscriber receives will represent the benefit amount payable for the service and will be attached to an Explanation of Benefits (EOB).
- The Subscriber will be responsible for making payment to the non-participating provider for the full amount of the check mailed to them, in addition to any applicable co-payment, deductible, coinsurance or other cost share allowances, according to their benefit plan.
- Please remind your employees to make sure that their mailing addresses and phone numbers are current with Oxford or United, so that claim payments for services from non-participating providers arrive at their homes without delay.
If Members choose to see providers who participate in the network, the physician or facility will continue to be reimbursed directly. Remember that in most cases, it will also be less expensive for them to visit a participating network providers.
Please contact your Thesco Account Executive with any questions.
Form 5500 Revisions – To File Or Not To File?
On occasion an insurer will issue a revised Schedule A. Does this mean that a previously filed Form 5500 must be re-filed? According to the U.S. Department of Labor, should any of the information submitted in a Form 5500 be subsequently revised then a revised Form 5500 must be done. The good news is that there is no deadline for filing a revised Form. For additional information please visit the DOL website at: http://www.efast.dol.gov/
Test Your Benefits Knowledge
We're all familiar with Medicare Parts A (hospital insurance), B (medical insurance) and the new Medicare Part D (prescription drugs), but...... what is Medicare Part C?
Last Issue's Question:
Are there any state laws that require an employer to cover domestic partners under their benefit plans?
Answer: This is a trick question! While there are no current laws that require an employer to cover domestic partners there is a law in California that effectively serves the same purpose. California State Assembly Bill 2208 requires health care service plans and insurers to provide coverage to a legally registered * same-sex domestic partner of an employee or subscriber on the same basis that it provides coverage to spouses. The law applies to insurance contracts issued in CA and extends to all forms of insurance (such as medical, dental, life, long term care) regulated by the CA Department of Insurance.
* In order to be "legally registered", both partners must meet the requirements of and file a Declaration of Domestic Partnership with the California Secretary of State.
Health Savings Accounts/Health Reimbursement Accounts:
Please visit our website, http://www.thesco.com/, for an up-to-date White Paper on Consumer Driven Healthcare. This recent survey will be posted under the NEWS section for your review within the next 24 hours.