HMO-Like Plans May Be Poised for Comeback in Online Insurance Markets

by Julie Appleby KHN Staff Writer  California Broker Magazine

Reprinted with permission by www.kaiserhealthnews.org.
It’s back to the future for insurers, which plan to sharply limit the choice of doctors and hospitals in some policies marketed to consumers under the health law, starting next fall.
Such plans, similar to the HMOs of old, fell into disfavor with consumers in the 1980s and 1990s, when they rebelled against a lack of choice.
But limited network plans – which have begun a comeback among employers looking to slow rising premiums – are expected to play a prominent role in new online markets, called exchanges, where individuals and small businesses will shop for coverage starting Oct. 1. That trend worries consumer advocates, who fear skimpy networks could translate into inadequate care or big bills for those who develop complicated health problems.
Because such policies can offer lower premiums, insurers are betting they will appeal to some consumers, especially younger and healthier people who might see little need for more expensive policies.
“Insurers, who are designing their plans for next fall, will start with as tight a network control as they can,” says Ana Gupte, a managed care analyst with Sanford Bernstein.
Plans may also benefit from offering such policies because they are less attractive to those with medical problems, who can no longer be turned away beginning in January 2014.
“Plans will basically say they can minimize their risk by creating narrow networks,” says John Weis, president of Quest Analytics, an Appleton, Wis., firm that analyzes provider networks for insurers.
“State or federal regulators, who must review the plans sold in the online markets, are unlikely to permit them to exclude an entire class of doctors, such as cancer or diabetes specialists. But there might be more subtle ways to discourage consumers with medical problems. They might have too few oncologists, or only general oncologists, for example,” says Stephen Finan, senior director of policy with the American Cancer Society Cancer Action Network, an advocacy group in Washington.
Cost Vs. Choice
“Narrow networks may be more than adequate 90% of the time,” Finan says, “but are not well-suited to deal with complicated medical conditions and chronic diseases.”
That’s because there may be few or no specialists available for certain complex conditions, so patients may have to seek care outside of the networks. If the policy doesn’t cover non-network care, they may end up footing the bill themselves. Even if policies allow for outside the network coverage, patients can incur large copays or other costs. Your (financial) exposure could be high, Finan says.
The federal health law requires the policies to include a standard set of essential benefits, from emergency room and hospital care to prescription drugs, but the law is less prescriptive about the size of the policies’ networks of participating doctors and hospitals.
In March, the Obama administration issued rules stating that insurers must maintain a network of a sufficient number and type of providers, including providers that specialize in mental health and substance abuse, to assure that all services will be available without unreasonable delay. That fell short of the standards sought by some consumer advocates, but pleased other groups that say insurers should have broad discretion to shape their networks to meet regional needs.
The administration noted that nothing in the final rule limits an exchange’s ability to establish more rigorous standards.
Shaving Costs
Insurers contend that by limiting network size, they can offer plans with higher quality or more efficient doctors and hospitals, which might slow spending or improve care.
Networks are already part of most health plans. For doctors and hospitals, joining a network brings in business. In exchange, they agree to negotiate their prices with insurers.
Driven by consumer and employer demand for lower-cost plans, insurers are already rolling out narrow network policies that have shaved premiums 10% or more. A recent survey by benefit firm Mercer found that 23% of large employers offered such plans this year, usually among a choice of plans, up from 14% in 2011. In Massachusetts, insurer Harvard Pilgrim launched its Focus Network in April, touting 10% lower premiums. While it includes 50 hospitals and 16,000 physicians, it excludes some of the state’s highest-cost systems.
In California, Blue Shield has a number of SaveNet HMO plans that contract with select doctor and hospital groups, creating networks averaging a little more than half the size of its standard ones. Next year, for example, one serving Marin and Sonoma counties will offer a network of about 100 primary care doctors and 325 specialists.
Still, narrow network plans are a hard sell to employers, particularly the large ones, which don’t want to hear gripes from workers about limited choice of doctors simply to save 10% on premium costs.
But small businesses and individuals buying their own coverage in the online markets might regard that tradeoff differently. “If my doctor is in the network and cheaper, it might work,” says Wall Street analyst Carl McDonald at Citi Research, a division of Citigroup Global Markets.
Competing On Price
“To stand out from competitors, some plans may choose to offer the lowest possible rates, and would narrow their networks to do so,” says Chet Burrell, CEO of insurer CareFirst in Maryland. He acknowledged that narrow networks could be a subtle but powerful way to discourage less-than-healthy applicants. The question will be what degree of tolerance will a state have to permit narrow networks?
State rules on what makes an adequate insurance network vary. Some states, including California, specify that specialists must be available within a certain driving time or distance. Others simply say insurers must have sufficient numbers of providers. Some states don’t have any requirements.
“State rules are very, very loose,” says Weis at Quest, who says that states should consider adopting the rules that now apply to Medicare Advantage, the private market alternative to Medicare. In that program, the federal government requires networks to include primary care physicians and more than 25 types of specialists, and sets county-level requirements on the minimum number of doctors required in each category and how far patients might have to travel to see one.
Even though state rules vary, regulators say plans that are too skimpy will be called out by regulators, or consumers. “We will look very closely at how plans put their packages together,” says Sandy Praeger, the elected insurance commissioner in Kansas. “If you have a crummy network, no one will buy the plan,” says consultant Robert Laszewski, a former insurance executive, adding that the law also includes programs that financially reward insurers that get a large share of sicker patients and penalize those that get a healthier and more profitable bunch.
Many policies that offer a limited network of doctors and hospitals generally allow patients to go to out-of-network providers, with whom they do not have negotiated prices. But patients who seek such care face significant co-payments, which often start at 30% of the bill and can go as high as 50%.
“It is often hard for consumers to figure out how much they might be charged if they go out of network,” says Lynn Quincy, senior policy analyst at Consumers Union, publisher of Consumer Reports magazine. In addition to meeting separate annual deductibles for out-of-network care, patients can be balance-billed by doctors or hospitals for the difference between what the insurer pays them and their total charges.
That doesn’t change under the federal health law, so consumers could be left on the hook for tens of thousands of dollars. There’s no escaping that we’re going to see insurance policies that include networks wide and narrow,” says Quincy.

SBA debuts resources to help businesses stay on top of ACA

The U.S. Small Business Administration is reaching out to small-business owners with a new website and blog to help them navigate the provisions of the Affordable Care Act. Resources include a glossary, a compliance timeline and a breakdown of provisions based on the size of the business. American City Business Journals/Charlotte, N.C.

Key aspects of healthcare reform you should know for your busienss.

The Patient Protection and Affordable Care Act (Affordable Care Act or ACA) enacted comprehensive health insurance reforms designed to ensure Americans have access to quality, affordable health insurance. Learn what the law means for small businesses.

The Affordable Care Act includes a variety of measures specifically for small businesses that lower costs and increase access to affordable health insurance. Depending on whether you are self-employed, an employer with fewer than 25 employees, an employer with fewer than 50 employees, or an employer with 50 or more employees, different provisions of the ACA may apply to you. Learn about the key provisions of the ACA based on the size of your business below.

Articles availabl on the SBC web site:Self Employed

Employers with fewer than 25 emploees

Employers with few than 50 employees

Key Provisions of the Affordable Care Act for companies under 50 employees

Health Care

The Patient Protection and Affordable Care Act (Affordable Care Act or ACA) enacted comprehensive health insurance reforms designed to ensure Americans have access to quality, affordable health insurance. Learn what the law means for small businesses.

Key Provisions of the Affordable Care Act

The Affordable Care Act includes a variety of measures specifically for small businesses that lower costs and increase access to affordable health insurance. Depending on whether you are self-employed, an employer with fewer than 25 employees, an employer with fewer than 50 employees, or an employer with 50 or more employees, different provisions of the ACA may apply to you. Learn about the key provisions of the ACA based on the size of your business below.

 

Self-Employed

Find out which Affordable Care Act provisions may impact self-employed individuals.

Employers with Fewer Than 25 Employees

Find out which key Affordable Care Act provisions may impact small businesses with fewer than 25 employees.

Employers with Fewer Than 50 Employees

Find out which Affordable Care Act provisions may impact small businesses with 50 or fewer employees.

Key Provisions of the Affordable Care Act for business

Health Care

The Patient Protection and Affordable Care Act (Affordable Care Act or ACA) enacted comprehensive health insurance reforms designed to ensure Americans have access to quality, affordable health insurance. Learn what the law means for small businesses.

Key Provisions of the Affordable Care Act

The Affordable Care Act includes a variety of measures specifically for small businesses that lower costs and increase access to affordable health insurance. Depending on whether you are self-employed, an employer with fewer than 25 employees, an employer with fewer than 50 employees, or an employer with 50 or more employees, different provisions of the ACA may apply to you. Learn about the key provisions of the ACA based on the size of your business below.

 

 

Self-Employed

Find out which Affordable Care Act provisions may impact self-employed individuals.

Employers with Fewer Than 25 Employees

Find out which key Affordable Care Act provisions may impact small businesses with fewer than 25 employees.

 

Employers with Fewer than 50 Employees

Find out which Affordable Care Act provisions may impact small businesses with 50 or fewer employees.

Key Provisions which you need to know about health care reform and your business.

The Patient Protection and Affordable Care Act (Affordable Care Act or ACA) enacted comprehensive health insurance reforms designed to ensure Americans have access to quality, affordable health insurance. Learn what the law means for small businesses.

Key Provisions of the Affordable Care Act

The Affordable Care Act includes a variety of measures specifically for small businesses that lower costs and increase access to affordable health insurance. Depending on whether you are self-employed, an employer with fewer than 25 employees, an employer with fewer than 50 employees, or an employer with 50 or more employees, different provisions of the ACA may apply to you. Learn about the key provisions of the ACA based on the size of your business below.

Health Care Reform and how small business will be effected

article

Self-Employed

Find out which Affordable Care Act provisions may impact self-employed individuals.

article

Employers with Fewer Than 25 Employees

Find out which key Affordable Care Act provisions may impact small businesses with fewer than 25 employees.

article

Employers with Fewer than 50 Employees

Find out which Affordable Care Act provisions may impact small businesses with 50 or fewer employees.

• article

  Employers with 50 or More Employees

  Find out which key Affordable Care Act provisions may impact small businesses with 50 or more full-time employees.

Key Provisions Under the Affordable Care Act for Self-Employed Individuals

Self-Employed

Implementation of the Affordable Care Act occurs in stages, with many of the reforms and requirements taking effect in 2013 and 2014. Some of the provisions that may impact self-employed individuals include:

• Individual Insurance Marketplaces

Coverage through new competitive health insurance marketplaces for individuals and small businesses will be in place January 1, 2014 with open enrollment beginning October 1, 2013. The individual health insurance marketplaces will offer a choice of four levels of benefit packages that differ by the percentage of costs the health plan covers. Individuals and the self-employed may qualify for individual tax credits and subsidies on a sliding scale, based on income. Increased access to quality, affordable health care will make it easier for potential entrepreneurs to go out on their own instead of staying at larger firms simply because of "job lock".

• Coverage through Medicaid Expansion

Each state operates a Medicaid program that provides health coverage for lower-income people, families and children, the elderly, and people with disabilities. The eligibility rules for Medicaid are different for each state, but most states offer coverage for adults with children at some income level. In addition, beginning in 2014, most adults under age 65 with individual incomes up to about $15,000 per year will qualify for Medicaid in every state. To learn more about your state Medicaid program and other options available to you, use the insurance and coverage finder or visit Medicaid.gov.

• Find Insurance Options

Find and compare health plans using this interactive tool provided by the U.S. Department of Health and Human Services.

• New Medicare Assessment on Net Investment Income

Beginning January 1, 2013, a 3.8% tax will be assessed on net investment income such as taxable capital gains, dividends, rents, royalties, and interest for taxpayers with Modified Adjusted Gross Income (MAGI) over $200,000 for single filers and $250,000 for married joint filers. Common types of income that are not investment income are wages, unemployment compensation, operating income from a non-passive business, Social Security Benefits, alimony, tax-exempt interest, and self-employment income.

• Timeline of Provisions

The Affordable Care Act timeline provided by the U.S. Department of Health and Human Services includes the next steps you can take to implement the provisions.

In Partnership with Business USA

Key Provisions Under the Affordable Care Act for Self-Employed Individuals

Self-Employed

Implementation of the Affordable Care Act occurs in stages, with many of the reforms and requirements taking effect in 2013 and 2014. Some of the provisions that may impact self-employed individuals include:

• Individual Insurance Marketplaces

Coverage through new competitive health insurance marketplaces for individuals and small businesses will be in place January 1, 2014 with open enrollment beginning October 1, 2013. The individual health insurance marketplaces will offer a choice of four levels of benefit packages that differ by the percentage of costs the health plan covers. Individuals and the self-employed may qualify for individual tax credits and subsidies on a sliding scale, based on income. Increased access to quality, affordable health care will make it easier for potential entrepreneurs to go out on their own instead of staying at larger firms simply because of "job lock".

• Coverage through Medicaid Expansion

Each state operates a Medicaid program that provides health coverage for lower-income people, families and children, the elderly, and people with disabilities. The eligibility rules for Medicaid are different for each state, but most states offer coverage for adults with children at some income level. In addition, beginning in 2014, most adults under age 65 with individual incomes up to about $15,000 per year will qualify for Medicaid in every state. To learn more about your state Medicaid program and other options available to you, use the insurance and coverage finder or visit Medicaid.gov.

• Find Insurance Options

Find and compare health plans using this interactive tool provided by the U.S. Department of Health and Human Services.

• New Medicare Assessment on Net Investment Income

Beginning January 1, 2013, a 3.8% tax will be assessed on net investment income such as taxable capital gains, dividends, rents, royalties, and interest for taxpayers with Modified Adjusted Gross Income (MAGI) over $200,000 for single filers and $250,000 for married joint filers. Common types of income that are not investment income are wages, unemployment compensation, operating income from a non-passive business, Social Security Benefits, alimony, tax-exempt interest, and self-employment income.

• Timeline of Provisions

The Affordable Care Act timeline provided by the U.S. Department of Health and Human Services includes the next steps you can take to implement the provisions.

 

Wellness programs dominated by dietary health, report says

Employee wellness programs are dominated by dietary health and related diseases but smoking-cessation initiatives have shown the most progress, according to a report from the Workplace Wellness Alliance, a consortium of companies from around the world. The report said the return on investment for wellness programs includes more than just money saved and can also be measured in better employee engagement and productivity. HI-Mag.com (1/23), Workplace Savings & Benefits online (1/23)

Elder Law Attorney Discusses Competency & Powers of Attorney

Question: "My mother is 91 years old and has Dementia/Alzheimer's. She does not know how to read or write, but recently she apparently granted Power of Attorney for her finances to my elder sibling. This was done in secrecy and did not take the rest of the family into consideration. Now my sibling has taken over my mother's house and her bank funds and has placed my mother in a nursing home where she is kept overmedicated. I am concerned about how something like this could have happened. Is there anything I and the rest of my family can do now to have this Legal Directive reversed?"

Answer: Your family is clearly in a difficult situation. There are several ways to attack this problematic situation, but neither way will be quick and easy, and there is no way to deal with the situation without involving your local probate court.

Your question seems to suggest your mother may not have been fully mentally competent when she executed the Power of Attorney. If so, the grant of authority was not legally valid. Unfortunately, her bank will not likely take action simply on the word of you or your other family members alone. Rather, you will need to petition the probate court to consider the facts and circumstances and ask that the court renders a judicial decision to that effect. A bank or the holders of other assets will not likely simply take the word of you or your family members that your mother could not have validly give the authority to your elder sibling, but a bank would have to respect the legal opinion of the probate court. The bank would then have to remove your elder sibling’s authority over your mother’s assets.

Another approach to take would be to concede the Power of Attorney was valid but to demonstrate that your elder sibling is now breaching his or her fiduciary duties and should be formally removed by the probate court.
In either of the above situations, the probate court would likely seek to formally appoint someone to look after your mother’s personal and/or financial self-interest. When a court makes such an appointment, the appointee is known as a “conservator.” Among the downsides to a conservatorship, there may be tedious reporting requirements put on the conservator and the costs of court proceedings must be borne by the assets and income of the “ward,” the person for whom the conservator has been appointed. On the plus side, since the activities of conservators are under the ongoing oversight of the probate court, banks will readily accept the authority of a court-appointed conservator whereas it may take more convincing to persuade a bank to honor the authority of an agent appointed privately under a durable power of attorney.

Your predicament illustrates the wisdom of getting one’s estate planning arrangements in order long before there are physical or cognitive health issues. Instead of a document being placed in front of a vulnerable family elderly parent in secret, the process of documenting and formalizing a parent’s wishes can be done in a way that leaves little question about who the parent would like to act for them and what their instructions are to the family members they have named. The plan can and should include the sort of “checks and balances” to make sure no individual appointee can act in their own self-interest, at odds with the wishes of the parent.
AMSINSURE LTC

Elder Law Attorney Discusses LTC Payment Options

Question: What are the financial options that are available to us for paying for long-term care for our elderly parents? For example, will Medicare and Medicaid pay for these elder care expenses?

Answer: There are three (3) main options for paying for long-term care – out of pocket (private pay), long-term care insurance, and government programs such as Medicare (very limited), Medicaid (income and asset dependent) and Veterans Administration (income and asset dependent). Which options are available to help your parents will depend on their situation.

Long-term care refers to medical and non-medical care for a person who has a chronic illness or disability. The need for long-term care, also known as custodial care, occurs when you need care but you are unlikely to get any better. For example, as we age our bodies simply start to wear out and fall apart. This may result in limited mobility, loss of independence and the need for assistance with everyday activities such as dressing, bathing and eating. Or we may need help with everyday activities due to diminished cognitive abilities, neurological conditions, confusion or dementia. Things that used to come naturally, such as turning off the stove when you are done, or remembering that you turned the stove on to make lunch are suddenly gone. The need for long-term care may also arise due to a sudden medical incident such as a heart attack or stroke, which even after the patient reaches “full recovery,” they may still be left with a reduced ability to care for themselves.

Most often long-term care is non-medical in nature and assists with support services such as activities of daily living like dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, in assisted living or in nursing homes.
Difference Between Medicare and Medicaid - There is a very large difference between Medicare and Medicaid and people confuse the two all the time.

Medicare is a federally funded entitlement program to provide health insurance primarily to Americans over the age of 65 and many individuals with disabilities. There are several parts to Medicare: Part A covers hospital bills, post-hospital nursing home stays and home health care, Part B covers medical insurance and pays most basic doctor and lab costs, and some out-patient medical services, including medical equipment and supplies, home health care, and physical therapy, Part C is called Medicare Advantage and is the Medicare HMO program, and Part D covers some of the costs of prescription medication.

Medicaid on the other hand is a federal program, administered by each State, that pays for certain health services and nursing home care for older people with low incomes and limited assets. It also pays for some long-term care services at home and in the community. Medicaid covers a broader range of services and people than Medicare, including children, pregnant women, parents of eligible children, seniors and individuals with disabilities. Its greatest difference from Medicare is that Medicaid is based on need and financial resources. In order to qualify a person must fall into a covered group and meet the financial needs test.

Medicare generally doesn’t pay for long-term care. Medicare also doesn’t pay for help with activities of daily living or other care that most people can do themselves or that can be provided by family or non-medical personnel. Medicare only covers a small amount of the nursing home care provided in the United States, and only under very limited circumstances, making the hope of Medicare paying the bill quite difficult.

Medicare pays for 20 days of full coverage if you discharged to a skilled nursing facility after being admitted for at least three days in the hospital, so long as you are receiving skilled care as opposed to custodial care. If you still need skilled care after the first 20 days, you can get up to 80 additional days of partial coverage from Medicare. When the Medicare coverage ceases, you will have to pay out-of-pocket unless you have private long-term care insurance or qualify for Medicaid (“Medi-Cal” in California) benefits.

If you need “custodial care,” rather than care associated with an injury or illness Medicare won’t pay a dime. Custodial care is defined by Medicare as help with activities of daily living, like dressing, bathing, going to the bathroom and eating. This is the kind of care that can be safely and reasonably provided by people without professional skills or training – like your family. Custodial care is also called “long-term care” and is the type of care that most people will need as they approach the end of their lives.
If you need custodial care there are a couple of alternatives to pay for it. First, you could purchase long-term care insurance – provided you are healthy enough and can afford the premiums. Many policies can also be used to pay for assisted living and in-home care, as well as skilled nursing care. Second, you can pay for everything directly out of your pocket. Third, if you qualify, Medicaid will pay for your care under certain circumstances. Finally, Veteran’s and widow(er)s of veterans may receive a Special Monthly Pension called “Aid & Attendance.” This benefit is based on a person’s assets and income. If approved for Aid & Attendance, the person will receive additional monthly income to help pay for the cost of health care.

Consulting with an experienced elder consultant can help you determine the options available to help your parents get and pay for the care they need. It is important that you look at and evaluate all of the options. Assessing the options to pay for long-term care before the need for care arises or before a crisis occurs will ensure the greatest flexibility. Even with good advance planning, making long-term care decisions can be difficult.

For more information on long term care insurance:  LTC
 

Payroll Tax Changes Effective January 1, 2013

The national legislation passed in the early hours of New Year's Day changed tax regulations and thus affected employees' personal income taxes and paychecks. Changes include general income tax rates and Social Security and Medicare tax rates and withholding rates.

The first change affects all employees equally. The 2 percent temporary Social Security payroll tax reduction that was in effect for calendar years 2011 and 2012 was not extended. Therefore,
the 2013 Social Security tax rate will revert back to the historical level of 6.2 percent. This will mean that all employees will see 2 percent less take-home pay starting with their January paychecks. The new tax rate will affect biweekly employees' Jan. 9 paychecks and monthly employees' Jan. 31 paychecks.

The second change affects all employees, but the effect will vary depending on each employee's personal situation. The legislation extended income tax cuts for single taxpayers earning under $400,000 a year and married couples under $450,000 a year. Employees with income above those levels will be affected by the top tax rate rising to 39.6 percent, up from 35 percent.

The third change affects employees with higher compensation and has two parts. Social Security taxes now will be assessed against wages up to $113,700, a change from the 2012 wage ceiling of $110,100.

In addition, although the overall Medicare tax rate remained unchanged, a new additional Medicare tax of 0.9 percent goes into effect in 2013. This additional tax applies to an employee's wages in excess of $200,000 in a calendar year. The additional Medicare tax withholding will begin in the pay period in which the employee's wages exceed $200,000 and continue until the end of the calendar year.

Due to the lateness of the recent tax legislation, the 2013 W-4 form has not been updated with the new tax tables. Therefore, W-4 forms for 2013 are not yet available from the Internal Revenue Service (IRS).

Until the 2013 forms are available, the IRS recommends using the 2012 form. It is necessary to cross out "2012" and write "2013" on the form for it to be valid.

New forms are anticipated in mid-January. A communication will be forthcoming when they are available.



 

Insurance Rule Will Go By Size Of 2013 Staff_Start counting your staffers now.

by The Wall Street Journal Jan 17,2013

That is the upshot of regulatory guidance issued by the government on Dec. 28, when few small-business owners noticed in the midst of the holidays and the "fiscal cliff" debate. Small-business owners have been bracing for 2014, when a health-care law provision is scheduled to kick in, potentially subjecting them to penalties if they don't offer health insurance. Many are planning to keep the number of "full-time-equivalent" employees under 50 to avoid being subject to the provisions of the law. But one critical detail that many business owners might not know is that the government will rely on data about the composition of their companies' workforces this year in order to determine whether a firm will be liable under that provision. That means employers need to adjust or manage the makeup of their staffs now—not in one year's time, as many of them had likely planned. "Business owners who don't prepare will find themselves paying potentially significant penalties for 2014," says Monique Warren, partner at workplace law firm Jackson Lewis LLP in White Plains, N.Y. "I don't think there is a high level of awareness" of the law's provisions, says Penny C. Wofford, employment law attorney at Ogletree, Deakins, Nash, Smoak & Stewart, P.C. in Greenville, S.C. "It's such a complex law and most employers don't fully understand it. But they have to get a handle on it this quarter so they have the option to make adjustments." Under the law, only the smallest businesses will be exempt from penalties if they don't offer health insurance in 2014. This provision is commonly called the "employer mandate." To determine the size of their firm, and whether it would be subject to the employer mandate, business owners have the choice to calculate their head counts by averaging the full 12 months of 2013 or a consecutive six-month period during the year. If a firm falls under the employer mandate and doesn't offer health coverage to their employees or their children up to age 26, and if at least one employee receives federal insurance subsidies, the penalty is $2,000 per year for each full-time employee in excess of 30 full-time employees. There are no penalties if part-time employees aren't offered coverage. There are other penalties if coverage is considered "unaffordable" or doesn't provide "minimum value," according to guidelines written in the law. The basics that companies need to know: —Employers who averaged 50 or more full-time employees or 50 or more full-time-equivalent employees during 2013 will be subject to the employer mandate. —A full-time employee is one who is employed (work and paid leave and vacation) an average of at least 30 hours a week, or 130 hours in a month. Seasonal employees may be counted as full-time. —A full-time equivalent refers to a combination of employees, each of whom individually is not a full-time employee. Part-time or part-time seasonal workers can be lumped together to count as full-time equivalent. —To calculate the number of full-time equivalents in a given month, add all the hours worked, but not more than 120 hours of service for any employee, and divide the total by 120. Copyright 2013 Dow Jones & Company, Inc. All Rights Reserved

California Health Benefit Exchange Vision, Mission and Values

 

The vision of the California Health Benefit Exchange is to improve the health of all Californians by assuring their access to affordable, high quality care.

The mission of the California Health Benefit Exchange is to increase the number of insured Californians, improve health care quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.
The California Health Benefit Exchange is guided by the following values:   http://www.ca.gov/

Strategies Boost Employees’ Health

Certain employer strategies, such as consumer driven or HSA (health savings) plans and wellness programs, are effective in motivating employees to improve their health, according to a survey from Aon Hewitt. Researchers surveyed more than 2,800 employees and their dependents covered by employer health plans. Sixty percent of employees who are enrolled in consumer-driven plans say they have made positive behavior changes related to their health; 28% get routine preventative care more often; 23% seek lower-cost health care options and 19% research health costs more frequently.

Seventy-eight percent of employees who are enrolled in consumer-driven plans are satisfied with the plans and 89% expect to re-enroll in this option for 2013. Ninety-seven percent of workers who have been in an account-based plan for two years or more say they plan to re-enroll.
Up to half of consumers would participate in a wellness activity that offered no financial incentive as long as participation was easy and convenient. Sixty-three percent of consumers would complete a health risk questionnaire for a monetary reward, and 62% would participate in a healthy eating or weight management program. Forty-eight percent would participate in a medically sponsored program to help them manage a health condition.

Fifty-eight percent of employers offer incentives for completing a lifestyle modification program (for example, to quit smoking or lose weight). About one-quarter offer incentives (monetary or non-monetary) for making progress toward meeting acceptable ranges for biometric measures, such as blood pressure, BMI, blood sugar, and cholesterol.
Eighty-six percent of workers who received suggested action steps based on a health-risk questionnaire went on to take some action, and 65% made at least one lifestyle improvement. Total health care costs per employee were $10,522 in 2012, and employers’ share of that cost was $8,318. When asked how much of the bill their employer pays, consumers significantly underestimate the portion their employers paid, guessing about half of the cost. For more information, visit www.businessgrouphealth.org.

Study links presenteeism to lifestyle, wellness support

Employees who had unhealthy diets were 66% more likely to have high presenteeism than those who ate healthier foods, while workers who exercised occasionally were 50% more likely to have presenteeism than colleagues who worked out more regularly, according to a study in the journal Population Health Management. Researchers found employees who said company management did not support efforts to be physically active or emotionally healthy were much more likely to have high presenteeism. The Salt Lake Tribune (Utah) (1/15)

Survey: 39% of employees say weight loss is top health concern

An employee survey by ComPsych found 39% of workers named weight loss as their top health concern, while 26% said it was stress. The survey found 17% of people were concerned about exercising and 6% said their top issue was to stop smoking. BenefitsPro.com (1/15)

Recent Survey shows company HSA services!

Learn About HSA Plans at AMSINSURE.COM

1. What are the primary services you offer as part of your HSA product?

Aetna: Compatible high deductible medical plan, HSA administra­tion. HSA investment services.

Anthem Blue Cross: We offer Medical HSA Health Plans and an op­tion to in an integrated Banking system through our contracted part­ners; NY/Mellon.

Blue Shield: Blue Shield offers an integrated eligibility and claims experience for clients that choose an account based health plan (i.e.. health plans wrapped with an HSA,

HRA or FSA account). 2013 will be a year of choice. Members can choose a HDHP PPO and couple it with a health savings account or choose a regular PPO or HMO plan and wrap a health reimbursement account around the product. In either case the member will be em­powered to manage their health and wealth.

Cigna: Cigna Choice Fund health savings account (HSA) is an inte­grated HSA, combining the plan's entire healthcare and financial management features into one easy- to-use healthcare product. It includes several features, such as health coaching, medical and HSA claim capabilities, a diverse range of mutual fund choices, employee education, and medical and pharmacy cost transparency tools. hospi-03I quality comparison tools, and online health risk assessments.

HSA Bank: HSA Bank provides HSA administration. Complimentary business support is offered to employers and brokers including imple­mentation planning, enrollment meeting support, remote Webinars, and communication planning. Through free online banking, accoun­tholders can view and download real-time transactions and year-to-date account information, transfer HSA funds to an investment ac­count or other accounts, and more. HSA Bank also funds each new HSA with a penny to meet OS establishment, enabling accounthold­ers to be reimbursed for qualified medical

expenses on day one.

HSA California: The HSA California Exchange is the only small-group, fully integrated HSA program with multiple carriers. Each employee can choose from a menu of HSA- qualified high deductible health plan benefits from Health Net, Kaiser Permanente, and Western Health Ad­vantage with no minimum participation requirements.

HSA banking and savings programs are offered through The Bancorp Bank, with accounts FDIC insured to at least $250,000. Accounts in­clude a free debit card, access to hundreds of investment options, personalized checks, and 24/7 secured online banking access. There is no application or fee to open an NSA with The Bancorp Bank.

HSA California also offers dental, vision, hearing, HR support, life, and Section 125 POP plans, as well as prescription discounts of up to 75% through the California Rx Card Program, and amusement park, movie ticket, and other discounts through the Cal Perks Employee Discount Program (offered at no cost to enrolling groups).

Kaiser Permanente: Kaiser Permanente offers HSA-qualified deduct­ible HMO plans (available to the Individual and Family market, Small, Mid and Large employer groups), PPO plans (available to Small busi­ness, and large groups), EPO plans for Individuals and Self-Funded EPO plans. We have selected Wells Fargo as our preferred financial administrator to provide HSAs in connection with our HSA-qualified health plans.

Wells Fargo offers to all Kaiser Permanente customers a competi­tively discounted monthly administrative fee, an FDIC-insured tiered interest rate account, HSA Visa debit cards, investment options, online account management, and dedicated customer service.

SeeChange Health: SeeChange Health Insurance offers high-deduct­ible health plans compatible with HSAs that financially reward mem­bers for taking actions to manage their health.

Sterling HSA: Sterling offers education, implementation and account management services through personal sales and service teams, as well as online for brokers, employers and accountholders. Among our primary services are HSA education, enrollment assistance, a review of the EOB, bill paying, record keeping, scanning and archiving of bills, receipts, and other critical information in case of an IRS audit.

We also offer options for self-directing investments and flagging ex­penses submitted as qualified and non-qualified for NSA distribution. Our online services include online enrollment, banking, account trans­action information, and the ability to make changes to the HSA ac­count. Our most recent satisfaction survey found that among the Ster­ling services valued most by our HSA accountholders, online services are at the top of the list with 91% of Sterling accountholders respond­ing favorably. We offer educational materials and services in English and Spanish. Our trans- created Spanish Website includes HSA online enrollment for individuals and employer groups. Our forms and collat­eral have also been trans-created for clients who prefer Spanish and we have many Spanish bi-lingual customer service representatives to help them.

UnitedHealth Group: Unitedl-lealthcare is the largest provider of consumer-driven health plans in the country with nearly 3 million members enrolled in consumer- driven health plans that incorporate a health savings account or health reimbursement.

Additionally, UnitedHealth Group uses its own financial corporation, OptumHealthBank, for its HSA program administration. OptumHealth-Bank, an FDIC-insured financial institution focused solely on health care banking, is the nation's largest HSA administrator. Account hold­ers receive market competitive interest rates on their deposits, online bill payment options. and direct debit card access to their accounts. Additionally, once they get a qualifying account balance, they also can invest in a range of highly regarded no-fee, non-proprietary investment options.

2. Do you offer an FISA-qualifying high deductible health insurance plan?

Aetna: Yes.

Anthem Blue Cross: Yes

Blue Shield: Yes, Blue Shield offers predictable qualified High Deduct­ible Health Plans that can be wrapped with a health savings account.

Cigna: Yes, Cigna offers a full suite of account-based medical plan designs that meet the definition of a qualified high deductible plan.

HSA Bank: No, HSA Bank offers direct health savings administration. HSA Bank is an independent bank and can administer HSAs for any qualified high deductible health plan offered by any regional or na­tional carrier. If the employer decides to switch carriers, they can keep their HSA with HSA Bank. There's no need to transfer accounts.

HSA California: Yes, HSA California only offers HSA-qualified health plans; our portfolio includes seven different HSA-compatible plan de­signs.

Kaiser Permanente: Yes, Kaiser Permanente offers an array of HSA-Qualified Deductible HMO plans for the Individual, Family and Employ­er group markets, PPO plans for Small and large business groups, EPO plans for Individuals and Self Funded EPO plans.

SeeChange Health: Yes. to the best of our knowledge we offered the nation's first value-based benefit HSA-compatible plans in the coun­try.

Sterling HSA: As an independent HSA administrator, Sterling can work with all HSA compatible plans — fully insured and self-insured. In mid-2011. we launched Sterling level funding and traditional self-insurance products that do include NSA-qualifying high deductible health plans as an employer option.

3. Are you providing a health spending arrangement or a savings vehicle?

Aetna: Yes.

Anthem Blue Cross: We have partnered with BNY/Mellon and their

support staff -ASC/Mellon to provide banking and investment options for the financial piece of our HSAs. Our integration allows members to login to and be linked to their BNY/Mellon account.

Blue Shield: Blue Shield offers choice. Our clients and members can choose to have an integrated HSA model or a stand-alone HSA bank account. Both options promote pre-tax deposits and after-tax depos­its; when the member reaches a certain dollar amount, he/she can choose to invest the savings in mutual funds. Cigna: Cigna has an extensive offering of consumer products that include an HSA, HRA, healthcare flexible spending account, dependent care flexible spend­ing account, and incentive health reimbursement accounts (Healthy Awards).

HSA Bank: For spenders, the health savings account is an easy and tax-advantaged way to save and pay for healthcare costs before and after the deductible is met. For savers, an HSA is a great way to build savings for retirement.

HSA California: HSA California and The Bancorp Bank have partnered to create a seamless, online approach for employers and employees to fund an HSA with a wide array of savings and investment options. Kaiser Permanente: Members who enroll in one of our HSA-Qualified Deductible HMO plans can open a health savings account through our preferred financial administrator, Wells Fargo. However, members are also free to open a health savings account with a financial institution of their choice. Our HSA-Qualified Deductible HMO plans are designed to work with HSA administration from any financial institution. In terms of other spending arrangements, Kaiser Permanente also offers dif­ferent deductible HMO plans paired with health reimbursement ar­rangements (HRAs).

SeeChange Health: No. Members have the flexibility to use the HSA administrator, which delivers the most value.

Sterling HSA: Yes, in addition to HSAs, Sterling also provides admin­istration services for HRAs, FSAs, POPs and COBRA.

UnitedHealth Group: Yes, UnitedHealthcare offers several HSA-qual-ified HDHPs. In addition to administering the medical plan, United-Healthcare offers a wide variety of health care services, tools, and tips for its HSA customers.

4. What size employee group is the HSA available for?

Aetna: All sizes of groups.

Anthem Blue Cross: All employee groups are eligible.

Blue Shield: We offer qualified HDHP to be used with an HSA for all markets, including individual and family, small groups (from 2 to 50 employees), midsize groups (51 to 299 employees), and large groups (300+ employees).

Cigna: Our HSA product is available for employers with 50or more eligible employees.

HSA Bank: An HSA at HSA Bank is available to employee groups of all sizes with no minimum or maximum number of participants. Our HSA is also available to individuals not connected to an employer group.

HSA California: HSA California is available for employers with 2-50 employees.

Kaiser Permanente: Kaiser Permanente offers HSA-qualified deduct­ible HMO plans to any group size. PPO plans are available to any group size, and Self Funded EPO plans are available to groups with 500 sub­scribers.

SeeChange Health: Our fully insured plans are available to groups of 2-to-200 or more employees. Our sister company, SeeChange Health Solutions offers value-based benefit ASO services that support HSAs.

Sterling HSA: We work with groups of all sizes, including large, me­dium and small companies. We also work with individuals, many of whom sign up for our HSA online.

UnitedHealth Group: Yes, UnitedHealthcare has partnered with Op-tumHealthBank for HSA administration, savings and investment op­portunities.

5. Is your management team experienced in health insurance, financial services, or both?

Aetna: Health insurance.

Anthem Blue Cross: Anthem has subject matter experts in health insurance and the financial services for our FISAs plans. These as­sociates can work with the client and agent/broker to explain all pro­cesses.

Blue Shield: Blue Shield's management team is experienced in healthcare services, but works closely with our preferred vendors-Health Equity, which provides the integrated model; and Wells Fargo, for stand-alone accounts.

HSA Bank: HSA Bank's leadership and national sales force is highly experienced and trained in both health insurance and financial ser­vices. David Drzymkowski, the Regional Vice President - California & Hawaii, has held his insurance license since 1988.

HSA California: Both.

Kaiser Permanente: Kaiser Permanente's management team is experienced in health insurance and HMO plans. Our preferred HSA administrator, Wells Fargo, brings the appropriate financial services expertise.

SeeChange Health: Our leadership has extensive experience in health insurance and financial services as well as with value-based benefit plan designs.

Sterling HSA: Sterling HSA's executive team has extensive experi­ence in healthcare, insurance, and consumer directed account man­agement. We have complemented those skills with staff and advisory board members who have experience in financial services to optimize support of our dents during enrollment and to manage their accounts with us long-term.

UnitedHealth Group: Both.

6, Do you provide training for brokers about HSAs?

Anthem Blue Cross: We provide ongoing broker communications, newsletters, and product demonstrations as new products are intro­duced.

Blue Shield: Yes, Blue Shield provides a continuing education semi­nar on HSAs to our IFP brokers periodically. Brokers also have access to educational programs and tutorials through Health Equity and Wells Fargo Websites:

Cigna: Cigna provides consumerism education on products including the HSA to brokers via forums and through highly skilled sales manag­ers.

HSA Bank: Yes, Our Business Relations department serves as a valu-

able resource for HSA-related questions by phone and email. Our team is also pleased to schedule training Webinars for brokers. Plus, your regional vice president David Drzymkowski is happy to visit your office and host a Lunch and Learn on a variety of HSA topics.

HSA California: Yes, HSA California has dedicated HSA experts ready to provide personalized training and HSA education to brokers. We can be reached between 8 a.m. and 5 p.m.. Pacific Time, Monday-Friday at sales@hsacalifornia.Corn or toll-free at (866) 251-4625. HSA Cali­fornia also provides ongoing seminars to provide brokers with the nec­essary information and tools to explain High Deductible Health Plans and HSAs to clients.

Kaiser Permanente: Yes, we provide training to our brokers. In addi­tion, our preferred financial administrator for HSAs, Wells Fargo, has a dedicated support line to assist our brokers with questions. Wells Fargo also has an online flash educational presentation for our cus­tomers about HSAs online at:

SeeChange Health. Yes. We provide extensive training on our prod­ucts, including HSA-compatible plans. We also work with the state's major general agencies to help educate brokers.

Sterling HSA: Yes, Sterling offers a variety of training options, includ­ing CE courses, Webinars, "lunch and learn" meetings for large region­al brokerage groups, and individual sessions pairing Sterling account representatives with brokers and consultants.

7. What commissions are paid to brokers and when?

Aetna: Standard commission levels, monthly.

Anthem Blue Cross: Brokers are paid the standard medical commis­sion for the HSA compatible medical plan.

Blue Shield: Blue Shield does not pay commissions for HSAs because we administer the HDHP.

Blue Shield: Enrolling online eliminates the need to complete and mail in paper enrollment forms. provides an efficient enrollment pro­cess that is accurate and secure, and delivers immediate enrollment confirmation to employees. During the Blue Shield group installation for our integrated program, the client will be seamlessly set up with HealthEquity_ Esiue Shield will pass employee eligibility information to HealthEquity, which will automatically set up bank accounts. The cli­ent will be able to fund its employees' HSA through payroll deduction. Employees enrolling in a Wells Fargo health savings account (HSA) through their employer are able to conveniently enroll online directly with Wells Fargo.

Cigna: Cigna pays its standard commissions for HSA sales.

HSA Bank: We recognize the important role you play in our success. To show our appreciation, we created a producer recognition program that rewards brokers on three levels. For more info, visit bank/AgentsBrokers.

HSA California: HSA California pays standard commissions monthly.

Kaiser Permanente: Brokers are paid the standard medical commis­sions on all of our HSA-qualified health plans.

SeeChange Health: We pay 7% level commissions for groups of 2-to-50 employees and 5% level for groups of 51 or more employees.

Sterling HSA: Commissions far our HSA business are 10% of the fees for all new and renewing groups and are paid quarterly. We also pay commissions on HRA, TSA, FSA, POP, and self-insurance business.

8. Are electronic enrollment forms accessible through your Website?

Aetna: Yes.

Anthem Blue Cross: Yes.

Blue Shield: Enrolling online eliminates the need to complete and mail in paper enrollment forms, provides an efficient enrollment pro­cess that is accurate and secure, and delivers immediate enrollment Confirmation to employees.

During the Blue Shield group installation for our integrated program. the client will be seamlessly set up with HealthEquity. Blue Shield will pass employee eligibility information to HealthEquity, which will auto­matically set up bank accounts. The client will be able to fund its em­ployees' HSA through payroll deduction on the HealthEquity Employer Portal. Training Webinars occur every Wednesday; to sign up. clients go to: and click the link under LAUNCH AND BEYOND titled HSA Employer Portal Webinars.

Cigna: Cigna provides an online and paper version of the HSA bank enrollment application. Employers can provide online or paper enroll­ment options for their employees.

HSA Bank: Yes. HSA Bank offers a variety of online enrollment op­tions for the employer. With our Auto Enrollment File process, employ­ers can easily enroll all HSA-qualified employees in an HSA by upload­ing a Microsoft Excel file. With HSA Bank's Group Online Enrollment system, the employer can easily facilitate the HSA-enrollment process by providing their employees with a custom enrollment link to an on­line application.

HSA California: PDF enrollment forms are available on our Website at . Employers and employees can open and fund an HSA on our Website through a simple process driven by our partner, The Bancorp Bank. Employers can even maintain employees' membership information online.

Kaiser Permanente: Individuals and Families can apply for Kaiser Permanente health plans online by logging on to: . RSA Employer and Individual applications can be downloaded at wellsfargo.corn/hsa. Kaiser Permanente health plan enrollees from companies whose employer is not sponsoring an HSA, and individuals enrolled in Kaiser Permanente's individual and fami­lies health plans. can open and fund an HSA account online.

SeeChange Health: We expect to add this functionality in 2013.

Sterling HSA: Yes. We provide online enrollment for individuals who are part of employer groups, individuals seeking a HSA administrator on their own, and for employer groups to manage the HSA enrollment of employees. Sterling account enrollment and management forms are also available on our Website at in a fill-able PDF format to download, complete, and email, mail or fax to Sterling. Our online enrollment and paper forms are available in English and Spanish.

9. How do you assist account holders with paying medical bills?

Aetna: We provide cost estimator and quality assessment tools. Anthem Blue Cross: High Deductible Health Plans engage the mem­bers to be knowledgeable about their healthcare treatment and man­agement of funds.

Members manage their own bank accounts, pay for their medical and Rx needs with their HSA account. Members can view online their bank­ing balances and their claim activity.

Account status and explanation of benefits documents are available

10. How does the administrator help the accountholder with insurance-related questions?

Aetna: Customer service representatives are available by phone and through our Website.

Cigna: Cigna offers integrated customer service via our Website and 24/ 7/365 toll-free telephone service to respond to ques­tions about the member's health insurance and the HSA. Anthem Btue Cross: Anthem provides online resources as well as a customer ser­vice support line for all members. Support numbers are listed on the member's health insurance card.

Blue Shield: All HDHP-related questions are referred back to Blue Shield.

HSA California: Both HSA California and The Bancorp Bank have customer support teams with expert knowledge available by phone or e-mail from 8 a.m. to 5 p.m., Eastern Time, Monday-Friday. (866) 271­2649 or .

Kaiser Permanente: Our preferred financial administrator for HSAs, Wells Fargo, refers insurance-related calls back to Kaiser Permanente (KP). KP member service representatives are trained to answer any insurance related questions our members may have. At , we also have a Website for deductible plan members to educate them­selves about what to expect pre/during/post visits with our providers, including decision support tools (e.g., preventive services list, sample fee list, interactive treatment fee tool) that may facilitate better under­standing of their insurance coverage and optimize the wide range of health related services offered by KP. Visit to find out more.

SeeChange Health: Questions related to plan coverage are handled by SeeChange Health.

Sterling HSA: Our customer service representatives are available Monday - Friday from 7 am to 6 pm Pacific. Clients and brokers can reach us toll-free at 800-617- 4729 and via e-mail at .

UnitedHealth Group: LlnitedHealthcare's Customer Care Profession­als are available by phone to respond to all insurance and account-related questions; a number of resources, including calculators and FAQs are also available online at.

11. Is the administrator integrated with the health plan?

Aetna: Yes

Anthem Blue Cross: Yes, BNY/ Mellon provides consumers with: Online Checking Activation Services through Antherricom/ca Interest-bearing checking account Anthem-branded MasterCard debit card Checkbook (Consumer receives the HSA debit card, checkbook, etc. after completing the activation process.)

·                 Online Monthly HSA Statements (bank statement)

·                 Annual Tax forms: 1099s (January), 5498s (May)

·                 Online Investment opportunities through its subsidiary Dreyfus

·                 Online Bill Pay for the member's medical fees

Blue Shield: Blue Shield offers a fully integrated experience through our partnership with Health Equity. Our new Account Based platform offers a completely integrated healthcare experience for both mem­bers and clients. All accounts are on one platform with integrated en­rollment and claims information, and flexible contribution models. We will also provide clients with an Employer Portal with access in real time to eligibility information, contributions, fee payments, and more

Clients will also be able to run reports for easy reconciliation..

Cigna: Yes, the HSA is fully integrated with the high deductible health plan.

HSA California: HSA California is completely integrated with The Ban­corp Bank. Eligibility is automatically transferred to The Bancorp Bank, so that account set-up is simplified; employers can set up employee HSAs, fund employee HSAs, and complete other administrative capa­bilities - all online.

Kaiser Permanente: No, Kaiser Permanente provides the health plan Services and Wells Fargo. our preferred financial administrator for HSAs, provides the financial account.

SeeChange Health: No as members are free to select any HSA ad­ministrator they choose.

Sterling HSA: We are an independent administrator available to work with all health plans across the nation. We have the ability to pull EOB information from the carrier for payment on behalf of our accounthold­ers.

UnitedHealth Group: Yes, in 2002, UnitedHealth Group chartered Op-tumHealthBank to help advance the growing convergence of health­care and financial services and to give consumers a more integrated experience.

12. Are investment choices limited by the admin­istrator?

Aetna: The administrator provides a diverse fund selection by asset classes supporting a range of investment objectives.

Anthem Blue Cross: There are over 20 investment opportunities Through BNY/Melion's subsidiary Dreyfus.

Blue Shield: Under the Health Equity program, employees can invest their HSA dollars directly from the Website after reaching the $2,000 minimum balance; investments are on the same, single platform. There are no fees to invest and members can access up to 12 dif­ferent mutual funds and each fund prospectus. Tax statements are also available on the Website. Wells Fargo has 13 mutual fund options available for investment options.

Cigna: Cigna offers a customized slate of diversified HSA investment options through JP Morgan Chase as part of our Cigna Choice Fund HSA.

HSA Bank: Accountholders can select from two self-directed invest­ment platforms based on their unique approach to investing. The Mu­tual Fund selection offers a professionally, pre-selected group of no-load mutual funds covering a range of fund families and asset classes. The Direct Brokerage option offers stocks, bonds and thousands of mutual funds. There's no minimum HSA balance to begin investing. And, there's no default or proprietary investment based on account balance.

HSA California: The Bancorp Bank offers an extensive investment portfolio. from FDIC-insured savings accounts to more than 7,000 in­vestment options.

Kaiser Permanente: The Wells Fargo HSA offers both an FDIC-insured Interest bearing deposit account plus the option to direct funds into pre-selected investments and mutual funds.

SeeChange Health: That will vary based on the HSA administrator chosen by the member.

Sterling HSA: Not at all. Our accountholders can choose any IRS qual-

through our Website. Members can use their debit card or Mellon checks to pay for their out of pocket responsibility. The customer ser­vice advocates are available to help members understand their finan­cial responsibility.

Blue Shield: With our new account based platform with Health Equity. there are just five simple steps from visit to reimbursement:

1.Member visit to healthcare provider

2.Claims sent to HealthEquity by Blue Shield

3.Automatic notification of responsibility

4.Claim and account information on the same screen

5.Provider paid directly or reimbursement from CDH account

When employees are notified of a claim with member responsibil­ity, they just access the Website to process payment and reimburse­ment. After viewing the claim detail, members can choose the action to be taken: pay provider, reimburse themselves, or close expense. The medical expense payment process is easy and flexible. Members can directly pay a provider from their HSA pre-tax account or add an additional external bank account; both pre- and post-tax distributions are tracked and housed on the member portal for tax reporting pur­poses.

Cigna: Cigna helps account holders manage their healthcare expens­es with information decision support tools and ready access to HSA funds, Cigna provides cost and quality information according to the individual's plan for more than 200 procedures performed by special­ists, in hospitals and in outpatient facilities. The pharmacy price quote tool compares actual real time out-of-pocket costs for brand name, generic and over the counter medications at 57,000 pharmacies na­tionwide.

HSA California: Our carrier partners - Kaiser Permanente, Health Net. and Western Health Advantage - have created special units within their organizations to help members enroll in HSA California.

Kaiser Permanente: Money in the HSA can be used to pay for a va­riety of qualified medical expenses ranging from routine physicals to prescription drugs. To pay for expenses, the member can simply pres­ent their HSA debit card to the provider, and money will be deducted directly from their HSA. However, if the member wants to pay for ser­vices out of pocket and submit an HSA reimbursement claim manu­ally, they can. Kaiser Permanente's Member Service Unit can support our members with any medical bill question or concern. A member can also write their HSA debit card number on their Kaiser Permanente bill and remit for payment.

SeeChange Health: We help our members understand their share of medical treatment and how they can offset those costs by completing health actions designed to help them manage their health. Expendi­tures from their HSA are handled directly between the member and their account administrator.

Sterling HSA: Sterling reviews the EOB and medical bills for health plan discounts to insure that our accountholders do not spend more for a healthcare service or product than the insurance company would pay. We also alert accountholders when we spot disbursements that do not appear to comply with IRS rules. A number of our clients come to us for help with payment plans in the event there are insufficient funds to pay a medical bill. This service is especially valuabfe in this difficult economy. We also partner with Medical Cost Advocate to help our accountholders negotiate medical costs before and after they are incurred.

ified investment for their HSA funds. including stocks, bonds, mutual funds, and CDs. We made arrangements with Partnervest Securities LLC to offer investment services at a discounted fee for Sterling ac­countholders. Partnervest also provides Sterling with monthly account balance information to ensure the outside investment information contained in Sterling HSA account records is current. Partnervest con­tact information is available on our Website at investmentservices/

13.         What forms are needed to submit an HSA case?

Aetna: Aetna's standard enrollment processes are used. There are separate medical and HSA elections. Eligibility/enrollment options are electronic batch enrollment, paper enrollment. and Web enrollment. Anthem Blue Cross: An HSA Addendum and Agreement need to be completed. The HSA Addendum captures how the Employer wants to fund their employees' accounts.

The HSA Addendum is stating you will or will not use our integrated banking option.

HSA Agreement must be signed if the Employer chooses our inte­grated partner BNY/Mellon.

Blue Shield: There are no extra forms needed; ail questions are in­cluded in your Blue Shield group installation paperwork.

Cigna: Cigna's standard processes and forms are used for all Cigna products including the HSA.

HSA Bank: To make enrolling in an HSA convenient for employers and their employees, HSA Bank offers several enrollment options in­cluding electronic file format, online enrollment and paper application. Each enrollment option provides unique capabilities and is designed to work best for different types of groups.

HSA California: Standard application forms are needed to submit an HSA California case. These forms are available at www.hsacalifornia. corn.

Kaiser Permanente: We require our standard application and enroll­ment process plus necessary forms to set up the Wells Fargo HSA. Wells Fargo: A broker must complete the "HSA Broker Supplement ­Application for Services" form and an "HSA Employer Application." You can find copies of the applications at

SeeChange Health: No special forms are required when applying for an HSA-compatible plan.

Sterling HSA: It's very simple. Just a completed employer group ap­plication (for groups) and an individual accountholder application for each accountholder, along with a list bill and employer preferred form of contribution. Online enrollment and forms are available at .

UnitedHealth Group: Employers contributing to the HSA account are required to complete an employer discovery document. Individuals es­tablishing an HSA account.

14.         Do you plan to offer an HSA-eligible plan to your own employees?

Aetna: Aetna Inc. offers several HSA-eligible plans to our employees. Anthem Blue Cross: All Anthem Blue Cross and WellPoint eligible em­ployees have the option to choose a Lumenos HSA plan.

Blue Shield: Blue Shield employees have been offered a High Deduct­ible Health Plan and HSA since January 1, 2007.

Cigna: Yes, Cigna has offered employees HRA and HSA plan options since January 2005.

HSA Bank: Absolutely.

HSA California: CHOICE Administrators, the company behind HSA California, Cal iforn iaChoice, Ca I iforniaChoice 51+, Kaiser Permanente Choice Solution, Contractor's Choice. and Choice Builder, currently of­fers its employees access to HSA- compatible plans.

Kaiser Permanente: We consider our entire portfolio of health plans for our own employees.

SeeChange Health: Members are free to choose their own HSA ad­ministrators and, consequently. their own trustees.

Sterling HSA: We have offered our employees an HSA plan since Ster­ling was founded in 2004.

UnitedHealth Group: All UnitedHealth Group employees have the op­tion of enrolling in all an HSA or HRA.

15.   Are you using a trustee? If so, how long have you been with the trustee?

Aetna: Yes. since May 2004

Anthem Blue Cross: Anthem has partnered with BNY/Mellon FDIC to offer all of your banking needs for your HSA account.

Blue Shield: Blue Shield has vendor relationships in place today with Wells Fargo (since 2004) and, for our integrated model, Health Equity (new for 2011). Both vendors are qualified trustee and custodians that administer health savings accounts.

Cigna: JP Morgan Chase has been the trustee for our Cigna Choice Fund HSA product since January 1. 2005.

HSA Bank: Webster Bank, N.A. provides trust services and serves in a capacity as the custodian. HSA bank has been a division of Webster Bank. N.A. since 2005.

HSA California: Yes, the Bancorp Bank handles HSAs directly; HSA California's relationship with Bancorp dates back to the start of HSA California, but the bank has been offering services to customers since 2000. The HDHP insurance plans are fully insured products from Health Net, Kaiser Permanente, and Western Health Advantage.

Kaiser Permanente: We first began selling HSA-Qualified Deductible HMO plans with an optional HSA through Wells Fargo in our Colorado, Georgia and Northwest regions in 2005, Mid-Atlantic States in 2006, and California and Ohio in 2007.

SeeChange Health: We strive to provide excellent service on all of our health plans.

Sterling NSA: Sterling does not use a trustee. BNY Mellon Corpora­tion is the custodian of assets of accountholders of health savings ac­counts administered by Sterling Health Services Inc. and is investment manager of assets in accordance with the Sterling Health Services Inc. Administrative Services Agreement.

UnitedHealth Group: Yes. UnitedHealthcare partners with Optum Health Bank for trustee services. UnitedHealthcare's parent company, UnitedHealth Group chartered OptumHealthBank in 2002 to help ad­vance the growing convergence of health care and financial services.

As seen in January 2013 issue of California Broker Magazine