Total Benefit Systems Inc
Taking Care of Our Clients
Taking You in the Right Direction
- Experience: over 35 years of insurance experience, we understand the challenges employers are facing.
- Commitment: we are committed to developing long-term client relationships based on quality products, thorough and outstanding customer service, and most important ...trust.
- Integrity: we work with only the best carriers to insure quality coverage and claims for your employees.
- Creativity: plan designs to help you save money.
For additional information regarding CMS Creditable Coverage Disclosures click here:
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Senate Bill 7 |
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Senate Bill 7, the "Publicly Funded Health Insurance Contribution Act," has been approved by both chambers of the Michigan Legislature and is on its way to Governor Rick Snyder's desk for signature.
Senate Bill 7 limits the amount that public employers can pay toward employee medical benefit plans, beginning January 1, 2012. Based on the data provided to the Senate Fiscal Agency, this bill would save the State of Michigan approximately $70 million.
Public employers are defined as counties, townships, villages, cities, school districts, public school academies, intermediate school districts, community or junior colleges, or public institutions of higher education.
The new act will limit employers' contributions:
Hard Cap:
80/20 Alternative:
However, cities, villages, townships, counties, municipal electric utilities, airport authorities and metro parks may elect to OPT OUT, without penalty, with a two-third vote each medical plan year.
Any collective bargaining agreement or contract settled on or after September 15, 2011 MUST include the language of the act for implementation date of January 1, 2012.
If a public employer does not comply with the Act, they will be penalized either 10 percent of school aid payments or 10 percent of economic vitality payments.
For additional details on Senate Bill 7, please reference one of the following: http://www.legislature.mi.gov/documents/2011-2012/billintroduced/Senate/pdf/2011-SIB-0007.pdf
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Blue Cross Blue Shield & BCN - Member enrolllment forms change
Several months ago BCBSM/BCN began releasing their new Enrollment Change of Status (ECOS) form dated Oct 2010. (The previous form was dated April 09.) BCBSM Underwriting is now stating that they will only accept these old forms until April 1st. After April 1, 2011, the old forms will not be accepted, you must use the new Oct 2010 form. Please double check your supplies and use up or destroy any old stock you may have prior to April 1, 2011. If you need a copy of the new form, please contact our office.
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Health Care Reform
As you may know, under the Patient Protection and Affordable Care Act (PPACA), near-term benefit changes must be implemented for most group health plans, including collectively bargained, effective with plans years beginning on or after September 23, 2010.
What Does This Mean for Employers?
· What is Your Plan Year? Plan year is not synonymous with your “renewal date” or “enrollment date”, although there are circumstances where those dates could be the same. Typically, a plan year is when the annual deductible under your plan resets itself. Most insurance carriers will automatically implement the required changes to your plan as of your “Plan Year” beginning on or after September 23, 2010.
· Required Notices to You Should Provide to Employees:
o Notice of Opportunity to Enroll in connection with Extension of Dependent Coverage to Age 26
§ PPACA requires that groups offer dependent coverage for children up to age 26 who are related to the employee by birth, marriage, legal guardianship or legal adoption.
§ Eligibility will no longer be limited by financial dependency, marital status or enrollment in school.
§ Subscribers will no longer be able to choose the Family Continuation Rider (FC) for dependent(s). Under the interim final regulations, the FC rider will no longer be compliant as a different rate is charged depending on the age of the covered dependent.
§ Rates charged for dependents can no longer vary by the age of the covered dependent.
§ Special Enrollment Period - Dependent Coverage - Individuals who are now eligible for dependent coverage under PPACA can request enrollment in a health plan during the special enrollment period. The special enrollment period only applies to individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage ended before they turned age 26. The special enrollment period will be held Nov. 1, 2010 through Nov. 30, 2010 to enroll the qualified PPACA dependents in health plans effective Jan. 1, 2011. If a group currently holds their open enrollment during the fourth quarter, then the group can use their normal open enrollment period, as long as it is 30 days in duration. o Notice Lifetime Limit No Longer Applies and Enrollment Opportunity § Group plans may not place lifetime limits on essential health benefits. Any lifetime dollar limits specific to medical and prescription drug benefits will be removed. § Special Enrollment Period -Removal of Lifetime Dollar Limits- A member whose coverage ended because of reaching a lifetime dollar limit who is otherwise eligible for coverage under PPACA is now eligible to re-enroll in the plan. This special enrollment period should be held from Nov. 1, 2010 through Nov. 30, 2010. If a group currently holds their open enrollment during the fourth quarter, then the group can use their normal open enrollment period, as long as it is 30 days in duration. o Patient Protection Model Disclosure (typically applies to HMO plans) o To maintain status as a grandfathered health plan, a plan or health insurance coverage must include a statement, in any plan materials provided to a participant or beneficiary describing the benefits provided under the plan or health insurance coverage, that the plan or coverage believes it is a grandfathered health plan within the meaning of section 1251 of the Patient Protection and Affordable Care Act and must provide contact information for questions and complaints.
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