The NCMS Plan and Summary of Benefit and Coverage (SBC)
The Patient Protection and Affordable Care Act and the Health Care and
Education Reconciliation Act (collectively referred to as “PPACA”) created
a requirement for plan sponors and health insurance issuers to develop and
issue a “summary of benefits and coverage” (SBC) which went into effect
September 23, 2012. This requires plan sponsors like the NCMS Plan and its
plan administrator (BCBSNC) jointly to provide an SBC to eligible
employees, members, new hires and special enrollees upon application, on
the first day of coverage, upon renewal and upon request. SBCs must be
provided beginning on the first day of the first plan year that begins on
or after September 23, 2012. The NCMS Plan's plan year begins annually on
August 1st which means that the SBC requirement will apply to the NCMS
Plan and its participating practices effective August 1, 2013 and at
subsequent individual practice renewals thereafter.
The NCMS Plan
is working with BCBSNC to produce and make available SBCs to members
through the BCBSNC website (Member Services) like the benefit booklets are
now. We will also post digital copies of SBCs on our website for access by
practice administrators who need to give copies to new employees and
others who may request a copy. There will be more communication on this to
participating practices from the NCMS Plan as we get closer to the
Even though the requirement does not apply to the
NCMS Plan until August 1, 2013, we are working with BCBSNC now to develop
these documents and when they are ready, even if well before the required
date, we will publish and make available.
Question: Under the Affordable Care Act (ACA), I read that employers
are required to report the cost of employer-sponsored coverage on employee
W-2 forms beginning with the 2012 tax year. Does this apply to my
Answer: It depends on the size of your practice.
Yes, a requirement of the ACA is that employers are required to start
reporting the cost of their employer-sponsored health coverage on the
W-2’s issued to employees for 2012. However, the requirement only applies
to employers filing 250 or more W-2 forms for the preceding calendar year.
Employers filing less than 250 W-2 forms are exempt and the reporting
of the cost is optional at this time.
about the W-2 reporting requirement and a helpful guide can be found at GrantThornton.com
If you have questions about the appeals process, call me at (919)
878-7561 or e-mail email@example.com.
HSA Limits for 2013
The health savings account (HSA) limits for calendar year 2013 are as
Annual contribution limits
- Single coverage. The most that can be deducted for an individual
with employee-only coverage under a high-deductible health plans (HDHP)
is $3,250; up $150 from 2012.
- Family coverage. The deduction limit for an individual with family
HDHP coverage is $6,450; up $200 from 2012.
HSA holders 55 and older get to save an extra $1,000 which means $4,250
for an individual and $7,450 for a family.
- Single coverage. The maximum amount an employee is allowed to pay
out of pocket for employee-only HDHP coverage is $6,250; up $200.
- Family coverage. The max an employee is allowed to pay for family
HDHP coverage is $12,500; up $400 from 2012.
Note: Out-of-pocket expenses includes deductibles, co-pays and
co-insurance; but not premiums.
And, remember, you can still make
2012 contributions until April 15, 2013.
Health Management Program Changes
On January 1, 2013, the NCMS Employee Benefit Plan in partnership with
Blue Cross and Blue Shield of North Carolina (BCBSNC) will implement
changes to its health management programs in order to advance toward a
more data-driven, results-oriented, measurable solution.
of notable changes include:
Although members will still access the Health
Assessment via mybcbsnc.com, the
Health Assessment itself is being enhanced. The new Health Assessment will
be in place starting 1/1/2013, but until that time members will continue
to have access to the current assessment. Since the results of the current
assessment will not transfer to the new assessment, we encourage members
to print the results of their assessment for their records.
Blue Points will be discontinued for the
NCMS Plan as of 7/30/2013. In order to continue providing value to members
the Blue365® program will be expanded, which provides exclusive deals and
discounts for health and non-health services such as gym memberships, diet
programs, tax preparation and more. For more information on Blue365, visit
Member Health Partnerships (MHP)
Partnerships will be discontinued on 12/31/2012. In its place will launch
Healthy Outcomes Condition Care with focus on five key conditions –
diabetes, asthma, coronary artery disease (CAD), COPD, and heart failure.
Members currently enrolled in MHP will be dis-enrolled from the program as
of 12/31/2012 at which time the new enhanced identification process will
seek out and target members for outreach.
Members will access Health Line Blue, the 24/7 nurse line,
using the same phone number (1-877-477-2424). The Health Line Blue nurse
team can answer medical questions for almost any health care issue or
treatment – often helping members save time and money. The nurses can now
also take the extra step to guide members to the most appropriate place of
care based on established clinical guidelines and are available via chat
If you have any questions about these changes, please
contact Jason Horay, Health Promotion Coordinator at 919-878-7530 or firstname.lastname@example.org.
Raleigh Orthopaedic Clinic Receives Practice Wellness Grant
Raleigh Orthopaedic Clinic was awarded a $15,000 grant from the North
Carolina Medical Society Employee Benefit Plan (NCMS Plan) for encouraging
wellness and good health practices among its employees.
Orthopaedic Clinic’s comprehensive wellness program is opened to all
employees at no cost and includes activities such as onsite fitness and
circuit training, fitness challenges, promotion of community charitable
organization, Lunch N Learn program for fitness and health education,
on-site Nutritionist appointments and more. "As a leading medical
practice, we are strongly committed to making wellness a priority, not
only to our patients, but also to our employees and the entire community,”
said Rita Lytle, Human Resources Manager.
As a result of
qualifying for the grant, Raleigh Orthopaedic employees enjoy lower
premium costs by completing an annual online health assessment, annual
preventive care exam and logging fitness activities. The grant funds will
continue to assist Raleigh Orthopaedic in growing their programs to ensure
the health of their employees and their families for a lifetime.
To learn more about the Practice Wellness Grant Program and to
apply, please contact mailto:Jason.Horay@mmicnc.com?Subject=Practice
Wellness Grant Program or call (919) 878-7530.
About the North Carolina Medical Society
As the largest physician organization in the state, the North Carolina
Medical Society (NCMS) is devoted to representing the interests of
physicians and protecting the quality of patient care. The NCMS Plan,
sponsored by the NCMS, is the only statewide employee benefits plan
designed specifically for North Carolina physicians.
information about many other benefits of NCMS membership, visit http://www.ncmedsoc.org/.