December 2012

In This Issue


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 effective date.

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.

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Ask George

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 practice?

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.

Additional information about the W-2 reporting requirement and a helpful guide can be found at

If you have questions about the appeals process, call me at (919) 878-7561 or e-mail

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HSA Limits for 2013

The health savings account (HSA) limits for calendar year 2013 are as follows:

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.

Out-of-Pocket Maximum

  • 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.

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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.

A couple of notable changes include:

Health Assessment

Although members will still access the Health Assessment via, 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

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)

Member Health 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.

Health Line Blue

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 feature.

If you have any questions about these changes, please contact Jason Horay, Health Promotion Coordinator at 919-878-7530 or

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.

Raleigh 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 Wellness Grant Program or call (919) 878-7530.

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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.

For more information about many other benefits of NCMS membership, visit