|In This Issue|
||Happy Holidays From the NCMS Plan and MMIC
||The Greatly Exaggerated Death of Employer Sponsored
||Notice of Privacy Practices Updated Per HIPAA
||Actuarial Values Posted|
||“To eat is a necessity, but to eat intelligently is
an art” |
||Did You Know? Nutritional Counseling Visits Covered
Happy Holidays From the NCMS Plan and MMIC Agency
As the year comes to a close, we reflect on our many blessings and we
are thankful for the opportunity to serve you and the hundreds of
practices across North Carolina that participate in the NCMS Plan.
Peace, joy, and happiness to you and your loved ones this holiday
We wish you much success in the new year!
Pictured (L to R): George Fanelli, Diane Irvine, Jason Horay, Aya
Wallace, Barry Hill, Gary Bossert, Rachel Eaton, and Nancy Johnson
The Greatly Exaggerated Death of Employer Sponsored Insurance
Since the Affordable Care Act was passed in 2010, much has been written
about whether employer sponsored insurance (ESI) will survive. Without
question, ESI plays a critical role in the provision of health insurance
to millions of Americans, North Carolinians, and specifically medical
practices who participate in the NCMS Plan. Medical practices seek advice
from us about what to do for their employees and where they should seek
health insurance in 2014 and beyond.
A vast majority of employers
indicate they will continue ESI in 2014. 94% of employers “definitely
will” or are “very likely” to continue offering ESI to their workers in
Employers are not required to offer ESI, but
something compels them to do so, and that reason will not change because
of the ACA:
- 87% of employers offer ESI to “retain good
- 83% of employers offer ESI to “attract
Practices need to be concerned about the
competitiveness of their practice if they choose not to offer ESI.
Competing for top talent in the healthcare industry has never been more
difficult. Practices in the NCMS Plan have demonstrated year after year
that they care about their employees. Dropping ESI could send a
detrimental message of “you’re on your own” and could alienate staff.
But what about the Exchange and sending employees to
www.healthcare.gov for their coverage? Won’t our practice and our
employees be better off if we don’t have to deal with health insurance
anymore and they get affordable coverage through the Exchange?
Currently, practices receive favorable tax treatment for ESI. Both
the employer and the employee benefit from the tax deductibility of ESI
premiums. But what happens if you no longer offer ESI and instead give
your employees more money to purchase their coverage through the Exchange?
Yes, you could increase employees’ wages by an amount equal to
what you are paying for ESI now, but
• that increase becomes taxable
wages to the employee, decreasing their purchasing power with those same
• that decrease in the employer’s ESI premium payment
increases their corporate tax liability, too.
Additionally, one of
the touted features of the Exchange is its ability to match enrollees up
with appropriate subsidies and credits. However, by increasing the wages
of employees, you may inadvertently make them ineligible for the very
subsidies and credits that make Exchange coverage affordable.
Higher paid employees of a medical practice are likely the most
difficult and costliest to replace. The higher paid employees are also,
probably, older employees for whom the cost of coverage is higher, and
based on their salary, unlikely to be eligible for Exchange subsidies. If
faced with the choice of employment with a practice without ESI and a
practice with ESI, the latter is likely the more attractive option. Higher
paid workers (e.g. doctors, nurses, PAs, etc.) are better off with ESI and
receiving the pre-tax deductibility of their premiums.
hypothetically, let’s say you’ve dropped ESI and your employees are
covered by the Exchange, now what? Well, the Exchange rates were initially
set based on an actuarial projection of what likely costs will be incurred
by those who enroll. But, at this point, who knows who and how many will
enroll? What if the rates on the Exchange were too low to begin with? If
hordes of uninsured suddenly get Exchange coverage and begin receiving
care (which is a good thing), the cost is likely to drive up rates.
Possibly driving rates back up to the point where ESI is, again, the
better cost option. Once a practice has dropped ESI, it will be very
difficult to “herd the cats” back into a group plan.
The ACA has
created options and opportunities never before available. When making
decisions that significantly impact an employee’s health care and an
employer’s bottom line, you must think carefully about changes that are
difficult, if not impossible, to undo.
The NCMS Plan and its agent
consultants are here to serve North Carolina medical practices and to help
them navigate these decisions. Hundreds of practices have trusted the NCMS
Plan for more than 15 years with their ESI, and we remain a stable and
1 International Foundation of
Employee Benefit Plans, 2013 Employer-Sponsored Health Care: ACA’s Impact
(Brookfield, Wisconsin: International Foundation of Employee Benefit
Plans, May 2013).
2 Deloitte, 2012 Deloitte Survey of U.S.
Employers: Opinions about the U.S. Health Care System and Plans for
Employee Health Benefits (Washington: Deloitte, July 2012).
Notice of Privacy Practices Updated Per HIPAA Omnibus Rule
As most of our participating practices are well aware, the final
amendments to HIPAA resulting from the HITECH Act are now in effect.
Compliance was required by September 23, 2013. Every HIPAA "Covered
Entity" is required to have a Notice of Privacy Practices (NPP)
that accurately reflects patient (or members in the case of the NCMS Plan)
rights and practices at the entity. The NCMS Plan, as a health plan, is a
covered entity as defined by HIPAA.
The NPP must include the
- How the covered entity may use and disclose protected
health information about an individual.
- The individual’s rights
with respect to the information and how the individual may exercise these
rights, including how the individual may complain to the covered entity.
- The covered entity’s legal duties with respect to the
information, including a statement that the covered entity is required by
law to maintain the privacy of protected health information.
Whom individuals can contact for further information about the covered
entity’s privacy policies.
The changes to the NPP include, but are
not limited to, the following:
- Breach notification obligations.
- Description of uses and disclosures.
- Prohibition from using or
disclosing PHI that is an individual’s genetic information for
The updated NPP can be found at http://www.ncmsplan.com/wp-content/uploads/2013/09/130923-NCMS-Plan-Notice-of-Privacy-Practices-final-v-9.23.13.pdf
and a hard copy can be provided upon request.
Actuarial Values Posted
The Affordable Care Act establishes four levels of coverage based on
the concept of “actuarial value,” which represents the share of health
care expenses a plan covers for a typical group of enrollees. As plans
increase in actuarial value – bronze, silver, gold, and platinum – they
would cover a greater share of enrollees’ medical expenses overall, though
the covereage details could vary across plans.
Since NCMS Plan
coverage is available exclusively outside the Exchange, the metal-tier
plan levels are not directly relevant. However, as members hear such terms
as they relate to the Exchange, understanding how such plans correspond to
their coverage in the NCMS Plan is important to compare apples to apples,
so to speak.
We have developed an Actuarial Value chart (posted here) for all NCMS Plan health products along with a
chart showing the metal-tiers and their corresponding Actuarial Value
ranges. With this additional information, you can approximate the value of
your NCMS Plan coverage in terms of a metal-tier.
Question: George, in addition to the support you provide our
practice, does the NCMS Plan have a dedicated service representative at
BlueCross BlueShield of North Carolina (BCBSNC), the NCMS Plan’s health
Answer: You’ll be pleased to know that
yes, indeed, there are dedicated NCMS Plan contacts at BCBSNC that you can
reach out to directly. Many of our practice managers have worked with
DeAngelo Dykes in the past. Recently, DeAngelo was tapped for a special
assignment within BCBSNC, a testament to the quality of service DeAngelo
provided to our practices over the years and we thank him for his service.
As a result of this change, we now have new service representatives
working on our behalf.
For general service issues such as adding
employees/dependents, terminating employees/dependents, name changes,
address changes billing and routine maintenance, please feel free to
contact Chris Pierce at (919) 765-2515 or email Chris at firstname.lastname@example.org. Changes can also be
sent directly to Chris via fax at (919) 765-3564. In the event that Chris
is not available, Carla McCoy can be contacted at (919) 765-3256 (e-mail
and fax are the same).
Please note that neither Chris nor Carla
can assist with claim status or similar customer service requests. For
this, please contact BCBSNC Customer Service at (877) 258-3334.
always, you can contact me directly with an inquiry at (919) 878-7561 or
“To eat is a necessity, but to eat intelligently is an art”
What you reach for when you need a midday snack can make the difference
between staying at a healthy weight and putting on unneeded, unhealthy
pounds. The NCMS Plan encourages you and your employees to create healthy
eating habits this holiday season. Recently, the NCMS Plan sponsored a
Healthy Smoothie Break at the North Carolina Medical Society 159th Annual
Meeting. The healthy fruit smoothies were offered between sessions and
proved to be a hit among attendees.
Did You Know? Nutritional Counseling Visits Covered 100%
Did you know the NCMS Plan covers nutritional counseling visits, which
may include counseling specific to achieving or maintaining a healthy
weight? There is no limit to the amount of nutritional visits during the
benefit period. As long as the nutritionist is an in-network provider, the
session is considered to be a preventive service covered at 100%. To
search for an in-network provider, log in to Member Services at http://www.bcbsnc.com/,
and click on Find a Doctor.
Have you considered
implementing a wellness program that addresses nutrition and overall
healthy eating? The NCMS Plan continues to work closely with participating
practices to implement a comprehensive wellness strategy that works.
Contact Jason Horay, Health Promotion Coordinator at email@example.com, to learn
more about creating or enhancing your practice's wellness program, using
proven strategies, at no additional cost to participating practices.
Let's work together to create a healthier future for your
About the North Carolina Medical Society
Established in 1849, the North Carolina Medical Society (NCMS) is
devoted to representing the interests of physicians and protecting the
quality of patient care as the largest physician organization in the
state. The NCMS Plan, sponsored by the NCMS, is the only statewide
employee benefits plan designed specifically for North Carolina
For more information about many other benefits of NCMS
membership, visit http://www.ncmedsoc.org/.