Regional Training - Benefits ProgramJuly 2010

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Christy Edwards, NMPSIA 800-548-3724 christy.edwards@state.nm.us

Martha Quintana, ERISA 800-233-3164 mquintana@santafe.cserisa.com

Managed Health Care Bureau 800-947-4722 mchb.grievance@state.nm.us

Julie Garcia, Poms & Associates• 800-898-6236 JGarcia@pomsassoc.com

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FY 10 Fund Balance

July 2009 ($8,848,728)

August 2009 ($10,727,703)

September 2009 ($8,079,069)

October 2009 ($6,511,653)

November 2009 ($4,357,466)

December 2009 ($3,102,810)

January 2010 ($1,352,357)

February 2010 $2,700,000

Self – Insured Coverage

Began FY 09 with an $8 million deficit

No Premium Increases allowed in FY10 legislative budget process

Current fund balance is a positive$7 million

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Blue Cross Medical: +6.4%Presbyterian Medical: +6.4%UCCI Dental: +6.4%

Davis Vision: No ChangeThe Standard Life: No ChangeThe Standard LTD: No Change

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Carrier Contact Information now on inside covers

References to Healthy Vistas deleted

New Employer Plan Matrix & Rates

Medco Pages 33 and 34

Correction of maximum on Non-Network High Option Dental

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Infusion Therapy

In-office Sterilization

Maternity Benefits (see handout)

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CHIPRA

Mental Health Parity Opt Out

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ID cards and welcome kits mailed June 22

Temporary ID card can be printed from “medco.com”

Alternate ID number same as it was with Catalyst

Mail order prescription number same as it was with Catalyst

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Catalyst Formulary Status grandfathered until January 1, 2011

NMPSIA and ERISA have access to Client Website allows view of claims and changes to eligibility real-time

Important for members to register on “medco.com”

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Specialty drug are filled by Accredo (separate division of Medco). Retail fills limited to 2x.

Immunization program to continue.

Diabetes Pilot Program will probably expand this fall or early 2011.

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PPACA – Patient Protection and Affordable Care Act

HCERA = Health Care and Reconciliation Act (aka “budget reconciliation bill”

Combined form, they form Federal Health Care Reform

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By 2014 everyone must have minimum essential healthcare or pay a tax.

Employer obligations dovetail with programs for low paid persons who cannot afford coverage

Low paid means employee household income of 100% to 400% of Federal Poverty Level

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Specific plan design – yet to be determined Bronze (60%), Silver (70%) Gold (80%) and

Platinum (90%) Must cover ambulatory patient service,

emergency services, hospitalization, maternity & newborn care, mental health & substance abuse, prescription drugs, Rehab services, lab services, wellness & preventive services, chronic disease management, pediatric services

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Avoid $2,000 penalty per employee by offering plan to all full-time employees

Avoid $3,000 penalty by offering a voucher to anyone who is low income and would pay between 8 – 9.8 % of income for group plan

Tax deductible voucher: a contribution to plan to which employer pays greatest proportion of costs (not highest dollar amount of contribution).

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Household income $15,000 (single EE < $15,000)

Current BCBS premium: $458.40

EE contribution 25% or $114.60 per month, $1375 annually, or 9.1% of $15,000 income

If EE declines NMPSIA coverage, employer issues voucher to EE for employer share of $343.80 month

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Plan year after October 1, 2010: no annual and lifetime caps except on “non-essential benefits”

Children covered until age 26 (including married children) effective 7/1/11 (first plan year after October 2010)

2011 must include cost of employer sponsored benefits on employee’s W-2

July 1, 2014, pre-ex exclusion eliminated, automatic enrollment required

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The Standard Life Insurance coverage also includes MEDEX assistance

Pre-trip Assistance (visa, inoculation requirements, health hazards, etc. )

Emergency evacuation and repatriation when 100 or more miles away from home or out of country

Coordinates with any medical coverage Benefits for companion or children

transportation

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ARRA is an acronym for?

(a) Accounts Receivable’s Receivable Accounts

(b) Aggravating Rules and Regulations Activities

(c) American Recovery and Reinvestment Act

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July 2, 2010 News from the Hill

“Prospects for congressional approval of another extension of the COBRA subsidy are dim. The subsidy was first authorized in last year’s stimulus bill and has already been extended twice. However, the 15-month subsidy was not available after June 1.

An extension of the subsidy was included in House jobs bill but conservative Democrats and Republicans forced Democratic leaders to jettison it over cost concerns. The provision was never in the Senate bill.  Sens. Sherrod Brown, D-Ohio, and Bob Casey, D-Penn., want to reinstate the subsidy as an amendment to the bill if it again reaches the Senate floor. But since reconsideration of the bill seems unlikely, a spokeswoman for Brown said the senators are pushing for the COBRA subsidy as a separate piece of legislation, and pay for it by eliminating a tax break.

The Senate proposal would, be retroactive, giving people laid off since June 1 six months (through 11/30/2010) of the federal subsidy instead of the 15 months that earlier law had provided. “

Encouraged for Employer Transactions:◦ Basic Life Enrollment◦ Update EE and Dependent Information (like employee

address or dependent SSN)◦ Cancel All Enrollment◦ Log on to districts.nmpsia.com and click on Online

Enrollment

Encouraged for Employee◦ View and confirm enrollment◦ Update address, phone or add email address◦ Switch Enrollment◦ Go to nmpsia.com “Members” tab and click on

Employee Online Enrollment System

August Board discussion of no longer allowing 1 penalty waiver per rolling 12 months

Staff recommendation because of additional work involved in penalty waiver research and accounting

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Any More Questions?

Comments?

Thanks! Let’s Break for Lunch

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