As promised, the Department of Labor (DOL) reduced our collective anxiety yesterday by publishing the COBRA Subsidy Extension notices to be used for compliance with the notice provisions of the COBRA Extension legislation included in the National Defense Appropriations Act (NDAA) enacted into law on December 19, 2009.
Background
As we previously reported (2009-20) on December 21, 2009 that Congress extended the availability of COBRA subsidies to Assistance Eligible Individuals from nine months to fifteen months for COBRA Qualifying Events (involuntary terminations) occurring on or after September 1, 2008 through February 28, 2010.
The NDAA legislation requires plans subject to federal COBRA to notify Assistance Eligible Individuals, past and present and future, of these additional rights.
The Notices
1. Updated General Notice. Plan Administrators must provide this updated notice to all qualified beneficiaries who experienced or will experience a Qualifying Event at any time from September 1, 2008 through February 28, 2010, regardless of the type of Qualifying Event, and have not yet been provided an election notice. This notice also serves as an election notice. This notice should also go to individuals whose Qualifying Event occurred (in December) but whose COBRA coverage began on or after January 1, 2010. In that case, Plan Administrators must allow these individuals a full 60 days from the date the notice is provided to make their election.
2. Premium Assistance Notice. Plan Administrators must provide this notice to individuals who have previously received an ARRA/COBRA notice without mention of the December 19, 2009 extension legislation. There are two classes of individuals involved here:
a. Due Date of Notice: February 17, 2010. For individuals who experienced an involuntary termination of employment sometime on or after October 31, 2009 and lost health coverage must receive the Premium Assistance Notice describing the extension provisions.
b. Due Date of Notice: No later than 60 days following the first day the Assistance Eligible Individual has reached the maximum period of the original subsidy (nine months), especially applicable to all of those individuals whose subsidy started March 1, 2009 and ended on November 30, 2009. For these individuals, the Plan Administrator must provide the Premium Assistance Notice no later than January 31, 2010, regarding their right to have the subsidy benefit reinstated back to the date the individual lost the original subsidy.
3. Small Group/State Law Plans: Updated Alternative Notice. Insurers that provide group health benefits in states with a small group (under 20 lives) continuation coverage similar to federal COBRA, must provide notice of the extension of subsidy benefits to all individuals who became eligible for subsidy benefits under state law.
You can find electronic versions of each of these notices here:
· Updated General Notice
· Premium Assistance Extension Notice
· Updated Alternative Notice
Or by going to the DOL website.
Further Discussion
1. DOL Appeals Process. As under the original COBRA subsidy law, individuals who are denied subsidy rights may request an expedited review by the DOL. The DOL must act within 15 days of receipt of a completed request for approval. The DOL now has a standard form individuals must use to exercise this right. The form appears on the DOL/COBRA website.
2. Alternative Plan Options. The new subsidy legislation extends the ARRA unique provision allowing individuals to elect other coverage at the time he/she exercises COBRA rights and the subsidy if an employer offers additional coverage options to active employees and makes these plans available to qualified beneficiaries. In other words, this option is permissible for employers to exercise, but the employer is not required to do so.
3. Old Income Limits. The new extension legislation did not change the threshold income limits ($145,000 single; $290,000 joint filers) for receiving the subsidy benefit.
On the horizon, as we all know, are various initiatives to extend coverage subsidies well beyond February 28, 2010. We will keep you informed of future developments.
Copyright © 2009 Alfred B. Fowler, Attorney at Law.
All Rights Reserved. Reprinted with permission.
Thursday, January 14, 2010
Tuesday, January 5, 2010
FMLA: Expanding Military Leave Entitlement
On October 28, 2009, President Obama signed the 2010 National Defense Authorization Act (NDAA) into law. The NDAA contains an expansion of Family Leave Rights. The FMLA provision actually contains no specific effective date. As a result, most practitioners advise employers to treat the expansion as being effective immediately.
Background
As you may recall, Congress amended the Family and Medical Leave Act in January 2008 to contain leave rights for family members associated with a call to service for members of the National Guard or Military Reservists. That law provides up to 12 weeks of “Exigency Leave” as well as 26 weeks of unpaid leave for a caregiver to provide care for a family member who was injured while on active military duty. Please refer to our previous updates (2008-5, 2008-26, and 2008-27).
The Expanded Benefit
1. Exigency Leave. The new law expands Exigency Leave rights to family-member employees to care for the urgent needs of active duty service members, not just reservists. The term “exigency” can include the following: short-notice deployment; military events and related activities; child care and school activities; financial and legal arrangements; counseling, rest and recuperation; post-deployment activities; and any other event the employer and employee agree to be a qualifying exigency.
2. Caregiver Leave. The new law also expands the definition of Covered Service Member to include veterans who are undergoing medical treatment, recuperation or therapy for serious injury or illness that occurred while on active duty any time during the five years preceding the date of treatment.
3. State Laws. State legislatures in states with similar leave laws must adopt these changes for these changes to be effective under their respective date leave laws.
Action Plan
Although this appears to affect only a small number of employers, it is important that each employer subject to the Family and Medical Leave Act do the following:
1. Amend your FMLA leave policies to comply with these changes; and,
2. Notify all staff who administer company leave policies regarding the expansion of coverage.
Click here and go to Page 120 of the bill to review the new law.
Air Flight Crew Technical Corrections Act
For your information, Congress has also passed additional legislation to clarify the hours of service requirements for FMLA rights for airline pilots and flight attendants. As you may know, FMLA generally requires employees to have worked for their employers a minimum of 12 months and for at least 1,250 hours during the previous 12-month period, as determined under the terms of the Fair Labor Standards Act (FLSA). Airlines pay pilots and flight attendants for being on mandatory standing as well as for flight time. The FLSA does not recognize “mandatory stand-by pay.” As a result, airline flight crews will be eligible for FMLA calculated on the basis that he/she had worked or been paid for 504 hours during the previous 12-month period.
Copyright © 2009 Alfred B. Fowler, Attorney at Law.
All Rights Reserved. Reprinted with permission.
Background
As you may recall, Congress amended the Family and Medical Leave Act in January 2008 to contain leave rights for family members associated with a call to service for members of the National Guard or Military Reservists. That law provides up to 12 weeks of “Exigency Leave” as well as 26 weeks of unpaid leave for a caregiver to provide care for a family member who was injured while on active military duty. Please refer to our previous updates (2008-5, 2008-26, and 2008-27).
The Expanded Benefit
1. Exigency Leave. The new law expands Exigency Leave rights to family-member employees to care for the urgent needs of active duty service members, not just reservists. The term “exigency” can include the following: short-notice deployment; military events and related activities; child care and school activities; financial and legal arrangements; counseling, rest and recuperation; post-deployment activities; and any other event the employer and employee agree to be a qualifying exigency.
2. Caregiver Leave. The new law also expands the definition of Covered Service Member to include veterans who are undergoing medical treatment, recuperation or therapy for serious injury or illness that occurred while on active duty any time during the five years preceding the date of treatment.
3. State Laws. State legislatures in states with similar leave laws must adopt these changes for these changes to be effective under their respective date leave laws.
Action Plan
Although this appears to affect only a small number of employers, it is important that each employer subject to the Family and Medical Leave Act do the following:
1. Amend your FMLA leave policies to comply with these changes; and,
2. Notify all staff who administer company leave policies regarding the expansion of coverage.
Click here and go to Page 120 of the bill to review the new law.
Air Flight Crew Technical Corrections Act
For your information, Congress has also passed additional legislation to clarify the hours of service requirements for FMLA rights for airline pilots and flight attendants. As you may know, FMLA generally requires employees to have worked for their employers a minimum of 12 months and for at least 1,250 hours during the previous 12-month period, as determined under the terms of the Fair Labor Standards Act (FLSA). Airlines pay pilots and flight attendants for being on mandatory standing as well as for flight time. The FLSA does not recognize “mandatory stand-by pay.” As a result, airline flight crews will be eligible for FMLA calculated on the basis that he/she had worked or been paid for 504 hours during the previous 12-month period.
Copyright © 2009 Alfred B. Fowler, Attorney at Law.
All Rights Reserved. Reprinted with permission.
Monday, December 21, 2009
COBRA Extension Legislation on President’s Desk
On Saturday, December 19, 2009, Congress extended the COBRA subsidy first enacted on February 13, 2009 from nine (9) months to fifteen (15) months for those who undergo an involuntary termination of employment between September 1, 2008 through the end of February 2010.
Discussion
1. The Original Nine Month Subsidy. The American Recovery and Reinvestment Act of 2009 (ARRA) COBRA subsidy provisions provided for the 65% COBRA premium subsidy to begin on March 1, 2009. For Assistance Eligible Individuals (AEI) whose jobs had terminated prior to March 1, 2009, the subsidization ended with the November 2009 premium period. Individuals who lost their jobs after that date whose COBRA began prior to January 1, 2010 would get nine months under the original COBRA subsidy law.
2. The New Subsidy. For those whose subsidy ended as of November 30, 2009, the new law would extend coverage for another six months retroactively to December 1, 2009 through May 31, 2010. Individuals whose COBRA subsidy began after March 2009 will have access to the subsidy for a full fifteen (15) months from the inception of the original COBRA coverage.
3. December Terminations. Under the original law, both the termination and the inception of COBRA had to occur on or before December 31, 2009, leaving individuals whose COBRA benefits began on January 1, 2010 without the advantage of the subsidy. With the passage of the Extension Legislation, these individuals now will have rights to a full fifteen months of subsidy, commencing with the inception of their COBRA coverage.
4. February 28, 2010. The Extension Legislation contains the same requirement that both the termination and inception of COBRA occur no later than February 28, 2010. This means that individuals whose COBRA begins on March 1, 2010 will not be eligible for the subsidy.
5. Transition Period. Since the original subsidy benefit may have expired for some Assistance Eligible Individuals, the Extension Legislation contains transition rules applicable to any period of coverage beginning prior to December 21, 2009 so long as such period is subject to the provisions contained in the Extension Legislation. The rules applicable to individuals in the transition period follow.
6. Transition Rules:
a. Timely Payments. COBRA continuees whose subsidy ended on November 30, 2009 will have 60 days from December 21, 2009 or no less than 30 days from the date they are notified of the Extension Legislation, to pay their portion of the subsidized COBRA premium. The individual also must have been covered under COBRA continuation coverage to which such premium payment relates for the period of coverage immediately preceding December 21, 2009.
b. Overpayments. In the case of an Assistance Eligible Individual who pays the full COBRA premium for periods (e.g. December 2009 or January 2010) prior to receiving notice, the Plan Sponsor must either credit the overpayment against future COBRA premium payments (as long as the amount is exhausted within 180 days) or refund the overpayment to the individual.
c. Notice Requirements. The Extension Legislation requires Plan Sponsors to provide two types of Notices:
· General Notice: Regarding the Extension Legislation to all individuals who were or have become Assistance Eligible Individuals on or after October 31, 2009 by February 21, 2010 (60 days after enactment); and,
· Transition Notice: Regarding the right to restore coverage to individuals who lost assistance by failing to pay full COBRA premiums after the nine (9) month subsidy ceased within 60 days of the beginning of the individual’s transition period.
d. Model Notices. We expect that the Department of Labor (DOL) will prepare and publish new model notices within the next 30 days.
7. Original ARRA Rules. All other provisions contained in the original legislation will continue in effect to the extent they are consistent with the Extension Legislation. Please note that states which have adopted “small group” COBRA laws may need to amend current state COBRA laws to achieve conformance with the Extension Legislation.
Action Plan
1. The Plan Sponsor in conjunction with the COBRA Administrator (if applicable) must identify all Assistance Eligible Individuals:
a. Whose subsidy began March 1, 2009 or later; and,
b. Whose nine (9) month subsidy has expired or will expire shortly.
2. The Plan Sponsor/COBRA Administrator, using the model notices, once provided, must prepare and mail:
a. The General Notice of the Extension Legislation to all Assistance Eligible Individuals as of October 31, 2009 or later; and,
b. The Transition Notice of the Extension Legislation to all Assistance Eligible Individuals who have exhausted the nine (9) month subsidy and are currently paying the full COBRA premium (102% of rate for active plan coverage) or who have ceased paying premiums upon exhaustion of the nine (9) month subsidy.
Additional COBRA Changes. It is likely that Congress may, yet again, address the COBRA subsidy issue prior to the end of February 2010, either as a part of the pending Health Reform Act or independently. We will keep you informed of these matters.
Click here to view the full text of the COBRA Extension Legislation (beginning on Page 64).
Copyright © 2009 Alfred B. Fowler, Attorney at Law.
All Rights Reserved. Reprinted with permission.
Discussion
1. The Original Nine Month Subsidy. The American Recovery and Reinvestment Act of 2009 (ARRA) COBRA subsidy provisions provided for the 65% COBRA premium subsidy to begin on March 1, 2009. For Assistance Eligible Individuals (AEI) whose jobs had terminated prior to March 1, 2009, the subsidization ended with the November 2009 premium period. Individuals who lost their jobs after that date whose COBRA began prior to January 1, 2010 would get nine months under the original COBRA subsidy law.
2. The New Subsidy. For those whose subsidy ended as of November 30, 2009, the new law would extend coverage for another six months retroactively to December 1, 2009 through May 31, 2010. Individuals whose COBRA subsidy began after March 2009 will have access to the subsidy for a full fifteen (15) months from the inception of the original COBRA coverage.
3. December Terminations. Under the original law, both the termination and the inception of COBRA had to occur on or before December 31, 2009, leaving individuals whose COBRA benefits began on January 1, 2010 without the advantage of the subsidy. With the passage of the Extension Legislation, these individuals now will have rights to a full fifteen months of subsidy, commencing with the inception of their COBRA coverage.
4. February 28, 2010. The Extension Legislation contains the same requirement that both the termination and inception of COBRA occur no later than February 28, 2010. This means that individuals whose COBRA begins on March 1, 2010 will not be eligible for the subsidy.
5. Transition Period. Since the original subsidy benefit may have expired for some Assistance Eligible Individuals, the Extension Legislation contains transition rules applicable to any period of coverage beginning prior to December 21, 2009 so long as such period is subject to the provisions contained in the Extension Legislation. The rules applicable to individuals in the transition period follow.
6. Transition Rules:
a. Timely Payments. COBRA continuees whose subsidy ended on November 30, 2009 will have 60 days from December 21, 2009 or no less than 30 days from the date they are notified of the Extension Legislation, to pay their portion of the subsidized COBRA premium. The individual also must have been covered under COBRA continuation coverage to which such premium payment relates for the period of coverage immediately preceding December 21, 2009.
b. Overpayments. In the case of an Assistance Eligible Individual who pays the full COBRA premium for periods (e.g. December 2009 or January 2010) prior to receiving notice, the Plan Sponsor must either credit the overpayment against future COBRA premium payments (as long as the amount is exhausted within 180 days) or refund the overpayment to the individual.
c. Notice Requirements. The Extension Legislation requires Plan Sponsors to provide two types of Notices:
· General Notice: Regarding the Extension Legislation to all individuals who were or have become Assistance Eligible Individuals on or after October 31, 2009 by February 21, 2010 (60 days after enactment); and,
· Transition Notice: Regarding the right to restore coverage to individuals who lost assistance by failing to pay full COBRA premiums after the nine (9) month subsidy ceased within 60 days of the beginning of the individual’s transition period.
d. Model Notices. We expect that the Department of Labor (DOL) will prepare and publish new model notices within the next 30 days.
7. Original ARRA Rules. All other provisions contained in the original legislation will continue in effect to the extent they are consistent with the Extension Legislation. Please note that states which have adopted “small group” COBRA laws may need to amend current state COBRA laws to achieve conformance with the Extension Legislation.
Action Plan
1. The Plan Sponsor in conjunction with the COBRA Administrator (if applicable) must identify all Assistance Eligible Individuals:
a. Whose subsidy began March 1, 2009 or later; and,
b. Whose nine (9) month subsidy has expired or will expire shortly.
2. The Plan Sponsor/COBRA Administrator, using the model notices, once provided, must prepare and mail:
a. The General Notice of the Extension Legislation to all Assistance Eligible Individuals as of October 31, 2009 or later; and,
b. The Transition Notice of the Extension Legislation to all Assistance Eligible Individuals who have exhausted the nine (9) month subsidy and are currently paying the full COBRA premium (102% of rate for active plan coverage) or who have ceased paying premiums upon exhaustion of the nine (9) month subsidy.
Additional COBRA Changes. It is likely that Congress may, yet again, address the COBRA subsidy issue prior to the end of February 2010, either as a part of the pending Health Reform Act or independently. We will keep you informed of these matters.
Click here to view the full text of the COBRA Extension Legislation (beginning on Page 64).
Copyright © 2009 Alfred B. Fowler, Attorney at Law.
All Rights Reserved. Reprinted with permission.
Monday, November 30, 2009
Important COBRA Alert
COBRA Premium Assistance
IRS Notice 2009-27 issued April 20, 2009 applicable to ARRA COBRA subsidies contains a very important and now very relevant rule: both the qualifying event and the inception of COBRA coverage must occur prior to December 31, 2009 for the ARRA Premium Assistance to apply.
At present, both Treasury and the Department of Labor have confirmed that there has been no modification to this rule. Here is the rule:
Notice 2009-27: Q& A 13
Q-13. If an individual’s involuntary termination occurs no later than December 31, 2009, but the loss of coverage resulting in eligibility for COBRA continuation coverage occurs after December 31, 2009, is the individual an assistance eligible individual?
A-13. No. Both the involuntary termination and eligibility for COBRA continuation coverage must occur during the period from September 1, 2008, through December 31, 2009. If the loss of coverage is after December 31, 2009, the individual cannot become an assistance eligible individual.
Discussion
1. Background on ARRA Subsidy. The American Recovery and Reinvestment Act of 2009 (ARRA) provides for a 65% reduction of actual premiums required for COBRA coverage payable by assistance eligible individuals. To be assistance eligible, an individual must be a COBRA Qualified Beneficiary as a result of an involuntary termination of employment occurring during the period beginning on September 1, 2008 and ending on December 31, 2009, and who elects COBRA coverage. Employers, under most circumstances, front the 65% subsidy and recover the full amount as a credit toward their payroll taxes.
2. Termination of Health Care Coverage. Most group health plans contain a provision allowing health care coverage under the active employee plan to continue until the last day of the month during which a COBRA Qualifying Event occurs (“End of Month” Termination). A small number of plans will terminate active coverage on the day the Qualifying Event occurs (Immediate Termination).
a. “End of Month” Termination. In the event the active plan benefits terminate on the last day of the month, COBRA coverage begins on the first day of the month following the month in which the COBRA Qualifying Event occurs. Under these circumstances, a COBRA Qualifying Event (involuntary termination) which occurs in December 2009 will result in COBRA coverage becoming available on January 1, 2010, eliminating the availability of the COBRA 65% subsidy.
b. Immediate Termination. If the plan’s active coverage ends on the date of the COBRA Qualifying Event, COBRA coverage, if elected, begins the following day. As a result, the premium subsidy would apply to all involuntary terminations in December (except for one which occurs on December 31, 2009) since COBRA coverage, if elected, would begin on or before December 31, 2009.
c. It is unlikely that a health care insurer would entertain a request at this time to amend an existing group policy to modify its termination provisions from “End of Month” to “immediate” cessation of active plan coverage upon the occurrence of an involuntary termination.
3. Proposed Legislation. In early November, two Senators authored and introduced the COBRA Subsidy and Enhancement Act of 2009(S.2730). This proposed legislation would extend the availability of the subsidy beyond December 31, 2009 to June 30, 2010, increase the amount of the subsidy to 75% and extend the period of benefits from nine (9) months to fifteen (15) months. This bill now sits in the Senate Committee on Health, Education, Labor, and Pension (HELP).
The House has a similar bill (Extended COBRA Continuation Protection Act of 2009 (H.R. 3930), currently under review by House Ways and Means, as well as the House Committees on Education and Labor, and Energy and Commerce. H.R. 3930 would extend benefits from nine (9) to fifteen (15) months for current Assistance Eligible Individuals, that is, those with involuntary terminations between September 1, 2008 and December 31, 2009, who qualify for assistance under the original Act (ARRA). The bill would also cover involuntary terminations occurring between January 1, 2010 and June 30, 2010. H.R. 3930 does not appear to address those whose Qualifying Events occurred in 2009 with COBRA beginning in 2010. Finally, this bill would extend traditional COBRA from 18 months to 24 months for those whose job losses occurred as a result of the recession, from 2008 to present; however, this extension would not continue beyond December 31, 2010.
At present, neither bill has progressed beyond Committee level. To see copies of these bills, please refer to the links above.
Copyright © 2009 Alfred B. Fowler, Attorney at Law.
All Rights Reserved. Reprinted with permission.
This legislative update is published as an information source for our clients and colleagues. It is general in its nature and is no substitute for legal advice or opinion in any particular case.
IRS Notice 2009-27 issued April 20, 2009 applicable to ARRA COBRA subsidies contains a very important and now very relevant rule: both the qualifying event and the inception of COBRA coverage must occur prior to December 31, 2009 for the ARRA Premium Assistance to apply.
At present, both Treasury and the Department of Labor have confirmed that there has been no modification to this rule. Here is the rule:
Notice 2009-27: Q& A 13
Q-13. If an individual’s involuntary termination occurs no later than December 31, 2009, but the loss of coverage resulting in eligibility for COBRA continuation coverage occurs after December 31, 2009, is the individual an assistance eligible individual?
A-13. No. Both the involuntary termination and eligibility for COBRA continuation coverage must occur during the period from September 1, 2008, through December 31, 2009. If the loss of coverage is after December 31, 2009, the individual cannot become an assistance eligible individual.
Discussion
1. Background on ARRA Subsidy. The American Recovery and Reinvestment Act of 2009 (ARRA) provides for a 65% reduction of actual premiums required for COBRA coverage payable by assistance eligible individuals. To be assistance eligible, an individual must be a COBRA Qualified Beneficiary as a result of an involuntary termination of employment occurring during the period beginning on September 1, 2008 and ending on December 31, 2009, and who elects COBRA coverage. Employers, under most circumstances, front the 65% subsidy and recover the full amount as a credit toward their payroll taxes.
2. Termination of Health Care Coverage. Most group health plans contain a provision allowing health care coverage under the active employee plan to continue until the last day of the month during which a COBRA Qualifying Event occurs (“End of Month” Termination). A small number of plans will terminate active coverage on the day the Qualifying Event occurs (Immediate Termination).
a. “End of Month” Termination. In the event the active plan benefits terminate on the last day of the month, COBRA coverage begins on the first day of the month following the month in which the COBRA Qualifying Event occurs. Under these circumstances, a COBRA Qualifying Event (involuntary termination) which occurs in December 2009 will result in COBRA coverage becoming available on January 1, 2010, eliminating the availability of the COBRA 65% subsidy.
b. Immediate Termination. If the plan’s active coverage ends on the date of the COBRA Qualifying Event, COBRA coverage, if elected, begins the following day. As a result, the premium subsidy would apply to all involuntary terminations in December (except for one which occurs on December 31, 2009) since COBRA coverage, if elected, would begin on or before December 31, 2009.
c. It is unlikely that a health care insurer would entertain a request at this time to amend an existing group policy to modify its termination provisions from “End of Month” to “immediate” cessation of active plan coverage upon the occurrence of an involuntary termination.
3. Proposed Legislation. In early November, two Senators authored and introduced the COBRA Subsidy and Enhancement Act of 2009(S.2730). This proposed legislation would extend the availability of the subsidy beyond December 31, 2009 to June 30, 2010, increase the amount of the subsidy to 75% and extend the period of benefits from nine (9) months to fifteen (15) months. This bill now sits in the Senate Committee on Health, Education, Labor, and Pension (HELP).
The House has a similar bill (Extended COBRA Continuation Protection Act of 2009 (H.R. 3930), currently under review by House Ways and Means, as well as the House Committees on Education and Labor, and Energy and Commerce. H.R. 3930 would extend benefits from nine (9) to fifteen (15) months for current Assistance Eligible Individuals, that is, those with involuntary terminations between September 1, 2008 and December 31, 2009, who qualify for assistance under the original Act (ARRA). The bill would also cover involuntary terminations occurring between January 1, 2010 and June 30, 2010. H.R. 3930 does not appear to address those whose Qualifying Events occurred in 2009 with COBRA beginning in 2010. Finally, this bill would extend traditional COBRA from 18 months to 24 months for those whose job losses occurred as a result of the recession, from 2008 to present; however, this extension would not continue beyond December 31, 2010.
At present, neither bill has progressed beyond Committee level. To see copies of these bills, please refer to the links above.
Copyright © 2009 Alfred B. Fowler, Attorney at Law.
All Rights Reserved. Reprinted with permission.
This legislative update is published as an information source for our clients and colleagues. It is general in its nature and is no substitute for legal advice or opinion in any particular case.
Friday, November 6, 2009
PROINSURANCE COMPLIANCE ALERT!
MEDICARE PART D NOTIFICATIONS - NOVEMBER 15TH DEADLINE.
Please carefully read this important notice. All employers who offer medical plans with prescription drug coverage to Medicare-eligible employees and dependents have two Medicare disclosure requirements:
1.Employers are required to disclose the creditable or non-creditable status of their employer prescription drug plans to the Centers for Medicare and Medicaid Services (CMS).
2.Employers are required to disclose to Medicare eligible plan members whether their plans qualify as creditable or non-creditable coverage. We recommend distributing the notice to all employees because you may not be aware of dependents on Medicare.
CMS DISCLOSURE:
Employers must disclose to the Centers for Medicare Services (CMS) if their plans are creditable or non-creditable annually before November 15th. To complete the disclosure on the CMS website you will need the company's EIN number and an estimated number of Medicare eligible members on the company plan. The CMS website is:
www.cms.hhs.gov/creditableCoverage
DISCLOSURE TO PLAN PARTICPANTS
The Part D notices must be given to the employees and eligible dependents annually before November 15th, and when the company's prescription plan changes , or upon request from an employee. We recommend distributing the notices during the company's open enrollment annually and inserting the notice in all new hire packets. Model disclosure forms that you can customize with the applicable plans and company contact information are available at the ProInsurance "Legislative Updates" web page listed below.
ARE THE COMPANY PLANS CREDITABLE?
lists of creditable and non-creditable small group plans for Anthem and Blue Shield are available on the "Legislative Updates" web page listed below. All Kaiser plans offer creditable prescription coverage. If your company plan is not listed on the attached documents, or you have plans with a different carrier please contact your ProInsurance account manager at 650-326-1900.
ProInsurance Legislative Updates
Please carefully read this important notice. All employers who offer medical plans with prescription drug coverage to Medicare-eligible employees and dependents have two Medicare disclosure requirements:
1.Employers are required to disclose the creditable or non-creditable status of their employer prescription drug plans to the Centers for Medicare and Medicaid Services (CMS).
2.Employers are required to disclose to Medicare eligible plan members whether their plans qualify as creditable or non-creditable coverage. We recommend distributing the notice to all employees because you may not be aware of dependents on Medicare.
CMS DISCLOSURE:
Employers must disclose to the Centers for Medicare Services (CMS) if their plans are creditable or non-creditable annually before November 15th. To complete the disclosure on the CMS website you will need the company's EIN number and an estimated number of Medicare eligible members on the company plan. The CMS website is:
www.cms.hhs.gov/creditableCoverage
DISCLOSURE TO PLAN PARTICPANTS
The Part D notices must be given to the employees and eligible dependents annually before November 15th, and when the company's prescription plan changes , or upon request from an employee. We recommend distributing the notices during the company's open enrollment annually and inserting the notice in all new hire packets. Model disclosure forms that you can customize with the applicable plans and company contact information are available at the ProInsurance "Legislative Updates" web page listed below.
ARE THE COMPANY PLANS CREDITABLE?
lists of creditable and non-creditable small group plans for Anthem and Blue Shield are available on the "Legislative Updates" web page listed below. All Kaiser plans offer creditable prescription coverage. If your company plan is not listed on the attached documents, or you have plans with a different carrier please contact your ProInsurance account manager at 650-326-1900.
ProInsurance Legislative Updates
Wednesday, September 23, 2009
Blue Shield of California to Cover H1n1 Flu Vaccine Administration for All Members
Blue Shield of California announced today that it will cover the administrative costs of the H1N1 virus (swine flu) vaccine for all its members, regardless of which plan they have. Blue Shield will be waiving prior authorizations, copays and deductibles for office visits when members go to an in-network doctor to get H1N1 vaccinations.
The U.S. Government will be providing H1N1 vaccinations (including the equipment, like syringes) free of charge. While providers will initially focus vaccination efforts on the most at-risk populations, members of all groups will be covered.
Blue Shield of California also provides prescription drug coverage for Tamiflu (oseltamivir) and Relenza (zanamivir) -- the two anti-viral drugs used to treat flu symptoms. The company has designated both drugs as Tier One prescriptions, which reduces the copayment that members make to get the medication. Coverage is also being extended for conditions authorized by the FDA under Emergency Use Authorization. This coverage applies to all members.
"We stand ready to help our members in every way possible," said Meredith Mathews, MD, chief medical officer of Blue Shield of California. "We want to make it easy and affordable for everyone to get the care they need."
In addition, Blue Shield will be providing H1N1 educational materials to members in order to familiarize them with both prevention and treatment options.
Blue Shield of California continues to monitor the H1N1 influenza outbreak closely. The facts of the outbreak and the flu virus are rapidly changing, so please refer to the CDC website or call 800-CDC-INFO (1-800-232-4636) or e-mail: cdcinfo@cdc.gov for emerging details.
The U.S. Government will be providing H1N1 vaccinations (including the equipment, like syringes) free of charge. While providers will initially focus vaccination efforts on the most at-risk populations, members of all groups will be covered.
Blue Shield of California also provides prescription drug coverage for Tamiflu (oseltamivir) and Relenza (zanamivir) -- the two anti-viral drugs used to treat flu symptoms. The company has designated both drugs as Tier One prescriptions, which reduces the copayment that members make to get the medication. Coverage is also being extended for conditions authorized by the FDA under Emergency Use Authorization. This coverage applies to all members.
"We stand ready to help our members in every way possible," said Meredith Mathews, MD, chief medical officer of Blue Shield of California. "We want to make it easy and affordable for everyone to get the care they need."
In addition, Blue Shield will be providing H1N1 educational materials to members in order to familiarize them with both prevention and treatment options.
Blue Shield of California continues to monitor the H1N1 influenza outbreak closely. The facts of the outbreak and the flu virus are rapidly changing, so please refer to the CDC website or call 800-CDC-INFO (1-800-232-4636) or e-mail: cdcinfo@cdc.gov for emerging details.
Friday, August 28, 2009
How to eat healthy
Eating right is important, because nutrition plays a big part in your overall health. For example, a healthy diet can lessen your risk of certain cancers, obesity, type 2 diabetes, and hypertension, according to the U.S. Centers for Disease Control and Prevention.
So what is a healthy diet? In a nutshell (no pun intended), it includes lots of fresh fruits and vegetables, whole grains, nuts, and beans, as well as some calcium-rich dairy products and healthy protein such as poultry, fish, eggs, or tofu.
Tips for healthy eating
Add color. A vegetable’s color signals the vitamins and minerals it contains. To get a wide range of nutrients, try to eat lots of different colored vegetables daily. Salads are great for this of course, but you can toss some veggies into almost any dish, from scrambled eggs to pasta to meatloaf.
Separate your plate. Before you eat, mentally divide your plate into four equal parts. Then fill two with vegetables, use one for starchy foods (like potatoes, beans, rice or pasta), and one for a serving of lean meat, fish, or a meat substitute (such as eggs, cheese, or tofu). Just don’t use a big platter-size plate, or you may pile on too much food.
Know portion size. If you think a cereal bowl full of your favorite chocolate chip ice cream equals one serving, you may need some help estimating portion sizes (sorry). Here are some easy ways to measure single servings:
1 cup salad greens = a fist
½ cup cooked rice, pasta or potato = ½ baseball
3 oz. meat = deck of cards
3 oz. grilled/baked fish = checkbook
2 tablespoons peanut butter = ping pong ball
¼ cup nuts or raisins = an egg
1 teaspoon butter = a sugar cube
Eat your veggies first. If you’re absolutely starving at meal time, start with some vegetables or salad. This will ease your hunger and help keep you from overloading on meat or starchy foods.
Head off temptation. If the cookie jar is the first thing you see when you walk into your kitchen, you’re asking for trouble. Instead move the cookies, ice cream, chips, etc. where you can’t see them, like a high shelf or the back of the freezer.
Avoid processed foods. Stay away from foods that are highly processed and contain added sugars like corn syrup. Hint: Check the ingredients on the label. If there’s a long list of unidentifiable chemicals, don’t eat it.
Drink healthy, too. Want a beverage to go with your healthy meal? Choose water rather than soda or juice, which is high in calories and less nutritious than a piece of fruit.
More online resources:
Detailed nutrition guidance from the Harvard School of Public Health
Tips on how to add more fruits and vegetables to your daily diet, plus tools to help you calculate how many servings you need: Fruits and Veggies Matter
Guidance to help you choose the healthiest dishes at different types of restaurants.
So what is a healthy diet? In a nutshell (no pun intended), it includes lots of fresh fruits and vegetables, whole grains, nuts, and beans, as well as some calcium-rich dairy products and healthy protein such as poultry, fish, eggs, or tofu.
Tips for healthy eating
Add color. A vegetable’s color signals the vitamins and minerals it contains. To get a wide range of nutrients, try to eat lots of different colored vegetables daily. Salads are great for this of course, but you can toss some veggies into almost any dish, from scrambled eggs to pasta to meatloaf.
Separate your plate. Before you eat, mentally divide your plate into four equal parts. Then fill two with vegetables, use one for starchy foods (like potatoes, beans, rice or pasta), and one for a serving of lean meat, fish, or a meat substitute (such as eggs, cheese, or tofu). Just don’t use a big platter-size plate, or you may pile on too much food.
Know portion size. If you think a cereal bowl full of your favorite chocolate chip ice cream equals one serving, you may need some help estimating portion sizes (sorry). Here are some easy ways to measure single servings:
1 cup salad greens = a fist
½ cup cooked rice, pasta or potato = ½ baseball
3 oz. meat = deck of cards
3 oz. grilled/baked fish = checkbook
2 tablespoons peanut butter = ping pong ball
¼ cup nuts or raisins = an egg
1 teaspoon butter = a sugar cube
Eat your veggies first. If you’re absolutely starving at meal time, start with some vegetables or salad. This will ease your hunger and help keep you from overloading on meat or starchy foods.
Head off temptation. If the cookie jar is the first thing you see when you walk into your kitchen, you’re asking for trouble. Instead move the cookies, ice cream, chips, etc. where you can’t see them, like a high shelf or the back of the freezer.
Avoid processed foods. Stay away from foods that are highly processed and contain added sugars like corn syrup. Hint: Check the ingredients on the label. If there’s a long list of unidentifiable chemicals, don’t eat it.
Drink healthy, too. Want a beverage to go with your healthy meal? Choose water rather than soda or juice, which is high in calories and less nutritious than a piece of fruit.
More online resources:
Detailed nutrition guidance from the Harvard School of Public Health
Tips on how to add more fruits and vegetables to your daily diet, plus tools to help you calculate how many servings you need: Fruits and Veggies Matter
Guidance to help you choose the healthiest dishes at different types of restaurants.
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