june 2015 what happens decline your...
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June 2015
THE AFFORDABLE CARE ACT:
What happens when employees decline your coverage PAGE 5 >
BUSINESS OF BENEFITS: WORKPLACE WELLNESS PAGE 8 >
My Healthy Business
NEWS
Featured Articles
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A new look and shorter, customized content in our next newsletterHave you noticed? We’re rolling out some
exciting changes to My Healthy Business
News in 2015. We’ve already moved from
a quarterly to a bi-monthly schedule this
year, and our newsletter will look different
the next time you get it. Starting with our
August issue, this publication will be known
as MyEmpire News and we’re launching a
new digital enewsletter design that’s easier
to read and navigate. With the new design,
you’ll get a better, broader experience. Best of
all, you can read it anywhere on your mobile
devices, like tablets or smartphones! And you
can share and interact with stories through
social media.
Shorter, easy-to-scan articles will feature
images and videos. With a focus on top-of-
mind topics like cost of care, health care
reform, and health and wellness, our new
enewsletter will have content customized to
your group size. With a simple click or tap,
you’ll be able to share articles easily with your
employees. And all articles will be archived
for later reference, if you need them.
Stay tuned for our new enewsletter MyEmpire
News, coming in August to your inbox!
To access an archived issue from earlier
this year, please contact your Empire sales
representative.
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Also in this issue of My Healthy Business News:FEATURED ARTICLES:
5 > The Affordable Care Act: What happens when employees decline your coverage
7 > Introducing Empire Whole Health Connection
8 > Business of Benefits: Workplace wellness
10 > Health care coverage shopping tips for your employees
12 > Looking for free and easy-to-use wellness resources? Check out Time Well Spent!
15 > Your employees may get a confidential call from us
NEW YORK NEWS:
16 > Coming soon for groups with 100+ employees: a faster, more personalized reporting tool
17 > New amendments to the New York Insurance Law
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.
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Featured Articles
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THE AFFORDABLE CARE ACT:
What happens when employees decline your coverageBeginning in 2016, employers who have 50 or more full-time or full-time-equivalent employees are required to
offer health insurance to these employees under the Affordable Care Act. Employees, however, do not have to
accept the insurance, and inevitably, some will turn it down. The consequences for a business if an employee
declines the employer-sponsored coverage depend on the nature of the health insurance offered and what
employees do instead.
Plan coverage requirements
The Affordable Care Act requires health plans to cover at least 60 percent of the cost of services on average in
order to qualify as minimum coverage (also known as the Bronze plan), according to Kaiser Family Foundation.
In addition, coverage needs to be affordable, meaning that employee contributions are limited to 9.5 percent or
less of household income, and plans must be offered to at least 95 percent of full-time employees.
What situations do not trigger penalties?
Regardless of your plan type, some scenarios will never trigger penalties. If you have employees who join their
spouses’ plans, you will not be penalized.
What causes a company to incur a penalty?
The real difficulties arise if your company doesn’t offer minimum essential coverage and full-time employees
end up qualifying for government subsidies when seeking coverage at federal or state health insurance
marketplaces (sometimes called “exchanges”). Starting in 2016, businesses with at least 50 full-time employees
will be subject to penalties if even one of their employees receives a subsidy, according to the IRS.
Employers that offer high-quality, affordable coverage to essentially all of their full-time employees can be
confident that they will not face penalties, even if some employees decide not to participate in the plan.
Excerpted from an article by David E. Williams featured on our Making Health Care Reform Work blog.
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Featured Articles
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Introducing Empire Whole Health Connection Connected care means better care for you and your employees
Health care should serve the whole person – head to toe, at each stage of life.
With Empire Whole Health ConnectionSM, we’re connecting our health, pharmacy,
dental, vision, and our affiliate life and disability plans offered through Anthem
Life & Disability Insurance Company* – resulting in better health and a simplified
experience for you and your employees. Employees get complete care while you
enjoy the ease of working with one account team – meaning less administrative
hassle and less energy managing different plans.
Our health care plans work in tandem with patients and providers in a new way.
Through the portfolio, we get claims and clinical data from dentists, eye doctors,
primary care doctors and care coordinators. Then, we securely share relevant patient
information back to network providers through electronic health records, including
patient summaries, diagnoses, lab results and prescriptions. This shared data allows
us to create more complete member health profiles, which help identify gaps in care
and lead to the delivery of better, more informed care by providers.
Check out this new video and flier to learn more. And then start a conversation with
your Empire sales representative or visit empire.com/specialty.
* Life insurance benefits provided under Certificate Form Number LBO A NY 0105 C REV 0209. Disability insurance benefits provided under Certificate Form Number DLS A NY 1113 C. The expected benefit ratio for the Disability policies is 60% for groups of less than 50 lives, and 65% for groups of 50 or more lives. This ratio is the portion of future premiums which the company expects to return as benefits, when averaged over all people with this policy. This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services.
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Featured Articles
Business of Benefits: Workplace wellnessAre you thinking about starting a
wellness program for your office,
or are you looking for some advice
on how to make your current
program more effective? There
are three main steps to follow in
order to lay the groundwork. By
using these tips and tricks, you’ll
see your office transform into a
healthier environment. To gain
even more insight on optimizing
your wellness program, check out
#businessofbenefits on Twitter.
CLICK ANY OF THESE IMAGES FOR MORE INFORMATION
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Featured Articles
Health care coverage shopping tips for your employeesAmericans are natural shoppers. We
like to find the best deal on pretty
much everything we buy — except our
health care coverage. When it comes
to health care, people don’t really think
about looking for a good deal, and this
can be costly for your company and
your employees. To help keep costs
under control, there are a few effective
shopping tips that you can share with
employees.
Use online shopping tools. The Internet
has made finding deals on health care
coverage much easier. FAIR Health
and Healthcare Bluebook list the
average prices of medical services and
procedures. Whenever your employees
need treatment, recommend that they
double-check the price with these
websites to make sure they’re being
treated fairly.
Ask for lower-cost options. There are
ways to get the same quality health care
coverage at a lower cost.
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Stay in the network. Your health care plan
will have a network of qualified providers.
Most plans let your employees see out-of-
network providers, but the costs will be
higher.
Avoid unnecessary procedures. Doctors
may sometimes prescribe procedures
to avoid liability or to receive a fee —
not necessarily because it’s medically
necessary. In a poll of more than 50
medical societies, doctors said annual
Pap smears, regular PSA tests for prostate
cancer, regular EKGs for people with no
history of heart disease and MRIs for back
pain were some of the most unnecessary
procedures.
By following these shopping tips, you and
your employees will be able to put a dent
in your costs and leave more money in all
of your pockets.
Excerpted from an article by David Rodeck
featured on our Making Health Care
Reform Work blog.
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Looking for free and easy-to-use wellness resources? Check out Time Well Spent!When employees are healthy, they’re likely to
remain productive on the job and be less costly
than unhealthy employees.* That’s where Time
Well Spent comes in. This easy-to-use online
resource is designed to help you create or
improve your workplace wellness strategy. It’s
available free of charge and includes turnkey
wellness campaigns, health education resources
and more to help make planning your wellness
strategy simple.
Think of Time Well Spent as your own
health library
It gives you materials and toolkits to help educate
your employees on ways to improve their overall
health and well-being. When you visit the website,
you’ll find resources on a variety of health topics,
such as chronic conditions, nutrition and physical
activity, quitting smoking and more.
You can use them whenever and however they
work best for your organization. You can email
materials, print them out and leave them in
high traffic areas, or use them in employee
newsletters or mailings.
NEW! Create healthy eating habits with
our LunchWell campaign
LunchWell is a communications campaign to
help your employees create healthy eating habits
by making small changes in how they eat – and
think about – lunch. The materials are grouped by
topic and you’ll find a comprehensive employer
guide to make it simple for you to roll out this
campaign in your workplace.
See how Time Well Spent
can make a difference in
your workplace. Click for
more information.
Not sure where to start?
Check out this online tutorial.
In just five minutes, you can get
suggestions on ways to use the
Time Well Spent materials and
get pointed to resources that
could help.
* Centers for Disease Control and Prevention website: Workplace health programs can increase productivity (accessed April 2015): cdc.gov.workplacehealthpromotion/businesscase/benefits/productivity.html.
Featured Articles
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Featured Articles
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Your employees may get a confidential call from usWe care about your employees’ health and about helping them feel better.
Because we care, we may call them from time to time. For example, we
might reach out to help with things like:
~ Health issues that may include weight loss, tobacco cessation or
making healthier lifestyle choices
~ Preparing for surgery
~ Important health reminders, including appointments
~ No-cost health programs, like introducing a pregnant employee to
our maternity management program, which could help her have a
healthier pregnancy
The health and wellness programs we offer cost nothing extra, and when
we talk to your employees, we explain how they work with their health
plan. Our calls are always meant to be helpful and are always confidential.
We make sure of that by verifying the date of birth and address of the
person when we call.
Our phone calls make a big difference
About 92 percent of people who talked with our health and wellness team
members were satisfied with the support they received.* And, of course,
if your employees prefer not to get calls from us, they can contact our
Customer Service team to opt out.
* Internal study, 3-year comparison based on YTD Q2 2014 data.
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LARGE GROUPS
Coming soon for groups with 100+ employees: a faster, more personalized reporting toolAt Empire we want to make doing business with us as easy as possible. That’s why we’re
pleased to let you know enhanced Client Information Insights reporting tools are coming
soon. You’ll get insightful information – health care plan reports that make sense and are
easy to access. Your reports will help you make good decisions for your company.
With Client Information Insights, you’ll get:
~ Faster delivery. Get key reports up to two weeks earlier each month.
~ Online convenience. Get reports 24/7 – the information is there when and where you
need it.
~ Up to three years of trend data. See the big picture of what’s happening in health
care.
~ Reports that go as far back as 25 months. Easily view details from the past, to base
future decisions on historical data.
~ Easy-to-customize reports. Sort data by choosing from five high-cost claim
thresholds. Plus, most of our reports give you four ways to view time periods.
Watch for more details soon
We’ll help you take advantage of these new, easy-to-use tools. Your Empire account
representative will contact you soon to discuss Client Information Insights reporting
tools in more detail and show you how to access them online.
New York News
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New amendments to the New York Insurance LawHow a new law is helping your employees
deal with unexpected medical bills from out-
of-network providers
New amendments to the New York Insurance
Law went into effect April 1, 2015. They include
new consumer rights about “surprise bills” and
emergency services. The law also requires that
members get information about out-of-pocket
costs for out-of-network services.
The law gives members protection from
“surprise bills” they receive from non-
participating doctors and other providers like
labs. But not all bills from non-participating
providers are “surprise bills.” Check out some
examples of both.
Other provisions of the new law include new
rules for payment of emergency services
by non-participating doctors and new cost
disclosure requirements for providers and
insurance plans when going out-of-network.
New language will now appear on Explanation
of Benefits (EOBs), the notices and updates
section of empireblue.com, and certain pre-
certification and other utilization management
letters.
There are other elements to the new
amendments that went into effect on April 1.
More information is available through New
York’s Department of Financial Services.
Members should consult their plan’s Evidence
of Coverage document for complete coverage
details and conditions.