BCBSNC Announces Mobile App for Members

Blue Cross and Blue Shield of North Carolina (BCBSNC) is proud to announce a convenient mobile app for members called HealthNAV. Visit http://www.bcbsnc.com/ today to learn more. The unexpected does not alway happen when a computer is available, however your smartphone is most likely always with you. BCBSNC understands that having your health insurance information at hand no matter where you are is important, especially when health care decisions need to be made quickly.
With the HealthNAV app, members can:

• View benefits and claims
• Verify coverage
• Find a doctor, including the nearest urgent care center
• Compare costs for prescription drugs
• Access health care cost estimates

This exciting addition to the many services BCBSNC provides to their members will be a great convenience. For full access to "My Member Services" please visit My Member Services & register today. 

Surviving the Summer Heat

Summer heat can be more than uncomfortable- it can be a threat to your health, especially for older adults and children. Whatever your age, don't let the summer heat get the best of you.

Heat Exhaustion
Heat exhaustion occurs when a person cannot sweat enough to cool the body, usually the result of not drinking enough fluids during the hot weather. It generally develops when a person is playing, working, or exercising outside in extreme heat. Symptoms include:

• Dizziness, weakness, nausea, headache, and vomiting
• Blurry vision
• Body temperature rising to 101 degrees Farenheit
• Sweaty skin
• Feeling hot and thirsty
• Difficulty speaking

A person suffering from heat exhaustion must move to a cool place and drink plenty of water.

Heat Stroke
Heat Stroke is the result of untreated heat exhaustion. Symptoms include:

• Sweating
• Unawareness of heat and thirst
• Body temperature rising rapidly to above 101 degrees Farenheit
• Confusion or delirium
• Loss of consciousness or seizure

Heat stroke is a serious medical emergency that must be treated quickly by a trained professional. Until help arrives, cool the person down by placing ice on their neck. If the person is awake and able to swallow, give him or her fluids.

Tips for Staying Cool

• Drink plenty of water. In hot weather, drink enough to quench your thirst. The average adult needs eight 8-ounce glasses of water a day- more during heat spells.
• Dress for the weather. When outside, wear lightweight clothing made of natural fabrics and a well-ventilated hat.
• Stay inside if possible. Do errands and outside chores early or late in the day.
• Eat light. Replace heavy or hot meals with lighter, refreshing foods.
• Think cool! Take a cool shower or apply a cold compress to your pulse points. Or, try spending time indoors at an air-conditioned mall or movie theater.

DID YOU KNOW?
Staying well hydrated is one of the most important things you can do to beat the heat. Feeling thirsty means that your body is on the road to becoming dehydrated- so don't wait to drink until you are thirsty, especially if working or exercising outside in extreme heat.

Supreme Court's Decision on Health Care Reform Law

Supreme Court Upholds Health Care Reform Law

On June 28, 2012, the last day of its current term, the U.S. Supreme Court announced its decision on the constitutionality of the health care reform law. The Court essentially upheld the entire law, holding that Congress acted within its constitutional authority when enacting the individual mandate. This means that the health care reform law will continue to be implemented as planned and provisions that are already effective will continue. 

BACKGROUND

The health care reform law, commonly referred to as the Affordable Care Act, was enacted in 2010. Opponents of the law quickly started filing legal challenges to its validity. Most of the legal challenges focused on the constitutionality of the law’s individual mandate—the requirement that individuals purchase health insurance coverage or pay a penalty beginning in 2014.

The U.S. Courts of Appeals split in their decisions regarding the law’s constitutionality. To resolve this uncertainty, the U.S. Supreme Court reviewed the health care reform law in March 2012. The Court heard six hours of oral argument on the case, which is an extraordinary amount of time for oral argument. Most modern court cases only receive one hour of oral argument so this was indicative of the importance of the health care reform law challenges.

Challenges to the Individual Mandate

The main substantive challenge to the health care reform law was whether Congress had the authority under the U.S. Constitution’s Commerce Clause to require individuals to purchase health insurance coverage. The Commerce Clause gives Congress the power to regulate multi-state, economic activity. Most of the arguments centered on whether enacting the mandate fell within the Congressional power to regulate interstate commerce.

Opponents of the health care reform law argued that the Commerce Clause does not give Congress the power to regulate economic inactivity (that is, the decision not to purchase health insurance). They noted that Congress’ Commerce Clause power has never before been extended to this degree, and argued that this would open the door for the federal government to have unrestricted power to regulate.

The Obama Administration, however, stated that the law was an attempt by Congress to address the problems of access and affordability in the national health care market. The Administration pointed to the health care costs associated with the uninsured to demonstrate the economic effect of not purchasing health coverage, and argued that the law expands access to health care by making affordable health insurance more widely available.

Opponents of the law also argued that without the individual mandate, the law could not function as intended and would have to be struck down in its entirety. The Obama Administration argued that,  in the event the individual mandate was ruled unconstitutional, only certain provisions of the law—those related to guaranteed issue and underwriting restrictions—would also be invalid. Thus, these parts of the law could be severed and all other provisions could stand.

the court’s decision

The Supreme Court ultimately ruled that Congress acted within its constitutional authority when enacting the individual mandate. In its ruling, the Court first concluded that the Commerce Clause did not give Congress the power to pass the individual mandate. The Court concluded that Congress has the authority to regulate interstate commerce, but does not have the authority to compel it. The Court stated that “construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority.”

However, the Court held that Congress had the power to enact the mandate under its authority to impose taxes. The majority of the Court agreed that the individual mandate’s penalty is essentially a tax that Congress can impose using its taxing authority. The Court held that “our precedent demonstrates that Congress had the power to impose the exaction in [the individual mandate] under the taxing power, and that [the individual mandate] need not be read to do more than impose a tax. That is sufficient to sustain it.”

Because the Court upheld the individual mandate, it did not need to decide whether other provisions of the health care reform law were constitutional. One exception to this is a provision that required states to comply with the health care reform law’s new Medicaid eligibility requirements or risk losing their federal funding. The constitutionality of this provision was also before the Court. On that issue, the Court ruled that the provision is constitutional, but that Congress cannot penalize states that decide not to participate in the law’s Medicaid expansion by taking away their existing Medicaid funding.

Future Implications

Because the individual mandate was upheld, all aspects of the health care reform law that have been implemented will remain in effect. Additionally, the remaining provisions of the health care reform law that are not currently in effect will continue to be implemented as planned. Most notably, beginning in 2014, all individuals will generally be required to purchase health insurance or pay a penalty.

Many of the health care reform law’s provisions require agency guidance to be implemented. The Departments of Labor (DOL), Health and Human Services (HHS) and Treasury have been regularly issuing guidance to implement the health care reforms. These agencies will continue to promulgate regulations relating to the health care reform law, and employers and health plans will be required to comply with these to the same extent that they are required to comply with the various provisions of the health care reform law.

Although the Supreme Court held that the individual mandate is constitutional, opponents of the health care reform law may challenge other provisions using various legal arguments. If any further challenges arise, courts will address these accordingly.

Additionally, members of Congress have already introduced new legislation to amend or repeal various parts of the health care reform law, and likely will continue with this strategy. Each of these possibilities may have an impact on the health care reform law and its requirements in the future.

Additional Resources

A copy of the Supreme Court’s decision is available at: www.supremecourt.gov/.

Reduce your Prescription Costs- Be a Wise Healthcare Consumer

You can drastically cut prescription costs by becoming an informed consumer and using the same buying techniques that you use when shopping for other goods and services. As more individuals comparison shop for drugs, more retailers will compete to win their business, which will drive prices lower. These strategies can help you become a savvy prescription drug consumer.

Price comparisons. Drug prices are not uniform; you can save a considerable amount of money by shopping around. It pays to call several pharmacies in your area to inquire about the cost of your medications.

Samples. Drug companies give thousands of samples to doctors every year. Your doctor may be able to provide you with weeks’ worth of the medication at no charge.

Drug substitution. When your doctor prescribes a drug, ask if a cheaper alternative is available.

Generic medications. Generic medications work as well as brand name drugs and can cost 20 to 80 percent less. This applies for both prescriptions and OTC drugs.

Over-the-counter drugs (OTC). Ask your doctor if an OTC drug will work just as well as a prescription drug. Today there are hundreds of OTC drugs that were previously only available by prescription.

Bulk buying. As you may know from your everyday shopping, it’s cheaper to buy in bulk. The same is true for drugs. Buying larger quantities at a time generally reduces the per dose cost of drugs. This is especially true for generics purchased by mail.

Pill-splitting. Many prescription drugs are available at increased dosages for similar costs as smaller dosages. Prescribing half as many higher-strength pills and having the patient split them to achieve the desired dosage can reduce the cost of some medications as much as 50 percent. However, pill splitting is not safe for all medications. If a pill is FDA-approved for pill splitting, it will say so on the label or informational insert that comes with the prescription. The FDA recommends pills only be split if FDA-approved and after consulting with your doctor to ensure it is safe.

Pharmaceutical company assistance programs/state drug assistance. Many drug companies and states offer drug assistance programs for the elderly, low-income and /or people with disabilities.

Discount prescription cards. Look into a discount card, either through a drugstore chain or a national plan. They can provide additional discounts on your prescriptions for a small monthly or annual fee.

*Stay on your meds. If you take medication regularly, don’t skip doses or go off your meds to save money. Sticking to your medication schedule will help you avoid health complications that will cost more money in the future.

This article is provided by Marc Jessup Insurance. It is to be used for informational purposes only and is not intended to replace the advice of a medical professional. Visit us at http://www.marcjessupinsurance.com/index.html. © 2010-2011 Zywave, Inc. All rights reserved.

ARE YOU HAVING DIFFICULTY OBTAINING HEALTH INSURANCE DUE TO PRE-EXISTING MEDICAL CONDITIONS?

Do you have a pre-existing medical condition and have been quoted an enormous rate for individual coverage?  Or maybe even told that you are medically ineligible for health insurance?  We have important information to share with you!

The North Carolina General Assembly established the North Carolina Health Insurance Risk Pool (NCHIRP) in 2007. Today NCHIRP operates as Inclusive Health providing affordable, individual health insurance coverage to residents of North Carolina who do not have access to an employer health plan, have been declined by an individual carrier or face higher premiums due to a pre-existing medical condition. Inclusive Health also offers coverage to individuals who are eligible for, enrolled in or exhausting COBRA or state continuation coverage. Just like most traditional employer-sponsored health plans, Inclusive Health covers a broad range of services including preventive care, urgent care, outpatient services, a prescription drug benefit and other common health care services. Inclusive Health offers several plan options, so you can choose the plan that best meets your individual medical and financial needs.

You may visit www.inclusivehealth.org for plan details and the eligibility requirements. For agent assistance, please contact us at www.marcjessupinsurance.com or 252-638-9000.

Benefits Satisfaction = Loyal Employees

Have you ever heard, “A happy employee is a productive employee?” This mantra holds true at all levels when it comes to the state of mind while at work. It is not only important to value & respect the time, efforts, and opinions of employees, but employers also need to provide a work environment that fosters growth for the team and the individuals. Not surprisingly, majority of workers put a benefits package at the top of the job requirement list, sometimes even above wages, and employers should take note. With the cost of healthcare continuing to rise and healthcare reform on the horizon, companies should take stock of what they offer & educate their employees on what is provided. What a disservice it is to pay for benefits & then not utilize them or even understand them! Satisfaction with benefits is directly related to employee loyalty and many workers would look for employment elsewhere if the opportunity arose for improved conditions. How can you accomplish this? 1) Take advantage of open enrollment; schedule individual meetings with each employee to review benefit options. 2) Set up a timeline for announcing various programs the insurance carrier offers, from online maintenance, wellness programs, cost estimators, etc. These can be discussed at a monthly or quarterly meeting or given to employees via memo or email. Employers can even set up a monthly email campaign to address these benefit features. 3) Engage your employees in the control of their healthcare costs. Remind them that they can do things such as ask for generic medications when available versus brand drugs. You can also initiate a wellness incentive program for improving the health of your workers. Many employers offer gift cards or additional paid time off for participation in programs for exercise, smoking cessation, or control of a chronic health condition. These are intended to be an open invitation for employees with rewards for participation, not punishment for rejecting participation.

As your insurance agent, we encourage you to contact us to see what resources for wellness your plan offers. Happier/healthier Employees = Loyal Employees = Better Workplace. What’s not to like about that equation?

Online Resources- Healthcare Reform

We would like to share with you some of the most interesting & helpful links we have found regarding healthcare reform. With an overwhelming amount of information available to us online these days, it's difficult to filter out the unnecessary information that complicates an already intricate topic. We hope you take the time to review these links & find them helpful to your understanding of the importance of insurance for you & your family.

These two are from the Kaiser Foundation's website which is a valuable resource for us.

http://healthreform.kff.org/timeline.aspx?source=QL

http://healthreform.kff.org/the-animation.aspx

The following we recently heard about & found them to be very interesting.

http://video.pbs.org/video/2198039605/

http://globalpublicsquare.blogs.cnn.com/2012/03/17/zakaria-how-to-fix-u-s-health-care/

BCBSNC- COBRA Changes Effective May 1, 2012

As of May 11, 2012 BCBSNC’s contract with Ceridian to administer Federal COBRA services will end and BCBSNC will begin to handle this internally for all groups by May 1, 2012. Currently with Ceridian, group administrators are required to notify them when a member loses coverage & Ceridian in turn sends a packet to the member notifying them of their COBRA rights. If the member elects COBRA coverage, they are billed by Ceridian, the group administrator must notify BCBSNC to get the member back on the group bill, & Ceridian reimburses the group for the member’s premium. In addition the group administrator initially needs to notify BCBSNC of the termination for the member so they are taken off of the bill as an active employee & if they elect COBRA they are put back on in a two step process. This creates a lot of extra work for the group administrator, who already more than likely handles multiple duties.

Hopefully with this change it will be much simpler for groups, members, & the carrier. Beginning in May, the process will go like this: member loses coverage, group notifies BCBSNC to remove member from active coverage on group, BCBSNC sends packet to member, if member elects they get billed by BCBSNC. The most important advantage for groups with this change is that they will no longer have to front the premium for the COBRA member on their group invoice & wait for reimbursement from Ceridian. BCBSNC will be billing the COBRA member directly, therefore taking the group out of the equation. This will happen at no cost for the groups. BCBSNC will bill the 2% admin fee to the COBRA member, just as Ceridian does. BCBSNC will be notifying current COBRA members with Ceridian of the change as well as mailing COBRA groups a list of their participants to make sure all is accurate. Existing COBRA members appearing on a group’s invoice will disappear once BCBSNC begins billing the member directly. For questions on this process, contact your BCBSNC agent or the BCBSNC COBRA service number at 1-888-694-7860.

COBRA & NC State Continuation

COBRA and North Carolina State Continuation

What is it?          

When a member of a group insurance plan loses coverage, they are offered the opportunity to remain covered by that plan for a designated amount of time, 18-36 months depending on the reason for losing coverage, as long as they pay the full monthly premium amount. Reasons for losing coverage include: resignation, termination for reasons other than gross misconduct, lay-off, or reduction of hours to part-time. A family member covered on an employee’s group can also be eligible to continue if they lose coverage due to divorce or a child aging out of being an eligible dependent, or when they lose coverage if the employee’s eligibility ends for one of the reasons above.

How does it work?         

Once the coverage ends, the member(s) will receive a packet of information, either from the group employer directly or a designated company which administers the continuation benefits, notifying the person of their continuation rights & member has a certain number of days to elect continuation.

Federal COBRA guidelines can be viewed here.

North Carolina State Continuation guidelines can be viewed here.

The Basics of a Health Insurance Plan

Useful definitions:

Coinsurance- percentage divided between patient and insurance company to pay a remaining claim after the deductible is met. The insurance company will pay a certain percentage, 60% for example, leaving the remaining 40% to the responsibility of the member. There are coinsurance maximum amounts designated by each plan that will limit the out of pocket cost for a member in a benefit year. This amount is usually several thousand dollars and when the maximum is reached the member’s responsibility is complete and the insurance carrier would then pay for 100% of the remaining cost for deductible/coinsurance related claims for that benefit year.

Copay- amount you pay at an office visit, primary or specialist. The primary copay can range from $5 to $50. The specialist copay is usually twice the primary amount. Plans also have copays for prescriptions and these amounts are determined by what type of drug you are taking: generic, brand name, or specialty medication. Generics are known to be a much more affordable option for patients when available compared to brand name drugs.

Deductible- amount of money, usually ranging from $250 to $10,000 (though most are between $1,000 and $5,000) that would be applicable for any major service such as surgery, hospital stay, outpatient procedures, etcetera as designated by your plan.

EOB (explanation of benefits)- statement member receives from carrier for each processed claim providing information about how the claim was paid and what amount, if any, is due from member to provider.

Open enrollment- designated period of time that a member has to make plan changes for the following benefit year without penalty or requiring a qualifying event.

Premium-  cost of the insurance plan which member must pay to carrier to keep policy in place.

Preventive Care- services considered to be critical to the monitoring of general health or prevention of diseases for all members. Most plans will pay for these services in full with no cost to the member as an incentive to promote preventive care and awareness of general health. This is an opportunity to see your primary care physician once a year to have a physical and check blood pressure and cholesterol, etc. Similarly, dental plans cover a preventive exam and cleaning with your dentist once every six months.

Types of health plans:

PPO- this is the “traditional” plan most people are used to. It has coverage for in and out of network, though out-of-network coverage is less, and also copays for doctor visits and prescriptions. There is also a deductible & coinsurance percentage for major claims.

HDHP/HSA- gaining popularity, this type of plan has 2 key parts. The high deductible health plan (HDHP) at the insurance carrier & a health savings account (HSA) at the bank of the member’s choice. Together, these two components give the member tax benefits & very good coverage after the deductible is met. Preventive is free, but all other services including prescriptions are paid by the member to accumulate the deductible amount. Once the deductible is reached, the health plan pays the coinsurance percentage. It is usually recommended that the member have a plan that pays 100% after deductible, which ensures the member’s cost is better controlled each benefit year. Think of the HSA as a tax sheltered money market account that can be used for medical purposes. It can be used to reach the deductible, pay for qualified medical expenses for family members (even those not on the member’s health plan), dental expenses, and prescription glasses/contacts/sunglasses. A complete list of qualified medical expenses can be found at the IRS website as they designate the rules of this type of account. They also establish deposit limits for the account each calendar year.

HRA- a Health Reimbursement Account is an option for employer’s when offering group benefits to their employees. Essentially, it is an account set up to pay the members back if they incur a certain amount of medical costs that are deductible/coinsurance based. For example, if a group plan previously had a $1,000 deductible and then changes to a $2,500 deductible. The employer can set up the HRA to pay members back if they incur a deductible charge over $1,000. The theory behind this type of plan is that most members do not meet the deductible and therefore an employer can obtain a full year of lower premiums by having a higher deductible plan.

Welcome

Welcome to the Marc Jessup Insurance blog! We have served Eastern North Carolina for twenty-five years by providing health, dental, life, short and long-term disability, and long-term care insurance to individuals and employers. The price tag on employee benefit packages continues to increase each year. Equally on the rise is the desire of employees to obtain the most worth from those benefits. Most companies make great efforts to provide those values, but may have limits due to the demanding nature of their business. We aim to provide ways to accomplish benefits’ objectives for our groups. Our expertise has earned the trust of many clients through the years and our staff of professionals create personalized benefit packages that meet the needs of your company and workers. We stay informed on developments with continuing education, cutting edge resources, including Zywave technology, and a vast community of insurance resources.

Our intent for these blog entries will be to provide up-to-date, valuable information on the insurance industry, primarily with regards to healthcare reform. By using this advanced technology in today’s modern market, we can deliver the information you need to know in a fast, efficient method. We will be a trusted source of simple, unbiased information. As we all navigate through the complex world of healthcare reform in the years to come, we will make announcements to keep you informed on how each piece of new legislation could impact you & your family. In addition, we will be providing general information as related to healthcare, insurance, and developing and maintaining a healthy lifestyle in hopes of not just improving your knowledge of the insurance realm, but also your health in general which has a direct impact on your medical costs. All of these value-added services we provide intend to improve employee satisfaction, reduce consumer costs, increase efficiency, and improve the quality of care with the overall goal of capitalizing on your benefits.