June Headlines

We need your information for Medicare Secondary Payer!
Members can now store information in Microsoft HealthVault
Oral oncology formulary change
CHIPRA signed into law
COBRA subsidy update: Look-back period passed by the State of Wisconsin
2010 HSA contribution amounts
Freedom group plan expands service area into Wisconsin

We need your information for Medicare Secondary Payer!

Time is running out for you to provide HealthPartners with critical information to comply with Medicare Secondary Payer Reporting requirements.

If you have already provided your information, thank you for your partnership. If not, please read on to see what’s due to HealthPartners by June 30, 2009.

HealthPartners will be contacting you via phone, e-mail or letter to obtain your group size and Federal Tax Identification Number if we do not currently have this information. You can also go to healthpartners.com/msp to provide this information. It will be used to properly identify you within the Federal Medicare system. We have a handy Frequently Asked Questions with information about these requirements to assist you.

If you have questions, please contact your HealthPartners Membership Accounting contact, sales executive or broker.

Members can now store information in Microsoft HealthVault

At the Microsoft Connected Health Conference, HealthPartners announced that members can now transfer information from their HealthPartners account directly to Microsoft HealthVault. Members will be able to permanently access their health information and share it free of charge, even if they change jobs, health plans or doctors.

Currently, about 1.2 million members have the ability to transfer information from their healthpartners.com account to HealthVault. Initially, members will be able to transfer their HealthPartners explanation of benefits. Later this year, 450,000 members will be able to transfer additional health-related information to their HealthVault account, including: benefits and copays, lab results, immunizations, allergy and medication lists, health and wellness information such as results from HealthPartners health assessments and other information stored in HealthPartners Clinics and Regions Hospital electronic medical records.

HealthVault is an open platform designed to put people in control of their health information. People can use HealthVault to store copies of their health records obtained from their providers, plans, pharmacies, government or employers; upload information from health and fitness devices; share information with healthcare providers and trainers; and access products and services.

This is an enhancement to HealthPartners strategy to give members easier access to information online. The goals of the new relationship with HealthVault are for members to experience a central place to store their health information, improved quality of care and reduced duplication. View the news release for more information about this online enhancement.

Oral oncology formulary change

Specialty pharmacy is a continued area of focus at HealthPartners. Currently, oral oncology (cancer) medications can be obtained by HealthPartners members at retail pharmacies, mail order pharmacies and/or specialty pharmacies. Beginning on September 1, 2009, we will classify 14 oral oncology medications as specialty medications and require that commercial members obtain their oral oncology medications through SpecialtyScripts^TM Pharmacy, our preferred specialty vendor.

There are two reasons we’re making this switch:

1. To improve member safety and experience

• Traditional cancer chemotherapies were intravenous infusions that were administered by healthcare professionals – resulting in a high level of patient adherence and safety monitoring. Many oncology medications are now available in oral versions that can be obtained at retail pharmacies and taken by patients at home. These oral oncology medications have significant toxic potential and are often used as part of complex treatment regimens. SpecialtyScripts^TM has an active and effective clinical management program for oral oncology medications, which includes patient education, monitoring of medication-related side effects and adherence support. Adherence is critical to the effectiveness of oral oncology chemotherapy. SpecialtyScripts^TM Pharmacy also provides 24/7 support and refill reminders.  This level of patient support and clinical expertise is essential to safety and the member experience.

2. To manage cost

• The monthly costs for oral oncology medications can be several thousand dollars - SpecialtyScripts^TM Pharmacy offers more aggressive pricing on oral oncology products and is experienced with complex coordination of benefits. Additionally, SpecialtyScripts^TM actively works with the manufacturers and third-party assistance programs, which can help to minimize any financial burden for members.

There are 14 oral oncology medications that will be designated specialty medications beginning on September 1, 2009: Gleevec, Nexavar, Revlimid, Sprycel, Stutent, Tarceva, Tasigna, Temodar, Thalomid, Tykerb, Vesanoid, Xeloda, Zolinza and Afinitor.

Across HealthPartners commercial population a total of 200 to 250 members will need to transfer their medication to SpecialtyScripts^TM Pharmacy. Those affected will be notified in the mail and SpecialtyScripts^TM Pharmacy will do outreach calls to help with the transition.

Beginning on January 1, 2010, members with a specialty pharmacy benefit will pay their specialty medication copay or coinsurance amount. We are allowing this grace period in order for members to reset their Flexible Spending Account (FSA) contribution, if applicable. They will be notified about this change in the initial letter and again in December 2009. Any new prescriptions after September 1, 2009 will follow the specialty medication benefits, if applicable.

Please contact your HealthPartners sales executive or your broker if you have any additional questions.

CHIPRA signed into law

In February 2009, President Obama signed the Children’s Health Insurance Program Reauthorization Act of 2009 into law. CHIPRA both funds and expands the State Children’s Health Insurance Program through 2013. The Act changed the name of the program from SCHIP to CHIP. Some provisions of this Act created new obligations for employers that apply regardless of the number of employees or whether the plan is fully or self-insured.

Life events
Effective, April 1, 2009, CHIPRA creates the opportunity for two new special enrollment rights or “life events” for eligible employees. Employers need to allow employees a special enrollment period when they or one of their dependents:

1. Become eligible for a state premium subsidy (if the state in which the employee resides offers a subsidy)
2. Lose eligibility for Medicaid or CHIP

The employee must request coverage within 60 days of the event.

HealthPartners is ready to administer these new life events. We will be updating self-insured plan documents effective July 1, 2009 as groups renew and fully insured plan documents on January 1, 2010 as groups renew.

Notification requirements
Employers must provide written notice to their employees regarding any available premium assistance opportunities offered by their state. The Department of Labor and the Department of Health and Human Services have until February 4, 2010 to provide employers a model notice that will satisfy this requirement. Employers have until the first plan year after the date the model notice is issued to distribute the notice to employees.  We expect to have clear information about which states adopted a premium subsidy program by the time the notification requirements take effect.

The Act offers employers several opportunities to distribute the notice:

1. Provide to employees when they first become eligible under the employer’s group health plan
2. During open enrollment
3. As part of the plan’s Summary Plan Description (SPD)

The Department of Labor may assess up to a $100 per day penalty against any employer who fails to meet the notification requirement.

Please note that this information is intended to provide a summary of select requirements under the Children’s Health Insurance Program Reauthorization Act of 2009. It is not intended to provide legal guidance or advice. If you need additional information, please speak with your legal counsel.

COBRA subsidy update: Look-back period passed by the State of Wisconsin

As covered in previous editions of Beyond Benefits, in February 2009 the American Recovery and Reinvestment Act of 2009 was signed into law by President Obama. This new law includes a 65 percent federal subsidy for COBRA premiums for up to nine months.

In May 2009 the State of Wisconsin passed the look-back period. This period applies to individuals who were involuntarily terminated by Wisconsin-based employers that are not subject to Federal COBRA law (generally those with fewer than 20 employees). The look-back period, also called the special election period, allows individuals who were involuntarily terminated and previously declined or dropped continuation coverage a new opportunity to elect coverage.

The rules for Wisconsin’s look-back period are slightly different than the State of Minnesota’s rules:

• If an individual is involuntarily terminated from September 1, 2008 to February 16, 2009, they have a new opportunity to elect continuation coverage with coverage and premiums beginning on March 1, 2009. (This is the same for the State of Minnesota and the State of Wisconsin.)
• If an individual is involuntarily terminated from February 17, 2009 to May 19, 2009 (the effective date of the law), they have a new opportunity to elect continuation coverage with coverage and premiums beginning on the date they became eligible for continuation coverage. (State of Wisconsin only.)

The Wisconsin-based employers impacted by this law are required to send a notice to eligible individuals. If we are notified by an involuntarily terminated employee that the employer failed to provide this notice, we will provide it on their behalf.

If you have additional questions, please visit www.dol.gov/COBRA or healthpartners.com/employer.

2010 HSA contribution amounts

If you offer your employees a health savings account (HSA), please take note of the 2010 annual minimum deductibles, maximum out-of-pocket expenditure limits and contribution limits. Also, please note that any employee on the plan who is age 55 or older may make an additional “catch-up” contribution of $1,000 in 2010.

As set by the Internal Revenue Service, the amounts for both 2009 and 2010 are shown below:

For more information, please visit http://www.treasury.gov/offices/public-affairs/hsa/.

Freedom group plan expands service area into Wisconsin

The service area for the HealthPartners Freedom group plan has been expanded to include eight counties in western Wisconsin. It now includes Barron, Burnett, Douglas, Dunn, Pierce, Polk, St. Croix and Washburn counties in Wisconsin.

Retirees living in those counties are now eligible for their employer’s Freedom plan and existing members can now move into the eight county area and maintain their current coverage.

HealthPartners offers group Freedom Medicare plans for employers based in Minnesota and these eight Wisconsin counties. To learn more, please contact your HealthPartners sales executive or your broker.