Author Archives: Reeve Conover

Aetna Medicare gets new Pharmacy Benefits Manager

New Pharmacy Benefits Manager (PBM) for Coventry, Altius, HAPA and
First Health Part D members

In 2016, members of Coventry, Altius, HAPA and First Health Part D plans have a new Pharmacy Benefits Manager (PBM). A PBM manages their prescription drug benefits on behalf of our plan.

In 2015, the PBM was Express Scripts (ESI). In 2016, the PBM is CVSHealth. Because of this change, members may see or hear the CVSHealth name.

What you need to know

  • Members can use any 2016 network pharmacy to get their prescription drugs. Even though CVSHealth is now the PBM, they don’t have to use a CVS pharmacy to fill prescriptions. 
  • If members get mail-order drugs today, they may need to call us to keep getting them. To be sure, members should call Member Services.
  • Members received a letter about these changes in the 4th quarter. If they have any questions, they can call Member Services at the number on their ID card.

Can you require medical exams to participate?

From the National Law Review:

“Flambeau Wellness Program Testing Falls Within ADA Safe Harbor

On December 30, 2015, a federal judge in the Western District of Wisconsin ruled in favor of Flambeau, Inc. (Flambeau) and against the Equal Employment Opportunity Commission (EEOC) in holding that Flambeau’s medical exams as part of its wellness program and self-insured medical plan did not violate the Americans with Disabilities Act (ADA).”

This company required employees to take a health risk assessment and a biometric test (routine exam, height/weight, blood pressure, and bloodwork) if the employees wanted to participate in the companies medical plan.  All data was aggregated (except the smoker status) so that the employer was not aware of any one persons issues.  The information was used for setting costs and plan design in their self-insured plan.

1095 form filing deadline extended.

In a surprise announcement yesterday the IRS released the attached notice delaying a deadline for ACA reporting by almost two months.  The deadline for forms 1095-B and 1095C is as follows:

  • Form 1095-C – from employer to employees – original deadline was 2/1/16, was extended to 3/31/16
  • Form 1094-C and 1095-C IRS filing by the employer (paper) original deadline was 2/29/16, was extended to 5/31/16
  • Form 1094-C and 1095-C IRS filing by employer (electronically) original deadline was 3/31/16, was extended to 6/30/16

Employers may still file the returns by the original dates if they are ready.

Please note the delay is specific to forms relating to the 2015 calendar year that will  be filed in 2016 (and presumably the previous deadline will go back into effect starting in 2017).  The original deadline for furnishing the Form 1095-B/C coincided with the deadline for furnishing the W2 to employees and was intended to aid taxpayers in filing their tax returns.  The IRS has acknowledged that the extension could cause issues for some individuals who will not receive their 1095-C forms prior to submitting their tax returns.  The guidance issued states those individuals will not need to amend their tax returns and can rely on the information available to them at the time of filing.

NY Medicare Advantage plan closes

Effective Jan. 1, 2016, Touchstone Health HMO, Inc. in New York will no longer be offering coverage of Medicare Advantage benefits in the following service areas: Bronx, Queens, Kings, Richmond, New York, Westchester, and Orange counties. Approximately 10,000 Touchstone Health HMO enrollees have the opportunity to return to Original Medicare and could be in the market for a new Medicare Supplement  or Advantage plan. CMS requires MA organizations to send a letter of termination notifying affected customers when their plan will end.

If you know anyone that needs assistance just send them my way!

Changes to Medicare 2016

The headline this year may be that Medicare will pay for end-of-life counseling.  “So far, the 2016 change getting the most attention is that Medicare will pay clinicians to counsel patients about options for care at the end of life. The voluntary counseling would have been authorized earlier by President Barack Obama’s health care law but for the outcry fanned by former Republican vice presidential candidate Sarah Palin, who charged it would lead to “death panels.” Hastily dropped from the law, the personalized counseling has been rehabilitated through Medicare rules.”

However, cost-control efforts may be the more interesting piece – attempts to “fostering teamwork among clinicians, emphasizing timely preventive services and paying close attention to patients’ transitions between hospital and home.”  These changes focus on Accountable Care organizations (“ACO’s”) conceptually allowed under ObamaCare.  This year you will be able to pick your ACO, previously you could just opt out.

For the full article, click here.

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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