Category Archives: Uncategorized

Do you have missing participants in your 401K?

As employees terminate, they typically leave their balances with the prior employer.  In these cases, they are still participants – meaning you still pay to administer their account, and you have an obligation to communicate with them as much as any active employee.   This is not a problem, until you lose track of the ex-employee.  While it is not your Fault, it is still your responsibility under the law.

50% of Millenials in a recent survey learned of a retirement account with a previous employer they didn’t realize they had.

Enter the “Missing Participant IRA.”  The best solution is to get the ex-employee to take their balance with them when they leave.  Since that doesn’t always work, you need a mechanism to handle this.  With some of our clients we use a third-party outside service, but more and more high-end TPAs are providing this service automatically.

 

If you are concerned about COMPLIANCE in your 401k just give us a call.

CIGNA Opioid-related formulary changes

A communication is being sent to impacted Cigna clients in the next few days to announce updates on our July 2018 formulary changes.

Pharmacy costs are currently the number one driver of client expenses under both pharmacy and medical benefits.1 At the same time, opioid abuse continues to be a U.S. public health crisis according to the Department of Health and Human Services.2 To address these issues, Cigna’s formulary strategy will be updated to maintain high clinical value while continuing to use a low net drug cost approach to manage coverage for costly branded drugs. At the same time, we will build upon current steps to administer prescription drug coverage in a manner that promotes safe opioid use.

Effective July 2018* our formularies will be updated and Cigna will implement tighter utilization management around the use of opioids.

Customers (employees and dependents) affected by these changes (estimated to be less than 1% of customers3) will also receive a letter from Cigna in early April informing them of the change. Depending on the change, the letters contain steps to work with their doctor to find covered alternatives, prescribe lower quantity levels or apply for drug coverage approval through Cigna’s prior authorization process.

  • Click here to read a summary of Cigna’s July 2018 formulary changes.

Click the following links to view detailed (drug specific) changes for each of Cigna’s formularies. Clients will be sent the above summary and one of the flyers below based on their formulary:

There is still a penalty for not having insurance…

Just a reminder that, while recent legislation did eliminate the penalty, it does not take affect until 2019.

Employer penalties in 2018 are at elast $2320 after the first tirty employees.

The individual Penalty is

  • $695 for each adult and $347.50 for each child, up to $2,085 per family, or
  • 2.5% of family income above the federal tax filing threshold, which the Kaiser Foundation calculator estimates is $10,650 for an average single filer

or $21,300 for the average family who file jointly in 2018

Why LI Hospital Mergers make it harder…

A recent article in Newsday points out that there is only 1 independent hospital left on the island – Brookhaven Medical Center, now know as the Long Island Medical Center.

“Hospitals are combining nationwide. There were 78 hospital deals in the United States in 2017, in which 216 hospitals, with a total of 27,386 beds, were acquired, said Lisa Phillips, editor of HealthCareMandA.com, a publication that tracks health care mergers for health care consultant Irving Levin Associates in Norwalk, Connecticut…   In the New York metropolitan area, New Hyde Park-based Northwell Health, the most aggressive acquirer on Long Island, has expanded its network into Brooklyn, Westchester County and eastern Long Island by taking over hospitals. It has added four hospitals in the past 3 1⁄2 years.”

This has made it hard on patients – especially those on ObamaCare individual policies – to find insurance that covers their doctors.  Northwell does not have a relationship with Oscar Health Plans, the most affordable of the options.  Some hospitals simply refuse to accept the reimbursement rates of the individual plans as well.   NYU Hospitals don’t have relationships with Healthfirst either.  If you live in Nassau County, you are more or less forced into expensive options – Empire and Emblem.

I believe it likely that we will see some changes to this during the year, but only time will tell.  And any midyear changes don’t help you this year, since you cannot change until January 1…

Oxford Health Plans’ Cancer Support Program

Remind Oxford members to call the Cancer Support Program;
We’re here for them.

Dealing with a diagnosis of cancer can be overwhelming. It’s common to be faced with more questions than answers, and uncertainty about where to turn for help.

That’s why we offer the Cancer Support Program, a single source for Oxford members with cancer and their caregivers (physicians, family members, hospice, etc.) to get cancer information, support and guidance in navigating the health care system.

The attached flier offers more details about the Cancer Support Program. Please provide it to your Oxford clients so they can share it with their employees as a reminder of the program.

Members can opt-in.
The Cancer Support Program is available at no additional charge as part of Oxford members’ medical benefit plans. Participation is optional.

We may also identify members for the program through our internal processes and programs, such as provider notifications, and pharmacy and medical claims analysis, as well as through our nurse line (Oxford On-Call®) and Customer Service interactions. A member can also be referred to the program by his or her provider.

Compassionate care from an experienced team. 
Program nurses specializing in oncology serve as one contact for members in the program, helping them make more informed decisions about their cancer care. They can also offer information about oncology centers of excellence and specialists within the plan network. And our nurses are supported by an entire team of cancer specialists.

Through comprehensive case management services, members can receive one-on-one help with a range of cancer-related issues, while employers may save on cancer-related medical costs. Additional support from social workers offers members and their loved ones help with family, work, financial and other needs.

An integrative approach to close gaps in care. 
Members engaged in the program can get support from their experienced cancer nurse through education and proactive, targeted interventions addressing symptoms and side effects. Our dedicated nurses work to help members remain productive while focusing on getting and staying healthy.

More information.
For more information about the Cancer Support Program, please contact your Oxford representative.

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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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