Author Archives: Reeve Conover

Big Plan mergers not done deal.

The chief executive officers of Aetna Inc. and Anthem Inc. are confident that their planned acquisitions of rivals Humana and Cigna, respectively, will go forward. Shareholders have approved the $54.2 billion and $47.5 billion transactions, and both are expected to close in the second half of the year.

Yet a closer look at how the Department of Justice is treating such megamergers suggests that the sailing may not be quite so smooth.

A recent report from law firm Gibson Dunn & Crutcher LLP reveals that antitrust enforcement is growing, with 2015 a “banner year for [Department of Justice] merger enforcement efforts.” In fact, antitrust enforcement agencies brought an average of 34 merger enforcement ations per year, increasing to 41 between 2010 and 2012.

Going forward, Gibson Dunn believes federal agencies will “continue to challenge transactions at a relatively high rate.”

While the Justice Department is still reviewing the Aetna-Humana and Anthem-Cigna mergers, it has set a precedent of objecting to high-profile merger proposals in other sectors. General Electric and AB Electrolux called off their deal in December, as did Tri-Union Seafoods and Bumble Bee Foods, after the Department objected to them on the basis of reduced competition.

For the full article click here.

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.

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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. - SIPC - Brokercheck