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August
2011
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Group
Scoop
Health
Care
Starts
With
You.
We Can
Help.
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In This Issue
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Spotlight
On:
OncoSentrics
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Compliance
Corner:
HHS
Releases
Interim
Final
Rule
on
Women's
Preventive
Services
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New
Annual
Assessment
by
the
State
of
Maine
for
Childhood
Immunizations
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Medco/ESI
Merger
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Revised
Model
Notice
&
Guidance
on
Internal
Claims
&
External
Review
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Fees
(Taxes)
on
Self-Funded
Health
Plan
Sponsors
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HCC
Stop
Loss
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Our employees are why so many of you are comfortable doing business
with us.
Please join us in congratulating recent
employees who have been honored as Employee of the Month. |
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April 2011
Steve Rall
was our employee of the month for April. Many of you know Steve as your Financial
Funding Analyst. Steve has been in this position for nearly two years, and has
grown with Diversified for the past eleven years. Steve continues to show his strengths in the
financial area. His work ethic, time management, and organizational skills have
proven to be an essential part of his success.
May 2011
Kara Aiello was our employee of the month for
May. Kara continues to show leadership
and team work as our Prescription Administrator. You can depend on Kara's
knowledge to answer any of your questions, or guide you through some of the
tough drug related rules and regulations. Kara is diligent, resourceful, professional
and always willing to lend her expertise. Kara has just celebrated her eleven
year anniversary with Diversified.
June 2011
Laura Reska was our employee of the
month for June. Laura continues to be an instrumental part of working through
the Health Care Reform Act. With all the immediate and impending changes in the
health care industry, Laura maintains a positive attitude and is always willing
to lend her twenty-one years of knowledge to the various departments in need of
guidance. Laura is the ultimate team player and, with her positive attitude, is an
asset to her position as the Plan Document/Benefits Coordinator.
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ATTENTION:
MEDCO
CLIENTS
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Diversified has recently been
notified that Medco has announced a strategic combination with Express
Scripts. At this time, this merger will have no affect on Medco
members, and will likely take several months to complete.
We will continue to monitor this
merger and keep our Medco clients aware of any changes or updates as they
become known.
Click
here
to
read
Medco's
official
press
release.
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QUICK
TIP:
Trouble
printing
your
Group
Scoop?
Use
the
link
at
the
top
of
this
email
and
print
a
copy
from
your
web
browser!
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Summer 2011 has arrived!
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Everyone at DGB hopes you are enjoying your summer and will
take advantage of the nice weather, get your bodies moving, enjoy the outdoors
and your friends and family.
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Considering the whirlwind of change that has taken all aspects
of health care on a wild ride, we felt that the calmer (hopefully) days of
summer would be a good time to reflect back on all the positive and beneficial
reasons to self-insure your health and welfare plans. In times of great change, reacquainting ourselves
with the basics can have a settling effect. Read More....
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Welcome
New Clients!
Crowley
Transportation,
Inc. / Lyon &
Billiard / MASS Mentoring
Partnership, Inc.
/ Polamer Precision,
Inc. /The Pension
Service, Inc.
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Spotlight
On: OncoSentrics
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Biologics first introduced OncoSentrics
in 2005
and has
already
received
accolades
from payors
for its
focus on
evidence-based
guidelines
and integrated
clinical
care teams
which have
resulted
in an average
$8 net return
on investment.
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OncoSentrics was developed
with the understanding
that cancer is not one
disease with one clear
course of treatment.
There are more than
300 distinct types of
cancer, varying stages
of disease progression
and more new cancer
medicines than ever
emerging from manufacturers'
pipelines. And the world
of cancer is constantly
changing.
Along with positive developments
such as earlier diagnosis,
new promising treatments
and longer term survival,
come higher costs. Although,
on average, plans have
a 1% incidence rate
for cancer diagnosis
among enrollees, costs make
up about 15% of a plan's
overall healthcare costs.
Without a cancer management
strategy, cancer treatment
costs are projected
to escalate at a rate
of 233% in just four
years.
Biologics' singular focus on
cancer, strong longstanding
relationships within
the provider community
and determination to
ease each patient's
health, financial and
emotional burden has
translated into a robust
set of offerings designed
to most successfully
- and cost-effectively
- manage cancer.
The components of OncoSentrics
include: chemotherapy
plan of treatment review,
patient management,
claim review, provider
relations and performance
reporting - each
leveraging Biologics'
extensive oncology expertise
to respond to the growing
oncology services market,
as well as to the highly
individualized needs
of cancer patients.
NEWS FLASH! Biologics
Receives URAC Accreditation!
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| Contact
your Diversified Sales
Representative for more
information about OncoSentrics at
(888) 322-2524.
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Compliance
Corner: HHS Releases
Interim Final Rule on
Women's Preventive Services
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On August
1, 2011, Health and Human Services (HHS) released an interim final
rule adopting additional guidelines for women's preventive services, including
contraception, well-woman visits, support for breastfeeding equipment and
domestic violence screening. These items, explained more fully below,
must be covered by non-grandfathered plans and insurers without
cost-sharing in the first plan year that begins on or after August 1,
2012.
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HHS took
the recommendation of the Institute of Medicine (IOM) report issued on July 19,
2011 in developing their guidelines. PPACA specifically directed the
agencies to mandate the coverage of items and services recommended by certain
advisory bodies. Read More....
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| Please contact Dave Follansbee if you have any questions
at dfollansbee@diversifiedgb.com.
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NOTICE: New
Annual Assessment by
the State of Maine for
Childhood Immunizations
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The State of Maine
recently established a universal child immunization law. MRSA §1066 (the Maine
Universal Immunization Law) is intended to make vaccinations free
for all children residing in Maine.
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The program is to be funded through assessments to Insurers and Self-Insured
Plans that provide coverage to Maine
residents.
For the period July 1, 2011, through June 30, 2012, the
assessment will be $6.98 per month for each covered child life that
resides in Maine.
As your TPA, Diversified will be responsible for collecting and filing the
assessments for its self-funded employers on a Quarterly basis. The first
assessment will be for the period July 1, 2011, through September 30, 2011, and will
be added to your October bill. For more information on the web, visit http://www.mevaccine.org/
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| Please contact your Account Executive with any questions
regarding your bill
at (888) 322-2524.
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Revised
Model Notices
& Guidance
on Internal
Claims &
External Review
After the recent
Technical Release 2011-02, self-funded plans, insurers and payers will be able
to comply with PPACA's internal appeals and external review provisions within
the timelines provided. The new rules (released June 24 by the U.S. DOL,
Treasury and HHS) made significant changes to the claims appeal and review
obligations under the DOL rules released last year. Many of the changes and
amendments take effect as an interim final rule on July 23, 2011. Among the
changes, a transition period for enforcement of the External Review standards
will take place in January 2012 rather than July 1, 2011 as set out in previous
regulations. Read
More...
Fees
(Taxes) on Self-Funded
Health Plan
Sponsors
The
IRS released Notice 2011-35 on June 9, 2011, requesting comments on a provision
in PPACA that imposes fees on self-funded health plan sponsors and insurers to
fund comparative clinical effectiveness research relating to patient-centered
outcomes.
The notice invites comments on how the fees should be determined and
paid.
When are the fees effective? Read
More...
Diversified
now offers stop
loss coverage
through HCC Life
Insurance Company!
We are excited about working with HCC Life Insurance
Company, which has been one of the leading insurance carriers in the
self-funded industry for more than 30 years. HCC Life insures more than
3,200 self-funded plans which generates over $700 million in stop-loss
premium. HCC's continued analysis and research by their on-staff
actuaries enables HCC to accurately price products, leading to competitive
rates. They are A+ rated by A.M. Best Company and are a direct
writer, assuming 100% of the stop-loss risk which allows them to
quickly review and pay claims. Working with HCC will strengthen the
guarantee that Diversified will continue to offer your company
quality insurance products at a reasonable price.
Learn more about the Diversified family of
companies at dgb-online.com:
Diversified Group Brokerage
(DGB)
Diversified Administration
Corporation (DAC)
Corporate Managed Health
Services (CMHS)
Corporate Fitness & Health
(CF&H)
Questions? Comments? Feedback? Email Us: dgb.marketing@dgb-online.com
369 North Main Street
P.O. Box 299 Marlborough, CT 06447
Phone: (860) 295-0238
| Fax: (860) 295-6598
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