August 2011

Group Scoop

Health Care Starts With You. We Can Help.

In This Issue

Spotlight On: OncoSentrics

Compliance Corner: HHS Releases Interim Final Rule on Women's Preventive Services

New Annual Assessment by the State of Maine for Childhood Immunizations

Medco/ESI Merger

Revised Model Notice & Guidance on Internal Claims & External Review

Fees (Taxes) on Self-Funded Health Plan Sponsors

HCC Stop Loss

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.

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.


 

ATTENTION: MEDCO CLIENTS

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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Summer 2011 has arrived!

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.

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....


Welcome New Clients!

Crowley Transportation, Inc. / Lyon & Billiard / MASS Mentoring Partnership, Inc. / Polamer Precision, Inc. /The Pension Service, Inc.

Spotlight On: OncoSentrics

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.

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!

Contact your Diversified Sales Representative for more information about OncoSentrics at (888) 322-2524. 

Compliance Corner: HHS Releases Interim Final Rule on Women's Preventive Services

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. 

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....

Please contact Dave Follansbee if you have any questions at dfollansbee@diversifiedgb.com. 

NOTICE: New Annual Assessment by the State of Maine for Childhood Immunizations

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.

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/

Please contact your Account Executive with any questions regarding your bill at (888) 322-2524. 

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