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Weed is legal. Should you disclose your use on a life insurance application?

We typically write 20-30 term life policies annually for business owners and other high-net worth individuals, often as part of a buy-sell agreement or key person policy for our small business clients. Our general agency partner gives us access to a medical underwriting director with 25 years of experience, enabling us to match the right carrier with our client-specific needs and health/family history.

One new wrinkle is the legalization of recreational marijuana in California in 2018. How does a life insurance company looks at marijuana use? Here are a few examples from our medical underwriter:

Ex 1: 39 year old male, admits to smoking an occasional marijuana cigarette once a month.  Urine specimen is negative for THC.  All other underwriting criteria are standard or better.  Case will likely be STANDARD (or better).

Ex 2: 28 year old male, does NOT admit to marijuana use on his application or insurance exam.  Urine specimen is positive for THC.  All other underwriting criteria are standard or better. Case will likely be RATED or DECLINED.

Ex 3: 54 year old male, history of chronic back pain controlled with medical marijuana obtained by prescription.  No physical limitations and employed full time.  No disability or extended time off from work.  No other underwriting concerns.  Case could be STANDARD or RATED.

(putting some jargon into understandable terms):

“Standard” = not great (3rd or 4th best risk class) = more expensive.

“Rated” = a LOT more expensive.

“Declined” = might get Standard or Rated sometime in the future, (but maybe not).

If you are thinking about taking advantage of one of California’s new “green businesses,” you may want to consider first locking in a 20- or 30-year term life policy. Once in place, you will then be truly free to choose whether to use.

Those wages your employees put into commuter benefits? No longer an employer deduction.

Wait, what? Yes, you have to read that carefully. Check out the complete explanation from our friends at WageWorks. This is a 2018 little-mentioned change as a result of the Tax Cuts and Job Act (HR 1).

The employee still receives an income tax deduction on the dollars they voluntary put aside for commute-related public transit and parking. And the employer does not have to pay FICA on those funds. But the employer cannot also deduct those same wage dollars as a normal business expense.

WageWorks offers a clear example and deeper explanation here.

Our take: offering pre-tax commuter benefits is still a great (and often required) part of any employer benefit package. But the change will disproportionately affect smaller businesses, that are less likely to reap the full benefits of other business tax cuts that were part of HR 1.

 

Accessing the BlueCard PPO network outside of California

For our clients who are covered on a small business PPO plan from Anthem Blue Cross or Blue Shield of California, your network of providers extends nationwide through the BlueCard program while traveling outside of CA – or if you are based in another state. This includes those enrolled with Anthem or Blue Shield via an exchange: CalChoice or Covered CA for Small Business.

To find coverage with out of state providers, go here from any web browser.

From the big blue box in the middle of the screen, select “In the United States, Puerto Rico, and US Virgin Islands” for your location.

Enter your location (city, state or zip) and plan:

enter location and plan

Under the “Your Plan” drop down menu, you can either enter the number from your medical ID card or you can “Select by Plan Name”:

BlueCard PPO popup

The plan name to choose from the list is BlueCard PPO Basic:

bluecard ppo basic

Feel free to reach out to us at Allpointe with any questions or if you would like any assistance. We are here to bridge the gap between you and the insurance company so please don’t hesitate to call or email us!

Sutter, Health Net agree on new contract; Blue Shield contract expires, negotiations continue

As the clock ticked down the last hours of 2016, Health Net and Sutter Health were able to come to agreement on an extension of their current contract, extending Sutter Health’s in-network status for most Health Net plans.

With the turn of the calendar to 2017, the contract between Sutter and Blue Shield of CA has expired, although the two health giants continue to negotiate. Full text of notifications from the carriers are posted below.

From Health Net senior account executive (12/30/2016):

Read More

Blue Shield of CA Switching to CVS for Pharmacy Management

Blue Shield recently notified policyholders of the upcoming change to their pharmacy network benefits. The details in full are outlined below. Please review, and contact Allpointe if you have questions about how this may affect your pharmacy coverage. The change will take effect January 1, 2017 regardless of when your plan renews.

 

Blue Shield has entered into an agreement with CVS Health to support manufacturer rebate and pharmacy network contracting for the outpatient pharmacy benefit, which has been approved by the Department of Managed Health Care.

CVS Health will manage Blue Shield’s national retail pharmacy network, and become our exclusive mail order pharmacy for Commercial and Medicare plans and our specialty pharmacy for Commercial plans, starting January 1, 2017.

This new agreement will enable us to leverage CVS Health’s purchasing power and reduce pharmacy costs. It will allow us to offer more competitive pharmacy products while continuing in our commitment to provide access and convenience for our members.

Who is affected?
The new pharmacy network changes will apply to all Blue Shield lines of business:

  • Commercial
    Premier, Core, Small Business, Individual and Family Plans (IFP) and Self-Funded/Administrative Services Only (ASO)
  • Medicare
    Individual and Group Medicare Advantage and Prescription Drug plans

Pharmacy network changes that will affect how our members access their benefits at the retail, mail order and specialty pharmacy will become effective January 1, 2017. Impacted members will be notified 60 days in advance of these changes by mail and telephone.

What are the pharmacy network changes?
There are three areas that will be affected by these changes. The member impact for most of these changes are relatively minimal and are as follows:

  • Retail pharmacy
    CVS Health will support Blue Shield’s retail network contracts. The Blue Shield network retail pharmacies will be nearly unchanged and will continue to include all key chains such as CVS, Walgreens, Rite-Aid, Costco and many others. The vast majority of our members will continue to have the same convenient access to network pharmacies near where they live and work. In fact, the network pharmacies with preferred cost-sharing will expand to include additional national retail pharmacies. Please refer to the 2017 Medicare Pharmacy Directories for more information.
  • Mail order pharmacy
    Blue Shield will transition from current mail order pharmacy, PrimeMail, to CVS Health mail order pharmacy.
  • Specialty pharmacy
    Currently, Blue Shield’s commercial specialty network includes two vendors, CVS/Caremark and Walgreens Specialty, with the majority of specialty prescriptions filled by CVS/Caremark. With the agreement, CVS/Caremark will become our exclusive specialty pharmacy for Commercial plans. Members shall continue to have the convenient access to pick up their specialty medications at a local retail CVS pharmacy. Medicare plans will continue to have an open specialty pharmacy network, which includes Walgreens Specialty and CVS/Caremark.

Transition plan
Blue Shield Pharmacy Services has been working with CVS Health to develop an implementation plan that ensures a smooth transition. As part of the plan, members who may be affected by these changes will be notified 60 days in advance of the January 1effective date.

  • For retail
    Letters will be sent to impacted members, which will provide information on up to four network pharmacies (two based on the member’s address on file and two based on the terming pharmacies address).
  • For specialty and mail order
    Letters will be sent to impacted members. Members will also receive CVS Health Welcome Kits.
  • Active specialty and mail order prescriptions
    For prescriptions that have active, remaining refills, Blue Shield will work with PrimeMail (mail order) and Walgreens Specialty (for specialty drugs) to transfer members’ remaining refill prescriptions to CVS/Caremark. Member payment information, such as credit card details, will not be transferred. Members will need to register with CVS/Caremark to provide this information. CVS will conduct a call campaign to these members to assist with registration.
  • Non-transferable drugs
    Some selected drugs are not eligible for transfer, such as Schedule 2 prescriptions. Since Federal law doesn’t allow refills for Schedule 2 prescription drugs, members using such drugs will have to visit their provider to get new prescriptions for each fill, even when using mail order.

Blue Shield of CA and Sutter Health: Negotiating a new contract

From Blue Shield today:

Blue Shield and Sutter Health are engaged in contract negotiations
Blue Shield of California and Sutter Health are engaged in discussions on rates and terms for a new network contract (HMO/PPO and in some cases, Group Medicare Advantage). The current contract is set to expire at the end of this year and without a new deal, Sutter Health would no longer be a Blue Shield in-network provider starting January 1, 2017.

We are working diligently in good faith to complete a new contract that is fair and sustainably affordable for our customers. If the network relationship terminates, Blue Shield will ensure that members have continued access to care in their area, including continuity of care for those who qualify to continue in their current course of treatment with a Sutter Health provider.

What are the lines of business affected by the negotiations?
The contracts being negotiated apply to all Blue Shield plan types, including HMO, PPO, EPO, POS-HMO Tier, POS-PPO Tier and Group Medicare Advantage.

  • Individual and Family Plans: Grandfathered and Non-Grandfathered Plans (on and off exchange)
  • Medicare: Group Medicare Advantage Prescription Drug (GMAPD) plans
  • Small Business (1-100 employees)
  • Fully Funded Large Employers (101+ employees)
  • Self-Funded/ASO Large Employers (101+ employees)
  • Self-Funded/Shared Advantage (101+ employees)
  • CalPERS
  • FEP
  • FEHBP

Sutter Health providers are located in Northern and Central California (see listing of counties below). In addition, Sutter Health has surgery centers in San Diego County.

Sutter Health Counties
Alameda Marin San Joaquin Santa Cruz Sutter
Amador Merced San Luis Obispo Shasta Yolo
Contra Costa Placer San Mateo Solano
Del Norte Sacramento Santa Barbara Sonoma
Lake San Francisco Santa Clara Stanislaus

The contracts currently being negotiated include the following Sutter Health hospitals:

  • Alta Bates Medical Center Herrick Campus
  • Alta Bates Summit Medical Center Alta Bates Campus
  • California Pacific Medical Center – California Campus*
  • California Pacific Medical Center – Pacific Campus*
  • California Pacific Medical Center – St Luke’s Campus*
  • California Pacific Medical Center Davies Campus*
  • Eden Medical Center
  • Memorial Hospital Medical Center
  • Memorial Hospital of Los Banos
  • Menlo Park Surgical Hospital
  • Mills Peninsula Health Center
  • Mills Peninsula Medical Center
  • Novato Community Hospital
  • Sutter Amador Hospital
  • Sutter Auburn Faith Hospital
  • Sutter Center for Psychiatry
  • Sutter Coast Hospital
  • Sutter Davis Hospital
  • Sutter Delta Medical Center
  • Sutter Lakeside Hospital
  • Sutter Maternity and Surgery Center of Santa Cruz
  • Sutter Medical Center of Santa Rosa
  • Sutter Medical Center, Sacramento
  • Sutter Roseville Medical Center
  • Sutter Solano Medical Center
  • Sutter Surgical Hospital North Valley
  • Sutter Tracy Community Hospital

    *Includes Medicare Advantage

In the event of a termination with Sutter and in accordance with DMHC regulations, Blue Shield of California would notify HMO members assigned to a Sutter Health Primary Care Provider (PCP) 60-days in advance of a potential termination with Sutter Health. PPO members with an out-of-network benefit could receive services from a Sutter-affiliated provider, but the out-of-pocket costs will be at the non-preferred benefit level.

Our commitment to affordably priced health coverage
Blue Shield continues its provider contract discussions with Sutter Health in hopes that new agreements will soon be reached. We appreciate your patience while we work to secure the best possible outcome for our customers and members. Our goal is to provide our members with access to quality health care at an affordable price.

Emergency services
Blue Shield of California members who need emergency services should call 911 or seek care at the nearest emergency room. Blue Shield will provide the full emergency care level of benefits for these services.

Oscar is coming to San Francisco

Oscar is coming in 2017. No, not that Oscar.

A new health insurance carrier will offer plans both on- and off-exchange, in San Francisco, San Mateo, and Santa Clara counties. A little surprising it took this long, considering they are Google-funded, and we’ve heard them described as “great software – with health insurance attached.”

It appears their Bay Area rates and network will be middle-of-the-pack (current word is no Sutter Health/PAMF, though that could change). Will their customer service and user experience be enough to consider Oscar as a viable choice? Stay tuned.

Reach for the stars: how to use online review sites to your advantage

The monetary impact of review sites like Yelp, Angie’s List, Google, Facebook and others can be a boon (or devastating) to both new and established businesses.

Seventy-two percent of users are willing to try a business with a 3-star rating, but only 27% of users would look at a business with a 2-star rating. Every increase in overall stars leads to a 5-9% jump in revenues.

How is this an HR issue? Reviewers share their opinions based on your product…and even more importantly, on their interaction with your team. Hiring, training, and retaining engaged employees is the key starting point to better reviews. Resolving a conflict with a customer is an opportunity to convert them into a fan for life.

To learn more, please join us for a free webinar with our partners at HR Answerlink on Wednesday, September 15th. Space is limited – click below to register today.

Allpointe-Yelp-Reviews

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