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Open Enrollment: Last Chance! PDF Print E-mail
Written by Ellen Breslow   
Sunday, 09 November 2014 00:00
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Do you automatically enroll in the same health insurance as you did last year? It looks the same— maybe a premium increase, but that is expected. What could really be that different? Perhaps a lot. Open enrollment is your chance to make changes in your plans as well as to educate yourself on the latest changes in health care plans. Consider some of these trends that you may encounter during this open enrollment season:


Continued adoption of high deductible health plans. These plans include the ability for an employee to establish a health savings accounts as well as pricing that puts the responsibility on employees to choose and pay for care. Many employers will contribute to a health savings account for employees who select these high deductible plans as a means to increase their appeal.

Financial Incentives for wellness. Many plans will now reward wellness initiatives and care that meets certain, specified requirements. Some example of these incentives include encouraging employees to use preventative care and participating in health management programs to achieve health improvement. These incentives can include a reduction in monthly premiums, among other benefits.

Formulary. Although there is a fair amount of media attention given to specialty drugs and their high costs to the consumer, few employees make a list of their family’s prescription drugs during open enrollment. This is particularly important where there are adult children who may not reside with parents but still have some prescription drug requirements. What is and isn’t on a formulary could have an impact on your plan selection.

Changes to eligibility. Some employers are excluding coverage for working spouses eligible for other plans, requiring that they enroll in their employer’s plan. In addition, there are some plans that are charging per-dependent rates!

Transparency. As consumer driven plans become more prevalent in the marketplace, the comparable cost of services is critical. If you are enrolling in a high deductible health plan, look for a transparency site. Many employers are offering a transparency tool for employees to be able to understand and compare the total cost of services before engaging a provider.


There is no right or wrong method to approach open enrollment. The best answer to open enrollment is to educate yourself about your health insurance benefits. They will, and do, change every year regardless of how it may appear. Pay attention!





For additional information, contact EAB HealthWorks.


Last Updated on Sunday, 09 November 2014 10:15
Your Health Insurance: Tierful Prescription Drug Coverage? PDF Print E-mail
Written by Ellen Breslow   
Sunday, 12 October 2014 00:00
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For most individuals, it’s open enrollment season. Bombarded with words like deductible, coinsurance and formulary, employees will be comparing their employer sponsored plan offering with an eye towards selecting an alternative, better coverage for 2015. An employer may only offer one plan; another employer several. One important component that is present in almost all employer plans is a prescription drug benefit and a tier formulary benefit.

Many employer sponsored plans have had a tier prescription drug program that includes three or more tiers. Generic drugs are usually in the lower tiers: often as little as $5 for a 30 day supply. Over time, plan participants have become more savvy when routine medications are available with a possible generic substitute.

Sadly, this doesn’t mean that a physician no longer will prescribe a brand name drug. In fact, new brand name drugs are regularly prescribed for diseases such as rheumatoid arthritis, multiple sclerosis and cancer. According to a May 2014 report from the IMS Institute for Healthcare Informatics, the average cost for brand name cancer drugs has doubled in the last decade to $10,000 for a month’s supply . In addition to brand names, specialty drugs are the fastest growing component of the prescription drug marketplace. And although your plan includes a prescription drug plan, these drugs may be found on the highest tier or on no tier at all.

Most participants must use a step therapy program before reaching the highest tier in a plan. Step therapy requires that patients first try medications that may be on a lower tier before moving to a specialty drug. With each tier comes a higher employee copayment or coinsurance. Ultimately, the drugs can become cost prohibitive for a participant.


It may be impossible to predict what drugs you or your family may need in 2015. However, if your employer offers a menu of health insurance plans, it does make sense to take an inventory of your family’s ongoing prescription medications. Each year, tiers are revised and your medications may move to a different tier. If your doctor is considering a particular medication, you may want to check the different plans’ tiers to see if it is covered.





For additional information, contact EAB HealthWorks.


Last Updated on Sunday, 09 November 2014 10:10
Coming Soon: HMO, PPO, EPO, POS and ACA PDF Print E-mail
Written by Ellen Breslow   
Wednesday, 03 September 2014 00:00
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In a few short weeks, October will be upon us and with it, the Open Enrollment season for employee benefits. In addition to the alphabet soup of health insurance coverage options, there are new provisions of the ACA to consider. Selecting a plan from these options has become increasingly difficult as the provisions seem to overlap.

Most employees expect that these plan abbreviations will signify the level of coverage, access to providers outside of a plan’s network, or cost sharing, among other provisions. Unfortunately, there are no industry wide definitions that correspond to these plan types and, as is the case with most health insurance plans, state standards can vary. Depending on the state and the carrier, some of these plans look alike. Generally:


Health maintenance organizations (HMOs) cover only care provided by the plan’s network of providers. Often an HMO will require that a participant get a referral from a primary care doctor in order to see a specialist.


Preferred provider organizations (PPOs) cover care provided both inside and outside the plan provider’s network. Participants typically pay a higher percentage of the cost for out-of-network care.


Exclusive provider organizations (EPOs) operate like HMOs. Most of the time, they don’t cover care outside of the provider network. Unlike HMOs, however, participants may not need a referral to see a specialist.


Point of Service (POS) can vary, but they are usually a hybrid HMO/PPO. Participants may need a referral to see a specialist, however, they may use out-of-network providers with higher cost sharing.


Although your health insurers may identify plans with these names in the plan summaries, it is critical that you compare the underlying provisions. If you are offered more than one PPO, the networks may be entirely different. The cost sharing may also be higher. It is also possible for an HMO to offer an out-of-network option which makes them look like PPOs. EPOs, although the name may indicate otherwise, most often don’t offer out-of-network benefits and can be confusing.


Before selecting a plan for 2015, consider the following:


Is there out of network coverage and what is the cost sharing arrangement?


Do participants need a referral to see a specialist?

Does out-of-network spending accrue toward the participant’s out-of-pocket maximum?

Also, note that employer sponsored plans (unless grandfathered) will begin to offer Essential Benefits which will include preventative services. Keep in mind that although these services are most often without cost sharing, providers will likely be limited.



Still unclear? Be sure to study plan coverage summaries carefully and ask questions.





For additional information, contact EAB HealthWorks.


Last Updated on Monday, 08 September 2014 12:18
Your Open Enrollment Shopping List PDF Print E-mail
Written by Ellen Breslow   
Sunday, 21 September 2014 00:00
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In a few short weeks, open enrollment will be upon us, and with it, an encyclopedia of information on 2015 employer sponsored benefit opportunities. Health care will occupy many pages of this vast document. Whether the volume of this information will make it easier to understand remains to be seen, but it is critical that you make a list of what to review for your and your family’s situation. It is unlikely that the health care offering will be exactly the same as 2014 so you should look carefully and not automatically assume that you elect the same health benefits as last year.

Assess your and your dependents needs. Review how much you’ve spent in the past year in out-of-pocket expenses, the cost of routine prescriptions and the number of doctor visits you and your family have had in the past year. Also evaluate any life decisions that may impact your choice of health insurance: did anyone develop a new medical condition? Thinking about adding to your family?


Research the provider network of available plans. There have been many changes in physician and hospital networks. Your health plan options may offer a vastly different provider combination than in the past. You should examine the cost impact and quality of different providers when selecting your new health plan.


Establish the best source of coverage for your dependents. If your spouse or adult children have access to health coverage elsewhere, it may be more cost effective for them to enroll in this coverage. Your student dependents can explore health insurance offered by a college or university to determine if enrolling in these plans is a viable and cost effective alternative.


Use health and wellness programs to your advantage. Many employers now offer a wide variety of health and wellness programs including health assessments, weight loss and health coaching programs. Employers often offer a financial incentive for your participation in these company sponsored wellness plans.


Does a CDHP makes sense for me? Consumer driven health plans are offered by most employers, and in fact, may be the only plan available at a workplace. Premiums are less, however deductibles are higher. If you participate in a CDHP, you are eligible to establish a Health Savings Account (HSA). HSAs allow you to contribute up to $3350 as an individual or $6650 for a family in 2015. Your contributions may be made on a pre-tax basis and used to pay unreimbursed expenses or accumulated for the future.


Although there may seem to be too much information to review, spending the time to evaluate your needs and compare them to plans offered is important. Your health care election will certainly affect your 2015 benefits.






For additional information, contact EAB HealthWorks.


Last Updated on Sunday, 21 September 2014 15:20
Your Tuition Dollars at Work: Health Insurance PDF Print E-mail
Written by Ellen Breslow   
Monday, 28 July 2014 00:00
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Sticker shock. That’s what many parents are feeling when they open an email to find that their child’s annual college tuition is over $60,000 annually. And it’s not just a handful of schools. Tuition and expenses have exceeded the $60,000 for the 2014-15 school year at many private colleges and universities. Is health care a line item on this invoice? Should you be looking at a college health insurance plan? Is it mandatory?

According to most recent studies, more than 3 million young adults under age 26 have remained or rejoined their parents’ employer sponsored health insurance plans. That has been, and continues to be, an attractive option for many college students. If a student is going to school in a different state, however, it’s important to contact the insurance company to make sure there is a network provider near campus. Large insurers often have networks in other states, but parents should check with their plan.


If your college or university offers a student health insurance plan, you may find that it is automatically added to the tuition bill. This does not mean THAT insurance is mandatory, but student health insurance is. Before selecting a college health insurance plan, parents should look at the level of coverage. Often college plans have more limited coverage than employer sponsored coverage. If a student elects to stay on a parent’s plan, the parent must sign a waiver and provide the coverage information to the college or university. The waiver will remove the health insurance charge from the tuition bill. Otherwise, the charge will remain on your tuition bill!


Health insurance may be near the bottom of your student’s college concerns, but it should be at the top of yours. Be sure to review your student’s coverage before he (or she) leaves at the end of the summer. It may trim your tuition bill and allay at least some of your worries.




For additional information, contact EAB HealthWorks.


Last Updated on Monday, 28 July 2014 09:35
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