DMC Now Out-of-Network With Humana

In the Know & How It Applies |   OCTOBER |  2016

As of October 1, 2016 all of the DMC’s doctors, hospitals, ambulatory surgery centers, urgent care centers, imaging centers, laboratories and home health centers nationwide, are now Out-of-Network for all patients with Humana.  This includes:

  • Humana Commercial
  • Humana Medicare Advantage
  • Humana Medicaid
  • Humana on the Exchange
  • Humana TRICARE

 What DMC centers are affected? 

  • DMC Children’s Hospital of Michigan
  • DMC Detroit Receiving Hospital
  • DMC Harper University Hospital
  • DMC Heart Hospital
  • DMC Huron Valley- Sinai Hospital
  • DMC Hutzel Women’s Hospital
  • DMC Rehabilitation Institute of Michigan
  • DMC Sinai-Grace Hospital

The DMC announce earlier this month that after repeated efforts to find common group, they were unable to reach an agreement on a new contract.

Are any other carrier impacted by this change?

The DMC currently participated with many major health insurance plans other than Humana such as (to name a few):

  • Aetna
  • Blue Care Network
  • Blue Cross Blue Shield of Michigan
  • Cofinity PPO
  • HAP
  • Priority Health
  • United Health Care

For a complete listing of participating insurance plans, please visit the DMC’s website or click on the link below:

DMC Participating Insurance Plans

What this means for clients/members: 

  • Emergency Care: Emergency access is NOT impacted. Clients/Members can continue to receive emergency care at the DMC Emergency Rooms, regardless of the network status with Humana
  • Continuity of Care: Certain patients may be eligible to receive “Continuity of Care” benefits with Humana for a period of time if they need ongoing treatment or already have a procedure scheduled. For questions about ongoing care or benefit coverage, less advise members insured with Humana to call the phone number on the back of their Humana Insurance Card.
  • Out-of-Network Care: Members with Humana PPO may still access the DMC health care provider and hospitals for health care services using their out-of-network benefits.

 

ADDITIONAL INFORMATION

Information contained in this Important Updates—In The Know & How It Applies is not intended to render tax or legal advice. Employers should consult with qualified legal and/or tax counsel for guidance with respect to matters of law, tax and related regulations. Creative Benefits & Insurance Solutions provides comprehensive benefits advice and administrative services with respect to all forms of employee benefits, risk management, property & casualty, workers’ compensation, staffing insurance and human resources services. For additional information about our services, please contact us at (586) 992-0404 or email us at cbis@cbis-lc.com.

Affordable Care Act – Reinsurance Fee

The following Update addresses Section 1341 of the Affordable Care Act established a transitional reinsurance program to stabilize premiums in the individual market inside and outside of the Marketplaces. The transitional reinsurance program will collect contributions from contributing entities to fund reinsurance payments to issuers of non-grandfathered, Affordable Care Act-compliant reinsurance-eligible individual market plans, the administrative costs of operating the reinsurance program, and the General Fund of the U.S. Treasury for the 2014, 2015 and 2016 benefit years. 

How it Applies

 This fee on health plans totals $25 billion, which will be collected over the three-year period from 2014 through 2016. The majority of the money will be used to fund a reinsurance program, which is intended to lessen the impact of adverse selection in the individual market. The fee applies to both insured and self-funded commercial major medical plans effective January 1, 2014 and ends with the last fee payment on January 1, 2016.

Fully-Insured employers will have this fee included in either their monthly fixed premium rates from the carrier or included as a separate line item on their carrier invoices.  The carriers submit on behalf of their fully-insured clients.

Self-Funded employers are required to report a count of lives covered to the Health and Human Services during the fourth quarter of the respective filing year.  The ACA enrollment and contributions submission form is provided online only through www.pay.gov.

What is the fee?

For the 2014 benefit year, HHS offered contributing entities the option to pay:

  • the entire 2014 benefit year contribution in one payment no later than January 15, 2015 reflecting $63.00 per covered life; or in two separate payments for the 2014 benefit year, with the first remittance due by January 15, 2015 reflecting $52.50 per covered life, and the second remittance due by November 15, 2015 reflecting $10.50 per covered life.


For the 2015 benefit year, HHS will offer contributing entities the option to pay:

  • the entire 2015 benefit year contribution in one payment no later than January 15, 2016 reflecting $44.00 per covered life; or
  • in two separate payments for the 2015 benefit year, with the first remittance due by January 15, 2016 reflecting $33.00 per covered life, and the second remittance due by November 15, 2016 reflecting $11.00 per covered life.

 For the 2016 benefit year, HHS will offer contributing entities the option to pay:

  • the entire 2016 benefit year contribution in one payment no later than January 17, 2017 reflecting $27.00 per covered life; or
  • in two separate payments for the 2016 benefit year, with the first remittance due by January 17, 2017 reflecting $21.60 per covered life, and the second remittance due by November 15, 2017 reflecting $5.40 per covered life.

2016 is the last year self-funded employer plans will be required to submit the Reinsurance Fee in accordance to the three year benefit filing fee requiring under the Affordable Care Act.

How does CBIS assist clients?

For those Self-Funded clients that would like assistance from CBIS, as in the past year’s reporting and payments, CBIS will provide the Average Number of Covered Lives enrolled and calculate the Reinsurance Fee.

 

What are Covered Lives?

Covered lives are all covered individuals, both employees and their dependents. For example, an employee who has family coverage including a spouse and two children would be counted as four covered lives.

What is the process self-funded employers must follow to pay the reinsurance fee?

There is a streamlined membership and contribution process through http://www.pay.gov. Pay.gov is a secure, web-based application that serves as the portal where employers can report and submit the required membership data elements. Registration on pay.gov is required in order to complete the reinsurance process.

As part of the membership and contribution process, a contributing entity, e.g. the employer or insurer making the contribution, can begin to collect the data, calculate their annual enrollment count and prepare the supporting documentation.

Additionally, a reporting entity will need to complete the following steps:

  • Register on pay.gov
  • Access and complete the form on pay.gov, titled “ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form.” A copy of this form has been included in the email communication for client’s reference and use.
  • Upload the supporting documentation (this would be the same .CSV format file from last year with the updated numbers).
  • Enter payment information (e.g. payment date and banking information).
  • Self-funded employers should also contact their bank to have the ALC+2 value added to allow for automatic debits

 

What if after receiving the snapshot report clients have questions?

Please feel free to contact your dedicated CBIS Account Representative and they will assist with any questions as well as provide additional guidance and clarification if needed.

ADDITIONAL INFORMATION

Information contained in this Important Updates—In The Know & How It Applies is not intended to render tax or legal advice. Employers should consult with qualified legal and/or tax counsel for guidance with respect to matters of law, tax and related regulations. Creative Benefits & Insurance Solutions provides comprehensive benefits advice and administrative services with respect to all forms of employee benefits, risk management, property & casualty, workers’ compensation, staffing insurance and human resources services. For additional information about our services, please contact us at (586) 992-0404 or email us at cbis@cbis-lc.com.

 

 

Are you ready for Open Enrollment?

Health care reform

FRAUD WARNING:
When shopping for health insurance on the Marketplace (Exchange) be sure to ask for their Federal Facility or Start Partnership Marketplace Unique ID. All licensed professional are required by law to complete training including a federal background check in order to assist individuals with their health care options on the Marketplace.

CBIS Marketplace ID: CBISEXCHANGE
National Producer Number: 976408
Producer Name: Patricia A. Shall

What to Know:

The 2017 annual Open Enrollment for the Health Insurance Marketplace is vastly approaching. November 1, 2016 starts the beginning of annual open enrollment where uninsured individuals may again review available plan options and make decisions as to the best plan to meet their personal and/or family health care needs.

How CBIS can assist:

CBIS can help assist you in finding the right coverage and right budget that fits your household needs.

CBIS has the tools, technology and the access to all the major carriers participating in the Health Insurance Exchange. Let CBIS take the worry out of reviewing the fine print of each available plan design.

Whether you are looking for coverage ON the Marketplace through Healthcare.gov or OFF the Marketplace through several carriers offering Individual plan, CBIS can help.

Give us a call at (586) 992-0404 or email us at cbis@cbis-lc.com to get started TODAY!

Tips for Non Profit Summer camps Insurance

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It is the age old tradition of being the first day of summer camp.  You have spent the last few months putting the finishing touches on your campsite.  You have painted all the walls and gotten all the cabins ready.  You take much pride in being a Non-profit Summer camp director.  It is the night before all of your eager campers arrive and you are very excited yet a little nervous that everything is ready for there 6 week adventure.  There is much responsibility to having kids spend the summer at your camp and also in keeping all the kids safe.  Today I am going to give those summer camp directors  some very useful tips on what types of insurance will protect your camp.

 

First off being a non-profit summer camp has more challenges than a for profit summer camp.  You deal with tighter budgets and different liabilities.    Many directors have the kids sign a waiver but that is just nearly the beginning in keeping yourself protected.   The first type of insurance that is very important to have is General Liability Insurance.  General Liability Insurance protects your nonprofit organization from a wide range of lawsuits and liabilities.   This is a very important insurance to have in case your organization gets sued and the plaintiff claims that your camp was responsible for the child’s injury.  Another positive about this type of insurance is that it can protect your camp if it has damaged property.   Another scenario most camp directors do not want to think about is if some kids decide to steal something.  For instance say there are some boats housed close to the camp and some kids damage the boat or even steal the boat.  General Liability Insurance could protect you from being sued by the owner of the boat.    General  liability insurance can protect you from lawsuits from parents, vendors and various others.

 

Property insurance can be very important to your camp.  Any loss of property due to a fire or other unforeseen event will protect you. If a building on your campground were to burn down property insurance would pay for the building of a new building on the site.   An interesting fact about this type of insurance is that it will pay for the current value of the property.  Due to many items depreciating in value over the years the policy will only pay for what the current value of the item is.  If you bought a computer for $1,000 and now it is only worth $200 you will only be reimbursed for the $200.   Replacement policies cost more but will cover the full amount of an item even if it has depreciated over time. 

 

Another type of insurance that will help you save money is a Business Owner’s Insurance Policy.  It is referred to as a BOP.  This means that you can combine two policies into one.  For instance you can combine your General Liability Insurance with your property Insurance.  You will get a lower rate because you combined the two policies.  Not every non-profit organization applies for this type of coverage.   The following reasons below are the reasons a non-profit would not qualify for this. 

  • Don’t work in high-risk industries.
  • Don’t work in large-scale premises or offices.
  • Don’t need more than a year’s worth of Business Interruption Coverage (a Property Insurance policy that pays for your business to relocate after a covered claim destroys its offices, building, etc.).

 

As the eager campers arrive you can take solace in knowing that you have taken your insurance precautions to make sure this will be a very safe and non dramatic summer.  If there is some sort of an emergency you will have the proper coverage and will be properly covered.  Now you just have to sit back and let the kids enjoy the splendors of summer camp.

 

 

 

 

 

 

Insurance Tips for Lightning Strikes On Your House

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You are sitting on your front porch enjoying a cold glass of lemonade when you start to see the dark clouds starting to roll in.  It is late June and this is prime thunderstorm season.  You suddenly begin to feel some raindrops falling on you.  Then a sudden downpour begins.  The wind starts to pick up and it is time to head back inside your house.  The storm intensifies and the lightning begins.  Repeated quick strikes of lightning.  Lightning  can be a very dangerous part of a thunderstorm.  Not only can it very dangerous to be outside in the lightning it can also be very dangerous to your house.  Today I am going to give you some statistics about lightning and the types of insurance that can protect your house from lightning damage.

 

A very interesting statistic I came across is that there are 20 million air to ground strikes every year in the United States.  Each lightning bolt has over 100,000 volts in it.  In 2009 it was estimated that there were over 185,000 claims filed related to lightning damage on there house.  Many homeowner’s insurance plans should cover lightning related damage.  It should also cover any fire related damage caused by lightning strikes.  It is estimated that for some equipment damaged you may not get fully paid due to the depreciation of the equipment or due to the cost of the deductible.  If the power surge was not caused by a lightning strike you may not be covered for this type of coverage.  Many home owners or businesses  can get surge protection coverage for power surges not tied to lightning.

 

The Cost Of Lightning Damage

Lightning can cause power surges that send energy into phone lines, plumbing, electrical  wires and even ductwork.  These spikes and surges in power can cause much damage.  Surges to electrical wiring can cause arcing which is a spike in energy and this can lead to fires. 

 

Nationwide recommends that homeowners and business owners adopt three main protective measures.

  1. Use point-of-device surge protectors to protect individual electronic devices, like TVs, computers and printers.
  2. Use a service panel suppressor to manage large power surges before they enter your building. Note that a panel suppressor alone may not be enough protection. For instance, a direct lightning strike on your building would bypass the suppressor and cause direct damage to electronic devices unprotected by point-of-device surge protectors.
  3. Get equipment breakdown insurance. This coverage can protect your property if power fluctuations cause damage to products or lead to things like spoiled food, lost income or emergency repairs.

 

So the next time you see a major thunderstorm storm rolling in remember to go inside and stay away from large windows.    If you have the proper insurance and have taken the proper safety precautions you can find solace in knowing you have done everything possible to keep you and your family safe until the thunderstorm blows over.

 

 

Tips for Fireworks Insurance and Safety tips

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What a great day to be an American.  All of your family and friends are enjoying this very special day.  You have the American flag proudly waving  on the front of your house.  Patriotic music is playing on the radio.  The barbecue is about ready to be fired up.  The fireworks show you have planned is just a few short hours away.  What a great way to celebrate the Fourth of July in grand style.  Today I am going to give you some tips concerning fireworks and liability insurance which can help to keep everyone safe. 

 

Fourth Of July fireworks can be extremely fun and entertaining.  It can also be very dangerous.  Many times fireworks displays can go bad and cause great bodily harm or injury.  In a 2005 study it was estimated that fireworks caused 1,800 structural fires and accounted for $39 million dollars in damage.  Any injury or property damage can cause major liability issues to adults or children.  If you have a homeowner’s policy you are covered by any damage the fireworks may cause. Anyone 21 and over is covered by any fireworks damage to property or a person’s well being.  There is one caveat to this.  Children who are over 12 years of age and are teenagers are not covered under this policy.  If your teenager decides to light some fireworks and damage a neighbor’s house they can be held liable.  Children who are 12 and under are excused because many companies feel that it may be an innocent mistake.  Teenagers are not granted that same luxury knowing what they are doing may be every dangerous.

Fireworks Safety Tips

I wanted to give you some fireworks safety tips also.  Never let young children use fireworks.  Many children can suffer great burns to there body even though they do not know what they are doing.  Teenagers and older children should only use fireworks under adult supervision.  It is very important for adults to be handling the fireworks and setting the best safety precautions available.  The person handling the fireworks should always wear safety glasses.  Always have a water hose available when using fireworks.  This could really come in handy and help to prevent serious injuries.  Also be a good neighbor and report any illegal fireworks or explosives to your local Police or Fire Department.

 

So as the sun sets on another Fourth Of July Holiday and it is nearing that time for fireworks, make sure you have taken every precaution and safety measure.  Knowing you are safely and properly prepared will lead to a very safe and enjoyable fireworks show for everyone. 

Pool Safety Tips for Summer

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What a beautiful warm summer day it is! With the family over, the barbecue fired up and the nice swimming pool right next to it… It is time for the first pool party of the year which signifies the start of summer. All of your friends have brought their pool toys and are ready for a very relaxing day swimming and lounging in the pool.

These summer leisure activities are what the season is all about. Just remember that if you are going to be playing outside you need to remember that safety comes first. I am going to give you some ways to make sure your swimming pool has the proper insurance and that the pool is following the latest standards and ordinances.

 

Pool Safety Tips to Consider

A swimming pool makes a great addition to any house. There are ordinances and building codes that must be met when having a swimming pool. One of the most important questions a home owner should ask themselves is, “is my pool safe?” There are hundreds and thousands of pool injuries and drowning incidents every year across the country. Many accidents can be prevented with the proper safety measures.

Does your pool have a fence or a pool cover? Investing in a pool cover could be very valuable when you are not using your pool. It could help prevent injuries and save lives. Installing a fence around the pool can help keep small children or animals out of the pool and to prevent further injury. The width of the fence is important to keep small children from squeezing through. Some fenceless neighborhoods will even require you to put up a lockable fence around your pool for liability reasons.

It is important to keep lifesaving flotation devices all throughout the area and a pool hook nearby to helping in a rescue situation. Always have a first aid kit on hand when children and adults are using the pool in case of an emergency. Always put in “No Diving” signs on the pool walls to prevent diving accidents in shallow water.

Another important thing is to remove all pool toys and devices at the end of the day so curious children do not go into the pool unsupervised. Remember to cover the pool and lock the fence at the end of the day.

 

By following these simple measures your family and friends will have an amazing summer with some very wonderful memories around the pool. So, if you follow a few of these suggestions you will have an summer splashing around in the comfort of your own backyard.