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| Volume 2, Issue 26: November 5, 2007 |
Legislative Watch Oregon HB 2002 and Small Employer Health Benefit Plans As many of you are aware, effective January 1, 2008, Oregon House Bill 2002 changes the definition of “small employer” to include all employers with 2 to 50 eligible employees. For the purpose of determining an employer’s small employer status, “eligible employees” is defined, in part, as employees who work on a regularly scheduled basis with a normal work week of 17.5 hours or more. We have received several inquiries as to how the requirements of HB 2002 will affect our small employer groups from a rating and underwriting standpoint. The Oregon Insurance Division adopted temporary rules for the implementation of HB 2002 on August 16, 2007. (Temporary rules relating to small employer health benefit plans can be found on the Oregon Insurance Division Web site.) The following summary information is based on our interpretation of the temporary rules relating to small employer health benefit plans: Premium Rating Factors HB 2002 allows carriers to use a number of factors in developing rates for small employer health benefit plans. These factors include: ages of enrolled employees and dependents; level of employer premium contribution; level of employee participation; level of member tobacco use; level of member participation in wellness programs; and duration of uninterrupted coverage with the carrier. In accordance with the temporary rules, PacificSource will file and implement its rates and rating methodology for small employer health benefit plans issued or renewed April 1, 2008 and after. The rating factors we use to vary rates will be applied to all small employer groups regardless of size. Carrier rate filings will be available on the Oregon Insurance Division Web site at the time they are filed. Enrollment Policies We do not anticipate changing our current participation and contribution requirements. However, the regulatory requirement limiting the probationary period to a maximum of 90 days will apply to all small employer groups. Eligibility requirements must be applied uniformly throughout all categories of eligible employees. (We have recommended to the Oregon Insurance Division that, for small employer groups with 26 to 50 eligible employees, the permanent rules include a provision allowing different eligibility requirements for different categories of employees.) Employment Classifications The law permits carriers to provide different benefit plans to different categories of employees if the categories are bona fide employment-based classifications. For small employer groups of 26 to 50 eligible employees, an employer is permitted to limit coverage to a category of employees. In this case, we require that at least ten employees are enrolled. Oregon Standardized Group Profile Form Beginning April 1, 2008, carriers will be required to use an Oregon Standardized Group Profile form to determine if a group is a small employer. The form must be completed by new and renewing groups prior to receiving a premium quote. PacificSource will take care to ensure that these forms are handled and documented in a manner acceptable by the Oregon Insurance Division. April 1, 2008, Implementation Since the rules for the implementation of HB 2002 are not yet finalized and some of the more significant requirements of the law will not impact small employer business until April 1, 2008, we do not yet have answers to all your questions. We will keep you informed through the Agent Bulletin as more information becomes available. In October, we distributed the following Medicare Part D employer notices and sample member notices to all our group clients, depending on their pharmacy plan. You may use our new Medicare D Creditability Matrix to determine which PacificSource pharmacy plans are creditable. A (creditable): B (noncreditable): C (changing from creditable to noncreditable): ’Tis the Season for Benefit Meetings As we enter renewal season, please encourage your group clients to schedule a benefit meeting for their employees. A benefit meeting is a great time to go over benefit changes, review current benefits, and inform members about new programs. Our Client Service Representatives are available to help answer questions and explain our benefits and programs. PacificSource introduced some exciting value-added programs this year, so there's a lot to talk about, including:
In addition, as of January 1, 2008, Free & Clear® Quit For Life™, our tobacco cessation program, will be a contract benefit for all groups. All members will have two covered attempts for tobacco cessation, even if they previously used the benefit under the pilot program. See our Free & Clear member flier for program details. To schedule a benefit meeting or to obtain member materials, you or your group clients can contact our PacificSource Client Service Representatives. Sales fliers and materials for members are also available in the For Agents/Materials area of our Web site. Weight Management Materials for the Workplace Many of us, including wellness-savvy employers, recognize that weight management is not just about looking slim. The effect of excess body weight not only impacts quality of life and self-esteem, it increases the risk for several chronic diseases, including heart disease, diabetes, and even cancer. Most Americans gain between three to five pounds between Thanksgiving and the New Year. While this amount doesn’t sound threatening, most people don't lose the excess weight, and the cumulative effects over several years can contribute to a substantial increase in body weight. A new PacificSource workplace wellness campaign, Maintain Don’t Gain, is a seven week self-directed program designed to help individuals maintain their weight during the holiday season, and to avoid the cumulative effects of gradual weight gain. The goal for participants is to maintain their weight within two pounds between Thanksgiving and the New Year. Maintain Don’t Gain weight management campaign materials—posters, payroll stuffers, and newsletter articles—are part of our new Workplace Wellness Toolkit, designed for employer groups with 50 to 100 employees. If you have a client you think would benefit from this toolkit, please contact us. Two PacificSource value-added programs are also worth noting this time of year. Our Healthy at Heart™ and Diabetes Control Network programs can help members to make choices to maintain their cardiovascular health or control their diabetes through the sugar-filled holiday season. The programs help members better understand and manage their condition, whether they have high blood pressure, high cholesterol, or diabetes. A Healthy at Heart™ and Diabetes Control Network member flier is available in the For Agents/Materials/Member Materials area of our Web site. PacificSource offices will be open on November 12, Veterans Day observance. We will be closed on November 22 and 23 for the Thanksgiving holiday. Our offices will reopen at 8:00 a.m. on Monday, November 26. PAHU Member Events Portland Association of Health Underwriters will host a CE seminar on November 14 in Portland, Oregon. Contact PAHU for more information or visit www.pahuonline.org and select Upcoming Events. PacificSource is proud to sponsor Northwest community events that support healthy communities and health-focused organizations. We hope you will join us in supporting these events: Festival of Trees—McKenzie-Willamette Community Health Foundation Festival of Trees Festival of Trees—Providence Community Health Foundation Festival of Trees—Mercy Foundation and Children's Healthcare Fund Festival of Trees Festival of Trees—Hospice of Redmond-Sisters |
Questions? You’re always welcome to contact us! |
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Portland Manley Services Select Benefit Administrators |