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| Volume 2, Issue 29: December 14, 2007 |
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PacificSource Celebrates 75 Years of Service In 2008, PacificSource Health Plans will mark its 75th anniversary. We’re planning several special community events and promotions to celebrate this milestone throughout the year, and we’ll keep you informed as those plans take shape. You'll soon see the anniversary noted on some of our print materials as well. PacificSource was founded on April 12, 1933, by a group of 21 physicians in Eugene, Oregon. Today, we provide medical and dental benefits to more than 4,000 employers and cover more than 150,000 people in the Northwest with our group and individual health insurance plans. Read more about our history and the growth of our organization by visiting the Our History area of our Web site. AlternaCare Discounts and Wellness Resources Online As we announced in the previous issue of the Agent Bulletin, beginning January 1, PacificSource medical members will have access to the AlternaCare Savings Program. This new discount program for alternative care services will replace our Healthyroads™ amenity program. On January 1, members will be able to access the PacificSource AlternaCare area of our Web site for links to discounts and wellness resources, including:
For more information, download our AlternaCare sales flier (Bend, Boise, Eugene, Medford, Portland), or contact your PacificSource Marketing Representative. Revised Summaries for Preferred FlexPerks Plans Available Revised benefit summaries for two HSA-qualified group plans have been posted on our Oregon Benefit Summary page—Preferred FlexPerks FP 80+2900 Indexed and FP 80+2900 Indexed + Rx. These plans are effective January 1, 2008, and will replace the FP 80+2850 Indexed and FP 80+2850 Indexed + Rx plans. The annual deductibles and out-of-pocket limits are slightly higher than in the 2007 plans. Is an Oregon Business with Two People a SEHI Group? Often, a business with as few as two employees qualifies for group coverage, but not always. Employers are eligible for coverage under Small Employer Health Insurance (SEHI) law when two or more employees are regularly scheduled to work 17.5 or more hours per week on the date coverage is to take effect. Oregon's small employer insurance regulations do not permit carriers to vary from their filed premium rating formulas for a specific group, or make eligibility exceptions for individuals within a group. Although a business has two or more employees, it may still not qualify for group insurance coverage under small employer laws. For example, the owner of a small farm hires three employees to work from April through October. They would not qualify as a small employer group, because seasonal employees do not meet the law’s definition of an “eligible employee” for the purpose of determining small employer status. In another example, an independent plumber employs his spouse to do occasional bookkeeping. Because his spouse works fewer than 17.5 hours per week, they do not qualify as a small employer group under the law. We realize that SEHI rating and eligibility can sometimes cause confusion for both agents and their clients. To help shed light on SEHI eligibility, we have developed SEHI Coverage Guidelines as a reference for agents. The guide details criteria for various small business types, such as sole proprietorships, LLCs, and partnerships. Oregon FHIAP No Longer Accepting Applications Oregon’s Family Health Insurance Assistance Program (FHIAP) helps thousands of Oregon families pay their monthly premiums for high-quality, private health insurance plans. Because of new federal fund limitations, FHIAP is no longer able to accept individual or group applications. Additionally, those group and individual applications that have been submitted to FHIAP but have not completed the review process will not be completed at this time. FHIAP will notify these applicants by letter. Program openings may not be available again until mid-2009. A recent letter from FHIAP details the impact of the funding changes and suggests additional resources for your clients. As you know, PacificSource offers a variety of individual and family health plans for Oregon residents not covered by employer-based group insurance policies. Our new Elect Value Option plans, available beginning January 1, provide low-cost catastrophic coverage. Our Individual Department is happy to work with your clients to help them find an affordable plan that meets their needs. For more information, please visit the Individual and Family Plans area of our Web site, contact your PacificSource Individual Sales Representative, or e-mail our Individual Department at individual@pacificsource.com. This month, our annual Member Bulletin (Oregon, Idaho) mails to PacificSource members. The bulletin includes information about our Preferred Drug List (PDL) and Value Drug List (VDL), AlternaCare Savings Program, Assist America Global Emergency Services, wellness, online tools, and our enhanced online provider directory. In addition, the issue includes a notice of our privacy policy and information on mastectomy-related benefits, in compliance with state and federal notice requirements. The Oregon Women’s Health and Cancer Rights Act (WHCRA) requires group health plans and health insurers to provide an annual notice of the act’s mandated benefits to all Oregon members. PacificSource satisfies this requirement through our annual member newsletter that mails to members each December. We will be closed for Christmas on December 24 and 25. We will also close at 3:00 p.m. Pacific Time on New Year’s Eve, December 31, and be closed for New Year’s Day, January 1. All of us at PacificSource wish you PAHU Member Event Portland Association of Health Underwriters will host a CE seminar on December 19 in Portland, Oregon. Contact PAHU for more information or visit www.pahuonline.org and select Upcoming Events. |
Questions? You’re always welcome to contact us! |
Eugene Bend Boise Medford |
Portland Manley Services Select Benefit Administrators |