Kluge Insurance

Pennsylvania has placed an order for the new H1N1 vaccine and announced distribution plans, according to the state Department of Health. The vaccine should be available for distribution by mid-October. Because the initial vaccine supplies are limited, doses will be administered first to top targeted groups. Healthy children between the ages of five to nine years and college students in locations where H1N1 flu outbreaks have occurred and are ongoing will receive vaccines first. Later this fall, as more vaccine becomes available, Pennsylvania will have mass vaccination clinics to administer doses to as many people in the targeted groups as possible. Eventually, anyone who wants the vaccine will be able to get it after the needs of those in high-risk priority groups have been met.

The federal government is paying for the H1N1 vaccine. However, health care providers and facilities may charge an administration fee for the vaccine. Below is information provided by area health insurance providers on how they will handle the administration fee. Self-funded plans that choose to cover the administration fee may require an amendment to their plan document. Contact Benecon if you have questions.

Aetna

Aetna will cover the administration fee for all fully-insured plans. Copays, coinsurance and deductibles will not apply. Self-funded plans may choose to cover the fee.

Capital BlueCross

CBC will cover the administration fee for fully-insured members and those with individual coverage. Self-funded groups may opt to cover the fee.

HealthAmerica

The administration fee will be covered for fully-insured plans; doctor’s office copays may apply. Self-funded groups may chose to cover the administration fee.

Highmark Blue Shield

Highmark will cover the administration fee for all health plan members.

Independence Blue Cross

IBC will cover the administration fee for the H1N1 vaccine.

Teachers Protective Mutual

Teachers will cover the administration fee. More information from Teachers is expected soon.

UnitedHealthcare

UHC will cover the administration fee for plans that cover immunizations and those that don’t.

Governor Rendell has signed legislation that extends health insurance coverage for dependent children of insured parents. The law requires insurers, at the employer’s option, to offer health insurance coverage to a dependent of an insured employee through age 29 under certain conditions. Employers with insured plans may choose to offer the extended benefits and can be charged an additional premium.

Previously, if an employer offered dependent coverage, insurers were only required to cover children on their parents’ policies until age 19. According to the Pennsylvania Insurance Department, almost 40% of those who are uninsured in Pennsylvania are between the ages of 19 and 29.

When is the Law Effective?

Act 4 applies to new policies and at the group’s next renewal after December 7, 2009. If a health insurance policy is issued or renewed in January 2010, the provisions will begin in January 2010. Policies that are issued or renewed less than 180 days after signing will wait until the next year. For example, if a policy is renewed in July 2009, the provision will be effective in July 2010.

Who is an Eligible Adult Child?

To be eligible, dependent children must:

• be over age 18 and under age 30;
• be unmarried;
• have no dependents;
• be residents of Pennsylvania or be enrolled as a full-time student at an institution of higher education; and
• not be provided coverage under any other group or individual health insurance policy or be enrolled in or eligible for government health care benefits.

What Benefits are Included?

The option applies to group health insurance coverage only, including HMOs. It does not apply to dental, vision, long term care, limited benefit, or individual health insurance policies.

What Do Employers Need to Do?

Employers will need to determine whether they want to include this extension at their next renewal after December 7, 2009.

• Act 2 of 2009 is a new law in Pa. that requires Employer groups (2-19 lives) to offer continuation of their group health plan to employees that are no longer employed by them. This coverage is referred to as Mini-Cobra.
• Who is covered: Employees and eligible dependents who have been continuously insured under the group policy during the entire 3 months period prior to their termination of employment.
• How will an employee be notified to elect continuation coverage: Within 30 days of the qualifying event, YOU (the employer) must notify the employee of his/her right to elect continuation coverage. (send attached Notice –Notice to Policyholder)
• How will an employee or eligible dependent elect coverage: Within 30 days of receiving notice of his/her rights to elect continuation of coverage, each covered employee or eligible dependent must notify the employer. (complete attached – Qualified Event Notice )
• What is a qualifying event: Termination of an employee (other than by reason of the employee’s gross misconduct), reduction of hours, death of a covered employee, divorce or legal separation of the covered employee, a covered employee becomes eligible for Medicare and their dependent still needs coverage, dependent child ceasing to be a dependent child. IMPORTANT – the employer will validate the qualifying event to determine eligibility for mini-cobra.
• Cost of mini cobra: The premium for the continuation coverage may not be more the 105% of the group rate.
• When will continuation coverage start: the date of the qualifying event
• When will continuation coverage end: 9 months after the qualifying event, the end of the period for which the covered person paid the premium, if the covered person fails to make timely payments, or the group health plan terminates. IMPORTANT – the employee has 14 days to notify his former employer if he/she is no longer eligible for mini-cobra.
• ARRA (American Recovery and Reinvestment Act of 2009): Assistance for employees or dependents that have been involuntarily terminated to reduce the amount they have to pay for min-cobra. The program is available until Dec 31, 2009. If an employee feels they qualify, they must submit the attached form – Request for treatment as an assistance eligible individual. You should include this form with all other documents you will be sending to the employee at the time of the qualifying event. If it is determined that they qualify for assistance, the employee will only be required to pay 35% of the total monthly cost.
• Administration of mini-cobra: You can self-administer the plan or if you would like to have it administered for you, please contact us and we will give you your options and pricing.
• Carriers: Each health insurance carrier will have some of their own forms to complete if an employee enrolls in mini-cobra.