EBSO Offers ACA Reporting Services For All Health Plans

ebso-aca-blogThere are numerous reporting and compliance challenges that can make managing a health benefit plan quite perplexing. As a full-service third party administrator (TPA), EBSO provides a comprehensive range of Compliance Management Solutions for self-funded health plans they administer, such as:

  • Standard Compliance Services
  • ACA Reporting Services
  • Legal Guidance & Support Services

EBSO Excels in ACA Reporting
Since many employers are not fully prepared for the complex ACA data gathering and reporting requirements that exist today, EBSO also offers a freestanding suite of ACA Reporting Services available to any employer group, regardless of how the plan is funded or administered. These services include options such as:

  • Reporting 6055 – self-insured (NON-ALE)
  • Reporting 6056 ALE not self-insured
  • Reporting 6055 & 6056 – ALE who are also self-insured
  • Populate 1094 and 1095 forms

EBSO offers all of the compliance resources necessary in today’s regulatory environment. With all these options, it’s time you trust EBSO as your ACA expert! To learn more, visit our website at: http://www.ebsobenefits.com/compliance-management.html

A Dose of Reality: PBM’s Job is Rarely To Save Costs

Article as seen in MyHealthGuide Source, written by Ron E. Peck, Esq., Sr. VP & General Counsel, The Phia Group, LLC, The Self-Insurer July 2016 – pages 10-15 Full Text

Utilization review. Precertification. Medical case management. It seems as if health plans have been, for lack of a better word, micromanaging how medical care is sought and obtained by plan participants, for decades upon decades. It makes sense. Whether I’m a fully insured carrier or a self-insured plan sponsor, I know that a complicated pregnancy, chronic illness, cancer diagnosis, or any other number of conditions will seriously hurt — if not sink — my plan.

As specialty drugs, implants and other devices usher in an age of skyrocketing costs, not enough attention is being paid to this area in dire need of improvement.

Drug costs already make up 25% of all healthcare expenses. Indeed, a recent study revealed that large employers spent — on average — almost a thousand dollars per covered life, on pharmacy costs in 2014.

  • Specialty and Compound drugs accounts for between 25% and 35% of total drug spending.
  • Further, the costs associated with specialty drugs is increasing at nearly double the 10% rate attributed to other drugs; meaning a 20% jump per year.
  • Even more startling, more than 50% of drugs in the later stages of FDA approval are specialty drugs.
  • Some existing medication have increased substantially, with some increases exceeding 47%.
  • All of this adds up to a total pharmacy spend projected to double by 2020.

The Role of the PBM

A report says that eighty percent (80%) of employers agree or somewhat agree that their Pharmacy Benefit Manager (PBM) is sufficiently managing drug costs. I’m sure — if asked about medical expenses in general — the same respondents would be full of complaints. Yet, when we focus on drug costs which — as described above — are one of the (if not the) fastest growing drivers of plan expense, 80%+ of plan sponsors are satisfied. Someone isn’t getting the memo!

  • PBMs are not necessarily the problem. The issue is that we — as an industry — don’t recognize their role, limits and mission. People assume PBMs exist to contain drug costs. This is simply not the case (with a few exceptions).

Plan sponsors contract with PBMs directly or through their third party claims administrator, to decide what drugs are covered, what the costs shall be and, as it relates to payment to pharmacies, the where, when and how much. Further, plans rely upon their PBM to set the participant cost-share and establish pharmacy networks. PBMs therefore serve many important roles; none of which are — first and foremost — dedicated to identifying cost containment opportunities.

  • Understanding the role of a traditional PBM, what they do to create revenue for themselves and recognizing the pros and cons of said arrangement, is the key to devising independent cost controls.

Some plan sponsors think that they simply pay the PBM for the cost of any drugs actually dispensed and usually an administrative fee for managing the prescription drug program. Little do they know, but many other costs — and conflicts — impact the bottom line when it comes to prescription drug purchasing and distribution, above and beyond the problem of rising drug costs.

The costs of the drugs purchased are exploding. Plans, however, are not only contending with the rising cost of the drugs themselves. They must also worry about lost refunds, PBMs pocketing spreads (the difference between what the plan pays and the pharmacy receives) and other revenue bolstering tactics, such as up-charging and therapeutic shifting. Continue reading

EBSO’s Mobile App Is Here!

ebso-mobile-imageMobile devices are the fastest growing medium for accessing healthcare data. With EBSO Mobile, your employees can now access a plethora of services 24/7 – right from their phone. EBSO Mobile puts our most popular online features right at their fingertips:

  • Look Up Claims
  • View Member ID Cards
  • View Benefits and Coverage Information
  • And More!

EBSO Mobile Is Safe & Secure

You must always sign in with your Username and Password to access the features in the app. Without that information, no one can reach your personal data, keeping it safe.

Please Note: You must sign in to access the app’s features. Only plan members whose employers use EBSO Online are allowed to Login and use the app. Once you have downloaded the app, simply use the same login information you have for EBSO Online.

Getting started is easy – simply click here to find the EBSO Mobile app for Apple or Android devices.

EBSO Mobile is just another example of how EBSO provides Benefit Solutions for Every Client, Every Situation, Every Day!

Will Mobile Enrollment Become the Standard?

mobileThe days when employers worried about workers who lacked a home computer with internet access have come and gone. Today, more employers are concerned with how to enable their workers to make benefit elections on their smart phone or mobile device.

It’s not surprising when you realize the speed at which the mobile revolution is taking hold. When you hear that 13 million new iPhones are sold on the first weekend they are released, it’s not hard to believe that 70% of working age adults possess a smart phone or tablet with internet access. As these devices become more and more powerful and displays become larger and easier to read, you have to believe that it won’t be long before email and printed handouts are replaced by mobile enrollment.

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What frogs and boiling water have in common with stop-loss and prescription drugs

Article is by By Zack Pace and Mike Zucarelli from Employee Benefit News

Commentary: Twelve years ago, the representative of a third-party administrator sat in my office. As our conversation unfolded, he looked at me in disbelief and objected, “Zack, are you kidding me? No one in their right mind would ever put prescription drug benefits underneath the self-funded medical plan’s stop-loss insurance! What a waste of money!”

In those youthful days, I tended to argue more and replied, “We are beginning to regularly see claimants with annual prescription drug claims of $15,000 or more. If an employer has an individual stop loss of $40,000 and wants to cap its risk at $40,000 per claimant, it would logically place prescription drug benefits underneath the stop loss.”

Twelve years later, even certain high-cholesterol medications are running close to $15,000 per year in cost (for example, Praluent and Repatha). And, it’s now not uncommon to see members on specialty medications exceed $100,000 in annual spend individually. Several market pressures – including innovation, price inflation, drug life-cycle management, increased new-to-market pricing and clinical-guideline changes – are all factoring into this. Two examples are:

  1. Yervoy/Opdivo combo – $250,000/year (cancer – four-month survival increase)
  2. Harvoni – $94,000/treatment (hepatitis C – one-time therapy)

Despite the continued escalation in specialty medication costs, many employers sponsoring self-funded health plans have not yet placed prescription drugs underneath the plan’s stop-loss insurance. Why is that?

Are you familiar with the parable of the frog and the boiling water? It goes something like this: If you drop a frog into a pot of boiling water, he’ll jump right out. However, if you place a frog in a pot of cool water and turn on the heat, he’ll happily hang out in the pot long past 212 degrees Fahrenheit. Perhaps our health plans are like the frog, and the rising cost of specialty medications is like the heat.

Look at it this way: If your health plan was presently fully insured and you were moving to a self-funded structure for 2016 with an individual stop loss of $60,000, would you even think twice about including the above specialty drugs within the stop-loss insurance?

In our travels this year, we’ve witnessed:

  1. A mid-size employer that was forced to modify its entire 2015 business plan when a claimant incurred a cumulative $90,000 specialty prescription drug early in the contract year.
  2. Major insurers routinely not quoting prescription drugs underneath the stop loss.
  3. The continued migration from fully insured to self-funding by small to mid-size employers as they seek refuge from the Affordable Care Act’s new premium taxations and “fair health insurance premium” rules.

If your self-funded health plan’s individual stop loss is $200,000 or less, do you agree that it’s time to end the debate on whether or not prescription drug benefits should be covered under the individual stop loss?If your individual stop loss is higher than $200,000, we’ll concede that highly risk-tolerant organizations could still, depending on the underlying break-even mathematics, make a facts- based argument for leaving the prescription drugs uninsured.

Next steps

  1. Read your current stop-loss agreement or contract and determine if prescription drugs are covered under the stop loss. If they are not, consider amending your contract now versus waiting until the renewal. Your stop-loss vendor should permit this mid-year change.
  2. Before purchasing stop-loss insurance, double-check that prescription drugs are covered. If this provision is not stated prominently on page 1, check the assumptions page. Even if your benefit consultant’s RFP requests this provision, vendors will often unintentionally (let’s hope) leave the prescription drug benefit uninsured.

Zack Pace is a senior vice president, benefits consulting at CBIZ, Inc. He can be reached at ZPace@cbiz.com. Follow him on LinkedIn and Twitter at @zpace_benefits. Michael Zucarelli, PharmD, is the national pharmacy practice leader at CBIZ, Inc. He can be reached at mzucarelli@cbiz.com.

Welcome to our Blog!

EBSO Inc. was formed by joining two nationally recognized third party administrators, SOMI and EBC. Today, EBSO administers and manages all aspects of employee benefit plans for employers, carriers and consultants.

By self-funding with a Third Party Administrator, employers have the opportunity to reduce administrative costs, increase flexibility and expand the services offered to employees.

Our primary focus is our client’s bottom line with products and services that touch every type of benefit plan an employer, carrier or consultant may have. As benefit experts and administrative risk managers, we provide our clients with meaningful, actionable multi-year strategies for an ever-changing world of employee benefits.

EBSO offers an array of self-funded and fully insured benefit plans and products, Human Resources and Finance support and compliance and auditing services. We also provide a full range of retirement plan processes for clients with specialization in the non-profit, public entity space for 403(b) and 457 plans.

For innovative, cost-effective benefit solutions and exemplary service contact us today. We are EBSO – Benefit Solutions for Every Client, Every Situation, Every Day!

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