Graduating Dental Benefits from MetLife encourages participants to maintain their dental coverage from their employer plan and provides enhanced coverage to help ALL participants achieve and/or maintain good oral health. Participants, including dependents, are rewarded for maintaining their dental coverage with an increasing annual maximum benefit each year for up to three years.

* Participants and their dependents maintain the maximum benefit once it’s reached for as long as they remain enrolled in the plan with no gap in coverage.

* If there is an interruption in MetLife dental coverage, participants start at the beginning, with the lower benefit level, after re-enrolling in the employer’s plan.

Unlike some of the other products in the marketplace, with Graduating Dental Benefits from MetLife there are:

* NO dollar threshold requirements
* NO “use it or lose it” feature
* NO regressive benefits

Tags: Dental Insurance, employer dental insurance, MetLife, MetLife dental

Effective January 1, 2009, the current Members First discount program will be replaced with the BlueExtras discount program. All BCBSIL members enrolled in individual health plans are eligible for the BlueExtras discount program.

BlueExtras offers discounts on value-added health care products and services that can enhance health and well-being – as another advantage of BCBSIL membership. There are no claims to file, no referrals or pre-authorizations, and no fees to participate.

For additional information about the products and services offered through BlueExtras, log into Blue Access® for Members (BAM) at www.bcbsil.com. Click on the My Coverage tab, and then the BlueExtras Discount Program link.

Tags: BCBS IL, Blue Cross Blue Shield of Illinois, BlueExtras Discount Program, Members First Discount Program

Effective December 31, 2008, Rush University facilities will be considered out-of-network for Humana® members. The following facilities are included in this network change:

* Rush University Medical Center
* Rush Oak Park Hospital
* Rush-Copley Medical Center
* Riverside Medical Center
* Rush University’s affiliated physicans

Please note that Rush-Copley Medical Center will continue to be considered in-network for Humana Medicare HMO members.

Humana will be communicating to affected employers and health plan members who have utilized any of these facilities in the past six months regarding this change. The member letter will request that members call Humana Customer Service or check Humana’s Physician Finder Plus Web-based provider directory to confirm in-network providers.

Tags: Humana, Rush hopsital, Rush University facilities

Assurant Health’s MaxPlan and CoreMed plans without the office visit copay, and OneDeductible plans include TelaDoc membership, a service that offers physician access — 24 hours a day, 7 days a week, and 365 days a year. Beginning on November 1, 2008, TelaDoc expanded their services to include consultations for children as young as age 10 (formerly age 12).

Tags: assuarant onedeductible plan, assurant coremed, Assurant Health, assurant maxplan, teladoc

The accident medical expense (AME) deductible for SuiteSolutions Secure and Select is changing to $250 for new policies with effective dates of January 1, 2009 and later. In addition, the table below shows the new Health Advocates Alliance (HAA) monthly membership fees for SecureSolution and SelectSolution for both single and family coverage.

SuiteSolutions New Monthly Membership Fees-Effective 1/1/09

Secure-AME Coverage $2,500 $5,000 $10,000
Single $29.95 $33.95 $38.95
Family $39.95 $43.95 $53.95

Select-AME/Critical Illness Coverage $2,500 $5,000 $10,000
Single $45.95 $49.95 $59.95
Family $55.95 $59.95 $69.95

Rates will change for existing policyholders at renewal, starting January 1, 2009. The HAA current monthly fee of $4 per month is not increasing. This fee is charged in addition to the monthly
membership fee rates.

Tags: Assurant, Assurant Health

As part of the economic stabilization package (H.R. 1424), Congress passed mental health parity legislation which was signed into law on October 3, 2008, by President Bush as Public Law No: 110-343.

This new law amends the Employee Retirement Income Security Act (ERISA), the Public Health Service Act (PHSA), and the Internal Revenue Code (IRC) and applies to all ERISA group health plans and to health insurers that provide insurance coverage to group health plans.

In general, this new law requires group health plans that provide mental health or substance use disorder benefits to provide such benefits on par with medical-surgical benefits.

Exemptions

Details of the New Law
The new Mental Health Parity Act does not require coverage of mental health or substance use disorder benefits.

However, if a group health plan does provide mental health or substance use disorder benefits, they are subject to a “parity” requirement, meaning that those mental health and substance use disorder benefits must have similar financial requirements (e.g., deductibles and co-pays) and treatment limitations (day/visit limits) as the group health plans’ medical and surgical benefits.

Financial Requirements
The financial requirements applied to mental health and substance use disorder benefits must not be more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits. “Financial requirements” are defined in the law as including deductibles, co-pays, coinsurance and any other out-of-pocket expenses.

Treatment Limitations
The treatment limitations applied to mental health or substance use disorder benefits must not be more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits. “Treatment limitations” are defined as including limits on the frequency of treatment, number of visits, days of coverage, or other similar limits on the scope or duration of treatment.

Annual and Lifetime Limits
If a health insurance plan includes an aggregate annual or lifetime financial or treatment limit on substantially all medical and surgical benefits, it must either:

Effective Date
The requirements of the new law are effective for plan years beginning on or after one year from the date the legislation was signed into law. As a result, the provisions apply to new contracts and renewals on or after October 3, 2009.

*If a group health plan is maintained pursuant to one or more collective bargaining agreements, the new law is effective for plan years beginning the latter of: (a) January 1, 2009, or (b) the date on which the last collective bargaining agreement relating to the plan terminates.

Tags: Mental health insurance, Mental Health Parity, Mental Health Parity and Addiction Equity Act

Advocate Health Care’s is acquiring Condell Medical Center effective December 1, 2008. The new name of the hospital will be Advocate Condell Medical Center. As of the December 1 acquisition date, the Advocate Condell Medical Center will return to the Blue Cross Blue Shield of Illinois PPO and HMO networks. Advocate does not participate in the BlueChoice Select network.

Information regarding the formation of the Advocate Condell PHO for the HMOI physician network will be forthcoming.

Tags: Advocate Health Care, BCBS IL, bcbsil, Blue Cross Blue Shield of Illinois, Condell Medical Center

The 2009 Medicare annual Open Enrollment Period for prescription drug plans runs from November 15th through December 31, 2008. Medicare beneficiaries will be able to begin making enrollment changes in their health and prescription drug coverage for 2009 if necessary during this time.

In addition, for Medicare Advantage (MA) plans only, beneficiaries can make one change in enrollment—enrolling in a new plan, changing plans or canceling a plan—between January 1 and March 31, 2009.

Now is the time for beneficiaries to prepare and compare their health and prescription drug coverage options and choose the plan that best meets their needs. Beneficiaries should take time to compare their current plan with the new plan options available in 2009. If they are satisfied with their current plan and the current plan does not intend to significantly change coverage benefits, they do not need to do anything in order to maintain that coverage.

Beneficiaries are encouraged to review their prescriptions and other health needs when assessing the plan options described in the Medicare & You handbook or on www.medicare.gov. Beneficiaries who feel they need assistance when reviewing the plan options can call Illinois Health Agents at (630) 930-9364 or any other Medicare Certified agency.

People comfortable with navigating the Internet should take advantage of the enhanced online Medicare Prescription Drug Plan Finder options available on www.medicare.gov. This feature offers information on available drug plans, including out-of-pocket costs and pharmacy networks. The enhanced online Medicare Prescription Drug Plan Finder and Medicare Options Compare tools enable beneficiaries to compare drug plan options for prescription drug plans and Medicare Advantage plans in their area.

The 2009 Medicare & You handbook, mailed to beneficiaries in October, includes tips on selecting a plan and an overview of plan options. Beneficiaries already enrolled in a Part D plan will also receive an Annual Notice of Change describing any changes in the benefits of their current drug plan.

Another focus for this year’s open enrollment period involves signing up beneficiaries eligible for extra help, known as the Low Income Subsidy (LIS), to pay for their drugs. This benefit is not only about providing affordable prescription drug coverage; it’s also about promoting better health. For millions of beneficiaries, prescription drug coverage is a critical component in maintaining a healthy lifestyle. Income and resource limits apply. If you or a loved one feels they may be eligible for the LIS, contact KIPDA or the Social Security Administration at 1-800-772-1213.

This is an important time for beneficiaries to review their current coverage and make a decision that will give them peace of mind for the rest of the year. We encourage everyone to make a decision by early December, to ensure a smoother transition into the Part D benefit.

Beware of Medicare Fraud:

Unfortunately, not everyone who contacts you about switching to a Medicare drug plan has the best intentions. To protect yourself from scam artists intent on taking advantage of your situation, here are some additional tips to avoid becoming a victim:

Beware of door-to-door sales people. Remember, agents cannot solicit business at your home without an appointment. Do not let uninvited agents into your home.

Do not give out personal information, such as Social Security numbers, bank account numbers or credit card numbers to anyone you have not verified as a licensed agent. People are not allowed to request such personal information in their marketing activities and cannot ask for payment over the Internet. They must send you a bill. Once you decide to purchase a plan and have verified that the agent is licensed, you may give the agent personal information to assist in enrollment and billing.

Tags: Medicare, Medicare Part D, medicare prescription drugs