Spring 2013 Update - Tufts Health Plan

REMEMBER THE MEMBERWe Remember the Member continued from page 1One of the initiatives is our “Remember the Member”contest. We’re teaming up to come up with new andfresh ideas to address the issues we know members have—because we’ve listened and documented them. The contestencourages all Tufts Health Plan employees to submit ideasthroughout the year for removing member hassles, providingtop-notch service, and more. Winning ideas will be selectedand implemented.Another key focus of the Member Satisfaction Committeeis better managing member expectations through ourmember communication materials. Our goal is to breakinformation down to a level that members can understandand find useful. “Marketing plays an important role incommunicating to our members,” says Jennifer Butler,Director of Marketing. “We want to touch every aspect of amember’s Tufts Health Plan experience. In order to achievethis goal, we are repositioning all of our materials to manageexpectations upfront.”Other initiatives include:• Timeliness of claims processing• Making sure the provider network is adequate—specifically,we have added many mental health providers to thenetwork, and• Reviewing the prescription drug formularyEducation for Advantage PlansIn addition to these efforts, we are targeting educationaloutreach to members in our Advantage plans, includingour HSA-compatible plans. We have created the AdvantageResource Center—an online resource for members whoneed help and information. Here, members will find videos,articles, and presentations designed specifically to educatemembers about how their plan works, particularly withrespect to deductible and coinsurance, HRAs, and HSAs.Butler explains: "Members have trouble understandingthe concept of adding a deductible to their HMO or PPOplan—particularly if they are coming from a plan that doesnot have a deductible or significant cost-sharing feature.They may not see the value that these health plans offer.We want to both manage their expectations about howthese plans work and provide them with helpful tools. TheAdvantage Resource Center helps fill the knowledge gap thatexists for members who are new to deductible plans." Visitthe Advantage Resource Center at tuftshealthplan.com/advantage.Helping Members Read the Summary of Benefits andCoverageUnder the terms of the Affordable Care Act, health plansare required to provide a Uniform Summary of Benefitsand Coverage (SBC) to members. The health care reformlaw created the SBC to provide consumers with simple andstraightforward information on plan coverage in a uniformformat. The intent of the SBC is to help consumers betterunderstand the coverage they have and compare differences inbenefits and coverage when they are shopping for a new plan.Because the language and format are dictated by thegovernment, we have limited ability to change the wordingor the content, and some members may find it confusing.We are producing a web-based video that walks membersthrough the process of reading and understanding the SBC.The video will be available at tuftshealthplan.com.2 Update Newsletter / Spring 2013

REMEMBER THE MEMBERWe Remember the MembeMobile Websites for Smartphone and iPadAccessible information is also important, especially in ourfast-paced world. Members with an iPhone, iPad, Droid,or BlackBerry can now take advantage of our new mobilecapabilities. Members can visit their secure online accounton their mobile device by entering tuftshealthplan.com inthe web browser to:• Check benefits, including copayments• Check the status of claims, referrals, and authorizations• Review drug coverage and refill mail-order prescriptions(for members whose plans include the Tufts Health Planpharmacy benefit)• Learn about Member Discounts• View a copy of their ID card, as well as email it toproviders• Find PCPs, specialists, hospitals, and other facilitiesMember DiscountsAlong with our focus on helping members understand theirbenefits and how to use them, we strive to offer discountsand other extras that might help them relax, get healthier,or just save some money. We believe this helps membershave an optimal experience with Tufts Health Plan. You’llread more on the following pages about some of the newestofferings we have for our members.We hope members find these mobile tools helpful andconvenient when they’re on the go and need to checkbenefits or look up a provider.Update Newsletter / Spring 2013 3

HEALTH CARE REFORMHealth Care Reform—What's Ahead for 2013 and 2014 continued from page 1Key Provisions Being Implemented in 2013Two specific provisions that impact employers and brokersare as follows:• Flexible Spending AccountsEffective for plan years beginning on or after January 1,2013, employee contributions to Health Flexible SpendingAccounts are limited to $2,500 per plan year.To view information on what expenses qualify forreimbursement under Flexible Spending Accounts, pleasevisit http://www.healthcare.gov/law/features/costs/fsa-hra/index.html.• Notice to Employees about Exchanges (Delayed)By March 1, 2013, employers must provide currentemployees and new hires certain information about theexchanges, including:- The availability of coverage through Exchanges- Possible eligibility for premium tax credits and/or costsharing reductions- Potential loss of employer contributions, if anyHHS is expected to issue model notice.This provision has been delayed until further guidance isissued.Key Provisions Being Implemented in 20142014 will see a number of key provisions implemented aspart of the Affordable Care Act, including:• Establishment of Insurance ExchangesExchanges will be established in each state as a methodthrough which individuals and small groups can purchaseinsurance.• Individuals required to have basic insurance planIndividuals who can afford to buy health insurance, withcertain exceptions, will be responsible to obtain a basiccoverage plan. If they fail to do so, they will have to payphased-in tax penalty for noncompliance. However, ifaffordable coverage is not available to an individual, he/shemay be qualified as exempt from this provision.• Employer “Shared Responsibility” Requirement“Applicable Large Employer” that employed an averageof “50 or more full-time equivalents” during the previouscalendar year must offer “affordable” health coverage of“minimum value” or pay a “shared responsibility” penalty.• Coverage for Individuals Participating in Clinical TrialsInsurers must cover routine patient costs associated withcertain approved clinical trials relating to cancer or otherlife-threatening conditions.• Insurers may not refuse to sell or renew policies basedon pre-existing conditions• Prohibition of Annual Dollar Caps on Essential HealthBenefits in the Individual and Small Group Markets• Phase 2 of Tax Credits for Small BusinessesSmall businesses (fewer than 25 employees) that choose toprovide health insurance to their employees may receiveincreased tax credits of up to 50% of the cost of healthinsurance to employees. Non-profits may receive taxcredits of up to 35% of the cost of insurance.• Voluntary Establishment of Wellness Programs andIncentivesFor more information, please read this article from theDepartment of Labor: http://www.dol.gov/ebsa/newsroom/fswellnessprogram.html.6 Update Newsletter / Spring 2013

HEALTH CARE REFORMSummary of Key Provisions of the Health Care Reform Taking Effect in 2013 and 2014 forEmployers and Brokers continued from page 1DefinitionsA Flexible Spending Account (FSA) is a tax-deferredsavings account established by an employer to helpemployees meet certain medical and dependent care expensesthat are not covered under the employer's insurance plan.Established under Section 125 of the Internal RevenueCode, FSAs were once known as medical IndividualRetirement Accounts (IRAs). FSAs allow employees tocontribute a limited amount of pre-tax dollars to anaccount set up by their employer. They can later withdrawthese funds tax-free to pay for qualified health insurancepremiums, out-of-pocket medical costs, day care providerfees, or private preschool and kindergarten expenses.FSAs can provide an attractive benefit for many employees,and they can also offer tax savings for both employeesand employers. As the cost of providing health insuranceto employees has risen rapidly over the last decade, manycompanies have greatly increased the employee portionof the insurance premium. Copays and deductibles haveincreased as well in an attempt to manage the overallpremium cost. The use of a health care FSA is one way inwhich employers may help their employees to self-fund withtax-free dollars the growing costs that they are asked to bearfor their partial company-funded health insurance.Exchanges are new organizations being established with thegoal of creating a more organized and competitive marketfor buying health insurance. They will offer a choice ofdifferent health plans, certifying plans that participate, andproviding information to help consumers better understandtheir options.Beginning in 2014, Exchanges will primarily serveindividuals buying insurance on their own and smallbusinesses with up to 100 employees, though states canchoose to include larger employers in the future. A statecan itself operate an Exchange, can partner with the federalgovernment to run the exchange, or can opt to have thefederal government facilitate the exchange in that state.Update Newsletter / Spring 2013 7

HEALTH CARE REFORMPatient Centered Outcome Research Institute (PCORI)The Patient Centered Outcome Research Institute (PCORI)is part of the Patient Protection and Affordable Care Act(PPACA). The funding of this patient-centered outcomesresearch comes from fees paid by both health insurers andself-funded plan sponsors.Insurers and self-funded employers will be responsible forpaying a fee to fund a federal Patient Outcomes ResearchInstitute. The fee will be equal to:• $1 for each of the average number of covered lives underthe plan for the first plan year ending on or after October1, 2012, and• $2 per life for each year ending on or after October 1,2013, subject to a possible increase and ending in 2019.This fee does not apply to government programs. Thefederal government issued a proposed rule on April 17,2012, that includes methods for calculating the fee. Plansand self-funded plan sponsors must submit an IRS filing(Form 720) with the fee each year by July 31.Tufts Health Plan is responsible for paying the fees for itscovered insured lives. Self-funded groups are responsible forpaying the fee directly to the IRS.If you have any questions, please contact your accountmanager.Coverage for Oral Chemotherapy Drugs—Effective January 1, 2013Effective upon renewal beginning January 1, 2013, Massachusetts-basedplans are required to cover prescribed, orally administered chemotherapydrugs as medical benefits. This means they are not subject to member costsharing associated with pharmacy coverage.Tufts Health Plan is actively updating its systems to comply with the newmandate. As part of the system update, we will process reimbursements formembers who were eligible to receive approved oral chemotherapy drugswith no out-of-pocket cost according to their group’s renewal date. Weappreciate your patience as we take the steps needed to implement thisnew legal requirement.If you have questions, please contact your account manager.10 Update Newsletter / Spring 2013

HEALTH CARE REFORMHealth Care Reform Online Resource for Employer GroupsHealth Care Reform—both on a federal and a state level—continues to be the primary catalyst for change in thearea of health insurance. For the past several years, TuftsHealth Plan and our customers have been actively engagedin evolving and changing our plans, communications, andstrategies to conform with the sweeping changes necessitatedby legislation, including the Affordable Care Act and, on thestate level, Chapter 224—MA Payment Reform.To help keep our employer groups informed of currentACA implementation work and requirements, as well asstate-related health care reform work and requirements, wehave created an online resource at tuftshealthplan.com/healthcarereform.Here you will find federal and state information, including:• An implementation timeline for the ACA• A summary of key provisions effective in 2013 and 2014• Useful web links• A news feed from a number of government sources ofhealth care reform information• A summary of MA Payment Reform legislation andimplementation• Links to Massachusetts government websites createdspecifically to inform the public of MA Payment Reformimplementation workThe site will be updated regularly, and will focus on theissues that directly impact employer groups. If you have anyquestions, please contact your Account Manager.Update Newsletter / Spring 2013 11

N E W S F O R T H E M A R K E T P L A C E705 Mount Auburn StreetWatertown, MA 02472tuftshealthplan.comPresorted StandardU.S. PostagePAIDBrockton, MAPermit No. 301MEMBER SERVICESHMO/POS/EPO/PPO800.462.0224Tufts Health Plan Medicare Preferred800.701.9000SALES OFFICES705 Mount Auburn StreetWatertown, MA 02472Phone: 800.208.8013Fax: 617.923.5880102 Shore Drive, Suite 402Worcester, MA 01605Phone: 800.208.9545Fax: 508.757.83111441 Main Street, Suite 925Springfield, MA 01103Phone: 800.337.4447Fax: 413.746.8300One West Exchange PlaceProvidence, RI 02903Phone: 800.455.2012Fax: 401.272.1233WHAT'S INSIDE ...We Remember the Member. ............................................................. 1Health Care Reform—What's Ahead for 2013 and 2014.................................... 1New Weight Management Program Discounts for Members ............................... 4Money-Saving Coupons to Support Healthy Lifestyles..................................... 5LifeMart ................................................................................ 5Tufts Health Plan Receives Kudos From Boston Globe ColumnistBroadway In Boston. .................................................................... 5Medical Loss Ratio (MLR)—What You Need to Know....................................... 8Patient Centered Outcome Research Institute (PCORI).................................... 10Coverage for Oral Chemotherapy Drugs—Effective January 1, 2013....................... 10Health Care Reform Online Resource for Employer Groups................................ 11