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Summer 2011
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7/12/2011 |
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Dear Visitor,
The Summer 2011 edition of the Enformed newsletter is included for your review. This issue highlights TPA services along with numerous articles on compliance issues, an interview with our actuary, Hobson D. Carroll, FSA, MAAA and a new service highlight on One Call Medical. I hope you find the information to be useful when considering your benefits.
Ed Jacobson
281-368-7878...ext. #111
14701 St. Mary's Lane, Ste. #150
Houston, TX 77079
Mailing Address:
P.O. Box 440309
Houston, TX 77244-0309
ejacobson@entrustinc.com
website: www.entrustinc.com
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In This Issue:
Robyn Jacobson, Chief Operating Officer of Entrust, Inc., discusses selecting a Third Party Administrator.
Also in this Issue:
Entrust, Inc is proud to
announce our new Website,
www.entrustinc.com .
The fresh, new look still contains the highly respected core products and services that you're familiar with. Our new features include: the Enformed web portal, enhanced Wellness information and tools to review medical costs and physician profiles. We hope you will find these new tools very informative.
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Hot Topic 
Third Party Administrator (TPA) Services
The Entrust, Inc. family of companies offers a myriad of administrative and consultative services. Although administrative (or TPA) services are the core of our service offerings, merely referring to Entrust as a TPA does not begin to describe our company.
Consultation has always been at the heart of what we do at Entrust. Consultative services are performed at every level of our business, beginning with new account consultation with both clients and our agent partners. This includes a business development interview to determine the needs and desires of the employer regarding the benefit plan and its cost, and only ends when an appropriate benefit design is agreed upon and implemented.
Consultation continues with our stop-loss insurers and other plan partners including preferred provider organizations (PPOs), pharmacy benefit  managers (PBMs) and other miscellaneous vendors that provide services to the plans we administer. It also extends to the medical providers our clients utilize and the other medical services and supplies covered by the plans.
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Choosing & Evaluating TPA Services
From: SPBA President Fred Hunt
Dear Friends,
I am often asked about evaluating the performance of a TPA. There is no handy formula or measure. There are no industry norms nor guidelines because it is such a personalized business that there are no com parables. First of all, from a legal standpoint, a TPA does only as much or as little as delegated by the client in the service contract, so each is a custom arrangement. From the practical perspective, things like the level & speed of cooperation from the client (such as notifying  about new workers, dependents, terminations, etc.)...not to mention the type of employment & plan (union, non-union, big, small, locations, design of plan, etc. etc.) all impact the "efficiency". There is also the extremely important issue that in employee benefits, there is often no "right" or provably correct way to do things, because huge segments of the law lack final comprehensive compliance guidance, and most government agencies judge situations on a case-by-case basis. Thus measuring "accuracy" is very subjective. On the other hand, TPAs model themselves on the toughest-ever consumer protection....which can impose both civil and criminal (jail time) penalties for transgressions. ERISA's fiduciary responsibility is inspected & enforced by the U.S. Department of Labor.
For the same reasons (unclear government compliance guidance and strict fiduciary duty) another seemingly-logical measurement...speed of processing...also backfires. As one employer/client (who happened to be a hospital) called to sheepishly apologize, "I guess what I was asking is like asking how fast our doctors do exploratory surgery. Being careful is the most important factor."
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Is your Health Plan Compliant?
The following article emphasizes the need to constantly monitor your HIPAA exposures and to continually train your staff in matters of HIPAA Privacy and Security. HIPAA is a very complicated law that requires not only the privacy protection of personal health information, but also the maintenance of physical and electronic security measures  necessary to preserve the information. If you are not currently utilizing the Entrust, Inc. Compliance Services, maybe you should reevaluate your decision.
Entrust has the experienced legal staff to assist in your implementation of the required HIPAA practices and procedures, and the technical staff to review and advise you on security issues. Give us a call today for more information.
The Million-Dollar Subway Ride: HIPAA Enforcement Sets Course in a New Direction
25-February-2011 Authors: Gina M. Kastel & Steve Lokensgard
This article is provided as a courtesy to the clients and friends of the Law Firm of Faegre & Benson, LLP
New Enforcement Actions
On February 24, 2011, the Health and Human Services Office of Civil Rights (OCR) announced a $1 million Health Insurance Portability and Accountability Act (HIPAA) settlement with General Hospital Corporation and Massachusetts General Physicians Organization, Inc. (Massachusetts General Hospital) for alleged violations of the privacy and security regulations of HIPAA
Entrust Compliance Update
Update of the Waiver Process Regarding the Annual Limits Requirements of PPACA
The Patient Protection & Affordable Care Act (“PPACA”) set annual limits on the dollar amount of essential health benefits that Plans can have between now and 2014. Specifically, for Plan years beginning between September 23, 2010 and September 22, 2011, Plans cannot limit essential benefits to less than $750,000. This restriction increases to $1.25 million for plan years beginning on or after September 23, 2011 and increases to $2 million for plan years beginning between September 23, 2012 and January 1, 2014. As PPACA is currently written, Plans will no longer be able to have annual dollar limits on essential health benefits coverage beginning with new plans and renewals issued after January 1, 2014. Essential benefits have not been clearly defined at this time, and we hope to have further formal guidance on these definitions later this year.
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Interview with the Actuary
Ed Jacobson, CEO of Entrust, Inc. interviews Hobson D. Carroll, FSA, MAA, consulting actuary for Entrust Risk Management Services
Ed: So, tell me all that I need to know about what’s wrong with the healthcare system, Hobson.
Hobson: Well, we spend a lot of money on medical care costs in this country, as you hear every day - you can hardly avoid it if you read the newspapers or read newsmagazines or listen to the radio and watch TV. You hear about health care costs in the United States being too excessive, especially when compared with other countries. However, that doesn’t always mean a lot to people, when you tell it to them, especially when they see graphs that say things like “The United States is spending 17.1% of GDP on medical costs.”
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Wellness Programs
Throughout the year, many organizations promote an Awareness program for a specfic medical condition. Entrust supports these programs and wants to share this information and web site links with you.
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New Health Care Reform FAQs Expand Grounds for Terminating Plan Options Without Losing Grandfathered Status
4/25/2011 Norbert F. Kugele
Frequently Asked Questions – and the answers -- issued this month by the government may provide some welcome relief for employers with grandfathered health plans who are thinking of terminating a health plan option. They also clarify issues relating to plan amendments, employer contribution rates, prescription drug coverage and value-based insurance designs.
Terminating plan options without losing grandfathered status
Under Health Care Reform, employers with grandfathered health plans must tread carefully before terminating a medical benefit package, as it may jeopardize the grandfathered status of its other medical benefit packages. Under the grandfathering regulations' anti-abuse rule, if an employer terminates a medical benefit package and moves employees to another package, and the differences between the two packages are significant, the benefit package into which employees are moved will lose its grandfathered status if there is not a "bona fide employment-based reason" for the change. The regulations go on to explain that eliminating a medical benefit package because of its high costs would not be considered a bona fide employment-based reason, suggesting that this exception is meant to be fairly narrow.With the new FAQs, however, the agencies are clarifying and perhaps even expanding the types of circumstances that will be considered bona fide employment-based reasons for
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Entrust welcomes One Call Medical to our offering of service providers.
One Call Medical, Inc., (OCM) was established in 1993 as a specialized provider network, offering a nationwide, credentialed, high-quality and reduced-cost MRI / CT / EMG service for the Workers’ Compensation, Group Health and Auto Insurance Industries. OCM provides solutions for ensuring access to high quality tests at low cost. OCM combines a national network of highly credentialed providers, unique scheduling services to assist patients with access to providers and a simple, uncomplicated reimbursement model into an effective program for payers and plan administrators.
For more information please visit www.onecallmedical.com.
Contact Entrust
If you are having difficulty complying with PPACA or any other complicated legal or compliance issues, let Entrust help you navigate these  treacherous waters as we do for all of our clients. We stand ready, willing and able to provide administrative services for your plan and take care of compliance as part of our global service to you. We also consult on the compliance component only.Contact Clint Wilson or (281) 368-7878 ext. 505 for more details.
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