Monthly Archives: September 2014

Highmark Announces Individual Plan Changes

In March 2014, the federal government announced that insurance carriers, with the consent of their state insurance commissioner, could offer individuals the option to renew existing, pre-2014 plans. The Pennsylvania Insurance Commissioner has confirmed that Pennsylvania insurers have the option to do so.

After careful analysis, Highmark Blue Cross Blue Shield has decided to offer Community Blue PPO plan members the right to renew their pre-2014 plans in western Pennsylvania. This decision will impact approximately 2,000 members.

In addition, Highmark has decided to offer members in its existing grandfathered, medically underwritten individual plans the option to renew and continue coverage in these plans in 2015. These plans include:

  •  Keystone Blue
  • Complete Care

However, this means that the following Highmark plans will end Dec. 31, 2014:

  •  Advance Blue
  •  Direct Blue
  •  Simply Blue
  • PPO Blue

Members enrolled in these non-renewing medically underwritten plans will need to enroll in a new plan by Dec. 15, 2014 to ensure they have coverage effective Jan. 1, 2015.

Notifications will be sent to members with Keystone Blue, Complete Care and Community Blue PPO plans to let them know that their coverage will be renewed.

Members enrolled in the discontinued medically underwritten plans were notified last year that their plans were being discontinued. They will receive an additional letter the week of Sept. 22, 2014 reminding them that their current plan will be ending on Dec. 31, 2014, and they will need to choose a new plan during the upcoming open enrollment period. Also included in this letter will be directions for how they can request a free 2015 Health Insurance Planning Guide, which covers:

  • What they need to know before they start to shop for a new plan
  • How they may be able to save money with financial assistance
  • When they need to act to avoid a lapse in coverage

The letter also directs them to contact their producer to set up an appointment for the upcoming 2015 open enrollment period.

A future letter will specifically state that they need to enroll in the new plan by Dec. 15, 2014 to avoid any gap in coverage.

The member letters and 2015 Health Insurance Planning Guide will be shared with you in the near future.

New tool coming Nov. 15, 2014

A new quoting tool will be available on Nov. 15, 2014 on the Highmark producer portal. This tool will enable you to quickly pull quotes for existing individual members. With this tool, you can assist your clients whose plans are not renewing by helping them find and enroll in a plan that meets their needs.


UPMC Training Portfolio for 2-50 Employees

UPMC Healthplan is rolling out a new portfolio for employer groups with 2-50 employees for 2015.  The portfolio covers the following plan types:

  • UPMC Small Business Advantage
  • UPMC HealthyU
  • UPMC Consumer Advantage
  • UPMC Inside Advantage

Live training webinars will be held on Friday, October 3, from 9 AM to 10 AM and Thursday, October 9, from 1-2 PM.

Don’t miss this opportunity to learn details about our new plans and the following topics:

  • SHOP Marketplace
  • Affordable Care Act Updates
  • 2015 Networks


 After you register, login instructions will be sent.


Carriers Announce Fall Kick Off Seminars

Three of the area’s major carriers have announced dates and times of their Fall Sales and Strategy Sessions for the Broker Community.  Use the links below to register for the appropriate carrier’s session.

Highmark Fall Agency Strategy Session

October 14, 2014
8:00 AM to 9:00 AM Breakfast and Trade Show
9:00 AM Strategy Session

Pittsburgh Marriott North
100 Cranberry Woods Drive
Cranberry Township, PA 1606

UPMC Healthplan Fall Producer Kick Off

October 2, 2014
8:30 AM Registration and Continental Breakfast
9:00 AM – 12:00 PM Presentations

Marriott City Center
112 Washington Place
Pittsburgh, PA 15219


October 1, 2014
8:30 AM Registration & Breakfast
9:00 Presentation

Pittsburgh Marriott North
100 Cranberry Woods Drive
Cranberry Township, PA

ACA Fees and Taxes on Alternate Funding Arrangements

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It is important to note that for alternate funding products All Savers does not pay  the ACA fees & taxes on behalf of the employer group. The employer will be responsible for handling them. Below are the steps they will need to take handle this.  Read the Employer’s Guide for more information.

In addition, the group will eventually need to apply for a Health Plan Identifier (HPID) but not until 11/15. You can read more about the HPID here.

There are two fees they are responsible for. 1) PCORI and 2) Transitional Reinsurance Fee. The attached quarterly excise tax return is also helpful.


• For plan years ending after Oct. 1, 2014, the fee is indexed for medical inflation above the current $2 per member per year fee.

• The indexed fee has not been released yet.

• The fee will no longer apply after Sept. 30, 2019.

• Payment must be submitted by July 31 of the calendar year immediately following the last day of the plan year.

• You will not be invoiced for the PCORI Fee. You’ll need to file federal excise tax return Form 720.

• Third-party administrators are prohibited under the health reform law from remitting the fee for you.

Transitional Reinsurance Fee:

• The Transitional Reinsurance Fee is $5.25 per member per month ($63 annually) for 2014. It decreases for the subsequent two years.

• The first payment is due Jan. 15, 2014 for the 2014 benefit year.

• You must submit membership counts for the 2014 to HHS by Nov. 15, 2014.

• Annual membership counts are based on the first nine months of the benefit year.

• HHS will invoice plans for the amount due by Dec. 15.


PCORI Fee Explained

UPMC_HealthPlan_H_2C-selectionThe Patient-Centered Outcomes Research Institute (PCORI) was created by the Affordable Care Act (ACA). The PCORI funds independent projects that research, evaluate, and compare health outcomes and the clinical effectiveness, risks, and benefits of medical treatments and services.

In general, the PCORI fee applies to policy or plan years ending on or after October 1, 2012, through September 30, 2019, as outlined in the chart below


Policy or Plan Years Ending




$1 per covered life



$2 per covered life



$2 per covered life increased by projected per capita National Health Expenditures

The fee applies to coverage provided to active employees, former employees, and qualified beneficiaries, as well as to coverage provided under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), and to health reimbursement arrangements (HRAs) and flexible spending arrangements (FSAs) that are not treated as excepted benefits.

The fees for fully insured plans are built into renewals and will be remitted by UPMC Health Plan. Note: HRAs associated with medical plans may be considered separate self-funded plans, and the group must remit any fees for the HRA on their own. Federal regulations do not permit UPMC Health Plan to remit fees for self-funded plans, including HRAs.

UPMC Health Plan calculates the amount of covered lives with the snapshot method: The sum of the total number of lives covered on one date in each quarter (or equal dates each quarter) divided by the number of counts.

More information is available in the final regulations published by the IRS.