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New Health Insurance Plan Years Start in January; Coverage May Have Changed

Posted on: Tuesday, 11 January 2005, 00:00 CST

Jan. 11--January isn't just the start of a new calendar year. If you signed up for health insurance at work this fall, this month is also the start of your new plan year.

You may have new coverage and different benefits to learn. Even if benefits didn't change, you likely have a fresh annual deductible. If you use a flexible spending account for health care, you'll have a new stash of pre-tax dollars to spend.

You also have an opportunity: to become a better educated and more organized health-care consumer.

As New Year's resolutions go, it isn't the sexiest. But if you follow through, you may save yourself both time and money. You'll get more out of your interaction with doctors and other health-care providers. And you could even add years to your life.

Still not convinced? Perhaps a little nudge from your employer will help. Companies, which pay most of workers' health insurance premiums, are increasingly offering rewards for good health behavior.

At IBM, for example, workers who do not smoke received a $150 cash bonus last year. Those who completed a 10-week challenge to exercise at least three times a week received a second $150 bonus.

SpectraSite, a Cary company that leases space on mobile phone towers, last fall challenged its 450 employees to learn more about their health status by completing personal wellness profiles. Workers who completed the profiles received a discount on what they pay in monthly premiums.

"The new employer strategy is all about building accountability," said Steve Graybill, a senior health-care consultant for Mercer Human Resource Consulting.

As you strive to reach the goal of being a better health consumer in 2005, here are five simple steps.

Health-care visits generate a mountain of paperwork that can quickly become overwhelming.

A single physician office visit -- for example, an annual physical that includes blood work -- may generate several statements. If you pay a percentage of most medical expenses, you will receive a bill from your doctor and a bill from the laboratory that processes your blood tests. Your health insurer will also send you an explanation of benefits or "EOB" -- that "not a bill" statement that comes in the mail -- showing the amount your insurance was billed for the medical care you received, the amount the insurance plan paid, and your share of the total cost. You may receive separate statements for both the doctor's visit and the laboratory work.

--Develop a system for managing the flow of medical bills and statements.

Some people maintain spreadsheets for each family member on their computer. But your solution needn't be so complicated. Plain old file folders will do.

"I have a folder for each member of my family," said Jennifer McLaurin, a health insurance broker with John Sipp & Associates in Chapel Hill. When billing statements or explanation-of-benefits forms come in, they go into the appropriate file.

Those explanations of benefits aren't junk mail. You can compare them with your bills to make sure payments from the insurer are in sync with the care you received. McLaurin said that at least a couple of times a month, she gets calls from clients who have been double-billed or had a claim for covered service wrongly denied.

McLaurin recommends keeping billing statements and explanations of benefits for at least a year. You may never need these statements. But when the doctor's office calls and says you owe money for a long-paid-for office visit, won't it feel great to have a statement that shows you paid in full?

--Make the most of your flexible spending account.

Flex accounts let workers set aside pretax income to pay for health-care and dental expenses. These are offered through employers, and sign-ups for the accounts are usually at the same time as health insurance.

Assuming an average tax rate of 25 percent, someone who puts $1,000 in their account in effect gets an "instant return" of $250. As flex account users spend money on eligible items throughout the year, they must keep receipts and submit claim forms to be reimbursed. Money that is unspent at the end of the year is forfeited to the employer.

Nationally, users of flexible spending accounts forfeit about $210 million in unspent money every year, according to Mercer Human Resources Consulting. This year, make sure you spend every penny. (If you didn't sign up for 2005, save receipts this year to determine how much to set aside next year.)

Flex plan claims can be submitted at any time during the year. Some people like to save up receipts, submit them all at once and get a big check. Others prefer to submit receipts as soon as they get them and have a steady stream of smaller reimbursement checks coming in. If you get behind, don't sweat it. Purchases must be made by Dec. 31, but receipts generally can be filed as long as 60 or 90 days after that. Check with your flex plan administrator.

Make sure you are using your flex plan for as many eligible expenses as possible. For example, flex account money can be used to pay for crutches and smoking cessation classes, in addition to glasses and prescription drug co-payments. Don't forget that many over-the-counter drugs, such as allergy medicine and cough syrup, are now eligible expenses. Many drugstores offer help in keeping track of eligible purchases. If you use a CVS "ExtraCare" card, for example, you can visit cvs.com, punch in your ExtraCare account number and receive an itemized list of eligible flex account purchases, so there's no need to hang on to individual receipts.

--List your medicines and shop smart for good prices.

Senior Pharmassist, a Durham nonprofit organization that helps older adults pay for and manage their medicines, has its clients list every prescription medicine, over-the-counter drug, vitamin and herbal supplement they take.

Clients carry the cards with them to the pharmacy and to their doctor visits so their health-care providers have full knowledge of all the medicines they take. Preparing a medication record is something everyone should do, said Gina Upchurch, a pharmacist who is executive director of Senior Pharmassist.

"If you're switching medicines and no one is monitoring, it can be very harmful," Upchurch said.

Have the brand name and the generic name of the product on the list, if available. The brand-name blood pressure medicine Lotensin, for example, is available in generic form as benazepril. If you're unwittingly doubling up on medicine, you're not only wasting money, you're subjecting yourself to possible harm.

If cutting drug costs is a concern, investigate mail order for medicines taken every day. Some mail-order programs will provide a three-month supply of a drug for a single month's co-payment.

Insurers are adding smarter online tools about prescription drugs, including cost information. If you plan to see a doctor about migraine headaches, for instance, you may be able to look up drugs prescribed for migraines and see which ones are covered by your plan.

--Learn more about your health insurance.

Everyone with health insurance should have a basic idea of what health-care services are covered and how much they will be expected to pay.

You don't have to commit this to memory -- just know how to get the information so you can figure out whether you're being properly billed.

Some insurers make it easy by printing the high points, such as what you pay for prescription drugs, office visits and trips to urgent care or the emergency room on member identification cards. This information, plus more specifics on coverage, also can be found on your plan "summary of benefits" -- a one-page sheet -- or in your full plan booklet. Haven't seen your plan literature since open enrollment? You can request another copy directly from the insurer. Customer service numbers are usually printed on your ID card.

Health insurers also offer Internet sites so members don't have to bother with paper. You can take care of just about any administrative matter online.

On most of the major carriers' sites you can look over a summary of benefits, find contact telephone numbers, download claim forms, get the mailing address for claims and update your contact information. You can also see who is covered under your plan, check whether the insurer has paid for your doctor or hospital visit, find doctors and hospitals and order a replacement ID card.

--Evaluate your health and consider how you can improve.

The diseases responsible for the most deaths and the bulk of health costs usually stem from things we do to ourselves. Carrying extra pounds, eating poorly, not getting enough exercise and smoking can lead to heart disease, stroke, diabetes and cancer.

If you haven't had a physical and complete blood work in a while, do so this year.

When your doctor gives you your results, do something about them. Every major carrier has resources and tools -- free to members. You can research medical conditions, look up medicines and their alternatives, and even compare hospitals on quality and cost. Some carriers, including United Healthcare and Blue Cross and Blue Shield of North Carolina, identify network doctors who have the best health results.

Most allow members to take a risk assessment that gauges their chances of developing stroke, heart disease and diabetes. Some assessments show how much of a person's risk is preventable -- dependent on their own habits and behavior -- and how much is based on family history.

"All of this there to set the patient up for a more intelligent conversation with their physician," said Meredith Baratz, vice president of business development for United Healthcare.

Leverage every resource available to you -- your premiums pay for this stuff. Many carriers offer 24-hour nurse advice lines. Some offer online chats with a nurse, who can guide callers to resources on the Web, as well as address specific medical questions.

If you have a chronic medical condition, you may be able to enroll in a free disease-management program that provides one-on-one consultation with a nurse who monitors your care. Some programs provide free medicine or discounts on medical supplies -- blood sugar test strips, for example -- to encourage participation.

You don't even have to be sick to get extra help.

Blue Cross and Blue Shield of North Carolina, the state's largest health insurer, has a pregnancy program that gives expectant mothers information on prenatal and infant care, including free copies of baby books, such as "The Nursing Mother's Companion." All you need to enroll is a due date.

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IBM, 6680, SSI, MMC,

Source: The News & Observer

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