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What Exactly Is a PBM?

What Exactly Is a PBM?

If your employer offers prescription medication benefits, you may think that you are getting your prescriptions directly through an insurance plan. The fact is that most health plans contract with a pharmacy benefits manager (PBM) to administer prescription drug benefits. So, what exactly is a PBM and what does it do for you? Simply stated, a PBM is a company that administers, or handles, the prescription drug benefit component of your...

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What You Need To Know: 1095 Filing

What You Need To Know: 1095 Filing

Another confusing part of Healthcare Reform (PPACA) is the 1095 filing that is taking place this year. There aren’t many things to do from an employer’s perspective but there are a few points that can help calm the frantic HR or CFO and your employees on the new IRS tax forms required for health insurance.  The Affordable Care Act (ACA) requires that health insurance carriers and some employers to provide new health insurance...

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5 reasons United Healthcare wants out of PPACA

5 reasons United Healthcare wants out of PPACA

I came across this great industry article in my inbox this morning and just had to share. Alson Martin does a great job of reviewing the latest news that United Healthcare has started to put it out there they would be leaving the health insurance marketplace due to the shortfalls in earnings on the PPACA exchanges. Take a look at the article and come to your own conclusions: On November 19, 2015, UnitedHealth, in a conference call for...

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HealthCare.gov extends Jan. 1 coverage deadline 2 days

HealthCare.gov extends Jan. 1 coverage deadline 2 days

Managers of HealthCare.gov have responded to complaints about website glitches and outages, and overloaded call centers, by pushing the application deadline for coverage that starts Jan. 1 to 11:59 p.m. Pacific Time Friday. The current Patient Protection and Affordable Care Act (PPACA) open enrollment period started Nov. 15 and is set to end Jan. 31. The original deadline for Jan. 1 start coverage was supposed to be at midnight Pacific...

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PPO’s are a dying breed…

PPO’s are a dying breed…

I came upon the latest batch of articles from Benefits Pro and immediately thought of our readership and the need to get this out. There has been a lot of “movement” in the health insurance market especially in the narrowing of network access. This is especially true as insurance companies try to stay not only relevant but cost effective in the Health Care Reform era. With the narrowing of doctor networks we are seeing a...

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What Does U.C.R In Dental Coverage Stand For?

What Does U.C.R In Dental Coverage Stand For?

From time to time we like to touch on a detailed part of your benefits package that you have probably read or at least heard of but not connected the dots.  This is especially true for Dental Insurance.  The term UCR comes up in almost every meeting our benefits team sets up. The reason for this is simple… It is a minute detail in how “out of network” dental coverage reimburses services.  Insurance payment for covered...

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Small Businesses No Longer Allowed to Reimburse

Small Businesses No Longer Allowed to Reimburse

As a small to medium sized group benefits broker we see a lot of difference cost savings techniques in benefits packages.  This is specifically true in the under 50 employee market. Our account and sales team analyze hundreds of plans a year and have pinpointed that an employer who isn’t overly thrilled with the cost of employer-sponsored health coverage will drill down in unique approaches to say the “offer” health...

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