Are you a small business owner?  Or, perhaps your company is opening a new office in North Carolina and you are interested in providing your employees with group health insurance.  If so, consider a Blue Cross Blue Shield of North Carolina group health insurance plan.

Group health insurance is often less expensive than individual insurance and is a great way to give your employees a perk.   In addition, group insurance can help employers by providing certain tax benefits.  What an employer contributes towards the health insurance coverage of their employees is a deductible business expense and in some small group cases may even qualify for a tax credit.  In addition, employees can often pay for their share of group health premiums using pre-tax dollars.  Pre-tax treatment of employee contributions saves employee’s money and it reduces net taxable payroll.  These same tax benefits do not apply to individual health insurance.

If you are interested in providing group coverage to your employees, talk with one of our licensed and professional agents to discuss your options.  For more information on North Carolina insurance coverage, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400.

Blue Cross is offering a variety of health insurance plans,  providing you with more choices, more savings and the same superior coverage you expect from BCBSNC.  Click here to request a group insurance quote today.

• Blue Options – Our flagship PPO plan
• Blue Options 1-2-3 – Our traditional PPO plan design with customer driven health care engagement
• Blue Options HSA – Our consumer-driven health savings account plan

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

We hope this change will take place beginning April 1, 2012. This change would result in lower pharmacy costs for BCBSNC and our group customers, and would provide more flexibility regarding services and programs.

Please refer to the questions and answers below for more information. Questions and Answers for BCBSNC Employers and Members

Who is Prime Therapeutics?

Prime Therapeutics (Prime) is a thought leader in the pharmacy benefit management (PBM) industry. Its mission is to provide the highest quality care and service for members while focusing on delivering the lowest cost of care and empowering clients to make informed decisions in health care management. Prime is owned by 9 entities, representing 12 BCBS plans, and is the fourth largest PBM in the industry.

What is Prime’s ownership structure?

Prime is a privately-held company owned jointly by 12 Blue Cross and Blue Shield (BCBS)health plans:

???? Blue Cross and Blue Shield of Alabama

???? Blue Cross and Blue Shield of Florida

???? Blue Cross and Blue Shield of Illinois

???? Blue Cross and Blue Shield of Kansas

???? Blue Cross and Blue Shield of Minnesota

???? Blue Cross and Blue Shield of Montana

???? Blue Cross and Blue Shield of Nebraska

???? Blue Cross and Blue Shield of New Mexico

???? Blue Cross and Blue Shield of North Dakota

???? Blue Cross and Blue Shield of Oklahoma

???? Blue Cross and Blue Shield of Texas

???? Blue Cross and Blue Shield of Wyoming

Through its private ownership structure, Prime is able to focus on BCBS stakeholder value, not stockholder value. Prime offers a proven, strategic partnership that supports its clients’ overall health care goals. BCBSNC would be part-owner of the company.

Why is BCBSNC looking to make this change?

BCBSNC decided to explore changing pharmacy benefits managers (PBMs) for a number of reasons. Most importantly, we want to secure the most competitive pricing possible, which means we would be better able to control pharmacy claims expense.

Prime offers the economies of scale of a national provider with the flexibility, customization and quality service of an in-house solution. As a leading PBM owned by Blue Cross and Blue Shield plans, Prime is uniquely able to meet our high standards, while at the same time leveraging best practices. As a result, Prime consistently delivers the best pharmacy trend of the major PBM competitors, and outperforms them in customer satisfaction.

How much will I save?

One important reason that BCBSNC decided to contract with Prime Therapeutics was to secure better pharmacy discount pricing. Prime works with clients to identify factors driving their pharmacy trend and then implements various approaches to lower pharmacy costs. These include:

• Low net-cost approach. Prime uses a low net-cost approach that is applied to formulary development, benefit design, manufacturer contracts, and network reimbursement. Using this approach, Prime has helped health plan clients successfully decrease overall per member per month costs.

• Maximum allowable cost (MAC) program (generic drug pricing). Prime believes its MAC program to be the most clinically comprehensive and competitive in the industry

• Driving employees to lower-cost drugs. Driving utilization to lower-cost products is a key to managing costs. Prime has several programs to move utilization to lowercost brand and generic products. Actual member or group level savings will depend on a number of factors including specific utilization patterns.

Does this have any impact on me now?

No. The target date for moving to Prime is April 1, 2012, pending completion of final negotiations and regulatory approval. Therefore, there are no changes for members at this time.

Why are you targeting a 4/1 implementation date?

The tentative 4/1/2012 implementation date was chosen to ensure that appropriate quality and service associated with planned annual renewals is maintained. Implementing off-cycle also ensures minimal disruption to membership during transition.

Will there be any cost to the group for this transition?

No. There are no costs to BCBSNC members or groups associated with the change from Medco to Prime Therapeutics.

Are my benefits changing?

Prime Therapeutics will be able to administer your pharmacy benefits without making significant benefit changes. Any changes to your pharmacy benefit will be positive additions driving to lowest net costs for you and your membership. The change from Medco to Prime Therapeutics will be nearly transparent to BCBSNC members.

How will my deductibles, accumulators, out of packet maximums transfer?

 BCBSNC will work with Prime to ensure that all records are transferred to the Prime claims system appropriately. When the change from Medco to Prime Therapeutics becomes effective, the change will not affect deductibles, accumulators or out of pocket maximums.

Will I need to change pharmacies?

While Blue Cross and Blue Shield of North Carolina reviews its retail pharmacy network options regularly to ensure the best pricing for its clients and members, there are no plans to change the pharmacy network at this time. The process for filling your prescription at a retail pharmacy would not change. Bring your prescription and member identification (ID) card to a pharmacy in your pharmacy network. The pharmacist will send your prescription electronically to Prime to confirm your benefit plan and ensure the correct prescription price.

What prescription mail service option is offered by Prime? How will mail order prescriptions transfer?

PrimeMail® is Prime’s prescription mail service. PrimeMail makes transferring prescriptions, ordering new prescriptions and ordering refills safe, fast and easy. In addition to easy ordering, PrimeMail members have access to member service agents 24-hours a day, seven days a week. PrimeMail customers can also use the member website to order refills, track their prescription history and find drug information. With PrimeMail, prescription medications are confirmed for accuracy and quality by registered pharmacists and delivered to your door in safe, plain-labeled packaging. When the transition occurs, if you have a prescription with Medco mail service, and there are open refills, that information will automatically be transferred to Prime and your refills will be delivered to you without interruption. You won’t have to wait for your important medications.

Will Prior Authorization (PA) files transfer?

Yes. During the integration, Prime will work with Medco to transfer historical PA files as part of the overall transition of member records. Members will not have to reestablish PA status.

Will this affect BCBSNC’s specialty pharmacy program?

No. There will be no change to the specialty pharmacy network launched on July 1st.

The information in this article was taken from a Press Release from Blue Cross Blue Shield of North Carolina on August 1, 2011.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

Jerry Ballard and Associates d/b/a NC Health Plans is pleased to introduce you to North Carolina Group Health Insurance Plans from Blue Cross and Blue Shield of North Carolina, the leading provider of group health and life insurance in North Carolina.

Choose from a variety of popular Major Medical plans, supplemental plans and term life plans to create a powerful package of benefits for your employees.

Plans include a choice of deductibles, low co-payments for doctor office visits and wellness benefits such as physicals, prescription drug coverage and unlimited lifetime benefits

What BCBSNC group health plan is best for your company?  Submit your online application by completing the employee census form, if you have 25 or fewer employees. If you have more than 25 employees, please print out and complete the 26+ Census Form and fax to Jerry Ballard & Associates, 919-287-2777.

We will email your Group Health Plan quote. Please note that we may have to call you once with questions to ensure the accuracy of our group health quote.

Any questions? Feel free to call the helpful professionals at Jerry Ballard & Associates, your independent North Carolina health and life insurance agency: toll free 888-765-5400 or 252-726-5400. Our goal is to provide you with exceptional customer service.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

That’s a particular problem for North Carolina, because small businesses are increasingly the engine behind the state’s economy: 98 percent of businesses in North Carolina are small businesses,* and more than half of them don’t offer health insurance.** It’s hard for small businesses to qualify for rates as low as those available for large firms, particularly if some of their workforce is in poor health.
About half of the uninsured in North Carolina (55.3 percent) work for a small firm or belong to a family where someone works for a small firm (fewer than 25 employees).***

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents.  Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health.  Call us for details.

United States Small Business Administration. http://www.sba.gov/advo/research/profiles/06nc.pdf
Fifty-nine percent of North Carolina businesses don’t offer health benefits. Kaiser Family Foundation State Health Facts. 2002.
“North Carolina’s Uninsured.” North Carolina Medical Journal. May/June 2006.BCBSNC, Blue Cross Blue Shield of North Carolina, Small Businesses and Health Insurance, Health Benefits

Addtionally, the NC Department of Insurance regulates the rating and policy issuance of employer groups differently than individual plans. For example, BCBSNC group plans are guaranteed issue, meaning they cannot be denied because someone in the group has a serious health condition, such as cancer. In contrast, in 2009 the Blue Advantage plan will become a “decline” policy, meaning that an individual’s health can be a determining factor in obtaining coverage or not. Pregnancy cannot be considered a pre-existing condition for exclusionary purposes under a group plan, but you cannot add maternity coverage to a Blue Advantage plan if an applicant or their spouse is currently pregnant. You can add maternity to Blue Advantage if the applicant or spouse is not pregnant prior to the effective date of coverage (conception determined by physician). Prescription drug coverage on group plans is often richer with no limitations on brand name drugs, and vision (lens and frames) services can be added at an additional cost. Furthermore, under a group plan an employer has the option of offering ancillary products, such as life insurance, short and long term disability, and dental insurance. These options are not available under the Blue Advantage plan, with the exception of Dental Blue individual plans that can be purchased as a separate stand-alone policy. Finally, the application process for groups is different. In addition to each employee completing an individual application, there are a number of other documents that must be completed/provided for groups, including an Employer Risk Appraisal, NCUI 101 Employer Tax and Wage Report (groups of less than 10 eligible employees), business owner tax statements or employee W-4 forms (if the owner or employees is applying for coverage and is not on the Tax and Wage Report), Agent of Record Letters, and the most recent billing statement if the group currently has another group policy. With Blue Advantage, an applicant simply completes an application with health questions.

This comparison is not inclusive of all the differences between group and individual plans. If you are self-employed or with a small group that does not sponsor a health insurance plan, call Jerry Ballard at 888-756-5400 and he will be glad to go over more of the pros and cons of each type of plan to ensure you pick what is best for you and your family or company.