NCMS Plan Administrator, BCBSNC, Contracts With New PBM
The NCMS Plan administrator, BCBSNC, has contracted with a new pharmacy
benefits management (PBM) vendor. Prime Therapeutics (Prime) will replace
Medco and administer pharmacy benefits for NCMS Plan practices effective
April 1, 2012. This change is expected to result in lower pharmacy costs
for our members and will provide more flexibility regarding services and
Prime is a thought leader in the 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 Blue organizations, representing 12 BCBS plans, including
BCBSNC, and is the fourth largest PBM in the industry.
April 1, 2012, members will receive new ID cards and information on
navigating the pharmacy section of the BCBSNC website. The new ID cards
will simply replace Medco information with Prime information. Your group
benefits will not change as a result of the change from Medco to Prime.
The formulary in place prior to the April 1, 2012 effective date will be
the same formulary in place on April 1, 2012. There will be no formulary
disruption as a result of the change to Prime. Additionally, members will
not have to reestablish prior authorization status for unexpired prior
PrimeMail will replace Medco's Mail Order Program
and participating members will receive a welcome kit notifying them of the
change. The kit will contain an engagement letter, FAQ, brochure, and
order form. If members have an open refill at Medco it will automatically
transfer to PrimeMail. Credit card information will not be transferred to
PrimeMail so members will need to provide that information. Instructions
on how to provide credit card information will be included in the welcome
Our expectation is that Prime will continue to meet our high
service standards and consistently deliver the best pharmacy trend of the
major PBM competitors, and outperform them in customer satisfaction.
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Question: George, we have a temporary employee who has been working
with our practice for a long time and will soon be hired full-time. We
have a 90-day probationary period, but since she has already worked at
least this long as a temp, can we start her benefits right away or would
she still have to satisfy the 90-day probationary period?
Answer: The long-term temporary employee will still need to
complete a 90-day probationary period as a new full-time employee. This is
because part-time and temporary employment status does not satisfy the
NCMS Plan eligibility requirement. A probationary period for new full-time
hirees begins on the first day of full-time employment with
benefits effective when the probationary period ends.
completing the enrollment form, your applicant will need to enter their
full-time date of hire in the field requesting "Date of Full-Time
Employment" right below the field for "Date of Birth". The probationary
period will be applied based on the hire date entered.
find that a 90-day probationary period no longer suits the needs of your
practice, you can change your probationary period by submitting a letter
on your practice letterhead indicating your change. Changes to
probationary periods, however, are not retroactive and would be effective
for hire dates on or after the date the letter is received.
Available NCMS Plan probationary period options are as follows:
Zero days: Eligibility on date of full-time employment.
days: Eligibility on the next first of the month following 30 days of
60 days: Eligibility on the next first of the month
following 60 days of employment.
90 days: Eligibility on the 91st day
of full-time employment.
Please remember that MDs and non-MDs can
have different probationary periods if you choose.
If you have
questions about probationary periods or employee eligibility, call me at
(919) 878-7561 or e-mail [email protected].
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Dedicated NCMS Plan Service Representative Change
Over the past three years, Kim Pryor has been one of the NCMS Plan's
dedicated service representatives for enrollment and billing issues at
BCBSNC (the NCMS Plan's administrator). She has been a primary point of
contact for practice administrators. Kim has provided both the Plan and
our participating practices with reliable and responsive service. Sadly
for us, Kim is transferring to another position in the BCBSNC
Until a replacement is named, DeAngelo Dykes will
continue to serve NCMS Plan practices. DeAngelo's phone number is (919)
765-2616. The e-mail address and fax number will not change
([email protected] and (919) 765-3564, respectively).
DeAngelo is a
contact for practice administrators only, not individual employees
or dependents. He can assist you with adding employees or dependents,
cancellations, address changes, or other routine maintenance and billing
Of course, George Fanelli (Account Service Representative,
MMIC Agency) will continue to assist you with any other concerns you may
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Don't Forget About the Small Business Health Care Tax Credit
The Affordable Care Act enacted on March 23, 2010, contained some tax
provisions designed to help small businesses and small tax-exempt
organizations afford the cost of covering their employees, specifically
targeted for those with low- and moderate-income workers.
years 2010 through 2013, the maximum credit is 35 percent for small
business employers and 25 percent for small tax-exempt employers such as
Here's what this means for you. If you pay $50,000 a
year toward workers' health care premiums-and if you qualify for a 15
percent credit, you save...$7,500. If you save $7,500 a year from tax year
2010 through 2013, that's total savings of $30,000. If, in 2014, you
qualify for a slightly larger credit, say 20 percent, your savings go from
$7,500 a year to $12,000 a year.
Even if you are a small business
employer who did not owe tax during the year, you can carry the credit
back or forward to other tax years. Also, since the amount of the health
insurance premium payments are more than the total credit, eligible small
businesses can still claim a business expense deduction for the premiums
in excess of the credit. That's both a credit and a deduction for employee
There is good news for small tax-exempt
employers, too. The credit is refundable, so even if you have no taxable
income, you may be eligible to receive the credit as a refund so long as
it does not exceed your income tax withholding and Medicare tax liability.
And finally, if you can benefit from the credit this year but
forgot to claim it on your tax return there's still time to file an
Be sure to ask your tax advisor about how this
credit can benefit your practice. For more information about the tax
credit you can visit http://www.irs.gov/newsroom/article/0,,id=223666,00.html
or to estimate your credit, try the Tax
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Practice Wellness Grant Program Update
In early January 2012, the NCMS Plan launched the Practice Wellness
Grant Program, with the mission of rewarding practices for implementing
sustainable health promotion programs or expanding existing ones. The
initial response has been exceptional, with grant applications totalling
nearly $50,000 already submitted for review and approval.
qualify for a Practice Wellness Grant, practices are required to achieve
certain participation and completion goals that are key elements of an
effective health promotion program. Please see the CORE program components
and eligibility at ncmsplan.com.
amount of money that a practice can receive depends upon the number of
employees enrolled in the NCMS Plan at the time of goal fulfillment and
the criteria levels attained. Up to $100 per enrolled employee can be
awarded to successful practices. The minimum grant is $250 and the maximum
grant is $15,000 and can be used to further support the practiceís health
promotion efforts. Some examples may include funding a weight management
group program, fitness membership fees, employee HRA/HSA accounts or
tobacco cessation products. A client in the western part of the state is
planning to use the grant money to purchase two mountain bikes for the
practice to further encourage physical activity among their employees.
Act Now! To learn more about the Practice Wellness Grant
Program and to apply, please contact mailto:[email protected]?Subject=Practice
Wellness Grant Program or call (919) 878-7530.
QuitlineNC Offers Nicotine Replacement Therapy at No Cost
If one or more of your employees' New Year's resolution was to quit
tobacco for good, they donít have to do it alone. QuitlineNC, the state's
toll-free telephone support service to help tobacco users quit, is making
nicotine replacement therapy (patches, gum or lozenges) available at no
cost for a limited time for NC residents who enroll in quit coaching.
North Carolinians ready to quit smoking in 2012 can call the
QuitlineNC at 1-800-QUIT-NOW (1-800-784-8669) any time, 24 hours a day,
seven days a week, to sign up for over-the-counter medication and support.
Callers who sign up for the four-call program will develop a personalized
quit plan with a quit coach and may receive up to eight weeks of
medication mailed to their homes. Nicotine replacement therapy (NRT) has
been proven in well-designed research studies to significantly increase
quit rates when used in combination with cessation counseling.
addition, if your practice is interested in going 100% Tobacco Free in
2012, the NCMS Plan can help and you could earn a Practice Wellness Grant
for doing so! To learn more about Practice Wellness resources for
supporting a tobacco free practice, please contact mailto:[email protected]?Subject=Tobacco
Free or call (919) 878-7530.
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About the North Carolina Medical Society
As the largest physician organization in the state, the North Carolina
Medical Society (NCMS) is devoted to representing the interests of
physicians and protecting the quality of patient care. The NCMS Plan,
sponsored by the NCMS, is the only statewide employee benefits plan
designed specifically for North Carolina physicians.
information about many other benefits of NCMS membership, visit http://www.ncmedsoc.org/.