February 2012

In This Issue


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 programs.

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.

Prior to 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 authorizations.

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 kit.

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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Ask George

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.

When 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.

Should you 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.
30 days: Eligibility on the next first of the month following 30 days of employment.
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 organization.

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 issues.

Of course, George Fanelli (Account Service Representative, MMIC Agency) will continue to assist you with any other concerns you may have.

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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.

For tax years 2010 through 2013, the maximum credit is 35 percent for small business employers and 25 percent for small tax-exempt employers such as charities.

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 premium payments.

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 amended return.

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 Credit Calculator.

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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.

To 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.

The 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.

In 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.

For more information about many other benefits of NCMS membership, visit http://www.ncmedsoc.org/.