Regional Training - Benefits Program
July 2010
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Christy Edwards, NMPSIA
 800-548-3724
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Martha Quintana, ERISA
 800-233-3164
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mquintana@santafe.cserisa.com
Managed Health Care Bureau
 800-947-4722
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christy.edwards@state.nm.us
mchb.grievance@state.nm.us
Julie Garcia, Poms & Associates
•
800-898-6236
JGarcia@pomsassoc.com
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FY 10
Fund Balance
July 2009
($8,848,728)
August 2009
($10,727,703)
September 2009
($8,079,069)
October 2009
($6,511,653)
November 2009
($4,357,466)
December 2009
($3,102,810)
January 2010
($1,352,357)
February 2010
$2,700,000
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Self – Insured Coverage

Began FY 09 with an $8 million deficit
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No Premium Increases allowed in FY10
legislative budget process
Current fund balance is a positive$7 million
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Blue Cross Medical:
Presbyterian Medical:
UCCI Dental:
+6.4%
+6.4%
+6.4%
Davis Vision:
The Standard Life:
The Standard LTD:
No Change
No Change
No Change
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Carrier Contact Information now on inside
covers
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References to Healthy Vistas deleted
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New Employer Plan Matrix & Rates
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Medco Pages 33 and 34
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Correction of maximum on Non-Network High
Option Dental
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 Infusion
Therapy
 In-office
Sterilization
 Maternity
handout)
Benefits (see
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 CHIPRA
 Mental
Health Parity Opt Out
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ID cards and welcome kits mailed June 22
Temporary ID card can be printed from
“medco.com”
Alternate ID number same as it was with
Catalyst
Mail order prescription number same as it
was with Catalyst
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Catalyst Formulary Status grandfathered until
January 1, 2011
NMPSIA and ERISA have access to Client
Website allows view of claims and changes to
eligibility real-time
Important for members to register on
“medco.com”
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Specialty drug are filled by Accredo (separate
division of Medco). Retail fills limited to 2x.
Immunization program to continue.
Diabetes Pilot Program will probably expand
this fall or early 2011.
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PPACA – Patient Protection and Affordable
Care Act
HCERA = Health Care and Reconciliation Act
(aka “budget reconciliation bill”
Combined form, they form Federal Health
Care Reform
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By 2014 everyone must have minimum
essential healthcare or pay a tax.
Employer obligations dovetail with programs
for low paid persons who cannot afford
coverage
Low paid means employee household income
of 100% to 400% of Federal Poverty Level
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Specific plan design – yet to be determined
Bronze (60%), Silver (70%) Gold (80%) and
Platinum (90%)
Must cover ambulatory patient service,
emergency services, hospitalization,
maternity & newborn care, mental health &
substance abuse, prescription drugs, Rehab
services, lab services, wellness & preventive
services, chronic disease management,
pediatric services
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Avoid $2,000 penalty per employee by
offering plan to all full-time employees
Avoid $3,000 penalty by offering a voucher to
anyone who is low income and would pay
between 8 – 9.8 % of income for group plan
Tax deductible voucher: a contribution to
plan to which employer pays greatest
proportion of costs (not highest dollar
amount of contribution).
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Household income $15,000
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Current BCBS premium: $458.40
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(single EE < $15,000)
EE contribution 25% or $114.60 per month,
$1375 annually, or 9.1% of $15,000 income
If EE declines NMPSIA coverage, employer
issues voucher to EE for employer share of
$343.80 month
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Plan year after October 1, 2010: no annual
and lifetime caps except on “non-essential
benefits”
Children covered until age 26 (including
married children) effective 7/1/11 (first plan
year after October 2010)
2011 must include cost of employer
sponsored benefits on employee’s W-2
July 1, 2014, pre-ex exclusion eliminated,
automatic enrollment required
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The Standard Life Insurance coverage also
includes MEDEX assistance
Pre-trip Assistance (visa, inoculation
requirements, health hazards, etc. )
Emergency evacuation and repatriation when
100 or more miles away from home or out of
country
Coordinates with any medical coverage
Benefits for companion or children
transportation
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ARRA is an acronym for?
(a) Accounts Receivable’s Receivable
Accounts
(b) Aggravating Rules and Regulations
Activities
(c) American Recovery and Reinvestment Act
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July 2, 2010 News from the Hill
“Prospects for congressional approval of another extension of the COBRA subsidy are
dim. The subsidy was first authorized in last year’s stimulus bill and has already been
extended twice. However, the 15-month subsidy was not available after June 1.
An extension of the subsidy was included in House jobs bill but conservative Democrats
and Republicans forced Democratic leaders to jettison it over cost concerns. The
provision was never in the Senate bill. Sens. Sherrod Brown, D-Ohio, and Bob Casey, DPenn., want to reinstate the subsidy as an amendment to the bill if it again reaches the
Senate floor. But since reconsideration of the bill seems unlikely, a spokeswoman for
Brown said the senators are pushing for the COBRA subsidy as a separate piece of
legislation, and pay for it by eliminating a tax break.
The Senate proposal would, be retroactive, giving people laid off since June 1 six
months (through 11/30/2010) of the federal subsidy instead of the 15 months that
earlier law had provided. “
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Encouraged for Employer Transactions:
◦ Basic Life Enrollment
◦ Update EE and Dependent Information (like employee
address or dependent SSN)
◦ Cancel All Enrollment
◦ Log on to districts.nmpsia.com and click on Online
Enrollment
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Encouraged for Employee
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View and confirm enrollment
Update address, phone or add email address
Switch Enrollment
Go to nmpsia.com “Members” tab and click on Employee
Online Enrollment System
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August Board discussion of no longer
allowing 1 penalty waiver per rolling 12
months
Staff recommendation because of additional
work involved in penalty waiver research and
accounting
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Any More Questions?
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Comments?
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Thanks! Let’s Break for
Lunch
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