August 2019
Stay Current Newsletter

Q: Why am I getting billed for preventive services that should have been covered at no share of cost?

A: Under the Affordable Care Act, most insurers must provide preventive care services at no share of cost to the member.  Not all services, however, that are deemed preventive are covered under the ACA requirement for no share of cost.  The list of ACA mandated preventive services are clearly defined with specific guidelines as to when they are covered.  Colonoscopies, for example, are considered preventive for people over 50.  If you find yourself receiving a bill for services you believe should be covered under the preventive services mandated benefits, it usually ends up being for one of the following reasons:
  1. The service you received was not one of the ACA mandated preventive services benefits and/or the service was performed outside of the guidelines for age/frequency of administration of such service;
  2.  You may have gone in for a preventive service and ended up receiving additional non-preventive services at the same visit which resulted in billable charges for the non-preventive services;
  3. You may have had symptoms of a condition when your doctor ordered services that are often considered preventive.  Since you've shown symptoms, the service does not qualify as preventive;
  4. The service could have been billed with the wrong CPT code in error.  In this case, you should reach out to your provider's office to have them correct the billing error and resubmit your claim.

The key to avoiding surprise costs is knowing what is considered preventive, paying attention to the details and knowing your health plans rules on interpreting the ACA guidelines.   You can find a full list of preventive services from your insurers' member portal or by visiting Healthcare.gov.
Anch2Harassment Prevention Training

Governor Brown passed SB 1343 which expands the requirements for harassment prevention training for California employers. Employers with five or more employees are required to provide training to all employees by January 1, 2020.

Click here to register for our next manager/supervisor harassment prevention session on August 20.

Click here to register for our next manager/supervisor harassment prevention session on September 11.
Arch3High Deductible Health Plan Preventive Care Benefits Expanded

A new IRS notice expands the list of preventive care benefits that may be covered by a high deductible health plan (HDHP) without a deductible, or with a deductible below the minimum deductible for an HDHP. Except for preventive care benefits, an HDHP can pay for benefits only after the deductible has been reached.

The following treatments are those that have been newly classified as preventive care for the chronic conditions indicated:
  • Angiostatin converting enzyme (ACE) inhibitors (for congestive heart failure, diabetes, and coronary artery disease);
  • Anti-resorptive therapy (for osteoporosis and osteopenia)
  • Beta-blockers (for congestive heart failure and coronary artery disease)
  • Blood pressure monitors (for hypertension)
  • Inhaled corticosteroids (for asthma)
  • Insulin and other glucose-lowering agents (for diabetes)
  • Retinopathy screening (for diabetes)
  • Peak flow meter (for diabetes)
  • Glucometer (for diabetes)
  • Hemoglobin A1c testing (for diabetes)
  • International normalized ratio testing (for liver disease and bleeding disorders)
  • Low-density lipoprotein (LDL) testing (for heart disease)
  • Selective serotonin reuptake inhibitors (SSRIs) (for depression)
  • Statins (for heart disease and diabetes) 
The change is effective immediately. Please contact a member of the account management team for more information. 

Article reprinted with permission from HR360.com

Arch4 HRDR Blog - Pre-Tax vs Post-Tax: Are You Deducting Properly?

To be pre-tax or to be post-tax, that is the question. At least, that is the question when it comes to payroll deductions. While every payroll deduction can be classified as either pre- or post- tax, how does an employer correctly classify these deductions? While several are classified by IRS regulations, other deductions are a matter of choice. 

Click here to read the HR Done Right Blog .
Arch5 Office Closure: Employee Appreciation Day

Our office will be closed Friday, August 16, 2019, as we recognize the hard work of our employees at our annual Team Appreciation Day. 

We will process and respond to all email and voicemails when normal business hours resume Monday, August 19, 2019.


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