Gray & Troy Insurance Services, Inc.

Several new California employment laws took effect January 1, 2012. Employers with five or more employees should pay particular attention to SB 299, which references Pregnancy Disability Leave (PDL).

With the passage of SB 299, there are significant changes to California’s Pregnancy Disability Leave for small businesses with five or more employees.  If the employer offers group health insurance and the employee has opted for coverage, the employer is now required to maintain the group plan coverage (up to four months) for employees on a PDL, and the cost to the employee is not to exceed the normal employee contribution (if there is one).  This is a significant change to current law, which does not require the continued insurance coverage during a PDL.

View the complete SB 299 Bill.

View the Pregnancy Disability Leave summary and the full overview of the new 2012 Laws.

An annual preventive care physical exam could help stay on the path to good health, detect problems early, and in some cases, save lives. Depending on age, there are lists of screenings, tests, and vaccines that are covered, in addition to a yearly annual exam.  Always consult with your physician to help determine which tests are most appropriate.   The exam, and additional preventive care tests are covered at a 100% rate, as long as you are using an in-network provider.  For a list of covered screenings and immunizations, please refer to the links below.  For specific questions related to your plan, please contact Gray & Troy Insurance (805)540-7010.

Anthem Blue Cross Preventive Care Benefits

Blue Shield Preventive Care Benefits

Catholic HealthCare West (CHW) has announced that it has changed its name to Dignity Health as part of a restructuring, which ends its affiliation with the Catholic Church (San Jose Mercury News).  The system will remain a not-for-profit system and its Catholic hospitals will continue to operate based on Catholic values and principles. This restructure will assist in its expansion, and ability to remain viable and thrive in the changing healthcare environment.

According to Lloyd H. Dean, president and CEO of CHW, “Changing our name to Dignity Health reflects our commitment to excellent care for all in need and to being a national leader in quality care.  The new structure supports our long term plan to grow and coordinate care, while reinforcing our mission of service to the communities we are so privileged to serve” (CHW News Release).

Currently CHW is the fifth largest health care organization with 40 hospitals in its system located in California, Arizona and Nevada.  One of the goals of the change will be to triple in size with mergers and affiliations, growing nationally while maintaining the outstanding medical care it has provided to its patients (USA Today).

According to Sister Judy Carle, (who will remain a member of the board of directors), “Our mission, our vision, our values are not changing nor will they change.  This particular restructuring can carry on that mission” (Kaiser Health News).

This change will have no effect on patients or medical care provided at the 40 hospitals in the system.

2012 IRS Plan Limits for HSA
Health Savings Account contributions are indexed annually for inflation and updated by the IRS.  Key changes to the HSA contributions and HSA compatible plan limits include the following:

View the IRS document for more information about the 2012 contribution limits.

On November 30^th, 2011, the U.S patent on Pfizer Inc’s drug, Lipitor, expired. This enables generic versions of the medication to go on sale. Depending on your insurance carrier, patients may have to switch to the generic brand, which could result in a lower payment for the drug.  Please review the following article from the Wall Street Journal for detailed information: A User’s Guide as Lipitor Goes on Sale.

What this means…

FOR BLUE SHIELD MEMBERS

• The generic copay applies, with the purchase of the generic version of Lipitor
• Members have the option available to continue with the brand name drug, though additional costs will be applied

FOR ANTHEM MEMBERS FOLLOWING A TIERED STRUCTURE

• The generic brand of Lipitor will be added to tier 1 and will begin processing with a tier 1 copayment
• Lipitor will continue to process on tier 2
• When a second generic brand is released, Lipitor will then move to tier 3

FOR ANTHEM MEMBERS NOT FOLLOWING A TIERED STRUCTURE

• The generic copay applies, with the purchase of the generic version of Lipitor
• Members have the option available to continue with the brand name drug, though additional costs will be applied

** For specific questions pertaining to your plan, please contact us.