MLR – Medical Loss Ratio Group Size Surveys

The Affordable Care Act (ACA) includes a requirement that insurance companies report their medical loss ratio (MLR) to a federal agency and pay rebates if certain MLR targets are not met. MLR is the amount of every premium dollar paid that goes toward actual medical expenses. For large or small groups, insurance companies need to achieve MLRs of 85% or 80% respectively to avoid paying rebates. The calculation of the MLR is based, in part, on the size of the insurance company’s employer groups.

affordable care act

In order to accurately calculate and comply with the Affordable Care Act’s MLR requirements and determine whether any rebate will be due to its employer groups in 2012, Blue Cross and Blue Shield of Kansas City (Blue KC) will begin sending communications to current employer groups this week. Groups will be asked to complete a short questionnaire regarding the number of employees in their company.

For more information, please contact your Blue Star Benefits Representative at 913-647-1000.

Humana 2012 Drug List Changes

HumanaOne Logo

What do these changes mean?

These changes mean some medicines will have new requirements. These requirements include:

Prior Authorization: The member’s doctor must obtain authorization from Humana for drugs requiring prior authorization before we’ll cover the prescription.

Step Therapy: Members must try one or more alternative drugs first. If the member’s doctor doesn’t think the alternatives are right for them, they must request approval from Humana before we’ll cover the prescription.

Quantity Limits: Members can get up to the maximum allowable quantity for drugs with quantity limits. However, if their prescription quantity exceeds the maximum allowable quantity, they have two options:

  1. Pay the appropriate amount according to their plan to get the quantity allowed and then
  2. Pay the pharmacy’s retail price for the remaining quantity of their prescription.

If necessary, their doctor may request a medical exception form Humana to cover the full quantity of their prescription.

No Longer Covered: Members won’t be able to fill a prescription for one of the drugs no longer being covered because they’re available over the counter. They will be responsible for the entire cost for the over-the-counter medicine.

Level Changes: Members may pay a higher amount for drugs changing levels.

Next Steps

Please Review the attached list of medicines affected by these changes.

Members can take several steps to help control their medicine costs. That includes talking to their doctor about possible lower-cost options like generics, over-the-counter medicines, or other brand medicines.

  • Prior Authorization
  • Step Therapy
  • Quantity Limits
  • Rx3 Drug Movement
  • Rx4 Drug Movement

Blue KC 2011 Broker Seminar

Blue KC Invites You to the 2011 Broker Seminar

Wednesday, September 21st 2 PM – 4 PM Seminar

4 PM – 6 PM Networking Happy Hour

We are very excited to be holding our 2011 Broker Seminar this Wednesday, September 21st. We will be discussing our new and current Blue KC products and looking at the exciting new programs coming soon. Some of the topics in the discussion will be:

  • Small Group & Direct Pay
  • Product Information & Updates
  • 2012 Commissions
  • Direct Pay Rating Changes
  • New Small Group Initiative
  • Small Group Wellness

After the seminar, enjoy our complimentary happy hour and meet and greet with other Blue KC agents. This is a great time to find out what other agents are doing to get (and keep) business. If you would like more information about this event or Blue KC products in general, please call Blue Star Benefits at 913-647-1000.

Blue KC insurance sales

Cholesterol Awareness Month

September is Cholesterol Awareness Month

Take the necessary steps to prevent, detect & control cholesterol, which is a major factor in heart disease.

Why Is Cholesterol Important?

Your blood cholesterol level has a lot to do with your chances of getting heart disease. High blood cholesterol is one of the major risk factors for heart disease. A risk factor is a condition that increases your chance of getting a disease. In fact, the higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack. Heart disease is the number one killer of women and men in the United States. Each year, more than a million Americans have heart attacks, and about a half million people die from heart disease.

How Does Cholesterol Cause Heart Disease?

When there is too much of this fat-like substance in your blood, it builds up in the walls of your arteries. Over time, this buildup causes “hardening of the arteries” so that arteries become narrowed and blood flow to the heart is slowed down or blocked. The blood carries oxygen to the heart, and if enough blood and oxygen cannot reach your heart, you may suffer chest pain. If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack. High blood cholesterol itself does not cause symptoms, so many people are unaware that their cholesterol level is too high. It is important to find out what your cholesterol numbers are because lowering the levels that are too high lessens the risk for developing heart disease and reduces the chance of a heart attack or dying of heart disease, even if you already have it. This is important for everyone–younger, middle age, and older adults; women and men; and people with or without heart disease.

What Do Your Cholesterol Numbers Mean?

Everyone age 20 and older should have their cholesterol measured at least once every 5 years. It is best to have a blood test called a “lipoprotein profile” to find out your cholesterol numbers. This blood test is done after a 9- to 12-hour fast and gives information about your:

Total cholesterol
LDL (bad) cholesterol – the main source of cholesterol buildup and blockage in the arteries
HDL (good) cholesterol – helps keep cholesterol from building up in the arteries
Triglycerides – another form of fat in your blood
If it is not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels. If your total cholesterol is 200 mg/dL* or more or if your HDL is less than 40 mg/dL, you will need to have a lipoprotein profile done. HDL (good) cholesterol protects against heart disease, so for HDL, higher numbers are better.

A level less than 40 mg/dL is low and is considered a major risk factor because it increases your risk for developing heart disease. HDL levels of 60 mg/dL or more help to lower your risk for heart disease. Triglycerides can also raise heart disease risk. Levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more) may need treatment in some people.

What Affects Cholesterol Levels?

A variety of things can affect cholesterol levels. These are things you can do something about:

Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level go up.
Saturated fat is the main culprit, but cholesterol in foods also matters. Reducing the amount of saturated fat and cholesterol in your diet helps lower your blood cholesterol level.
Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. Losing weight can help lower your LDL and total cholesterol levels, as well as raise your HDL and lower your triglyceride levels.
Physical Activity. Not being physically active is a risk factor for heart disease. Regular physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes on most, if not all, days. Things you cannot do anything about also can affect cholesterol levels.
These include:

Age and Gender. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women’s LDL levels tend to rise.
Heredity. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.

What Is Your Risk of Developing Heart Disease or Having a Heart Attack?

In general, the higher your LDL level and the more risk factors you have (other than LDL), the greater your chances of developing heart disease or having a heart attack. Some people are at high risk for a heart attack because they already have heart disease. Other people are at high risk for developing heart disease because they have diabetes (which is a strong risk factor) or a combination of risk factors for heart disease. Follow these steps to find out your risk for developing heart disease.

Click here for more information

Individual Dental Changes 2011

Effective Wednesday, August 31st 2011

The 3 month required dental premium will be removed Wednesday Aug. 31st. We will no longer require the first 3 months premium. The dental will be set up just like medical.

Applicants will also have the option of the 1st and 15th of the month. Direct Bill and EFT will be the only choices of recurring payment offered the same as medical.

For more information on comprehensive Dental programs, please call Blue Star Benefits at 913-647-1000.

dental insurance