On July 14, 2010, the Departments of Health and Human Services, Labor and Treasury released an interim final regulation outlining the details of the preventive care coverage requirement for health plans established by the Patient Protection and Affordable Care Act (PPACA).  

PPACA requires that all plans provide first-dollar coverage of specific preventive care services recommended by the United States Preventive Services Task Force beginning on the first day of the first plan year following September 23, 2010. The requirements apply to all individual and group health plans, including self-funded plans, but grandfathered plans are exempt as long as they retain their grandfathered status. The complete list of preventive care services that are required to be covered can be found here.

The new rules not only outline what screenings and preventive care services must be covered without being subject to cost-sharing, but they also establish how cost-sharing will work under a number of more complicated coverage scenarios. For example, when the preventive care is administered during an office visit, and that office visit would normally be subject to a deductible or co-payment, generally the preventive care will need to be billed separately for other cost-sharing to apply. Also, if a preventive care screening or service results in the patient needing additional care or medication, cost-sharing can apply to the patient’s treatment.

If the plan has a network, out-of-network cost-sharing rules will apply to any recommended preventive services a beneficiary receives from an out-of-network provider. And, if the federal recommendation or guideline for a preventive service does not specify the frequency, method, treatment or setting for the provision of that service, the plan or issuer can use reasonable medical management techniques to determine any coverage limitations. If a plan covers any preventive care services above and beyond the new federal requirements, then the plan can impose cost-sharing requirements on those services. 

Finally, the rules make it clear that if a federal preventive care service recommendation changes, the health plan is no longer required to provide first-dollar coverage of that particular service. Additional guidelines are being developed regarding preventive benefits and the utilization of value-based insurance designs by group health plans.

For more information on this or to get your free quote for health insurance, contact IBD Insurance today.

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We all know that habits can be nearly impossible to break especially those we learned as a child! As a parent, this fact gives us a unique position to embed healthy habits into our children’s routines that will last a lifetime.

According to the CDC, tooth decay is the most common disease of childhood. However, thanks to an increase in dental awareness programs aimed at kids and adults, the CDC says that children’s oral health has improved significantly over the past several decades.

Perhaps because good oral health involves preventative measures, children of insured families are two and half times less likely to receive dental care before it becomes an emergency. For those who are insured, practicing good oral hygiene and teaching your kids to do so as well, is a smart way to reduce this portion of your healthcare cost.

Fun Dental Health Games for Kids

Here is a roundup of free and fun online games that kids can play while they unexpectedly learn about the responsibilities of taking care of their teeth.

Colgate Kids offers more than 20 games and activities organized by age group. Games like Toothpaste Power Pinball and Attack of the Plaque Monsters will keep kids entertained and learning for hours.

The ADA’s Mouth Power is a fun, interactive game and flash animation video that will keep kids interested and get them excited about absorbing the lesson within the fun. Upon completion of each activity, kids earn a tooth. Once they have earned all their teeth, they are awarded with a certificate of achievement.

The ADHA offers 5 interactive activities that kids can play on their own or that you can incorporate into part of a home lesson plan on dental health.

Fun Dental Health Products for Kids

There has been an increase in fun oral health products hitting the shelves over the past few years that are specifically targeted for kids. Kids love using fun, colorful products designed just for them. And when you incorporate the use of these products into an home lesson on dental health and consistent plan, good habits are likely to last a lifetime.

Here are some of the latest products to hit the shelves that are designed just for kids:

Dentek Fun Flossers
It has always been difficult to get kids (or adults) to floss. But these fun animal shaped flossers with Fluoride make flossing fun. The design is not only visually appealing; it is ergonomically designed to fit into little hands.

Act Fluoride Rinse
Kids can’t get the portions wrong with this kid-friendly bottle. Squeezing the bottle sends the Fluoride rinse into the cup reservoir which is designed to send any excess liquid back down into the bottle.


Listerine Agent Cool Blue
This is a fun pre-brush tinting rinse. It tints teeth blue so kids pay attention to their brushing. Kids have a great sense of accomplishment when they are finished. You can even get a $1 off coupon if you visit the Listerine Agent Cool Blue website.

While these exercises are great for kids, you may find that while working with them, you too become more excited and aware of your dental health!

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As you may be aware, the Patient Protection and Affordable Care Act recently passed by Congress establishes a new temporary high risk pool for individuals who have pre-existing medical conditions and need more affordable health insurance coverage.

Inclusive Health has been designated by Governor Perdue and Insurance Commissioner Goodwin to administer the federal pool in North Carolina under the name Inclusive Health–Federal Option. A July 1st date has been targeted to begin enrollment for an August 1st effective date. The Federal Option will be for individuals that have a pre-existing medical condition, who are legal US residents and who have not had insurance for at least 6months. There will be several plan options and the premiums will only be based on an individual’s age and smoking status, not medical conditions.

For more information contact IBD Insurance at 919-510-5980.

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Summertime means long days at the beach, traveling, vacations and precious time spent with family and friends. It also means a lot more exposure to the sun, since most of us will be out and about versus being cooped up in an office all day. Therefore, it is extremely important that we educate ourselves about sun safety.

The Sun: Both Helpful and Hurtful

Sure, we love our sunny days, but these are also the days that can hurt us most in the long run. Every time you go outside, you are exposing your skin to harmful rays that are emitted by the sun. These rays tend to be worse during the summertime because both the sun and people are out longer. Excessive exposure to the sun can cause significant damage to your skin and is, in fact, the leading cause of skin aging today! However, many people don’t see it this way. They want to be tanned and beautiful during the summer so that they’ll look better in their outfits. But the truth about tanning is that when your body gets a suntan, this is a sort of shield that your skin sets up in order to prevent the sun’s harmful rays from causing damage to the underlying tissues. So, while a tan might look good and healthy to onlookers, it can actually be bad for your health.

It is extremely important to use creams and even makeup that contains trace amounts of sunscreen year round. However, this is even more importan, if not mandatory during the summer. Sunscreens come in a variety of forms such as lotions, gels and creams and usually contain skin moisturizing agents such as cocoa butter, coconut oil, aloe vera and olive oil. These ingredients not only protect your skin from the sun’s rays, but they also keep your skin moisturized, which can help slow down the aging process (i.e. freckles, dark/age spots, wrinkles, etc.). The following are some helpful tips for that everyone should know before spending time in the sun:

1. Apply sunscreen or sunblock at least 1 hour prior to going outside.
2. Facial sunscreen or sunblock should be applied before any other moisturizer is put on your face.
3. Try to avoid spending time in the sun between 11am-3pm (when the sun’s rays are strongest).
4. Try to wear a hat as often as possible when in the sun because the sun can damage your hair as well!
5. Always stay hydrated by drinking plenty of water.
6. Always wear sunglasses when in the sun to protect your eyes.
7. If you do plan on going to the beach, bring an umbrella or make sure there is some sort of shade for you to sit in.
8. Never apply sunscreen to broken/infected skin.
9. If your skin is sensitive, apply a small amount of sunscreen to a small area to test it out before applying it elsewhere.
10. Check your body for any unusual moles or spots after sun exposure.

For more information about individual health insurance in North Carolina, visit BCBSNC today!

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Members who enroll in the programs receive comprehensive educational materials, tools and other benefits. All programs provide the opportunity to work one-on-one with a specially trained nurse.

Depending on a member’s customized program, members have access to discounts and free or discounted tools that will help them manage their health plan, including:

• Select brand–name asthma drugs for the same copayment as generics 
• Free peak flow meter and spacer for asthma
• Free glucose meter
• Discount of 40% off selected blood pressure monitors, heart rate monitors and scales for blood pressure and weight monitoring
• Deductible waiver for most diabetic supplies

Nutrition counseling

Upon enrollment in the Member Health Partnerships program, members will be covered for six nutrition counseling visits per year with a registered dietitian who can help find ways to eat healthier. If members see an in–network dietitian in an office setting, there is no copayment.

For more information about the Member Health Partnerships or Blue Advantage, contact IBD today.

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For applications received on May 1, 2010 and after, Blue Cross and Blue Shield of North Carolina (BCBSNC) made these important changes to their individual under-65 product portfolio (Blue Advantage and Blue Options HSA):

• BCBSNC will no longer decline any applicant under the age of 19 who applies for one of these products.
• BCBSNC will waive pre-existing condition waiting periods for any applicant under the age of 19 who applies for one of these products.
• These changes apply to both new sales (those under age 19 applying for their own policy) and existing policies (policy holders adding an under-19 dependant to an existing policy).

For the initial phase of this transition BCBSNC has developed manual processes to implement these changes. If an application would have been considered medically ineligible for coverage under the old rules, the application will continue to be declined in the Buy Online system; however, BCBSNC will re-set the final rate tier and call the applicant or agent on the next business day to notify him/her of the application’s status. BCBSNC plans to automate these processes at a later date.

This is a welcomed change and kudos to BCSBNC for implementing it before the September timeframe that was outlined in the recent Health Care Reform Legislation. If you have questions about these changes, please contact IBD Insurance at 800-615-5980.

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The Health Coverage Tax Credit (HCTC) Program will be sponsoring an informational session for individuals and their families that are eligible for HCTC. The event will be on Monday, May 10th in Raleigh from 9:00 – 3:00pm at the Clarion Hotel. Inclusive Health is the only state qualified plan for HCTC eligible individuals and their families. IBD representative Jody Fortune will be on hand to discuss Inclusive Health and to assist individuals with the enrollment process. To learn more about the event, click here.

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HealthCampRDU: Join Blue Cross and Blue Shield of North Carolina and other healthcare industry leaders on May 14, 2010, for HealthCampRDU, a one-day, user-organized “un-conference” that aims to bring together consumers, providers, health industry experts and technologists to openly and informally exchange views, and ultimately initiate and sustain positive change to improve health and wellness in our communities. HealthCampRDU participants will focus on three channels of personal health engagement: mobile (compliance, activity recording, consumer support at the point of care); telemedicine (eVisits, ePrescribing and online care); and, social medicine (crowd sourcing and shared wisdom). Visit the HealthCampRDU website for more information!

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Blue Cross and Blue Shield of North Carolina members get more than just health insurance. The BCBSNC family of discount programs is available to members at no additional cost and complements their health insurance plan, whether that plan is Blue Advantage or Blue Options HSA. These programs help individuals save money and take charge of their health.

BCBSNC members receive discounts on chiropractic services, hearing aids, vision care, laser eye surgery, vitamins, weight management programs, products and services – and more! All BCBSNC members need to start enjoying these discounts is their Blue Cross and Blue Shield of North Carolina ID Card. Click here to view a brochure about the many discounts available.

For more information about the discount programs or to get a free Blue Advantage or Blue Options HSA quote, contact IBD Insurance today.

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