RECEIVERSHIP MANAGEMENT, INC.
INDEPENDENT FIDUCIARY FOR MEDOVA LIFESTYLE HEALTH PLAN
FEBRUARY 14, 2023 - MOTIONS FILED TO AMEND APPENDIX AND CURRENT MEMBER ID WORKSHEET CAN BE VIEWED BY CLICKING LINKS BELOW
Compared Appendix A to Motion to Amend Appendix A to Consent Order
Appendix A to Motion to Amend Appendix A to Consent Order
Searchable Excel Medova Member ID by Group
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GENERAL UPDATE RELATED TO THE MEDOVA LIFESTYLE HEALTH PLAN UPDATED SEPTEMBER 30, 2022
“CHECK READY TO RELEASE”
Many members have asked why their claim has not been paid when an EOB issued indicates that the claim is in “ready to release” or “ready to pay” status. This language means that a check for payment of the claim will issue when there are sufficient funds in the account to pay the claim. This “ready to release” or “ready to pay” status does not mean that a check has been issued or that a check will be issued by a certain date or timeframe.
PROVIDERS REFUSING TO PROVIDE SERVICE
RMI has received many inquiries regarding providers who have refused to provide medical services because of unpaid medical bills. Unfortunately, the All-Writs Order can not legally require a provider to provide medical services to a patient. If you find yourself in this unfortunate situation, you should show the provider a copy of the All-Writs order and explain the situation that exists with your Medova Health Plan.
HMA REIMBURSEMENT PROCEDURE
If you paid any amounts toward a claim that were designated as Employer Plan Responsibility on your Explanation of Benefits (EOB), you should review the HMA Reimbursement Procedure and its conditions and limitations. You can obtain a Reimbursement Form by calling HMA at 866-827-6607.
EMPLOYERS OF UNDERFUNDED PLANS
If you are an employer and your plan is underfunded, you may have received correspondence from RMI regarding your funding status. If you have questions regarding your company’s plan, please contact RMI for an update or to resolve issues regarding your plan’s payments or stop loss coverage.
REIMBURSEMENTS
RMI and HMA have received several requests for reimbursement or refunds of funds remaining in the group’s bank account. It is important to understand that a reimbursement of funds remaining in the group’s bank account cannot be issued while a group has remaining unpaid claims or other unpaid plan obligations.
RMI IS NOT YOUR ATTORNEY
Please note: RMI does NOT represent individual members, patients, brokers, employers or any other persons. If you believe you need to appeal a claim decision, appeal a decision made by Medova or HMA, or review who is legally responsible for any impacts on you or your company’s health plan selection, you need to take your own individual steps with private counsel. There are time limits within which action must be taken so seek legal counsel quickly.
It is vital for you to understand that the actions of RMI do not serve as a substitute for your own actions when it involves individual appeal rights or the like (if any exist). You must take whatever action you deem appropriate to protect your own individual rights, including consulting with a private attorney and/or filing any appeals identified in this correspondence. Remember to carefully review your Health Plan documents to ascertain your rights, remedies, liabilities and obligations and carefully monitor time limits that may exist in asserting your rights. RMI employee’s actions and/or statements do not constitute legal advice to you as an individual or any other person.
PCORI TAX ANNOUNCEMENT
On July 15, 2022, Hawaii Mainland Administrators (HMA), the replacement Third Party Administrator (TPA) for the Medova Lifestyle Health Plans, mailed out letters with enrollment numbers for each Medova Lifestyle Health Plan to assist each group in filing its form 720 with the IRS related to PCORI taxes owed. In addition to reviewing the information contained in this writing, RMI would strongly encourage you to consult with your tax advisor and/or visit the link below on the IRS site, to determine if you need to file these documents with the IRS. Instructions on completing the 720 Form are located on the following link starting with Part II on page 8 of the IRS document: https://www.irs.gov/pub/irs-pdf/i720.pdf
The 720 form must be filed by the plan sponsor, which is the employer as defined by the IRS.
The enrollment numbers provided in the letter dated July 15, 2022, were gathered using the "Snapshot Count Method", which is "the number of lives covered on a date equals the actual number of lives covered on the designated date". This method can combine employees of the group and spouses/children/family members covered. The IRS instructions to use these numbers are to add together the 4 quarters for which you are reporting, then divide by 4 to get the average count per quarter.
The below example on how to determine the enrollment count to report for your group can be found on the IRS Website at https://www.irs.gov/newsroom/patient-centered-outcomes-research-institute-fee and on page 13 of the IRS document.
Example 1. (i) Employer B is the plan sponsor of the Employer B Self-Insured Health Plan, which has a calendar year plan year. Employer B uses the snapshot method to determine the average number of lives covered under the plan and uses the snapshot count method to determine the number of lives covered on a day in the first month of each calendar quarter of the plan year. (ii) On January 4, 2013, the Employer B Self-Insured Health Plan covers 2,000 lives, on April 5, 2013, 2,100 lives, on July 5, 2013, 2,050 lives, and on October 4, 2013, 2,050 lives. Under the snapshot method, Employer B must determine the average number of lives covered under the Employer B Self-Insured Health Plan for the plan year ending December 31, 2013, as 8,200 (2,000 + 2,100 + 2,050 + 2,050) divided by 4, or 2,050. To calculate the section 4376 fee under paragraph (c)(1) of this section for the plan year ending December 31, 2013, Employer B must determine the applicable dollar amount under paragraph (c)(3) of this section and multiply that amount by 2,050.
For issuers of specified health insurance policies, the fee for a policy year ending on or after October 1, 2021, but before October 1, 2022, is $2.79 (line 133(b)) ($2.66 for a policy year ending on or after October 1, 2020, but before October 1, 2021 (line 133(a))), multiplied by the average number of lives covered under the policy for that policy year.
PLEASE NOTE, HMA and RMI will not be completing these forms for any Medova Lifestyle Health Plan. HMA is only providing the enrollment numbers needed for each group and the information included with the July 15 letter. It is the Employer Plan Sponsor’s responsibility to use this information to determine whether it is required to complete a 720 form for its group. Again, RMI would strongly encourage you to consult with your tax advisor to determine if you need to file this 720 form or for assistance in completing this form if necessary. Inserts from the form 720 have been linked below for your convenience. Please contact HMA for additional questions at (480) 921-8944.
MEDOVA BROKER COMMISSION RELATED FAQ AND BROKER OF RECORD FORM
RMI has received a number of questions regarding Broker Commissions in the Medova litigation. Below is a brief Q&A which RMI hopes will be helpful to you regarding commissions and the requirement for a Broker of Record Document from the Employer:
Will the commissions that have not been paid ultimately be back paid? If so, when?
The obligation to pay commissions is a part of the sponsoring employer’s responsibility. As a result, it will be up to the sponsoring employer as to whether broker commissions are to be issued for its particular group. If an employer does not choose to pay the plan expense of commissions, the employer and broker will be notified at that time after the plan’s medical claim expenses are resolved.
Why have non-ERISA accounts been withheld when the IF has no control or jurisdiction over them?
In limited situations, the IF has jurisdiction over non-ERISA funds. One reason is that in certain circumstances, non-ERISA plans are reliant upon payments from the applicable accommodation funds. Medova has used accommodation funds for more than just medical expenses. Secondly, under the terms of the Consent Order, RMI has had control of all accommodation funds. {These funds have now been returned to the Stop Loss Carriers.} Medova failed to submit any supporting documentation or evidence of any procedure used to establish amounts to be deducted for plans (ERISA or non-ERISA) from the accommodation funds that were congruent with the aggregate stop loss policies that control this feature. Additionally, Medova represented certain plans to be ERISA when they were not and represented certain plans to be non-ERISA when they were not.
What is the procedure for a broker to obtain information from RMI or HMA regarding an employer sponsored plan?
Because of issues regarding alleged misrepresentation by parties of who they represent, RMI and its appointed third-party administrator, HMA, will no longer communicate directly with ANY broker regarding ANY MATTER until the employer sponsor has executed and submitted a Broker of Record form (link below) to Robert Moore and RMI has confirmed its authenticity with the employer. This form MUST be on the Sponsoring Employer’s letterhead and notarized. Any Broker of Record form submitted that is not on the Sponsoring Employer’s letterhead and that has not been notarized will not be accepted as valid. RMI has the authority as the Court-Appointed Independent Fiduciary to communicate directly with any employer sponsor of an ERISA plan, any employer member, and any stop loss carrier at any time, regardless of the involvement of a broker.
The Broker of Record template form is linked HERE
NOTICE TO MEDICAL PROVIDERS AFFECTED BY THE INJUNCTION ISSUED BY U.S. DISTRICT JUDGE TOBY CROUSE
It has come to the attention of Receivership Management Inc. (RMI), the court-appointed interim Independent Fiduciary, that many hospitals and medical providers are seeking to comply with Judge Crouse’s Order but may not have knowledge as to which of their patients may be covered by the Court’s Injunction. To that end, we have posted a searchable listing of Group Names, Group ID Numbers and Member ID Numbers to assist medical providers in their efforts to comply with the Court’s Injunction. You may access this listing by clicking HERE.
Information concerning the Injunction, current actions regarding the Lifestyle Health Plans/Bridgewell Plans is discussed below. A link to the Court’s Injunction Order can be found in a link at the bottom of this page.
RMI is appointed only over certain ERISA Medova Lifestyle Health Plans as identified on Appendix A to the Consent Order appointing RMI as Interim Independent Fiduciary. On November 10, 2021, RMI filed an Agreed Motion to Amend Appendices A and B to the Consent Order to include certain ERISA plans that were omitted from the initial Appendix A list and to remove some Non-ERISA plans that were mistakenly included on the initial Appendix A. The list of groups contained on Appendix A to the November 10, 2021, Motion to Amend replaced the previous Appendix A and can be located HERE.
On April 29, 2022, RMI filed another Agreed Motion to Amend Appendix A to the Consent Order to add additional ERISA plans to Appendix A and to remove certain Non-ERISA plans that were mistakenly left on the amended Appendix A filed in November 2021. This list is to be used in conjunction with the amended Appendix A filed on November 10, 2021 and can be found HERE. When searching for your group, please be sure to check both documents to ensure you have the correct information regarding the status of your plan.
STATUS UPDATE FROM THE MEDOVA LIFESTYLE HEALTH PLANS INTERIM INDEPENDENT FIDUCIARY
I. NEW TPA
On July 1, 2021, Medova Healthcare Financial (Medova) was replaced with a new Third Party Administrator (TPA) to provide TPA services to those Lifestyle Health Plans covered by the federal Employee Retirement Income Security Act of 1974, as amended (ERISA) pursuant to an agreement between Medova and RMI. This new TPA is Hawaii Mainland Administrators (HMA).
HMA is a large TPA located in Tempe, AZ, with experience handling numerous health plans. HMA has banking privileges with Arizona Bank and Trust, which is where the bank accounts of the ERISA Lifestyle Health Plan accounts are now located post July 1, 2021.
RMI continues to ask for the patience and understanding of the many thousands of ERISA health plans’ brokers, members, patients and providers of the over 2,500 Medova Health Plans. RMI believes this change will improve response time but transitions are always challenging. RMI has been working diligently – nights and weekends included – to help the ERISA Lifestyle Health Plan members, patients, brokers and providers, and we will continue to do so. We understand the frustration you are experiencing and we will do our best to assist whenever possible. We are responding to calls, emails, faxes and letters as soon as we can but the volume is quite high so, please be patient with us.
II. ERISA ONLY MEDOVA PLANS
It is important to understand RMI has not been appointed to address non-ERISA health plans handled by Medova. It is RMI’s understanding that the claims data and accounting information for Non-ERISA health plans have now been assumed by HMA. HMA should be contacted directly for any information needed for any Non-ERISA health plans.
III. UNPAID CLAIMS OVER 90 DAYS IN ARREARS
ERISA Medova Health Plan members who have unpaid claims over 90 days in arrears, should provide the following information below by encrypted email or fax. Please use “Medova Unpaid Claims” in the subject line and email to ckinser@receivermgmt.com or fax to 615-373-4336.
1. the Member’s full name;
2. the Name of the Member’s Employer;
3. Provide a copy of the Health Plan Card or provide your Member ID Number;
4. the Patient’s full name and date of birth;
5. the Claim Number, if known;
6. the Provider’s name and address;
7. the Date of Service(s);
8. the Amount Billed;
9. Copies of any Explanation of Benefits (EOBs) or bills you have received;
10. Have you been subjected to collection action regarding Medova’s portion of a bill? If yes, please provide copies of the collection notices; and
11. Have you filed an appeal? If yes, please provide copies of the appeal documents
If you do not have all the documents, you should send what you have available. The more information you provide the easier it is to identify your claims and to seek information.
IV. COLLECTION ISSUES
For ERISA Health Plan Members and Patients who are receiving collection notices and action regarding amounts owed by your ERISA Lifestyle Health Plan, U.S. District Court Judge Toby Crouse issued an Order under the All Writs Act enjoining collections and lawsuits against members and patients covered by the ERISA Lifestyle Health Plans. Click the link here to view the Order. RMI is also offering the following suggestions to Members and Patients with unpaid claims owed by the Plan to do the following:
1. Continue to gather and retain the information described above for claims unpaid by Medova for more than 90 days. Keep copies for yourself and provide to RMI as described above.
2. The Member should notify the Collection Entities in writing that you dispute the debt because it is owed by the ERISA Lifestyle Health Plan to the Provider (if such is the case). You can also notify the Collection Entities of the Motion filed by the Department of Labor and provide them with a copy. The Member should copy the letter to the Provider and RMI by encrypted email with “Medova Collections” in the subject line to ckinser@receivermgmt.com or by fax to (615) 373-4336.
3. Review available consumer educational materials regarding debt collection and credit reporting. For example, the Federal Trade Commission has excellent consumer information regarding how to dispute errors on credit reports and debt collection at www.consumer.ftc.gov.
4. If legal action is taken against a Member or Patient, the Member needs to respond within the legally required time frame and may need an attorney. RMI would also ask that you provide copies of any legal action taken asap to RMI by encrypted email with “Medova Lawsuit” in the subject line to ckinser@receivermgmt.com or by fax to (615) 373-4336.
V. ERISA HEALTH PLANS WITH INSUFFICIENT FUNDS IN THEIR ACCOUNTS TO PAY APPROVED CLAIMS
Please understand RMI cannot pay claims where the particular ERISA Lifestyle Health Plan is underfunded. ERISA Lifestyle Health Plans are self-funded health plans that rely on contributions by the Sponsoring Employer and a combination of Stop Loss policies. Many of these Stop Loss policies will not make their payments until the end of the Policy term. Gaps that occur between the amount of funds paid by the Employer and the Attachment Point of the Stop Loss Policy are to be funded by the Employer.
Shortfalls between the medical expense amounts funded by the Employer and the Stop Loss Attachment Point are to be funded by the Employer as outlined in the Plan Document adopted by the Employer. Amounts above the Stop Loss Attachment Point MAY be required to be funded by the Employer in accordance with the Stop Loss Policy unique to the Employer’s Plan. Some or all of the amounts above the Stop Loss Attachment point paid by the Employer may be refunded when Stop Loss payments are received.
VI. TERMINATION OF PLANS
Some employers and brokers have contacted RMI regarding termination of their plans. RMI cannot advise employers or their insurance brokers regarding the employers’ business decisions. RMI would advise employers and brokers to carefully review their Plan Document and Stop Loss Policies to determine how they would be impacted by an early termination. Employers may wish to consult an attorney regarding such an important contractual decision.
Please note: ERISA Lifestyle Health Plans cannot be renewed. At the end of the plan year, the Employer has the authority to decide whether to establish a new health plan or not to establish a new health plan.