tpaT day
a publication of EBMS
Symmetry
Harmony
Stability
Equilibrium
Clarity
4th Quarter
2014
Synergy
Rhythm
In This Issue:
Core Values Winners p2
Claims Department p6
ACA p8
Client Spotlight - Laika Releases The Boxtrolls
Alice Jagiello, Executive Administrative Assistant
Movie-making is associated with Hollywood not Hillsboro, Oregon. But maybe it should be. That’s where Laika Studios is located;
Laika specializes in stop-motion animation.
The Boxtrolls is the third stop-motion animation feature film from the Hillsboro studio. It garnered more than $22 million
dollars in worldwide box office sales the first weekend after its September 26 release. The film earned over $17 million dollars
in domestic box office sales alone. That’s the most successful opening weekend yet for a Laika film. The studio created the
Academy Award nominated box office hits Coraline and Para Norman.
The Boxtrolls is a comedic fable that unfolds in Cheesebridge, a posh Victorian-era town obsessed with wealth, class and the
stinkiest of fine cheeses. Beneath its charming cobblestone streets dwell the Boxtrolls, foul monsters who crawl out of the
sewers at night and steal what the townspeople hold most dear: their children and their cheeses. At least that’s the legend
residents have always believed.
The Boxtrolls was in production for three years. More than 20,000 tiny props were made by hand. The costume designer used
laser cutters to fit the puppets with handmade clothing.
If technology didn’t exist, they invented it. Technicians built a special device to create the illusion of water for just a few seconds
in one scene.
Laika’s most widely-recognized innovation is using 3-D printers to create thousands of expressions for the puppets. Using
a process called “replacement animation,” the faces were swapped out between shots. In the finished film, the puppets’
movements appear lifelike.
Laika’s lead animator and CEO is Travis Knight.
The studio is owned by Nike co-founder and chairman Phil Knight and is located in Hillsboro, Oregon. The company has two
divisions, Laika Entertainment for feature films and Laika/house for commercial content. Laika spun off the commercial division
in July 2014 to focus on feature film production
exclusively. The new independent commercial
division is now called HouseSpecial.
If you haven’t done so, see The Boxtrolls!
Eggs (center, voiced by Isaac Hempstead
Wright) is surrounded by his Boxtroll
friends in LAIKA and Focus Features’
family event movie THE BOXTROLLS,
which opened nationwide September 26th.
Credit: LAIKA, Inc. / Focus Features
Newsletter Staff
Alice Jagiello, Editor
Linsey Bishop
Stacey Loucks
Annie Miranda
Kathi Schweigert
Diana Brewington
Kerri Patterson
Julie Mogan
Jessa Remington
Kati Musson
Office Locations
Montana
2075 Overland Avenue, Billings, MT 59102
Colorado
5995 Greenwood Plaza Blvd,
Greenwood Village, CO 80111
Oregon
1001 SW 5th, Ste 410, Portland, OR 97204
Six Employees Receive Core Values Awards
Each quarter at the State of EBMS meeting, Living the Core Values awards are presented to deserving employees. Third
quarter’s awards were presented to six employees. Andrea Pluhar, Director of Claims received the award for Commitment;
Deanna Rutschke, Quality Assurance Specialist, for Commitment; Jarrod Weenum, miCare COO, for Excellence; Chris
Haugan, Stop Loss Supervisor, for Commitment; Sandra Wilson, Quality Assurance Specialist, for Excellence; and Donna
Hulteng, EDI Specialist, for Commitment. Awards were presented by Kevin Larson, President, at the October 22 meetings.
The nominations read:
“I am nominating Andrea Pluhar for the core value of Commitment. I regularly receive accolades directly from Andrea’s team
regarding Andrea as a manager. She is committed to employee development and success and ensures that EBMS’ clients and
members are always taken care of on their journey. Through her positive attitude, Andrea is always looking for a way to solve
a problem and is never afraid “to dig in and help out,” when her team needs help. I received this recent example from one of
Andrea’s team members:
I wanted to let you know what a wonderful Claims Director, leader and mentor we have in Andrea Pluhar.
Today Andrea asked me for some IVR information for a Clark County Firefighter dental provider. From what I gathered, she
was in phone and email contact with probably a not-so-happy provider so I think she was stompin’ out a fire (pun intended!).
Anyway, after I sent her the requested file – she thanked me profusely and was nearly apologetic: “Thank you so much, I
know you are busy but this will help when I call this provider back.”
Who else has a boss who takes the time to not only say thank you, but makes you feel like your job is so important that she
feels bad about asking you to do something for her ??? That’s crazy! I explained that we should always be busy doing our jobs.
Whether it is helping a member, a provider or each other – this is what we do – right?
I’ve worked with Andrea for many years and cannot say enough about her great attitude and work ethics. She is one of the
reasons I look forward to coming to work each day – it’s so easy to work hard for someone who works just as hard. Andrea is
fabulous and I love to follow her leadership. As I told her – she leads by example!”
“It is difficult to choose just one Core Value to describe what Deanna Rutschke has done for EBMS. Nevertheless, we believe
her true passion is her Commitment to our new members and clients by ensuring their plan and their benefit eligibility are set
up timely and accurately so the transition to EBMS is as smooth and seamless as possible.
Her new group auditing process has evolved to comprise a review of a wide variety of items, including processes too
numerous to list, within the Account Management, Plan Design, Plan Documents, Claims, Eligibility, and Consumer
Reimbursement departments. Perhaps it is her Commitment to be “right the first time”, as she methodically audits something,
whether it is the intent of a benefit, the way a claim was paid, or that the phone numbers are correct on a member’s ID card.
It is amazing to us that she finds things that no one else does or even considers. Deanna frequently uncovers and questions
potential issues before anyone else and before they become issues. Her questions often receive responses from her peers
such as “I didn’t even think about that” or “that could really impact the member if we don’t understand how the client intends
this to be paid.”
Deanna is so organized that if asked for “proof” of her audit findings, she is able to retrieve all kinds of documentation that
show where a decision was made, or client intent for a benefit was discussed and determined.
To the frustration of some, she doesn’t stop there. She follows up, follows up and follows up again until there is a resolution or
the potential issue is alleviated. If that isn’t commitment!”
“Over the past three years I have been continually
impressed with Jarrod Weenum’s professional manner,
positive attitude and extensive knowledge base in a variety of
fields. Having worked as an RN for 28 years I have worked with
many different Managers, even at EBMS I had two different
Managers before Jarrod and he is undoubtedly the best I have
had the pleasure of working with. He understands the need to
communicate with all parties involved to provide quality care. He
is capable of assessing complex situations, takes the time to connect,
efficiently evaluates, and addresses each individual complaint regardless
of time restrictions. Jarrod is an intensely motivated individual who is
detail-oriented, compassionate, and genuinely interested in continually
striving to make the miCare clinics run smooth and provide excellent
patient care. When he comes to help us at the Health Fair, no task is above
or beyond him and he always goes the extra mile. He is a hardworking, empathetic individual and a tremendous asset to EBMS. I
am so grateful to have the chance to work with Jarrod.”
“Chris Haugan has an unshakable Commitment to our clients, their members, and our colleagues. In every interaction with her,
you can sense her diligence and focus. Our clients are benefited by her unmatched expertise in all things stop loss. Their members
are benefited by her deep sense of empathy and understanding for their situations.
And as for all of us at EBMS, she does a lot more than set a high bar for us all to strive for. Chris takes each interaction with her colleagues
seriously…she positively influences, compassionately encourages, and she is unwavering in her professionalism and composure. Thank
you Chris for always making a difference.”
“Once in a great while, there is a person amongst us that exhibits a quiet strength. This person is Sandy Wilson, and her strength
is her Excellence in everything she does. Normally, you don’t hear much from Sandy, but she has a way of making a strong
impact. Through her work, she has identified several issues that if not changed, would have had the potential to cause our clients
and members much frustration or a possible financial impact. Last year alone, her findings resulted in about $500,000 in cost
avoidance for EBMS, our clients, and our members.
Sandy is fanatical about her personal Excellence in her work. Through her review processes, she ensures that anything she
discovers is thoroughly researched before she issues any type of finding. She has built a network of peers with differing
perspectives and uses them when she needs the expertise. This allows her to back up any discovery with tangible evidence, which
helps her internal customers understand the issue. Once she does identify an issue and weighs the relative impact, she places her
feet deliberately on solid ground to ensure the issue is resolved.
Sandy is constantly looking for areas of agreement. She believes there is little to be gained from conflict and friction. She works to
try to find a common ground and works to resolve conflict without confrontation. She is totally aware of the need to treat people
the same, providing a consistent environment where the rules are clear and are applied to everyone equally. Sandy has a unique
way of telling you that you’ve made a mistake without making you upset that you did something wrong.
Sandy’s Excellence also spills over into helping our customers. She does what needs to be done for her peers and our members
and clients, frequently going out of her way to assist as needed. She will drop what she is doing just to ensure someone gets what
they need. An example of this was when she spent several months on the eligibility SWAT team. Not only did she perform work for
another department, but also ensured her normal duties were completed in a timely manner.
Sandy is a careful, vigilant, and fairly serious person who approaches life with a certain reserve. She will definitely be
embarrassed by the fact that she may be recognized for her Excellence in everything she does. I hope you do recognize one of
EBMS’ unsung heroes, Sandy Wilson, for her commitment to EBMS’ core value of Excellence.”
“Donna Hulteng consistently goes above and beyond her duties as an EDI specialist. She has stepped in and helped manage
the miBenefits portal as well as several other projects, products and software. She ensures that systems are up and running
smoothly to support EBMS’ business and our clients/groups. She has developed several projects and implementation plans
to streamline processes and communication efforts. Donna is a WOO’er and a relationship builder. She has a great knack for
building lasting relationships with her coworkers to produce quality work that then can be passed on to our internal and external
customers. I nominate Donna Hulteng for the Core Value of Commitment as she continuously demonstrates unwavering
dedication to the improvement and overall success of EBMS.”
Nominations for Living the Core Value awards are submitted by employees who wish to recognize the accomplishments of a fellow
employee. The Employee Advisory Board reviews the anonymous nominations and selects recipients for the awards.
p3
Anniversaries
We truly value our experienced and
dedicated team members! Please join us in celebrating the following employees’
p4
Promotions and
Title Changes
We enjoy celebrating the growth
of our professional staff at EBMS.
Please help us congratulate the
following employees on their recent
promotions and/or position/title
changes!
Thu Tran
Consumer Reimbursement
Specialist to
Consumer Reimbursement
Contributions Specialist
Tiffany Johnson
Claims Supervisor to
Assistant Account Manager
anniversaries! Happy Anniversary to all of you!
Employee Name
Start Date Department Title
Sue Corie 10/1/1990
Claims Claims Review Specialist--Portland
Patty Zimmerman 10/1/2001
Support Services Receptionist
Shelly Jones
10/4/2010
Client Services Client Service Representative
Jill Towers
10/7/2013
Claims
Claims Review Specialist
Jackie Lansing
10/8/2007 Claims Senior Claims Consultant
Rhonda Thomas
10/8/2008 Client Services Senior Lead Client Service Representative
Erica Couch
10/9/2013
Health Benefits Coordinator--Vegas
Jo Anne Hartin
10/11/2004 Claims Claims Examiner
Brenna Yarina
10/11/2005 Legal Corporate Legal Assistant
Darci Roskelley 10/12/1998 Quality Assurance QA Specialist-Salt Lake City
Judy Rauser 10/13/1999 Claims Claims Support Clerk
Kimberly Hunt 10/14/2013 Eligibility COBRA Administrator
Jodi Byrne 10/14/2013 Human Resources Human Resources Generalist
Joe Tochihara 10/17/2007 Provider Services Provider Services Lead
Meagan Schiffer 10/18/2010 Account Management Strategic Account Manager
Lisa Joki
10/21/1994 Finance Lead Finance Specialist
Pam Castle
10/22/2012 Provider Services Provider Services Specialist I
Account Management Melissa Mathews-Roe 10/22/2012 Claims Claims Examiner
Christina Mill 10/22/2012 Claims Claims Support Clerk
Janice Langlinais 10/28/2013 Client Services
Client Service Representative
Renee Renney 10/28/2013 Provider Services Provider Services Specialist
Elaine Dodson 10/28/2013 Claims
Claims Examiner
Debra McKeen-Sparks 10/28/2013 Eligibility Eligibility Administrator
Clarice Hoffman 10/29/2007 Support Services Flex Check/Support Clerk
Melissa Hammons 10/29/2012 Claims Senior Stop Loss Analyst
Kerri Patterson 11/1/2002
Consumer Reimbursement Account Coordinator
Consumer Reimbursement Sharon Avolio 11/4/2013
LPN
miCare--Bellingham
Paula Frost 11/4/2013
Legal Plan Document Specialist
Meghan LaCroix 11/5/2007
Claims Claims Examiner
Julie Vaskey 11/6/2000
Eligibility Director Eligibility
Kathy Garretson 11/11/1992
Support Services Receptionist
Deb Meyer 11/11/2013
Quality Assurance Auditor/Quality Assurance Specialist
Lara Kuehn 11/11/2013
Client Services
Client Service Representative
Mark Smidt 11/13/2000 EBMS Re Director EBMS Re
Gloria McKay
11/15/1993
Claims Examiner
Sherry Healy
11/15/2010 Client Services Client Service Representative 2
Claims Examiner to
Claims Supervisor
Dagmar Schobert 11/15/2010 Client Services Client Service Representative
Alyson Borth 11/18/2002 Claims Member Advocate
Linda Miller 11/18/2002 CareLink Disease Management/Wellness Assistant
Jeraldine Garbiso
Benjamin Dorman 11/18/2013 Support Services Support Services Clerk
Justin Mattox 11/18/2013 Client Services
Client Service Representative
George Ehrlekrona 11/19/2007 Information Services EDI Specialist
Karesha Bailey 11/24/2008 Finance Finance Specialist
Lisa Berendt 11/25/2004 Claims Plan Design Specialist
Craig Smart 11/25/2013 miRx Pharmacist
Finance Specialist to
Billing Specialist
Lori Bernell 11/26/2013 Legal Legal Assistant
Tawana Joseph 11/26/2013 miRx Pharmacy Technician
Debbie Taylor 11/28/2006 Claims Claims Registrar
Jill Moser
Todd Porter
11/26/2001 Information Services IS System Administrator
Debbie Hatwigg 11/29/2002 Client Services Client Service Representative
Greg Helsel 12/1/1998
Consumer Reimbursement Consumer Reimbursement Accounts--Denver
Stacey Zumek 12/2/2013
Account Management Account Executive--Seattle
Kassi McBeth 12/4/2012
Client Services Client Service Representative 2
Christy O’Grady 12/4/2013
Client Services
Senior Lead Client Service Representative
Andrea Pluhar 12/6/1999
Claims Director Claims
Cathy Bentz 12/6/1999
Plan Documents Plan Document Specialist
Justin Bough
Client Service Representative to
Consumer Reimbursement
Specialist
Jodi Worden
Client Service Representative to
Client Services Representative 2
Karla Stricker
Client Service Representative to
Claims Support Clerk 1
Dagmar Schobert
Client Service Representative to
Client Service Representative 2
Claims When you aim for perfection, you find out it is a moving target.
~ George Fisher
Anniversaries Continued
New Employees
Employee Name
Start Date Department Title
Mike Trent
Donna Hulteng
12/9/2013
IS
Database/EDI Specialist
Kellie Hogsett 12/9/2013
miRx Pharmacy Clerk
Kendra Brown 12/9/2013
IS
Data Base Specialist
Cherish LaFurge 12/9/2002
Claims Claims Examiner
Sales
Regional Sales Manager-Denver
Lori Shelton
12/9/2002
Human Resources Corporate Trainer
Jarren Scheller 12/9/2013
Claims
Stoploss Specialist
Mary Deal
12/10/2008 Client Services Client Service Quality Trainer
Sherrie Grauman 12/13/2010 Claims Claims Examiner
Sheila Hutchinson 12/13/2010 Provider Services Provider Services Specialist I
Sally Schanz
12/15/2003 Claims Claims Examiner
Rod Kastelitz
12/16/1991
Vice President Sales
Sandra Meide 12/17/2007 Claims Claims Support Clerk
Karen Howell
12/19/2005 Marketing Printing Operations Specialist
Katrina Wagner
12/20/2002 Eligibility Eligibility Services Supervisor
Julie Nelson
12/20/2004 Account Management Client Success Manager
Kris Pendall
12/23/2002 Provider Services Provider Services Specialist I
Executive Billie Weston
12/29/1997 Account Management Strategic Account Manager
Angela Carlton
12/29/2008 Eligibility Eligibility Administrator
Jaime Holly
12/29/2008 Claims Claims Examiner
Jodee Etchart 12/30/2013 miCare
Physician Assistant
Healthcare Bluebook
Compare Providers, Shop for Care, Save Money
Healthcare Bluebook educates and empowers employees to find high-value providers
(labeled as green providers) for their healthcare needs. By choosing green providers,
the employee and employer save money. With the Go Green to Get Green Rewards
program, employees can save $1,500 on average per Shop Smart procedure and are
rewarded for using high-value providers for certain healthcare tests and procedures.
Healthcare Bluebook integrates with employer-sponsored resources such as
wellness, advocacy, on-site clinics, and other health management programs to
ensure that consumerism is reinforced as part of the overall engagement strategy.
Healthcare Bluebook will work with clients to create a tailored experience to leverage
and maximize programs, portals, and providers.
With Healthcare Bluebook, employees can quickly and easily understand what
they should reasonably pay for healthcare. Once they understand what healthcare
services should cost, they can compare providers and see quality and patient ratings
for doctors and hospitals. Healthcare Bluebook helps educate and engage your
employees, empowering them to get the best value for healthcare services.
Access to Healthcare Bluebook is simple – no new website or username is required.
Employees simply log into their existing EBMS online account once the tool is
activated. Contact your dedicated EBMS Account Manager today to learn more
about Healthcare Bluebook!
Kristi Bice
Client Services
Client Service
Representative
Jennifer Ramas
Client Services
Client Service
Representative
Dessiree Jagiello
Client Services
Client Service
Representative
Jackie Lambrecht
Client Services
Client Service
Representative
Carlos Valdez
Client Services
Client Service
Representative--Bilingual
Jane Russell
Eligibility
Eligibility Services Assistant
Rick Lubkeman
miCare
Business Development
Manager
p5
Claim Department Spotlight
Kathi Schweigert, Claims Business Analyst and Supervisor
p6
Holiday Closing
As a member of the EBMS family for almost 19 years, I have spent most of them
in the Claim Department. I marvel at how the industry has changed and the
Claim Department along with it.
With 80 employees, the Claim Department is the largest in the organization. We
are referred to as a Department but we are comprised of a number of smaller
teams that work together to perform a wide variety of functions to help our
customers along their journey. Each team within the department plays a vital
role in the services we offer to our clients.
In observance of the
upcoming holidays, EBMS
offices will be closed:
The Claim Department has team members in several locations including Billings
and Portland and a number of remote workers. The combined tenure of these
team members is a whopping 707 years! We have 6 employees who have each
been with EBMS over 20 years.
Wednesday, November 26 at 5 pm
Thursday and Friday, November 27
and 28 all day
The teams within the Claim Department are:
Friday, December 5 at 5 pm
(Billings only)
December 24 at 2 pm
December 31 at 5 pm
GBA
Certification
Melissa Lyon, Vice President
Human Resources, completed her
Group Benefits Associate (GBA)
designation. This designation is
an ideal fit for those dealing with
health and other group benefits.
The courses reflect up-to-date and
relevant information—including
the latest on health care reform—
needed to effectively design,
administer and communicate
group benefits. To earn the
GBA designation, three courses
are required--Group Health
Plan Design, Group Benefits
Management and Health Care
Financing, Quality and Reform.
All three of these courses apply
toward the eight-course CEBS
requirement.
Leadership Team: The supervisors, quality assurance specialist, and senior claims
consultants provide guidance on a day-to-day basis for the various teams and
their members.
Registration/Validation Team: This team is responsible for Data Entry of all
paper claims that are received. Data on scanned claims is verified prior to being
converted to electronic files that are loaded into the system.
Examiner Team: Each examiner is assigned approximately 2500 lives across
multiple groups. They are responsible for all claims and correspondence for their
assigned member lives. Many of the examiners are also in contact with clients.
They process claims in a timely and professional manner and assist members
who phone or walk in the office. These team members also back up the Client
Service Department when phone coverage is needed.
Claims Support Team: The team of individuals assists all areas of the department
where and when they are needed. Some of the functions of the team are to process
miCare claims, add Utilization Management information to the system, process
claims for fee payments and input HIPAA authorization information into the system.
Void/Refund Team: Refunds received are researched to determine why they were
received and where the money should be applied. Refunds are then posted to the
system. This team also reissues lost checks and processes void checks.
Claim Review and Appeals Team: This team assists the examiner with medical
related issues that require research and includes an RN dedicated to the efficacy
of treatment. These team members also review appeals/inquiries from members
and providers when there is a question on whether or not their claims were
processed properly.
Member Advocate Team: This team assists the rest of the department with
outreach to members and providers on a wide variety of topics. Their role has
recently expanded to include outreach to members who have high impact claims
to assist them on their journey.
Congratulations, Melissa!
If you tell the truth, you don’t have to remember anything.
~ Mark Twain
Plan Documents Team: This team works closely with
the account manager, broker, client, and the Legal
Department to ensure that plan language is consistent and
compliant with required regulations. They also work closely
with the Plan Design team to ensure the claims processing
system is set up following the intent of the client. In addition, they
prepare the Summary of Benefits and Coverage (SBC) for the client.
Plan Design Team: This team inputs the plan data into the processing
system so that claims are processed according to the plan language with
limited examiner intervention. They work closely with the plan documents
team to maintain the system set up for existing clients and processing any
changes necessary at renewal as well as setting up new clients when they
come to EBMS.
Stop Loss Team: This team works with clients and stop loss carriers to insure timely filing and reimbursement of stop loss and
aggregate claims. The team also works with the examiners and client to obtain discounts on large claims and shops for stop loss
coverage for the clients.
Large Claims Management Team: This team reviews large claims as soon as we are aware that they’ve arrived at EBMS. They work
with various vendor partners to obtain discounts from both in-and out-of-network providers. The team has recently added an inhouse negotiations manager to further assist in keeping our clients financially well on their journey.
There are several committees within the department that review processes and train the team members to help in increasing
efficiency and quality.
The Auto Adjudication Committee is a cross-departmental team that focuses on ways to increase the auto adjudication rate in the
system or generally increase efficiencies in the workflows by streamlining processes.
The On-going Training Committee develops and facilitates training sessions for the department to assist in areas where processes
may need clarification or to reinforce process changes that have taken place. Topics may come from questions raised in the
department or issues that come to light during quality assurance reviews.
The needs to recognize quality within the department lead the Claims Advisory Board to develop the EPIIC Recognition program.
This is a peer recognition program that focuses on our core values. Cards are given to a team member when one of the core values
is demonstrated. These cards can be exchanged for small prizes and are displayed on a wall in Claims for all to see. When 200
cards are collected a reward is given to the entire team.
In 2013 year to date there were 2,339,173 claims processed and we know that we will likely see an increase in that number as
the years progress. That is why the teams within the Claim Department work together and strive to keep our clients and their
members physically and financially well on their journey.
“What happens in Vegas stays in Vegas”
If the popular marketing slogan holds true, EBMS, miCare and various partner
organizations will benefit from new healthcare opportunities in the Las Vegas market by
way of discussions that took place at the EBMS-sponsored “Health Innovations Forum”
on October 9 at the InNEVation Center.
EBMS’ team of experts, joined by the City of Yakima, Healthcare BlueBook, Diplomat
Specialty Pharmacy and Brownstein, Hyatt, Farber, Schreck, LLP, shared new innovations
in healthcare and benefits that drive member satisfaction, positively impact patient
behavior, and reduce healthcare expense. Las Vegas area employers, large health plan
trusts and brokers, representing more than 400,000 members, were in attendance for the
event. EBMS will hold similar forums in locations to be announced throughout 2015.
Brent Husson, EBMS Las Vegas, welcomes
the Health Innovations Forum attendees.
p7
ACA and COBRA
Stacey Loucks, Compliance Officer
p8
Kid’s Corner
Janell Williams, daughter of
Janean Honadel, Strategic Account
Manager, graduated from Western
School of Law in May and passed
the Montana State Bar examination
in July. Janell achieved success
in the classroom, achieving
placement on the Distinguished
Honor Roll, graduating with Honors,
and receiving Witkin Awards.
During her studies, Janell took
on leadership positions within
several student organizations on
campus including the Student
Bar Association, Christian Legal
Society, and Phi Alpha Delta
Professional Law Fraternity to
provide events benefiting the
student body as a whole.
The Affordable Care Act (ACA) has brought about many changes to the world of
employee benefits. Recently, the interaction of COBRA and the ACA has been
at issue. The Initial COBRA Notice and the General COBRA Notice are now
required to include information regarding the availability of the Health Insurance
Marketplace. This will allow the former employee and his/her family to make an
informed decision about health care benefits. They are instructed to explore the
options available in the Marketplace including the cost of coverage (including the
availability of a subsidy) and compare that cost to the COBRA coverage.
COBRA is still required to be offered to all Qualified Beneficiaries. The total
benefits available through the COBRA coverage may be better overall than the
coverage available through the Marketplace. COBRA beneficiaries should be
aware of a potential gap in coverage if they decide to decline COBRA coverage
and elect Marketplace coverage. COBRA coverage will begin as of the date of
the loss of coverage under the group health plan. Marketplace coverage will
begin the beginning of the month following the election and will not be applied
retrospectively.
A Qualified Beneficiary will not lose eligibility to obtain Marketplace coverage
if they are offered COBRA. When the Qualified Beneficiary loses coverage due
to a Qualifying Event, a special enrollment period will occur in the Marketplace.
The special enrollment period is 60 days before the loss of coverage and the 60
day period after the loss of coverage. A Qualified Beneficiary may qualify for a
subsidy in the Marketplace even if they have COBRA coverage offered to them.
A Qualified Beneficiary who elects COBRA continuation of major medical
coverage will satisfy the individual mandate to obtain “minimum essential
coverage” (MEC). An individual must maintain coverage under an MEC plan each
month of the calendar year in order to avoid tax penalties.
An offer of COBRA coverage to an employee who is still an active employee will
satisfy the employer shared responsibility rules (Pay or Play) if the coverage
provides “minimum value” and is “affordable.” For example, if an employee
changes from full-time to part-time during stability period, the employer may
decide to offer COBRA coverage when the Qualifying Event occurs. If the
COBRA coverage is not “affordable” to the employee, then the employer may
be assessed the 4980(H)(b) fee if the former employee obtains coverage in the
Marketplace and qualifies for a subsidy. An alternative option is to offer the
Qualified Beneficiary COBRA coverage and continue to pay for the coverage
until the stability period is over. At that point, if the Qualified Beneficiary
elected COBRA coverage when it was originally offered, he/she would take over
payments for the COBRA coverage for the amount of time remaining in the 18
months of COBRA coverage.
Some questions still exist regarding the correct approach to offer COBRA
coverage in certain circumstances. Employers will need to make their
best efforts to comply with the COBRA laws while still keeping in mind the
requirements under the ACA.
Destiny is no matter of chance. It is a matter of choice.
~ William Jennings Bryan
Farm and Ranch Life
Plan Document Specialist, Heidi Henriksen, who works remotely from her home in South Dakota, and husband Eric, were featured
in the August edition Farm and Ranch Living magazine where Heidi kept a diary of details of life on their ranch for a month.
On top of her full time job with EBMS, Heidi and her husband are kept busy with their ranch in South Dakota and farms in Iowa.
The Double H Ranch is a 268 acre ranch between the Black Hills to the west and the rugged Badlands to the east. They also keep
track of their two Iowa properties, 10 hours away in northeast Iowa.
Heidi and family moved from Northeast Iowa to the South Dakota location 14 years ago. They have a small herd of cattle, bale
hay, raise chickens and board about 25 horses.
In Iowa, they have a log home that Eric built on the property where generations of Heidi’s family have lived. This property borders
the bike trail and is on the state’s River Bluffs Scenic Byway. The couple also has Bear Creek Farm, which is a 33-acre property
with five creeks running through it. The couple is building a top floor on the earth–bermed home that was there. The couple’s son
manages and lives on this farm, where they are raising calves and keep busy with a large orchard.
A typical day for Heidi begins at 5 a.m. with a walk along the creek, and then bookwork or meeting with their part-time helper to
discuss projects for the day. Heidi is in her office from 7-4 working for EBMS. After work is spent cooking, cleaning, and helping
with the ranch work--from baling to animal care.
The couple’s three children and their families live in Northeast Iowa--so to help get everything done, Heidi and her husband
participate in the Workaway program. The Henriksen family hosts guests that want to learn about life on a ranch. In exchange for
their part-time help, they offer housing in their bunkhouse and eat meals together. To be involved in the Workaway program, there
are no costs other than a nominal fee to be placed as a Worker on the site.
Anyone that needs extra help with anything can offer themselves as a host family by placing a profile. The potential workers contact
the host family with the details of how long they would like to stay and provide information of their past experiences and skills that
may help them on the ranch. There are no time frames, so the options are endless, from a weekend to a year or more. Heidi has been
surprised at how many people are willing to travel and work in this way. There are many potential workers that the family has turned
away due to not having the extra beds for them. Since being involved in this program, Heidi’s family has had guests from England,
Ireland, Switzerland and Norway stay with them. Their backgrounds have varied from training in teaching, veterinarian, travel agent,
chef/baker, construction and a person in the fishing industry off of an island in the Norwegian Sea.
In order to be sure the guest is a good fit, Heidi checks professional references and also holds a SKYPE meeting, if possible, to be sure
both parties understand expectations and all questions are answered. The Henriksens ask their guests to work 20 hours per week
for them and they must have their own health insurance. That allows quite a bit of time for sight-seeing and other fun activities.
Helpers at the Double H Ranch have done everything from painting, baling hay, fencing, moving cattle, helping in the kitchen, lawn
maintenance, construction projects, and working with livestock to stepping in as caretakers when the family is away on vacation.
Eric is in charge during the day for the training and supervising to be sure the guest is attentive to safety precautions and
understands the equipment and the job being asked. Heidi makes sure the kitchen in the bunkhouse is stocked for breakfast and
lunch for the guest and then everyone shares the evening meal (prepared by Heidi) together in their home. Luckily cooking is one
of Heidi’s hobbies so it doesn’t seem like a burden to have extra mouths to feed. One request always asked of the guests is that
they bring along a few of their favorite recipes so that they can prepare them and give the couple a taste of their culture as well.
If you are interested in the Workaway program see www.workaway.info.
p9
Celebrating Our Superheroes
In recognition of National Customer Service week October 6-10, the Leadership
team organized Superheroes Week. All employees were recognized for their
superhero abilities. The Leadership team also nominated employees they felt best
exemplified the characteristics of selected superheroes. Each day the selected
superhero employee was celebrated.
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Behold! The
Sacred Yams of
Nyarlathotep.
Rejoice! Descend!
Consume!
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Erin Jimison, Account Executive, was selected for Power Girl.
Tiffany Johnson, Assistant Account Manager, best portrayed Jean Gray.
Dale Welzenbach, Lead IS Systems Administrator, garnered the title of Captain America.
Nilo Cabrera, Leader Project Manager, was selected as Daredevil.
The Client Services Department was given the designation of the Forever People.
The week concluded with the Friday Fiesta—a potluck lunch.
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Jordan Drake, Provider Services
Specialist
Made with mashed roasted sweet
potatoes and a crunchy pecan
topping with a melty marshmallow
center.
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Ingredients - serves 6:
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3 lbs sweet potatoes
¼ cup unsalted butter at room temp
¼ cup sugar
¼ cup milk
1 large egg
½ teaspoon vanilla extract
¼ teaspoon salt
For the topping :
1 ¼ cup crushed cornflakes
1/3 cup chopped pecans
1 tablespoon brown sugar
1 tablespoon melted unsalted butter
1 cup mini marshmallows
Instructions:
Preheat oven to 400 and line a baking
sheet with parchment paper. Place
potatoes onto the baking sheet and bake
until tender (about an hour). Let cool
before peeling. Turn oven temp down
to 350 and oil a 9 inch pie plate. For the
topping, combine cornflakes, pecans
and brown sugar in a bowl and stir in the
butter, mix well and set aside. In a bowl,
use an electric mixer with the paddle
attachment to beat sweet potatoes,
butter, sugar, milk, eggs, vanilla extract
and salt on medium/high until well
combined (about 2 minutes). Add sweet
potato mixture to the pie plate, sprinkle
with cornflake mixture around the
outside of the dish and leave room in the
center. Place into the oven and bake for
20 minutes or until the topping is golden
brown. Add marshmallows to the center
and continue baking until marshmallows
are slightly golden (about 5 additional
minutes). Serve immediately!
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Wanda Clausen and Sharyl
Marcher, Client Service
Representatives, ring the bell to
recognize the Forever People.
Weenum Named miCare COO
EBMS President Kevin Larson
announced the promotion of Jarrod
Weenum to Chief Operating Officer
for miCare, LLC. Since joining EBMS
in 2004, he has held positions
with progressively increasing
responsibilities. Most recently, Jarrod
has been responsible for the business
operations of miCare including day-today operations as well and the sales
and implementations of new clinics.
During his tenure, miCare has seen
accelerated growth with the addition
of eight clinics. Jarrod holds a double
Bachelor’s Degree in Political Science
and Business Management from Rocky
Mountain College and a Masters in
Business Administration from the
University of Mary. Kevin said “I am confident under Jarrod’s dedicated
leadership that miCare will see continued growth.”
Good exercise for the heart: bending down and helping
another up.
~ Unknown
10 Tips for Staying Active this Winter
Linsey Bishop, Wellness Coach
Winter is upon us. Staying active can be a challenge this time of year. Winter weather can make working out less desirable.
Although you may prefer staying warm in your bed, winter time is not the best time to hibernate. With extra holiday treats around
this time of year, exercise helps balance them out. With the right attitude and creativity, winter time is a great opportunity to
change up your fitness routine!
The following tips can you help design a fitness plan that works for your schedule and lifestyle:
1.
Adopt a positive mindset. Embrace this new season. Take time to evaluate your health and wellness. What goals do you want
to achieve? Where does exercise fit into your plan? Reflect on your past accomplishments and develop new goals for the
upcoming months.
2. Have fun and play! Don’t feel like going to the gym? The best part about playing is that it doesn’t feel like working out. Unlock
your inner child and have fun! Try making snow angels, having a snowball fight, building a snowman, or ice skating.
3. Try something new. Sign up for a new fitness class or join an indoor sports league during these chilly months. Joining a new
activity can jump start your motivation for fitness. Find local exercise opportunities which might include indoor volleyball,
indoor soccer, yoga, boot camp class, or indoor tennis/racquetball. Find a fitness partner to help keep you motivated and
accountable.
4. Be creative at home. Getting to the gym can be a hassle, but that’s not an excuse to miss your workout. Brainstorm fitness
ideas to do at home, either by yourself or with family. Ideas include trying a new fitness DVD, investing in a few pieces of
exercise equipment, or using your body weight for a great work out. The best parts of working out at home are that it’s
convenient and private.
5. Try a winter sport. Unleash your competitive side and burn a lot of calories too. Great winter options include hockey, skiing,
snowboarding or snowshoeing.
6. Schedule your fitness regimen. Time management is a big barrier to staying on track with exercise. Each week, schedule your
fitness plans. Plan what time of day is the most realistic and feasible to exercise. Develop a schedule of days committed to
exercise.
7. Set long- and short-term goals. Set long-term goals that motivate and challenge you. Then, create smaller, achievable weekly
goals as an action plan towards your long-term goals. Make SMART goals which are Specific, Measurable, Action-based,
Realistic and Time-lined.
8. Utilize online resources and smart phone apps. Use technology to achieve your fitness goals. Try out one of these ten fitness
apps: C25K, Fitness Buddy, RunKeeper, Map My Fitness, Johnson & Johnson Official 7 Minute Workout, Fitocracy, Moves, Pact,
and Nike Training.
9. Use your Wellness Benefit. Through the Healthy Lifestyle Reimbursement Program, you are eligible for reimbursement up to
$150 per quarter for active participation in health and fitness programs. See the Intranet for more details!
10. Get Excited! Even if winter isn’t your favorite season, try to focus on something you do love about winter. Maybe it’s spending
quality time with family or enjoying your favorite seasonal produce and recipes. Adding exercise to your favorites will keep
you feeling energized and healthy.
Source: www.sparkpeople.com
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Running Around Montana
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Bread Pudding
Paula Frost, Plan Document Specialist
(credit to Theresa Ott)
Yum, yum, sit back and enjoy but
what ever you do, DON’T COUNT
THE CALORIES!
Ingredients:
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6 eggs
3 ½ c. milk
1 ½ c. sugar
1 c. whipping cream
2 tsp. vanilla
½ c. raisins
1 loaf French bread
The annual Montana Marathon was
held on September 21, a bright sunny
day. The runners departing from Molt,
on their way to Billings, had excellent
weather for the race. The temperature
started out cool, which is great for
the runners, and warmed up nicely
for the end of the race festivities at
Daylis Stadium. In addition to EBMS
being a major sponsor of the Montana
Marathon, EBMS employees participated
in and supported this great run.
Becky Bruner and Eve Mann, Claim Examiners, and Amy Hagan, Marketing
Assistant, all ran in the 10K portion of the marathon. These ladies are to be
commended for their commitment to running and maintaining a healthy lifestyle.
EBMS team members manned a water station to support the runners at mile 23.
Andrea Pluhar, Director Claims; Tara Keehn and Lisa Rel, Claims Supervisors; and
Tiffany Johnson, Assistant Account Manager; Misty Logan, Strategic Account
Manager and Sondra Arnold, Controller, were on hand to help keep the runners
hydrated and cheer to keep their spirits up as the end of the journey was in sight.
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Instructions:
1. Mix eggs, milk, sugar, whipping cream,
and vanilla in a large bowl or pan. Add
raisins and French bread (torn into
pieces).
2. Let sit for a couple of minutes to allow the bread to soak up the liquid.
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3. Bake in 9 x 11 pan at 325 degrees for
one hour+ (I found it difficult to determine when it was done. You may need
to bake it longer, but do not increase the
temperature.)
Caramel Sauce
Ingredients:
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½ c. butter
½ c. white sugar
½ c. brown sugar
½ c. whipping cream
1 tsp. vanilla
Instructions:
1. Mix butter, sugars, and whipping
cream in a heavy saucepan.
2. Bring mixture to a rolling boil; remove
from heat and add vanilla.
3. Pour over bread pudding (after baked/
removed from the oven).
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1 Eve Mann and Becky Bruner following the marathon. 2 The First Annual Bobcat Triathlon
was held September 21 in Bozeman; Nick Peterson, IS Programmer Analyst, participated in
the triathlon. 3 Cathy Bentz, Plan Document Specialist, and Jodi Richard, Quality Assurance
Specialist, following the Montana Warrior Run which benefits the veterans of Yellowstone County.
The course was either a 5K or participants could “dare” to take the Warrior Run Challenge which
was 8.5 miles that also included a 700 foot vertical climb within the run. Cathy and Jodi took
that dare and completed the challenge on a very cold, wet, rainy and muddy day! 4 Cathy
Bentz, Plan Document Specialist, and Terri Hogan, Director of Legal, at the John Colter Run which
held on September 20 outside of Three Forks, Montana. It is a 7.5 mile trail race re-enacting
John Colter’s infamous (naked!) escape from Blackfoot Indians. 5 Stacey Loucks, Compliance
Officer, and her husband, Bob, at the end of the Color Me Rad 5k held on September 20.
Imagination is more important than knowledge.
~ Albert Einstein
Challenge Accepted
Employees Receive Rewards for Wellness Participation!
Jessa Remington, Human Resources Generalist
Despite the fact that EBMS increased the difficulty of our health goals for our employee outcomes-based wellness program
in 2014, we had excellent participation, demonstrating a widespread commitment to improved health and wellbeing, which
translates into positive impacts on our claims experience and medical premium rates.
This commitment was especially noticeable in our miHealth Challenge, which 74% of eligible participants, including employees
and spouses on our EBMS Health Plan, completed by the October 1 deadline. The miHealth Challenge required participants to
complete a Health Risk Assessment blood panel, attend a follow-up appointment with a healthcare provider to review the results,
complete an online Health Risk Assessment questionnaire, and submit their challenge card to Human Resources indicating
completion of all steps. Employees will receive a $150 Health Reimbursement Account deposit for their own successful completion
and an additional $150 for an eligible spouse’s completion of the miHealth Challenge. Employees will also receive a $25 per month
reduction in their 2015 health insurance rates compared to employees who did not complete the challenge.
The second challenge in our wellness program, our Know Your Numbers Challenge, has been successfully completed by 57% of
eligible participants so far. Our 2014 goals are as follows:
• Blood Pressure: <140/90
• Cholesterol (LDL): <145
• Body Mass Index (BMI): <29
• Tobacco/Nicotine Use: None
Although the above goals remained the same as in 2013, participants had to meet all four this year whereas they only had to
meet three of the four in 2013. Alternatively, employees who are not able to meet all four have until year-end to work with a
healthcare provider to decide on and meet a reasonable alternative health goal and still be eligible for the incentives. Incentives
for completing the Know Your Numbers challenge include a $100 Health Reimbursement Account deposit for employee completion
and $100 for spouse completion.
To increase the impact of our wellness program on actual health outcomes and the accomplishment of health goals, EBMS added
an additional incentive this year for employees who complete both the miHealth and Know Your Numbers challenges. Successful
participants will enjoy two premium holidays, which means that they will not have the employee portion of their health premiums
deducted from their paychecks in December.
Congratulations to all EBMS employees who participated in this year’s wellness initiatives, and good luck to everyone who is still
working on meeting a reasonable alternative health goal by the end of the year.
2014 Poster Contest - The theme was 80s Movies.
The Client Service Department’s Star
Wars poster was voted the best poster
for 2014.
The second place vote went to Provider Services for their Ghost
Busters poster.
The Right Stuff, the miRx
team’s poster, placed third.
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Holiday Recipes
Compiled by Anna Miranda, Graphic Design and Event Coordinator
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Holiday season is coming up fast! Pull together your friends and family, whip
up a batch of hot apple cider and enjoy these delicious recipes. These dishes are
sure to feed and please the people you love, with familiar seasonal flavors that
everyone adores. We’ve pulled together five delicious holiday ideas that you will
love sharing with a room full of your favorite people this year!
Grandma’s Molasses
Cookies
Brazilian Style Strawberry Shortcake
Donna Paige, Sales Coordinator
This Brazilian-style Strawberry Shortcake has a decadent layer of home-made
condensed milk custard. Impossible to resist!
A sentimental reminder of childhood days at Grandma’s house,
this cookie shows up at all family
gatherings.
Ingredients:
Stir together and set aside.
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5 cups flour
1 ½ tsp salt
1 ½ tsp ginger
1 tsp baking power
1 tsp baking soda
¼ tsp cloves
Cream shortening and brown sugar.
• ¾ cup shortening
• 1 cup brown sugar
Add to shorting and brown sugar
and mix together.
• 1 cup molasses
• ½ cup water
Instructions:
Blend dry ingredients and molasses mixture into creamed mixture, blending well.
Chill dough, if desired. Roll 1/4“ thick on
a lightly floured surface. Use a 3” cookie
cutter and place cookies about 1” apart
on baking stone or cookie sheet. Bake at
375 for about 10 minutes until set and
remove to cooling rack.
Duane, Moody, Portland Branch Manager
Ingredients - serves 10:
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3 ounces strawberry gelatin
½ cup hot water (not boiling)
½ cup ice cold water
1 can (14 ounces) sweetened condensed milk
1 cup whole milk
4 egg yolks, lightly beaten
4 egg whites
8 tablespoons sugar
1 can (7.6 ounces) Media Crema (table cream)
¾ of a store-bought Angel Food cake, sliced into ½-inch thick slices (about 15 slices)
2 cups strawberries, steam removed and quartered, plus more for decoration
Instructions:
1. In a medium bowl, whisk together strawberry gelatin and hot water until dissolved. Mix ice
cold water, cover and transfer to refrigerator. Let it chill for 1 to 1 ½ hours, or until it is nearly
firm (it should be half way in between liquid and firm). Set aside.
2. In a medium sauce pan over medium heat, add sweetened condensed milk and whole milk
and cook, stirring constantly, until mixture is boiling lightly. Reduce heat to medium-low and
slowly add egg yolks, whisking vigorously until mixture thickens, 3 to 4 minutes. Remove
from heat and allow cooling.
3. Add egg whites to a medium, clean bowl. Using a hand mixer beat egg whites until soft
peaks form, 3 to 4 minutes. Slowly add sugar, 1 tablespoon at a time, constantly beating.
Turn off hand mixer and gently fold in table cream. Set aside.
4. Lay sliced cake on the bottom of a large deep dish (at least 3-inches deep, 10x15). Cake
slices should be slightly overlapping. Pour condensed milk mixture over cake and cover with
quartered strawberries. Carefully tip nearly firm gelatin over strawberries. Carefully spread
egg whites mixture over gelatin. Decorate top with a few strawberries. Cover and refrigerate
for at least 2 hours before serving.
Cook’s Note: Media Crema is Latin American style table cream. It can be found at the Latin
section of major grocery stores or at international markets.
Every great business is built on friendship.
– JCPenny
Halloween Festivities
1 The winner of the Funniest costumes was Dunkin Donuts with Becky Bruner and Stephanie Ketterling, Claims Examiners. 2 Kassie McBeth, Client
Service Representaive 2, won the prize for the Best Makeup. 3 The Most Original prize went to Pam Castle, Provider Services Specialist. 4 Shelly
Jones, Client Services Representative 2, took home the prize for Scariest. 5 Two teams were recognized for the Team Award. The Swat Team from Client
Services and the Claims Leadership Team with the Minons. Pictured is the Claims Team--Andrea Pluhar, Jodi Worden, (back row) Tiffany Johnson, Kathi
Schweigert, Tara Keehn, Lisa Rel, and Lori Shelton. 6 Connie Reintsma, Client Services Representative 2, just one member of the Swat Team.
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EBMS Leaders Learn to Leverage Power Effectively
Jessa Remington, Human Resources Generalist
Throughout September and October, EBMS leaders learned
to influence others more effectively through the recognition
and application of power bases. Participants learned about
the different types of power that that they can draw on
to influence up, down, and across the organization and
how the amount of power they have can be strengthened,
or unfortunately, eroded through their own actions or
surrounding circumstances. To do this, participants were
encouraged to relinquish any preconceived negative
perceptions surrounding the word “power,” and then were
given the opportunity to explore its practical application and
importance to the influence process.
Prior to attending the workshop, participants invited their
direct reports, peers, and managers to complete a 360°
assessment regarding their past use of power. Then, during
the workshop, participants were able to identify which power
bases they tended to use most often, and develop a plan for
influencing others more effectively by strengthening and
utilizing the appropriate power base.
Leveraging Your Power to Influence is a one-day instructor
led course that was facilitated on September 4th and again
on October 16th, by Situational Leadership trainers and
EBMS employees Erin Jimison, Account Executive and Jessa
Remington, HR Generalist. The program is part of an ongoing
Situational Leadership® curriculum that develops EBMS leaders
to be able to more effectively assess individual performance
readiness and apply the appropriate leadership style to meet
the needs of the individual being influenced.
p15
P.O. Box 21367
Billings, MT 59104-1367
www.ebms.com
P 406.245.3575
T 800.777.3575
F 406.652.5380
C R E AT I N G
COMMUNITIES,
O N E E M P LOY E R AT A T I M E
EBMS delivers strategies to transform the health and wellbeing of individuals, organizations and communities.
Book Review - Rebel Belle by Rachel Hawkins
Kati Musson, Consumer Reimbursement Supervisor
Harper Price is your average Southern belle. At age seventeen, Harper’s life is consumed with keeping top grades, preparing for the
upcoming Cotillion, and wearing the crown as Homecoming Queen. Harper’s life takes a turn in an unexpected direction when the
school janitor bursts into the girls’ bathroom the night of the Homecoming Dance and infuses her with the powers of the Paladin
before dying at her feet.
Determined to figure out why she suddenly has superpowers (most girls can’t take out their history teacher with a spike heel) Harper
uses her formidable research skills and finds out that she is the latest in a long line of Paladins charged with protecting the Oracle,
the only person on Earth who can foretell the future. The problem is that the latest Oracle, David Stark, is Harper’s nemesis and
determined to beat her for the spot of class valedictorian.
Working together Harper and David uncover the secret of the Paladin and the Oracle and discover that the final showdown is
prophesied to take place on the most important night of Harper’s life -- the annual Cotillion ball.
This book is written for a young adult audience but is a satisfying quick read. The
story is written from a first-person perspective and told from Harper’s point of
view only. The author, Rachel Hawkins, does not stray into excess world-building
or waste time giving unnecessary back-story. Harper is a likeable heroine and her
reasons for striving for perfection are told in a clear concise way without deviating
from the main objective of the story. Harper’s relationships with her friends, her
boyfriend, and her family are used to illustrate that she is a normal teenage girl
who just happens to be tasked with saving the world.
The sequel, Miss Mayhem, is due out in 2015.
If you want to lift yourself up, lift up someone else.
- Booker T. Washington