MMO MA Network Update — COPC

Medicare Mutual of Ohio has announced that effective January 1, 2018, Central Ohio Primary Care Physicians (COPC) will no longer participate in Medical Mutual’s Medicare Advantage network. Medical Mutual is diligently working to notify affected members of the provider exit to ensure a smooth member experience. COPC will continue to remain as an in-network provider with all other lines of business for Medical Mutual.

New Medical Mutual Underwriting Guidelines Available

Medical Mutual recently released its Underwriting Guidelines for 2017, which outlines guidelines for new business, existing business, and personal health plan general policies.

Click here to access the Underwriting Guidelines.

Cornerstone & Medical Mutual’s 2018 Individual Roll Out Meeting

You are invited to attend Cornerstone & Medical Mutual of Ohio’s 2018 individual plan roll out meeting in Cincinnati!

MMO will be expanding their sales footprint to include additional counties in 2018, helping to cover even more Ohioans. They will also be making changes to their product portfolio.


DATE: Thursday September 21

TIME: 2:00 pm–4:00 pm

LOCATION: Cornerstone Cincinnati Media Center

2101 Florence Avenue | Cincinnati, OH 45206

Medical Mutual 2018 Individual ACA Plan Meetings

Medical Mutual will be hosting a number of meetings to provide a first look at the 2018 Medical Mutual ACA Individual plan updates.

The company will be expanding their sales footprint to include additional counties in 2018, helping to cover even more Ohioans. They will also be making changes to their product portfolio.

There are a number of meetings conveniently scheduled in Strongsville, Cincinnati, Powell, Toledo, Lima and Mansfield.

To RSVP for any of the 2018 Individual ACA Plan Meetings, click here.



Sign Up Now for our 2018 Individual ACA Plan Meetings

Medical Mutual Broker Update

Mailings to Collect Missing Dependent Social Security Numbers
(Applies to: All fully insured business except Medicare Advantage)

This week Medical Mutual will start sending letters to approximately 5,100 group and individual members for whom they do not have Social Security numbers on file for their covered spouses and/or dependents. The mailings will occur in multiple phases over the next two to three weeks.

Medical Mutual is obligated by law under Internal Revenue Code Section 6055 to do this outreach to affected members one more time before the end of the year. As a reminder, members who do not comply with the requirement may be subject to IRS fines on their tax returns.

To capture any members whose policies take effect after this mailing, additional mailings are planned for November 2017 and January 2018. Mailings are released every January, August and November. The company will send a brief reminder before each mailing.

Implementing Coverage of Statins at No Cost Share for Certain Members of Non-Grandfathered Plans, Effective for Plan Years on or after December 1, 2017
(Applies to: All except Medicare Advantage, Medicare Supplement)

On November 13, 2016, the United States Preventive Services Task Force (USPSTF) recommended the use of low- to moderate-dose statins as preventive medications for cardiovascular disease. Statins are prescription medicines used to decrease high cholesterol. Based on this recommendation, all non-grandfathered plans under the Affordable Care Act must cover these medications at no cost share to members who meet certain criteria related to risk for cardiovascular disease. Criteria include being between ages 40 and 75, having no symptoms or history of cardiovascular disease, having one or more cardiovascular disease risk factors (e.g., diabetes, smoking, high blood pressure or high cholesterol), and having a calculated 10-year cardiovascular disease event risk of greater than or equal to 10 percent. Please refer to the December 13, 2016, Broker Update for more details.

Benefit Additions

Zero cost share for statins will apply to all non-grandfathered groups and individuals beginning with their first plan year on or after December 1, 2017, as noted below. Medical Mutual’s Underwriting department will adjust renewals to reflect the additional cost of this benefit change beginning with first renewals on or after December 1, 2017.

  • Medical Mutual
    • Non-grandfathered individual and small group plans: The benefit will be effective January 1, 2018.
    • Non-grandfathered alternative group structure plans (e.g., Middle Marketplace, Balanced Solutions, MEWAs): The benefit will be effective January 1, 2018.
    • Non-grandfathered 51+ groups: The benefit will be implemented effective at first plan years beginning December 1, 2017, and continuing implementation through plan years beginning November 1, 2017
  • Mutual Health Services
    • The benefit will be effective at first plan years beginning December 1, 2017.
    • Members must meet the clinical criteria noted above to qualify for statins at no cost share. We will communicate those criteria and our interpretation of them to our in-network providers through the third quarter issue of Mutual News, our provider newsletter.

Please see the attached talking points you can use to explain this benefit update to affected non-grandfathered groups.

Process at the Pharmacy

Members must get a prescription from their doctors or health providers and present it at an in-network pharmacy (retail or mail order). Members who qualify based on the clinical criteria will see the $0 cost share reflected at the point of sale. Member qualification will be determined based on pharmacy and medical claims data we send to Express Scripts. Members who do not meet the clinical criteria for the $0 cost share will pay their standard prescription drug plan’s cost share for the prescriptions they are filling.

Note: Zero cost share for preventive statins is limited to low- and moderate-dose generic products. In the rare instance none of the generics is appropriate or a member has tried and failed an equivalent generic, his/her provider should contact Express Scripts for a copay review for an equivalent brand-name statin. Before initiating statin therapy, providers are still advised to discuss lifestyle modifications and improve other cardiovascular disease risk factors, if applicable.

Early Release Planned for January 2018 Small Group Renewals
(Applies to: Small group)

To give their brokers adequate time to renew their small group business, Medical Mutual will release January 2018 renewals for transitional and grandfathered groups in early September. Typically, they release renewals 60 to 75 days prior to the group’s renewal date. This schedule will provide 120 days to renew this business.

Renewals for all ACA groups and grandfathered groups with November and December renewal dates will be released according to the traditional schedule. As a reminder, all transitional groups were converted to January renewal dates due to the anticipated end of transitional relief.

Cornerstone & Medical Mutual of Ohio’s 2018 MAPD Roadshow Training Sessions

MMO MAPD 2018 Rollout Roadshow Training Sessions

Join Cornerstone and MMO’s deep dive sessions into their 2018 MAPD products with $0 benefit options that meet the needs of Ohioans in 80 of the 88 counties in Ohio!

See below what else their plans will offer in 2018:

Medical Mutual

  1. HMO plan added and offered in 80 counties!
  2. University Hospital addition to network
  3. Dental & Vision benefits included
  4. MOOP as low as $3,400
  5. Less than $200 Rx deductibles
  6. Generic Rx Copays:
    Tier 1- $5 and below
    Tier 2- $20 and below

RSVP to ONE of the meetings below.

*please include your name and the location of the training you would like to attend*

Click here to RSVP.

September 14, 2017


9:00 am–11:00 am

Cornerstone Media Center

2101 Florence Ave. | Cincinnati, OH 45206


2:00 pm–4:00 pm

The Golf Club at Yankee Trace

10000 Yankee St.

Centerville, OH 45458


September 18, 2017


9:00 am–11:00 am

Holiday Inn French Quarter

10630 Fremont Pike | Perrysburg, OH 43551


1:00 pm–3:00 pm

Howard Johnson Inn

1920 Roschman Ave. | Lima, OH 45804


September 19, 2017


9:00 am–11:00 am

Wedgewood Golf & Country Club

9600 Wedgewood Blvd. | Powell, OH 43065


9:00 am–11:00 am

Holiday Inn

6001 Rockside Rd. | Independence, OH 44131


1:00 pm–3:00 pm

Holiday Inn

7410 South Ave. | Youngstown, OH 44512

19 Ohio Counties Will Have Access to Individual Health Insurance Coverage in 2018

According to a news release today from the Ohio Department of Insurance, 19 counties in Ohio will have access to individual health insurance coverage in 2018 from the following insurers: Buckeye Health Plan, CareSource, Medical Mutual of Ohio, Molina Health Care of Ohio, and Paramount Health Care.

The 19 counties are: Coshocton, Crawford, Guernsey, Hancock, Harrison, Hocking, Holmes, Jackson, Knox, Lawrence, Logan, Morgan, Muskingum, Noble, Perry, Van Wert, Vinton, Williams and Wyandot.  ODI estimates that approximately 11,000 Ohioans purchase coverage through the health care exchange in those counties.


  • Buckeye Health Plan: Harrison, Logan, and Van Wert
  • CareSource: Guernsey, Jackson, Lawrence, Morgan, Muskingum, Noble, Perry, and Vinton
  • Medical Mutual of Ohio: Crawford, Knox, Hocking, and Hancock
  • Molina Health Care of Ohio: Coshocton, Hancock, and Holmes
  • Paramount Health Care: Williams and Wyandot

Details regarding the types of plans that will be available, as well as the rates that will be charged will be released at a later time.

In order to sell coverage on the federal exchange, insurers are required to sign contracts with the federal government by late September.

Questions? Contact Cornerstone today for details.



Access to Health Insurance Restored in 19 Ohio Counties

University Hospital Joins Medical Mutual SuperMed Networks

Medical Mutual has announced that, effective October 1, 2017, University Hospitals main campus will join the Medical Mutual SuperMed network (PPO, POS, HMO, Preferred, and OhioMed) in Northeast Ohio. The following facilities will be in network:

  • UH Cleveland Medical Center—including MacDonald Women’s Hospital
  • UH Seidman Cancer Center
  • UH Rainbow Babies & Children’s Hospital
  • UH Bedford Medical Center

All other UH facilities remain in the SuperMed network.

Effective October 1, 2017, all UH facilities will also be part of Medical Mutual’s Medicare Advantage and individual product networks (with the exception of OhioHealth HMO, Mercy HMO, and ProMedica HMO). Members in these networks will no longer be required to obtain a waiver or go through an exception process to obtain services at UH’s facilities.


Not appointed with Medical Mutual? Contact us today to get started!

Medical Mutual: Med Supp Bonus Program

Medical Mutual is pleased to offer brokers the ability to earn up to an additional $200 per application on Medicare Supplement plans sold with effective dates of August 1, 2017 through December 1, 2017. At the end of the program period, they will calculate your total Medicare Supplement sales and pay a one-time lump sum bonus mid-January.

Click here for full details.


Medical Mutual SHOP Marketplace Exit Beginning January 1, 2018

Medical Mutual will no longer offer plans through the Small Business Health Options Program (SHOP) marketplace effective January 1, 2018. Coverage will terminate for affected groups on their renewal date. Medical Mutual will be releasing a letter to small group members informing them of the change. Group officials with affected members will also receive a letter.

Contact your Cornerstone representative for groups affected so we can assist you with a new plan selection.



Medical Mutual Broker Update — July 3, 2017