Update on Anthem 2018 SBCs and SOBs

The SBCs and SOBs are still being created and have been delayed.  The current ETA is the first part of November.

Please remember you can use Anthem’s plan comparison tool to obtain the spreadsheet style benefit outlines—including grandmothered plans.

For more information, click here.

Clearing Cache and Cookies for FormFire

FormFire users: If you are experiencing issues today with seeing the complete Employee List under your clients you need to clear your Cookies and Cache. Here are the easy instructions on how to do this for both Mozilla FireFox or Internet Explorer:

Internet Explorer:

  • Open Internet Explorer
  • Click on the tools drop down
  • Click on Internet options
  • Click the delete button in the Browsing history section
  • Check the box next to the information you want to delete
  • Press delete at the bottom of the box

Mozilla:

  • Click on Tools then Options. Select Privacy on the menu on the left.
  • Under the History category you will select the link stating, “clear your recent history”.
  • This will open another menu called Clear All History.
  • Under Details uncheck all but Cookies and Cache and hit “Clear Now”.

Updates to UHC Prescription Drug Lists

The following updates will take effect for the UnitedHealthcare Prescription Drug Lists (PDLs) Jan. 1, 2018. These updates apply to all UnitedHealthcare integrated commercial business. They do not apply to direct commercial business (OptumRx direct business without UnitedHealthcare medical coverage).

UnitedHealthcare Pharmacy Benefits

View UnitedHealthcare’s online, pre-recorded presentation of the pharmacy benefit strategies for Jan. 1, 2018.

Presentation for Clients

Click here to read more.

 

PDL Tracker

 

Anthem to Offer New Musculoskeletal and Pain Management Solution

Beginning in November, Anthem will offer a new comprehensive Musculoskeletal and Pain Management Solution, administered by AIM Specialty Health. This program reviews certain spine and join surgeries, and interventional pain services against clinical criteria to help make sure the care is appropriate and that it aligns with established evidence-based medicine.

The MSK program also includes an initiative to help get members engaged. Before any scheduled
procedure, they get information that educates them about the surgery or treatment. This initiative is
designed to drive adherence to care plans, motivate preventive action, and improve appropriate use
of care.

Starting in November 2017, the MSK program will be available only in certain states where Anthem does
business. The program will continue to expand into other states throughout 2018. It will be made
available to National Accounts in January 2019.

Here is the roll-out schedule for the new MSK program:

  • November 1, 2017: Fully insured groups in Kentucky, Ohio, Missouri, Wisconsin (Indiana is
    excluded)
  • March 1, 2018: Fully insured groups in Georgia, Virginia, New York, New Hampshire,
  • March 1, 2018: Fully insured groups in Georgia, Virginia, New York, New Hampshire,
    Connecticut, Maine, Colorado, Nevada, California
  • July 1, 2018: ASO (Administrative Services Only) groups
  • July 1, 2018: ASO (Administrative Services Only) groups
  • January 1, 2019: National Accounts
  • January 1, 2019: National Accounts

UnitedHealthcare 2018 Updates for Small Group Fully Insured

UnitedHealthcare’s Small Group fully insured business will have the following advantages in 2018, along with the full suite of UHC benefits:

  1. $0 Virtual Visits
    1. UHC’s telemedicine solution will now be included in all plans (except HSAs) at no cost, allowing your groups to save time and money for 70 percent of services they would seek at an Urgent Care or Emergency Room.
  2. RealAppeal: Embedded at no additional cost
    1. UHC’s state-of-the-art wellness solution, previously only available in Key Accounts, is now available for 2-50. Members will receive a Success Kit and have access to 1:1 coaching designed to lower BMI and lose weight.
  3. Increased Commissions
  Payment Per Enrolled Employee per Month
              Case Size First year commissions Renewal Commissions
1 to 4 enrolled employees $5 $5
5 or more enrolled employees $27 $24

Carriers with January 1 Effective Dates Available!

The following carriers have January 1, 2018, effective dates available for quoting as of October 4, 2017, this afternoon:

  • Aetna Funding Advantage
  • All Savers
  • Anthem (OH, KY, IN)
  • Anthem SOCA BP
  • Humana (OH, KY, IN)
  • UHC (IN, KY, OH)

 

For more information, contact your Cornerstone representative today!

House Bill 463 for Autism Spectrum Disorder Has Been Passed

House Bill 463 for Autism Spectrum Disorder, intended to include plans that were not included in the Governor’s 2012 Executive Order, has been passed.

The bill will be effective for all new and renewal individual policies and group contracts on or after January 1, 2018, and will impact:

  • Grandmothered and Grandfathered Small Group
  • Grandfathered and non-Grandfathered Large Group (this includes fully insured National
  • business and private exchange)
  • Grandmothered and Grandfathered Individual
  • Self-funded MEWA plan

For more information, click here to read the write up from Anthem.

Anthem Improves Security Measures

In an effort to keep members’ information and privacy secure, Anthem removed the option for Social Security numbers to be used as a registration data point when members are setting up an online account on their secure member website.

To register, members will enter their member identification number (found on their ID card.) For members who forget their username or password, they’ll need to use their email address or ID number to find their account. The member’s first name, last name, and date of birth are still required for registration and for username or password account recovery.

RESOURCES

Safeguarding the trust and security of our members is our top priority

Employer Action Required! Distribute Medicare Part D Notices by October 15, 2017

Group health plan sponsors must provide Medicare Part D “creditable coverage” notices prior to October 15th, the start date of the Medicare annual enrollment period for Part D, Prescription Drug coverage. (The enrollment period is October 15-December 7.) Most plan sponsors use the Model Medicare Part D Notices provided by the Centers for Medicare and Medicaid Services (CMS) to notify affected plan participants. Links to all the model letters (in English and Spanish) are available here.  These notices are in .pdf format.  Cornerstone has provided versions of the notice in Word Document format for your convenience.

The October 15th deadline applies for all group health plan sponsors, regardless of plan year, plan size, employer size, grandfather status, or whether the plan is insured or self-funded.

Employers who send out Open Enrollment packets prior to October 15th often include the Medicare Part D notices in the Open Enrollment packets, to avoid the extra cost and administrative burden of sending them separately.

Employers are also required to notify CMS online annually that they have sent out these Part D notices. The notice to CMS is due within 60 days after the start of the plan year. See the last paragraph of this article for details.

 

Background

The Medicare Modernization Act requires group health plan sponsors that offer prescription drug coverage to notify Medicare-eligible plan participants (employees and dependents) as to whether their prescription drug coverage is “creditable coverage” – which means the coverage is expected to pay on average at least as much as the standard Medicare Part D prescription drug coverage. The most current Model notices on the CMS website say “For use on or after April 1, 2011” in the heading, because in 2011 the Medicare Part D annual enrollment period changed from November 15th to October 15th.

 

When Is the Medicare Part D Notice Required?

Medicare Part D notices must be provided at least once annually, prior to October 15th, which is the beginning of the Part D annual enrollment period. Additional notices must be provided if the employer-provided coverage changes (from creditable to non-creditable, or vice-versa), if the individual requests a copy of the notice, and when an individual first enrolls in the employer plan.

Employers who provided these notices earlier this year are not required to provide them again, since these notices have not changed since last year. The notices are dated for use on or after April 2011. The CMS website page was last updated 4/5/2013. There are separate Model Notices for Creditable Coverage Non-Creditable Coverage.

 

Why is the Part D Notice Required?

The reason plan sponsors are required to provide Part D Notices is because a penalty will be imposed on an individual if he/she, after becoming eligible for Medicare Part D coverage, has a lapse of “creditable” prescription drug coverage for a period of at least 63 days. Additionally, such individuals may have to wait until the following October to join. An individual can elect either Medicare prescription drug coverage or other “creditable coverage” to avoid having a lapse in coverage. Thus, Medicare-eligible participants in employer group health plans must know whether or not the employer group coverage is “creditable” so they do not unwittingly incur a late enrollment penalty.

 

Additional Details on the Disclosure Requirements

  • Group health plan sponsors to whom this disclosure requirement applies include employers and Unions; multiple employer welfare arrangements (MEWAs); federal, state and local government employers; and churches.
  • The Part D Notice must be provided not only to Medicare-eligible active working employees and their dependents, but also to participants who are retired, on COBRA, or disabled and covered under the employer’s prescription drug plan.
  • Although the requirement is only that “Medicare-eligible” individuals be provided this notice, employers often provide it to all plan participants and dependents, because of the practical difficulty of knowing who is Medicare-eligible.

 

Annual Notice to CMS Also required, though not by October 15th

Additionally, plan sponsors are required to notify CMS annually, via the CMS website (Online Disclosure to CMS form). This notice must be made within 60 days after the beginning of the plan year (or contract renewal date, for small plans that do not file Form 5500s so do not specify a plan year), and it pertains to the creditable coverage status for the prior plan year. For calendar year plans, this notice must be provided to CMS no later than March 1.  Sponsors of non-calendar year plans should mark their calendars to make sure the disclosure to CMS is made within 60 days after the beginning of the plan year. (E.g., for an April 1 plan year, the CMS online disclosure should be made no later than May 30.)

Additionally, if applicable, plan sponsors must complete the Online Disclosure to CMS Form within 30 days after termination of a prescription drug plan or within 30 days after any change in creditable coverage status.

 

For additional information, click here for the main CMS webpage that provides guidance on “creditable coverage.” Or you can visit the webpage  at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/)

 

Model Creditable Coverage Notice (Word Doc)

Model Non-Creditable Coverage Notice (Word Doc)

Spanish Model Coverage Notice (zip file)

Click here for all 2018 Carrier Creditable Coverage Guides