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.

Anthem to Launch New Pharmacy Benefits Manager

Anthem’s new pharmacy benefits manager will be IngenioRx, which will offer a full suite of PBM solutions starting in 2020, coinciding with the conclusion of the company’s current PBM contract.

IngenioRx will serve customers of Anthem affiliated health plans, as well as non-Anthem
customers, with a seamless, integrated experience by taking Anthem’s new model to the
national marketplace. The IngenioRx pharmacy leadership team combined has more than 100
years of experience in the PBM industry, which will be invaluable in helping to ensure a
seamless transition for members.

To learn more, click here.

Earn Up To $200 With The Medical Mutual’s Medicare Supplement Bonus Program

MMO Med Supp bonus programs are an exciting way to be compensated for selling a very competitive and reputable Medicare Supplement plan.

Take advantage of the MMO Med Supp bonus program that will earn you up to $200 an application.

 

Click here for the full details.

Updates to Aetna/Coventry 2018 Pharmacy Network

Aetna pharmacy networks vary by plan so it’s important to understand the differences. For 2018 Aetna has 3 pharmacy networks, two of which are being used in Ohio. Some important points to note:

Walgreens is moving from a preferred pharmacy to a standard pharmacy…so it’s still in network, but will not have preferred pricing. On the new Select PDP, Walgreens is out of network (P3 network).

  • P1 – (All OH) MAPD – all plans
  • P1 – (All OH/KY MAPD plans, Aetna Rx Saver PDP, First Health Value Plus PDP)
  • P3 – (Aetna Select PDP)

The biggest difference between the two:

  • Walmart is NOT preferred in P3
  • No Aetna Rx Home Delivery in P3
  • Walgreens is out of network on P3 (Walgreens non-preferred/standard on P1)

S2 is used in states where there aren’t many preferred pharmacies so that pharmacy network does not use preferred pharmacies.

 

Read more here.

Medical Mutual to Include Northeast Ohio in HMO Strategy

Beginning January 1, 2018, Medical Mutual will expand their HMO strategy to include Northeast Ohio. Members currently enrolled in the MMO Individual ACA Point of Service (POS) product will be mapped to the new network, Northeast Ohio HMO.

Medical Mutual will also be expanding their individual portfolio to the following counties…

NETWORK COUNTIES
Mercy HMO
  • Allen
  • Auglaize
  • Brown
  • Butler
  • Champaign
  • Clark
  • Clermont
  • Columbiana
  • Defiance
  • Fulton
  • Hamilton
  • Hancock
  • Henry
  • Huron
  • Lorain
  • Lucas
  • Mahoning
  • Mercer
  • Putnam
  • Seneca
  • Trumbull
  • Wood
OhioHealth HMO
  • Athens
  • Delaware
  • Fairfield
  • Franklin
  • Hardin
  • Hocking
  • Licking
  • Marion
  • Morrow
  • Richland
  • Union
NE Ohio HMO
  • Ashland
  • Ashtabula
  • Cuyahoga
  • Geauga
  • Lake
  • Medina
  • Portage
  • Summit
ProMedica HMO
  • Lucas
  • Wood

Premier Health Will be Out-of-Network for United Healthcare Members In January

Premier Health in Southwest Ohio will be out-of-network starting Jan. 1, 2018. The following United Healthcare Medicare Solutions plans in the southwestern Ohio and Kentucky regions will be impacted:

  • AARP MedicareComplete (HMO) Plan 6 H5253-052
  • AARP MedicareComplete (HMO)  Plan 2 H5253-053
  • AARP MedicareComplete (HMO) Plan 3 H5253-054
  • Dual Complete® (HMO) H5253-059
  • Dual Complete (HMO-POS) H5322-028

 

Member information

  • Letters to impacted members will start arriving Oct. 23 alerting them to the network change.

 

Members in AARP Medicare Supplement Insurance Plans, insured by UnitedHealth care Insurance Company, will not be impacted by this change and may continue to access care from any doctor or hospital that accepts Medicare patients.

Don’t Miss National General’s Short Term Products! | Click for Contracting Details

Cornerstone Introduces National General for 2018 OEP

Write up to four consecutive 90-day Short Term policies with no pre-existing or underwriting after the first policy has been approved.

Cornerstone is now offering National General Short Term and Ancillary products for your clients’ needs in 2018.

 

The Advantage of Back-to-Back Policies? While the deductible and any out-of-pocket responsibilities start over with each subsequent coverage certificate, any medical conditions that arise and were covered by the initial plan will be covered under subsequent new certificates, subject to plan limitations.

 

To get contracted, click here.

Username: CornerstoneBrokerInsServicesAgencyInc

Password: CB!s_299sa

Filing Lead Generator Websites with Humana

Effective immediately, Humana sales agents do not have to submit lead aggregator websites from which they purchase MA or PDP leads to Humana for review and approval. Though lead aggregator websites are no longer required to be submitted to Humana for review and approval, sales agents using these websites for the purpose of obtaining leads to sell Humana MA or PDP are still responsible for ensuring the websites are compliant with CMS regulations and other applicable state and federal laws. If Humana becomes aware of a noncompliant lead source via complaint or otherwise, Humana will take corrective action.

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