October Medical Mutual Updates: Changing Payments, Deadlines, and Individual Market Updates

Medical MutualUpdating Medical Mutual Payments to Huntington Bank

Medical Mutual recently switched from PNC Bank to Huntington Bank for processing of premium and ASO-related payments. Group customers should now send payments to Huntington. Reminder letters will be sent to all affected groups ahead of shutting down the PNC Bank accounts prior to the end of the year.

COSE MEWA Columbus Territory Change

Effective November 1, 2019, the exclusive territory for the Columbus Chamber MEWA plan will expand beyond Franklin County and will include Union, Delaware and Licking counties. Any new group sold in those counties must be a member of the Columbus Chamber in order to enroll in the COSE MEWA health plan.

Two-Year Moratorium on Re-Entry to the COSE MEWA

Small groups choosing to leave the COSE MEWA and obtain other coverage will not be able to return to the COSE MEWA for two years. If a group wishes to return to the COSE MEWA before two years have elapsed, they will be charged a one-time fee of $1,000 per subscriber.

Pre-Submission Checklists

To help with submissions during the busy season, please complete your pre-submission checklist and send it in with your sold case documentation. Any submissions that are made after December 5, 2019, may not receive approval letters prior to the January 1, 2020, start date.

Health Insurance Tax

The federal government has not suspended the Health Insurance Tax for 2020, as they did in 2019. That means Medical Mutual will need to pass this tax along to their customers.

Medical Mutual Individual Market Updates

Medical Mutual will be offering ACA coverage in 12 new counties during plan year 2020. Click here to review the updated service area map. They have also added new $5,000 silver and $8,000 bronze deductible options that include office visit and Rx copays. Click here for the 2020 Plan Highlights flier for full details.

In addition, Medical Mutual has added statewide convenience walk-in clinics across Ohio and has expanded their Mercy HMO network with the addition of St. Luke’s hospital and more physicians.

Medical Mutual will discontinue the Promedica HMO network in Northwest Ohio. All members of that network will be moved to the Mercy HMO network.

Lastly, Knox Community hospital will no longer be a part of the OhioHealth HMO in Central Ohio.

Don’t forget to re-certify by the end of 2019 to receive renewal compensation for on-exchange plans!

Federally Mandated Fee Updated for 2020 Renewals

Since the Affordable Care Act went into effect in 2014, Medical Mutual has been subject to the Health Insurance Providers Fee, often referred to as the Health Insurance Tax or the Market Share fee. As a result, Medical Mutual has applied the Health Insurance Providers fee to all 2020 renewals.

Contact your Cornerstone representative with any questions about these updates.

Medical Mutual’s 2020 Small Group ACA Plan Grids Are Now Available

Medical Mutual’s updated plan grids, benefit highlight sheets, and Summary of Benefits and Coverage (SBC) documents are now available for the 2020 Small Group ACA rollout.

Updates to these plans include:

  • The elimination of the 1750 HSA plan. Current 1750 HSA members will be mapped into the 2800 HSA plan.

The addition of two HRA plans below:

  • Gold 5000 HRA with employer first contribution.
  • Silver 5000 HRA with employer second contribution.

Additionally, quoting for first quarter 2020 is now available in QRS. January 2020 renewals will be released soon.

MedFlex HMO Plan Options

2020 ACA Plan Options (Off Exchange)

Contact your Cornerstone representative for more information.

August 2019 Medical Mutual Updates

Medical Mutual released the following updates…

Group Sales Broker Advertising Program

Medical Mutual announced the Broker Advertising Program, which is for brokers who want to exclusively promote their products to group prospects through their media placements. MMO provides customizable marketing templates for brokers in the program to use.

Groups with COBRA Options Able to Add Ancillary Lines

Medical Mutual now allows groups of all sizes with their COBRA Options product to add external ancillary carriers.

Mutual Appreciation Reporting Capabilities

The Mutual Appreciation program encourages Medical Mutual’s employees to patronize their clients’ businesses. Medical Mutual now offers reporting capabilities for this program.

  • PDF Report for Prospective Customers: This piece, meant for prospective groups, showcases the potential employee support a group might experience if they become Medical Mutual’s customer and part of the program.
  • PDF Report for Active Customers: This piece showcases how much Medical Mutual employees have spent with a group and how many transactions have been made since they became their customer.
  • PowerPoint Renewal Report: For groups with upcoming renewals, Medical Mutual can create comprehensive reports for customers that showcase promotion spend (if applicable), year-over-year spend, rankings to similar customers within their industry and more.

Contact your Cornerstone representative for more information.

Medical Mutual’s SmartChoice Program Expected to Reduce Cost of Imaging Services

Medical Mutual’s SmartChoice concierge program (performed by eviCore Healthcare in partnership with MMO’s Radiology Utilization Management program) launched July 1, 2019, with the intention to help individual and group members to use lower-cost network facilities for approved imaging services like MRIs, CT and PET scans.

The program notifies providers of high cost facilities and recommends lower cost facilities instead. If the provider declines the lower-cost suggestion, the member is then notified that there may be lower-cost and more convenient options available.

Contact your Cornerstone representative for more information.

Accredo Will No Longer Dispense Certain Specialty Drugs

Medical Mutual recently announce that Accredo Specialty Pharmacy will no longer dispense prescriptions for Repatha and Praluent beginning September 1, 2019. These specialty drugs are taken by adults with cardiovascular disease to help reduce the risk of heart attack. Members who require these prescription drugs will need to have them transferred to a participating in-network retail pharmacy of their choice.

For more information on transferring prescriptions, contact your Cornerstone representative.

Medical Mutual Finalized Agreement With New COBRA Vendor

Medical Mutual has finalized its agreement with WEX Health, a new COBRA vendor for existing groups effective September 1, 2019. The new platform, COBRA Options —Brought to you by Medical Mutual, will offer enhanced benefits continuation service and faster set up for new groups.

Contact your Cornerstone representative for more information.

Update From Medical Mutual: Required COSE MEWA Form Available

Medical Mutual recently released a new Sold Case Pre-submission Review form that is required for groups to become part of COSE MEWA. Find the form here or at cosemewa.com.

The form must be filled out completely and accompany all sold case submission documents to ensure timely processing.

Contact your Cornerstone representative with any questions.

Medical Mutual Has Extended The Mid-Size Group Volume Bonus Program

Medical Mutual has extended their Mid-Size Group (51–99) Volume Bonus Program for the period from July 1 to December 31, 2019. This program pays a per-employee per-month bonus on 51–99 group contracts with effective dates through December 31, 2019, as follows:

Tier Mid-size Group Book of Business Bonus Amount
1 75-199 contracts $4 per employee per month
2 200-349 contracts $7 per employee per month
3 350-499 contracts $10 per employee per month
4 500+ contracts $13.50 per employee per month

As a reminder, the Small Group (1–50) Volume Bonus Program is in effect through Dec. 31, 2019.

Click here for more information about the Mid-Size Group Bonus Program.

If you have any questions, please contact your Cornerstone representative.

Medical Mutual Redefines SuperMed Service Area

Starting Jan. 1, 2019, Medical Mutual is redefining their SuperMed service area. The new service area will consist of all 88 counties in Ohio, three counties in Kentucky (Boone, Kenton and Campbell), and the 12 national/ancillary providers, which include labs, medical suppliers and other providers, listed below:

 Accredo Health  LabCorp
 Apria Healthcare  Lincare
 Coram Healthcare  The Little Clinic
 Davita  Quest
 Fresenius Medical Care  St. Elizabeth Healthcare (Kentucky only)
 Hanger  Tri-Health (all locations)

 

For more information, contact your Cornerstone representative.

New Broker Marketing Tools Available from Medical Mutual

Check out new broker marketing tools now available from Medical Mutual on MyBrokerLink. The tools vary per line of business. The new materials include:

  • MyBrokerLink Flier (Individual, 1–50, 51–99, 100+)
  • MyBrokerLink Video (Individual, 1–50, 51–99, 100+)
  • Transitional Coverage Whitepaper (1–50)
  • Small Business Custom Prospecting Letters (1–50)

Click here to learn more about the available materials.