Aetna Will Exit Obamacare Individual Insurance Market (Virginia)

Aetna will exit the Obamacare individual insurance market in Virginia because of the “financial risk” and “growing uncertainty in the marketplace.”  The move only affects individual plans sold on and off the federal Obamacare exchange at HealthCare.gov.

T.J. Crawford, Aetna’s spokesman, said in an email, “Despite significantly reducing our exchange footprint, our individual commercial products could potentially lose more than $200 million in 2017.”

Source: CNBC (http://www.cnbc.com/2017/05/03/aetna-will-exit-obamacare-markets-in-virginia-in-2018.html)

Customers covered by Aetna through employers or Medicaid and Medicare Advantage plans will not be affected by this change.

 

Questions? Contact your Cornerstone representative today.

RESOURCES

Aetna Will Exit Obamacare Markets in Virginia in 2018

Aetna to Exit Virginia Obamacare Individual Insurance Market

Medical Mutual Making Claims Adjustments Involving University Hospital Providers

After discovering that two pediatricians at University Hospital Medina Health Center were incorrectly loaded into the SuperMed network, Medical Mutual is working to update the directory so that the 70 members whose in-network claims were rejected will receive revised Explanation of Benefits statements with the correct claim information. Members who already submitted payment for those claims may be entitled to a refund.

For more information, contact your Cornerstone representative today.

RESOURCES

Medical Mutual Broker Update — May 3, 2017

Medical Mutual Requests Count for Total Number of Employees

Per the requirements laid out by CMS, Medical Mutual is requesting that all group health plan officials with 150 or fewer members report their total number of employees to help ensure Medicare accurately coordinates benefits and property pays claims. The total count should include full and part-time employees in each location, but does not include the total number of dependents under the plan.

Contact your Cornerstone representative today to submit your total number of employees.

 

RESOURCES

Letter from Medical Mutual

Medical Mutual Broker Update — May 3, 2017

Medical Mutual Now One of Express Script’s Top Five Health Plan Customers

Medical Mutual’s pharmacy benefit manager (PBM), Express Scripts, will lose Anthem business at the end of the current contract in 2019. Medical Mutual does not anticipate that this change will negatively effect their business with Express Scripts, noting that, due to Anthem’s departure, Medical Mutual is now one of Express Script’s top five health plan customers.

Medical Mutual’s contract with Express Scripts will run through 2020 and their pharmacy and finance departments will conduct a market check to be sure that their rates remain competitive.

RESOURCES

Medical Mutual Broker Update — May 3, 2017

Express Scripts Plunges After Losing Biggest Client Anthem

Ohio Valley Surgical Hospital Joins Aetna Cincinnati/Dayton/NKY Networks

Effective May 15, 2017 Ohio Valley Surgical Hospital will join Aetna networks in Cincinnati, Dayton, and Northern Kentucky. The hospital participates for a myriad of products, including Aetna Medicare Plan PPO, Aetna Medicare Plan HMO, and more.

The addition will increase member choice and  improve hospital and physician access.

Questions? Contact your Cornerstone representative for answers.

Anthem Contracts with Hearing Care Solutions

Anthem Blue Cross and Blue Shield has recently contracted with Hearing Care Solutions (HCS) to offer hearing care plans to members covered by Anthem’s HMO and PPO Medicare Advantage plans.

HCS supplemental hearing benefits will provide coverage in addition to Medicare-covered hearing benefits, including a routine hearing exam, hearing aid fitting and evaluation, an allowance toward the purchase of hearing aid(s), and one year of service at no charge after a hearing aid is purchased.

For more detailed information, contact your Cornerstone representative today!

RESOURCES

Clients Benefit From Hearing Care and Hearing Aids

Premier and UHC Extend Network Relationship

In response to Premier Health Network deciding not to renew its participation for employer-sponsored and individual plans with UnitedHealthcare, the two companies will extend their network relationship for Medicare Advantage plans through December 31, 2017.

Premier Hospitals are now considered out of network for commercial health plans, effective April 30, 2017.

 

RESOURCES

Important Information About Our Relationship with Premier Health Network

Premier Hospitals No Longer In Network for UHC Plans

Premier Health Network recently decided not to renew its participation in UnitedHealthcare’s employer-sponsored and individual plans. As a result, Premier hospitals are no longer in network for commercial health plans as of April 30, 2017.

According to UnitedHealthcare’s press release, the company’s goal is to “reach a long-term agreement with Premier that ensures stability in people’s access to their hospitals and doctors and helps local employers design competitive benefits.”

Premier has expressed its disappointment with the proposal. Mary Boosalis, president and CEO of Premier Health, said in a statement, “We put forth a proposal that included Premier Health forgoing a nominal rate increase. An agreement would have provided choice for our patients and area employers that we believe they deserve. We are extremely disappointed with the response from UnitedHealthcare, which disadvantages their enrollees.”

Premier states that UnitedHealthcare’s continued use of the tiered network is an issue with which the two companies have trouble meeting in the middle.

RESOURCES

Premier Health Network hospitals now out of network for UnitedHealthcare employer-sponsored, individual plans

No deal between UnitedHealthcare and Premier Health

Humana Marketpoint Plan Overview Training in Cleveland

Join Cornerstone for Humana Marketpoint plan overview training to help build your business!

Larry Farmer, Regional Sales Manager for Humana, will cover the following topics:

  • What’s the sizzle to sell?
  • Plan details / Q&A
  • Why Humana?

DATE: May 9, 2017
TIME: 9:30–10:30 am
LOCATION: Cornerstone’s Cleveland Office
4500 Rockside Road Suite 330
Independence, OH 44131
TO RSVP CLICK HERE.

Not appointed with Humana?
Contact Cornerstone today to get started!
1.800.248.7675

WEBINAR: Join Cornerstone and Altrua HealthShare for an Informative Training Session

Join Cornerstone and Altrua HealthShare for a training webinar with Ron Bruno on a great alternative to insurance that is exempt from the Affordable Care Act.

Important features of Altrua HealthShare:

  • Broad network
  • EXEMPT from Affordable Care Act
  • Purchase all year, not just during open enrollment
  • Very affordable memberships
  • Available in all 50 states
  • Pays great commissions

DATE: May 17, 2017

TIME: 10:00 am – 11:00 am

TO RSVP, CLICK HERE.

Not appointed with Altrua?

Contact us today to get started!
1.800.248.7675