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Medical Mutual Makes Change to National Network Effective Jan. 1, 2023

June 24, 2022/in Carrier, Employee Benefits, Medical Mutual/by Cornerstone

Effective January 1, 2023, Medical Mutual will change from their current national network to the Cigna PPO network*. The Cigna PPO network will be available to Medical Mutual and Mutual Health Services group members when needed outside Medical Mutual’s proprietary SuperMed network service area. This change allows Medical Mutual to continue providing broad access to care while managing overall costs.

Group members residing outside of Medical Mutual’s SuperMed service area will continue to enjoy convenient access to providers. Toward the end of the year, MMO will notify members who may experience a network disruption due to a provider no longer being in–network. They expect this impact to be minimal and will offer continuation of care waivers for those members in certain forms of active treatment.

Later this year, provider directories will be updated to reflect the change to the Cigna PPO network outside of SuperMed. New ID cards will also be issued.

*The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration. Cigna is an independent company and not affiliated with Medical Mutual. Access to the Cigna PPO Network is available through Cigna’s contractual  relationship with Medical Mutual. All Cigna products are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna  name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
https://www.crnstone.com/wp-content/uploads/2022/06/Medical-Mutual-Makes-Change-to-National-Network.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2022-06-24 15:22:352022-06-24 15:22:35Medical Mutual Makes Change to National Network Effective Jan. 1, 2023

The Updated Medical Mutual COSE MEWA Small Employer Exception Form is Available

June 17, 2022/in Carrier, Employee Benefits, Medical Mutual/by Cornerstone

An updated COSE MEWA Small Employer Exception form has been posted to cosemewa.com. This form, with a revision date of June 2022 (6/22) replaces the April 2022 (4/22) version. You’ll find the updated form, along with instructions on how to complete it, under Self-Help Compliance Resources > Medicare or Additional Tools and Resources > Links and Forms.

Forms like this can change often. That’s why it’s important to always access the form directly from cosemewa.com instead of saving a copy to your desktop. This will ensure you are always using the most current form. Using an old version could cause delays in processing your request.

When to use the form

Complete and submit the form for employees who wish to:

  • Be moved to Medicare Primary upon their 65th birthday
  • Be moved to Medicare Primary at enrollment (for new groups)
  • Be removed from Medicare Primary coverage
  • Leave the group’s plan

Where to submit completed forms

To ensure timely processing, send completed forms to cosebenefits@medmutual.com.

You can find this form in your AGB Broker Suitcase! Contact your Cornerstone representative with any questions.

https://www.crnstone.com/wp-content/uploads/2022/06/Updated-Medical-Mutual-COSE-MEWA-Small-Employer-Exception-Form-is-Available.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2022-06-17 14:28:292022-06-17 16:52:02The Updated Medical Mutual COSE MEWA Small Employer Exception Form is Available

Learn More About Humana’s EAP LifeWorks Transition

June 3, 2022/in Carrier, Employee Benefits, Humana/by Cornerstone

To ensure even greater success for their customers, Humana has decided to team up with LifeWorks, a global leader in total well-being, to administer Employee Assistance Program (EAP) benefits for their customers.

  • Specifically, standalone EAP customers will transition to the experts at LifeWorks.
  • Medical embedded EAP customers will transition automatically to LifeWorks as their EAP provider on July 1, 2022.

About LifeWorks:

LifeWorks offers a unified EAP platform to more than 37 million members in the United States and around the globe. In fact, they already work closely with Humana on their international EAP offering. Humana’s collaboration with LifeWorks will allow customers to enjoy industry-leading benefits from a company dedicated to total well-being, while allowing them to focus even more heavily on investing their resources in delivering experiences core to their business.

When is this change effective?

EAP benefits will automatically move to LifeWorks on July 1, 2022.  Agents and groups will receive an email from Humana with the new EAP account information.

Click here to review Humana’s agent communications.

Click here to review Humana’s employer communicaitons.

Click here to review the LifeWorks EAP flyer.

Please contact your Cornerstone Broker Advisor with any outstanding questions about existing groups. We remain committed in service to you as these changes are implemented and are grateful for your business.

https://www.crnstone.com/wp-content/uploads/2022/06/Learn-More-About-Humanas-EAP-LifeWorks-Transition.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2022-06-03 16:38:582022-06-24 15:05:36Learn More About Humana’s EAP LifeWorks Transition

Sun Life Completes Acquisition of DentaQuest

June 3, 2022/in Carrier, DentaQuest, Employee Benefits, Sun Life/by Cornerstone

Sun Life recently announced the completion of its acquisition of DentaQuest, the second-largest dental benefits provider in the U.S. by membership. Sun Life has acquired DentaQuest from CareQuest Institute for Oral Health, a U.S.-based nonprofit organization, and minority shareholder Centerbridge Partners, L.P., a private investment management firm.

While they are now part of Sun Life U.S., Dental Care Plus Group, a DentaQuest Company is still your dental benefits partner. Their sales, account management, and operations support teams remain the same, in addition to their provider network and claims management system, Windward.

Together, DentaQuest and Sun Life can do even more to improve access to oral health care. Their goal is to advance their shared purpose to help people live healthier lives and to improve access to oral health care for all.

Contact your Cornerstone representative with any questions.

https://www.crnstone.com/wp-content/uploads/2022/06/Principal-2021-Bonus-Programs.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2022-06-03 15:24:572022-06-03 15:24:57Sun Life Completes Acquisition of DentaQuest

Superior Dental Care Systems Migration to Medical Mutual Scheduled to Begin July 1

June 3, 2022/in Carrier, Employee Benefits, Medical Mutual, Superior Dental Care/by Cornerstone

As previously communicated, Superior Dental Care (SDC) is in the process of integrating their systems with Medical Mutual. In April and May, a small selection of SDC groups was transitioned to the Medical Mutual platform and administrative processes as pilot groups to facilitate live testing. While the overall transition of these groups was successful, a few opportunities for improvements were identified. To implement and closely monitor these improvements, a limited number of groups renewing in June will be placed on the newly integrated systems as pilot groups. June groups that were not selected as pilot groups will now complete the migration at their 2023 renewal. These groups have been notified of the delayed conversion and will renew in June on SDC’s systems as usual with no changes.

Starting July 1, 2022, all new sold SDC groups will be placed on the Medical Mutual platform and existing SDC groups will be migrated to the newly integrated systems as they renew. As a reminder, existing groups will experience significant administrative updates as they are transitioned, including new ID cards, new member ID and group numbers, and billing changes. SDC groups also enrolled in a Medical Mutual plan with the same funding type and renewal date will be transitioned to a more integrated experience within the Medical Mutual family of companies. All communications previously scheduled to these groups will continue, including the renewal and contract amendment by certified mail and several informational eblasts in the months prior to renewal.

If you have SDC groups, you will begin to receive your commission for these groups from Medical Mutual as each group renews. Until all of your SDC groups have been migrated to Medical Mutual’s systems, you will receive two commission payments: one from SDC for groups that have not yet renewed, and a second from Medical Mutual for groups that have renewed.

Contact your Cornerstone representative with any questions.

https://www.crnstone.com/wp-content/uploads/2022/06/Superior-Dental-Care-Systems-Migration-to-Medical-Mutual-Scheduled-to-Begin-July-1.jpg 400 600 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2022-06-03 15:16:282022-06-03 15:16:28Superior Dental Care Systems Migration to Medical Mutual Scheduled to Begin July 1

Carrier Updates Regarding the Transparency in Coverage Rules and Machine Readable Files

June 3, 2022/in Carrier, Employee Benefits, Legislation/by Cornerstone

The “Transparency in Coverage” final rules passed on October 28, 2020, requires health insurers and group health plans to create machine readable files (MRF) and member friendly cost estimation tools to be phased in throughout 2022, 2023, and 2024. The timeline is as follows:

  • July 1, 2022: Requires carriers, TPAs, and PBMs to publish two MRFs on a publicly available website displaying in-network and out-of-network rates for covered services. These files follow CMS guidance and are not meant for consumer-friendly search, but rather for a computer system to do further processing without human intervention.
  • January 1, 2023: Plans and payers must make available an online cost estimation tool for 500 “shoppable” services. Employers will be required to post the information or “link” with their plan’s information.
  • January 1, 2024: Plans and payers must make available an online cost estimation tool for all covered services.

We have put together a comprehensive resource with the latest updates and communications from our carrier partners. Click here to download the document.

Please reach out to your Cornerstone representative with any questions.

https://www.crnstone.com/wp-content/uploads/2022/06/Carrier-Updates-Regarding-the-Transparency-in-Coverage-Rules-and-Machine-Readable-Files.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2022-06-03 13:18:492022-06-17 16:54:22Carrier Updates Regarding the Transparency in Coverage Rules and Machine Readable Files

Earn More with Anthem Ohio’s Individual SEP Bonus Program!

May 20, 2022/in Anthem, Bonus Programs, Carrier, Individual, Marketplace/by Cornerstone

Anthem Ohio recently announced a new Individual special enrollment period (SEP) broker bonus program beginning with June 1, 2022, effective dates and running through December 1, 2022, effective dates.

Anthem will pay $30 for each member (four-member maximum) enrolled in an on- or off-exchange product within these effective dates. There must be at least 10 members sold and they must remain enrolled with Anthem for at least 90 days for the enrollment to qualify for bonus payout.

Click here to learn more about the bonus program.

Contact your Cornerstone representative with any questions.

https://www.crnstone.com/wp-content/uploads/2022/05/Earn-More-with-Anthem-Ohios-Individual-SEP-Bonus-Program.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2022-05-20 14:44:362022-06-01 18:32:31Earn More with Anthem Ohio’s Individual SEP Bonus Program!

The Dental Care Plus Group Releases New Updates and Improvements

May 20, 2022/in Bonus Programs, Carrier, DentaQuest, Employee Benefits, The Dental Care Plus Group/by Cornerstone

The Dental Care Plus Group recently introduced new updates and improvements to provide better ways for their members to access and receive care, including:

  • Find Care
    • Updating the Find A Dentist instructions
      • In an effort to simplify the process of locating an in-network dentist, DCPG has updated their instructions on the Find A Dentist tool. Now, members will know to search by DCPG and not to search by state when searching for an in-network dentist.
      • You can find the updated instructions on the Broker, Member, and Employer Resources pages.
  • Receive Care
    • Providing oral health care to local children
      • Last month, DCPG sponsored and partnered with the Cincinnati Bengals and TeamSmile to provide oral health care to local children along with some fun activities, continuing their mission of Preventistry and improving the oral health of all.
    • Bringing strength through their robust network of providers
      • DCPG continues to represent the largest regional provider network in Southwest Ohio/Northern Kentucky through both their proprietary and DenteMax Plus networks.
      • DCPG continues to enhance their member’s access to quality care; over 40 providers have been recently added to the network in the Cincinnati region.
      • Their network of providers includes over 293,000 access points nationwide.
      • Their partnership with providers benefits members through negotiated discounts balancing access with affordability.
  • Do Business With DCPG
    • DCPG relaxed their Coordination of Benefits guidelines to facilitate a better member and provider experience and make it easier and quicker for claims to be paid.
      • Members no longer need to provide proof of primary or secondary coverage to process claims. DCPG will process based on information contained in the submission of the claim. No more back and forth!
      • Members and providers can expect this update to go-live on June 1, 2022.
  • NAPD State Sheets are live on dentalcareplus.com 
    • The NADP’s annual Dental Benefits Fact Sheets have been released summarizing national and state enrollment data based on 2021 data.
    • The report showed 80 percent of the national population has dental benefits. In line with the national average are Ohioans at 81 percent and 83 percent in Indiana. Comparatively, Kentucky is at 79 percent and Tennessee was at 71 percent.
    • Access state-specific fact sheets below or at dentalcareplus.com:
      • Ohio
      • Kentucky
      • Indiana
      • Tennessee
  • Reminders!
    • Enrollment assistance
      • Be sure to point out to your employer groups that you, as their broker, can assist with enrollment:
        • Additions
        • Terminations
        • Changes
      • DCPG’s Master Application allows the employer/group administrator to grant permission for their broker to assist on page 2. Please discuss your office’s availability to assist with your employer groups when completing this form at point of sale.
    • Avesis partnership
      • The Dental Care Plus Group partners with Avesis to offer quality vision products available to groups of all sizes.
      • Enjoy competitively rated plans as well as multi-year rate guarantees with DCPG’s vision plans. Shelf rates are available and low participation requirements offer flexibility to smaller employer groups.
      • Vision shelf rates to 200, recently reduced rates for new sales by 5 percent, discounted dental rates when packaged together, rate guarantees for 4 years and easy install and administration.
      • You can find NEW updated Avesis group application and enrollment forms on dentalcareplus.com:
        • Ohio Group Materials
        • Kentucky Group Materials
        • Indiana Group Materials
        • Tennessee Group Materials
    • Updated shelf rates and bonus offerings
      • DCPG’s expanded shelf rates now are available for up to 99 eligible lives and you can earn up to $1,000/group for selling.
      • They have recently lowered rates by 5 percent, which are reflected in the rate sheets HERE for all new sales effective April 1, 2022, through December 31, 2022.
    • Relaxed underwriting guidelines
      • Their updated underwriting guidelines make it even easier for groups to join.
      • Groups can take advantage of their relaxed participation and extended age limits.

Please contact your Cornerstone broker advisor with any questions.

https://www.crnstone.com/wp-content/uploads/2022/05/The-Dental-Care-Plus-Group-Releases-New-Updates-and-Improvements.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2022-05-20 14:31:052022-05-20 14:31:05The Dental Care Plus Group Releases New Updates and Improvements

PCORI Fees Due to IRS No Later Than August 1, 2022

May 13, 2022/in Aetna, All Savers, Carrier, Compliance, Cornerstone Updates, Employee Benefits, Humana, Legislation, Whitepapers/by Shelly Brownell

Fees to fund the Patient-Centered Outcomes Research Institute (PCORI) are due to the IRS no later than August 1, 2022, from employers who sponsor certain self-insured health plans such as Level Funded and Health Reimbursement Arrangements (HRAs) that are not treated as excepted benefits.

How to Pay PCORI Fees
Employers that sponsor certain self-insured health plans (Level Funded) must report and pay the required PCORI fees via IRS Form 720 along with HRA plans, Quarterly Federal Excise Tax Return. Complete Part II, line 133. Employers should note “2nd Quarter” on the 720 form.

Click here to access the updated 720 form.

The fee applies to each Plan year that ends after October 1, 2012, and before October 1, 2029. “Plan year” refers to the plan year for your Level Funded Medical Plans or an HRA plan. Generally the plan year and the coverage period are the same. As an example, if your HRA benefit resets each January 1, your HRA plan year and your coverage period are generally a calendar year and end December 31.

Plan Year Ending Date Fee
October 1, 2020 – September 30, 2021 $2.66
October 1, 2021 – September 30, 2022 $2.79

There are three available methods that can be used to determine the average number of lives covered under a plan for the policy year. For an HRA plan it is acceptable to use the number of subscribers only. The most commonly used method for determining the fee for your Level Funded plan is the “Snapshot Method”.

  1. Actual Count Method: A plan sponsor may determine the average number of lives covered under a plan for a plan year by adding the totals of lives covered for each day of the play year and dividing that total by the total number of days in the plan year.
  2. Snapshot Method: A plan sponsor may determine the average number of lives covered under an applicable self-insured health plan for a plan year based on the total number of lives covered on one date (or more dates if an equal number of dates is used in each quarter) during the first, second or third month of each quarter, and dividing that total by the number of dates on which a count was made.
  3. Form 5500 Method: An eligible plan sponsor may determine the average number of lives covered under a plan for a plan year based on the number of participants reported on the Form 5500, Annual Return/Report of Employee Benefit Plan, or the Form 5500-SF, Short Form Annual Return/Report of Small Employee Benefit Plan.

Payments should be made payable to the U.S. Treasury and sent by August 1, 2022, to the address below:

Department of the Treasury
Internal Revenue Service
Ogden, UT 84201-0009

The following documents accompany this notice:

  • The Form 720
  • Instructions for the Form 720
  • Patient-Centered Outreach Research Institute Filing Due Dates and Applicable Rates Flier

Tools to Assist you by Carrier:

All Savers®

All Savers posts the employer group’s membership information to the employer website. The employer group is required to complete and file the IRS Form 720. For general questions please contact All Savers Broker Services at 1-866-405-7174.

Humana Level Funded

Humana provides a snapshot report that shows the monthly membership employers will need when filing the PCORI. It is an employer report (instructions below). As a broker, the employer may grant you access if they want you to pull it for them.

Click here to review the instructions.

Aetna Funding Advantage

This link takes you to the Aetna Funding Advantage PCORI Fee Estimator Tool. This tool gives you guidance on calculating the PCORI fees for this group.

 

**Anthem OH SOCA MEWA, Anthem KY Chamber Advantage, Anthem IN Chamber Health Alliance, MMO COSE MEWA, Humana KY Chamber and UHC MEWA have built the PCORI fees into the premiums, therefore, you will not need to file and pay any additional fees.

https://www.crnstone.com/wp-content/uploads/2022/05/PCORI-Fees-Due-to-IRS-No-Later-Than-July-31-2022-1.jpg 480 640 Shelly Brownell /wp-content/uploads/2019/11/Cornerstone_Logo.png Shelly Brownell2022-05-13 14:22:082022-05-31 12:56:49PCORI Fees Due to IRS No Later Than August 1, 2022

Medical Mutual Pharmacy Benefit Changes Effective July 1, 2022

May 6, 2022/in Carrier, Employee Benefits, Medical Mutual/by Cornerstone

Several changes to Medical Mutual members’ pharmacy benefits will be effective July 1, 2022. These changes are listed below.

Formulary Updates with Express Scripts

Formularies with Express Scripts are being updated effective July 1, 2022. These changes will have minimal impact on MMO groups and members. Medications on the lists below will change categories as noted (i.e., moving cost-share tiers, being excluded from coverage):

  • National Preferred Formulary Exclusion List Changes
  • National Preferred Formulary Exclusions (Full List)
  • High Performance Plus Formulary Exclusion List Changes

Drug Surveillance Updates for Basic/Basic Plus Formulary

There are some medications which are excluded today under National Preferred and High Performance formularies which will now also be excluded under the Basic/Basic Plus Formulary through the Drug Surveillance program. A list of the changes can be found here. As a reminder, this program helps to save MMO groups money and ensure that members are on the right medication to treat their condition. Additional information on the Drug Surveillance program can be found in the Drug Surveillance flyer.

SaveOnSP Drug Lists Effective July 1, 2022, Now Available

Updated drug lists for the SaveOnSP program effective July 1, 2022, are now available. SaveOnSP now includes more than 200 specialty medicines filled through Accredo, Gentry, and University Hospitals. MetroHealth pharmacy is also able to file SaveOnSP claims for CLE-Care groups. As a reminder, the SaveOnSP Exclusive list is for Fully Insured Major Medical groups and features a narrowed and more targeted list of drugs that have very large amounts of manufacturer assistance.

  • MedMutual 2022 SaveOnSP National Preferred Formulary Standard Drug List
  • MedMutual 2022 SaveOnSP National Preferred Formulary Public Entity Drug List
  • MedMutual 2022 SaveOnSP Basic Plus Formulary Public Entity Drug List
  • MedMutual 2022 SaveOnSP Basic Plus Formulary Standard Drug List
  • MedMutual 2022 SaveOnSP Exclusive Drug List for Fully Insured Major Med

Contact your Cornerstone representative with any questions.

https://www.crnstone.com/wp-content/uploads/2022/05/Medical-Mutual-Pharmacy-Benefit-Changes-Effective-July-1.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2022-05-06 13:49:522022-05-06 13:49:52Medical Mutual Pharmacy Benefit Changes Effective July 1, 2022
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Recent Posts

  • Marketplace Learning Management System Closes on July 15
  • Medical Mutual Makes Change to National Network Effective Jan. 1, 2023
  • The Updated Medical Mutual COSE MEWA Small Employer Exception Form is Available
  • Departments Issue Checklist for Surprise Billing IDR Process
  • Learn More About Humana’s EAP LifeWorks Transition

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