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

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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.

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

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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.

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

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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.

Medical Mutual Pharmacy Benefit Changes Effective July 1, 2022

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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):

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.

Contact your Cornerstone representative with any questions.

Updated MMO COSE MEWA Small Employer Exception Form

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An updated COSE MEWA Small Employer Exception form and instructions on how to properly complete it have been posted to cosemewa.com.

You’ll find them both under Self–Help Compliance Resources > Medicare or Additional Tools and Resources > Links and Forms.

Please discard any old versions of the form and start using this new form immediately. Using and completing the new form properly will expedite the approval process.

When is the form needed?

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

Contact your Cornerstone representative with any questions.

Medical Mutual Small Group Product Updates for May 1 Renewals

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Medical Mutual is offering new benefit plans for their COSE MEWA for May 1, 2022, renewals, including:

Alternative Copay Plans

  • Reduced $0 generic Rx paired with lower than market formulary, brand and specialty tiers
  • Reduced OV/SP/UC copays with an annual p/member cap (preventive visits not subject); post max subject to deductible and coinsurance
  • 30 percent coinsurance to drive cost down

Expanded HSA Plan

  • Low deductible qualified plan offering ($3K deductible) paired with
  • Reduced post-deductible copays (no restrictions on number of times used)
  • Reduced post-deductible Rx; $0 generic Rx paired with lower than market tiers
  • 30 percent coinsurance to drive cost down
  • No additional cost for an integrated HSA administration

New 8700 plan

  • Introduction of an alternative max liability for employers seeking a reduced cost health benefit plan option
  • Preventive services at 100 percent
  • No copays
  • Major medical Rx (all costs subject to deductible)
  • Not HSA qualified

Additionally, Medical Mutual released their COSE MEWA portfolio adjustments, including:

What’s changing within the COSE MEWA product offerings

  • Rx copay adjustment; specialty (4th tier) moving to a $275 flat
  • Non-network coinsurance transitioning to 50 percent
  • Non-network MOOPs (maximum out-of-pocket) no longer unlimited

Sunsetting these HRA plans (no new sales, current group enrollment can stay in plans)

  • HRA 30-1000
  • HRA 3000 w/ PD Rx
  • HRA 5000 w/ PD Rx

Continue to offer these HRA plan benefit options

  • 30-2000
  • 30-3500
  • 6550 w/ PD Rx

Finally, Medical Mutual is offering a small group level-funding solution:

  • Target market 10 to 50
  • Underwritten; great alternative solution for good risk group
  • Stable, 12-month premiums
  • Reporting available upon request
  • 2/3 of unused employer claims fund refunded
    • Historically ~65 percent of groups have received a refund
  • New business incentive
    • Small group self-funding solution first year $350 admin credit provided per contract on 12th month
  • Rolling out product education and support tools
  • Launch timeline
    • 7/1 official release with updated benefit options and expanded sales and marketing tools

2022 Medical Mutual COSE MEWA Benefit Changes and Marketing Materials Available

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Medical Mutual’s COSE MEWA product portfolio is updated with plan changes for 2022. All 2022 COSE MEWA plan designs are targeted to be available for quoting in early February for an effective date of May 1, 2022. Plan details are laid out below.

Groups will be informed of these benefit changes in their renewal notification. All updated plan grids, along with the updated Employer Application, summaries of benefits and coverage (SBCs) and benefit highlight sheets, are available to view and download on cosemewa.com.

COSE MEWA Benefit Changes

The COSE MEWA benefit designs have been updated for the preferred provider organization (PPO), health savings account (HSA), health reimbursement arrangement (HRA) and COSE MEWA SuperMed Share plan options. There are no changes for the 2022 benefit designs for MedFlex or CLE-Care.

Significant updates include:

PPO

  • Three new plan options added
    • 2530-3000 w/Rx and 2530-4000 w/Rx – These new plans include:
      • Reduced copay amounts with annual per member visit allowances. All copay visits in excess of the allowed will be subject to deductible and coinsurance.
      • A pairing with a reduced out-of-pocket Rx coverage that highlights a $0 generic drug copay to reduce costs and a 30% coinsurance.
    • 8700 MMRx – A new max liability option. Please note, this cannot be offered as a dual option with another plan.
  • Our specialty drug copay has been modified to $275

HSA

  • One new plan option added
    • HSA 30-3000 w/PD Copays and PD Rx – This new plan includes:
      • Post-deductible drug copays with reduced out-of-pocket Rx coverage that highlights a $0 generic drug copay.
      • Post-deductible office visit copays with no utilization caps on number of office visits.
      • 30% coinsurance.
  • On HSA plans with a PD Rx, our specialty drug copay has been modified to $275.

HRA

  • Three plan options were removed for new business (current enrolled groups will remain)
    • HRA 30-1000 w/Rx
    • HRA 3000 w/PD Rx
    • HRA 5000 w/PD Rx
  • Our specialty drug copay has been modified to $275.

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  • Our specialty drug copay has been modified to $275

Contact your Cornerstone representative with any questions.

Medical Mutual Small, Mid-Size Dental and Vision Plan Updates, Pricing, and Updated Materials

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As of January 1 and February 1, 2022, there are pricing adjustments and one product update for Medical Mutual dental and vision small and mid-size group products. The pricing adjustments are reflected in the new selection sheets linked in the update. These selection sheets are also updated on MyBrokerLink (and cosemewa.com for the COSE MEWA versions).

Updates Effective January 1, 2022:

Dental Small Group of 1

Product update: For Dental small groups of 1, orthodontia is no longer included on plans for new business. Existing groups with orthodontia will be grandfathered.

Dental Small Group (2-50)

VSP (51-99)

Update Effective February 1, 2022:

Dental mid-size (51-99)

(X10467) 51-99 Dental Selection Flier

Contact your Cornerstone representative with any questions.

Medical Review Institute of America Data Incident Impacts Medical Mutual Groups

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Medical Review Institute of America(MRIoA) is an independent review organization (IRO) that the Ohio Department of Insurance (ODI) and many health insurers use to review and make objective decisions on the medical necessity of certain healthcare procedures. While Medical Mutual does NOT contract directly with MRIoA, two of their partners –Express Scripts and MagellanRx Management (MRx)–do use them for review of prescription and medical drug prior authorization and/or appeal requests.

On November 20, MRx notified Medical Mutual that MRIoA experienced a data incident on November 9. Express Scripts notified them on December 1. The incident was due to a cyber-attack where an unauthorized individual infiltrated MRIoA’s system, made copies of certain records, and demanded a ransom for the deletion of the information. MRIoA received confirmation from the unauthorized individual that the copied data was deleted on November 16, 2021. Additionally, MRIoA confirmed, with the assistance of third-party computer specialists, that its network is fully secured. Around 2,300 Medical Mutual members were impacted through Express Scripts and 39 members were impacted through MRx.

By the end of the year, MRIoA will send a notification letter to alert these members of the incident and what actions, if any, they need to take. MRIoA will also offer all impacted members credit monitoring and a toll-free number they can call with questions. Please keep in mind that Medical Mutual systems were NOT involved in this incident. MRIoA received Medical Mutual member data directly from either Express Scripts or MRx.

Contact your Cornerstone representative with any questions.

Gender Affirming Surgery Exclusion Removed for Medical Mutual Small Groups

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Medical Mutual is removing the benefit exclusion for gender affirming surgery currently in place for small groups. This change will allow services related to gender affirming surgery to be covered when deemed medically necessary. Grandmothered/grandfathered groups and COSE MEWAwill see the change take effect January 1, 2022, while ACA groups will see the change at their next renewal in 2022.

There will be no immediate impact to medical rates. Certificate books will be updated to reflect the change and we will send letters to affected group officials. Grandmothered/grandfathered groups will also receive an updated certificate amendment. As a reminder, Medical Mutual does not mail certificate books to members when there is a change. However, members can always access them on their My Health Plan accounts under Benefits & Coverage.

Contact your Cornerstone representative with any questions.

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