CVS Health Announces Completed Acquistion of Aetna

CVS Health completed its acquisition of Aetna on Wednesday. The combined company intends to provide consumers access to the information and resources needed for quality health care, as well as remove barriers to access to affordable care.

New products and services developed by the combined company will be broadly available to the health care marketplace, regardless of one’s insurer, pharmacy benefit manager (PBM), or pharmacy of choice. Additionally, CVS Health offerings, including retail pharmacy services, specialty pharmacy and long-term care, walk-in clinical services, and PBM services, will continue to be fully accessible to other health plans. Aetna members will also continue to have a broad network of pharmacies, including community-based independent pharmacies, available to fill their prescriptions. CVS Pharmacy will continue to participate within the pharmacy networks for other PBMs and health plans.

Contact your Cornerstone representative with any questions.

 

Click here to view the official release from Aetna.

Click here to view the official release from CVS Health.

IMPORTANT UPDATE: National General Short-Term Products in OH to Activate TOMORROW

National General will open their Ohio plans for quoting and enrollment effective tomorrow, November 28, after temporarily suspending all sales of short-term medical plans.

Reminder: Short-term sales in Kentucky are still temporarily suspended as National General is required to refile their short-term plans and rates with the Kentucky Department of Insurance. This change does not impact current customers or sales submitted prior to November 13, 2018.

You are still able to quote and enroll all other National General products in Ohio, Kentucky, Indiana, and other states.

Please contact Geoff Beglen with any questions or additional information about short-term sales carrier options in Ohio and Kentucky.

Geoff Beglen | 513-629-9358 | gbeglen@crnstone.com

Allwell’s 2019 D-SNP Has Expanded Into 68 Counties In Ohio

ATTENTION NORTHWEST OHIO AGENTS

See new counties now available in your area!

Allwell’s 2019 D-SNP has expanded into 68 counties in Ohio!

Check out the D-SNP network below:

  • Promedica- Fostoria Community Hospital, Flower Hospital, Memorial Hospital, Toledo Hospital, Bay Park Community Hospital, Defiance Regional Medical Center, Arrowhead Behavioral Hospital
  • Mercy- St. Anne Hospital, St. Charles Hospital, St. Rita’s Medical Center, St. Vincent’s Medical Center, Defiance Regional Medical Center
  • And more- Cleveland Clinic, University Hospital, University of Toledo Medical Center, St. Luke’s Hospital, Bellevue Hospital, H.B. MaGruder Hospital, Regency Hospital of Toledo, Lima Memorial, Firelands Regional, Wood County Hospital, and Community Hospitals and Wellness Centers.

Competitive benefits to go with a strong network!

  • $1,000 allowance for comprehensive dental, including DENTURES
  • Member pays $0 copay for two hearing aids each year
  • Vision allowance for contacts and eyeglasses
  • $80 monthly allowance for over-the-counter items
  • Transportation included—48 one-way trips
  • Fitness membership

ALSO… take advantage of Allwell’s FULL REIMBURSEMENT of your AHIP fees!

  • It does NOT matter where you took the AHIP test. You do not have to take it through Allwell to receive full reimbursement!
  • Must be certified and contracted to sell 2019 Allwell/Health Net MA plans
  • Must have a minimum of 5 new sales with a January 1, 2019 effective date

Qualifying sales must remain active with the plan through March 31, 2019.


Not contracted with Allwell? Contact your Cornerstone Senior Marketing sales representative for more information.

Aetna Updates on January New Business Deadlines, Billing Timelines, and Reporting Notices

December and January Deadlines

The deadline for Aetna December sales notices is right around the corner. Make sure you get your notices in for December 1 effective dates by Tuesday, November 27th. Also, today is the last day to submit sales notices early and earn an administrative fee credit for your clients. You must also submit all required documents by Monday, November 26th in order for your clients to qualify for the credit. Click here for a flyer with more details on the administrative fee credit program and deadlines.

Below are the regular submission deadlines for December and January effective dates:

Effective Date Sales Notice Submitted All Required Documents Submitted
December 1 11/27/2018 11/30/2018
January 1 12/27/2018 12/31/2018

Billing

On the 25th of each month, Aenta posts monthly AFA invoices on Springboard Marketplace. Aenta emails invoices directly to those who do not use Springboard. The invoice is based on how many employees are enrolled for coverage on the 17th of that month. On the second business day of the following month, Aetna will pull funds from your account.

The first month’s bill may follow a different timeline if Aetna installs a group after the 19th of the month before their effective date. In this scenario, Aetna will pull eligibility on the first day of the month of their effective date and five days later post your invoice on Springboard. Aetna will pull funds by the 15th of the month. If they install a group after the effective date, they will not pull funds the first month. Instead, they will pull funds for two months of coverage on the second business day of the next month. For renewals, they will pull funds at their renewal and the next month’s invoice will include any changes that occurred after the 20th of the month.

*If group is not installed by the effective date, the customer will receive a bill for 2 months of coverage at once.

NY HCRA Notices

AFA customers may have recently received a communication from the New York State Office of Pool Administration regarding their NY HCRA filing eligibility. Please note, that there is no action needed. As the third party administrator, Aetna files NY HCRA forms on behalf of their Small Group AFA customers and determine whether that filing is annual or monthly.

Ohio Farm Bureau Health Benefits Plan Update for January 1, 2019 and Later Enrollments

JANUARY 1 DEADLINES

The following dates and deadlines pertain to enrollment for January 1, 2018:

December 10, 2018- Last day to request a January 1, 2019 quote (or re-quote) for any group.

December 17, 2018- Last day to bind coverage for January 1, 2019

Any group making a request after these dates will be able to receive a quote or join the plan on February 1, 2019 but will not have the option to be quoted or enroll for January 1, 2019.

Please share with your clients that due to the high end of year enrollment volume the delivery of paperwork such as employee ID cards may take longer than is normal. Those needing help accessing their benefits can contact Medical Mutual at 800-382-5729.

December 19, 2018- Please have all renewal confirmations and paperwork to Cornerstone no later than December 19, 2018 to allow for processing time in order to meet the Ohio Farm Bureau December 21, 2018 submission deadline.

MANDATORY ELECTRONIC BILLING

Any group sold after January 1, 2019 with ten (10) or fewer employees enrolling is required to sign up for ACH* payments. Groups in this size category will no longer have the option to pay their monthly premium equivalent rate by check.

Any group that is delinquent more than once in a six (6) month period will also be required to sign up for ACH payments as a condition of reinstatement.

These requirements will ensure that every group is able to participate in the Ohio Farm Bureau Health Benefits Plan without administrative difficulties.

ACH (Automated Clearinghouse also known as EFT or Electronic Funds Transfer) allows a group to provide payment details once and have funds debited from their bank account automatically each month to pay for their coverage.


Questions? Get in touch with us by phone or email!

Another Important Update Regarding National General Short-Term Products

Effective immediately, National General is temporarily suspending all sales of short-term medical plans in Kentucky. No quoting or enrollment for short-term plans in KY will be permitted until they get approval from KY Department of Insurance. This change does not impact current customers or sales submitted prior to November 13, 2018.

Reminder: Short-term sales in Ohio have also been temporarily suspended as National General is required to refile their short-term plans and rates with the Ohio Department of Insurance.

You are still able to quote and enroll all other National General products in Ohio, Kentucky, Indiana, and other states.

Please contact Geoff Beglen with any questions or additional information about short-term sales carrier options in Ohio and Kentucky.

Geoff Beglen | 513-629-9358 | gbeglen@crnstone.com

5 Reasons Aetna is Your Choice in Northeast Ohio

 

Cornerstone Senior Marketing & Aetna MA/MAPD want to share some insightful benefit information on Aetna’s plans if you have clients in the Northeast Ohio region.

5 reasons Aetna is your BEST choice in Northeast Ohio:

  1. Access to National Network on PPO and HMO plans. Network includes ALL acute care hospitals in Ohio, with access to a national network which includes Cleveland Clinic, Akron Children’s and Aultman.
  2. Expanded service area into Wayne, Carroll and Tuscarawas counties.
  3. $0 premium HMO Value and $0 premium Value PPO plans.
  4. $0 PPO includes dental, OTC, hearing and meal benefit.
  5. Reduction in MOOP and copays including $0 Tier 1, and Tier 2 Prescription gap coverage.

 $0/MONTH

Two plan options including both medical and prescription drug coverage at $0/month

PROVIDER NETWORK

All acute-care hospitals in Ohio are in-network for Aetna members

(The Ohio State University is in-network for Aetna PPO members only)

NEW BENEFITS ADDED

Plans may include: OTC allowance, transportation, post-discharge meals, and dental, vision, & hearing benefits

If you have questions or want to get contracted with Aetna please contact your Cornerstone Senior Marketing representative.

The Importance of Wrap Documents

Jennifer Agnello

Jennifer Agnello | President

Are you looking to provide even more value for your group clients?

By now most of you are familiar with a Summary Plan Description (SPD) issued for your clients’ medical plan. The SPD is one of the most important documents participants are entitled to automatically receive. This document must be provided and maintained by the plan administrator (typically the employer) and should be distributed automatically to all plan participants no later than 30 days after a written request. It outlines specific details of the health plan, such as a description of the employee benefits that are covered through the plan, participation rules, annual limits, election procedures, eligibility, employer contributions, and the plan year. It also summarizes claim filing procedures and plan sponsorship and administration.

Herein lies the issue. The Employee Retirement Income Security Act (ERISA) requires that the majority of health plans hold a Summary Plan Description. Only three exemptions exist in this ERISA regulation: 1) Indian Tribal Governments, 2) Church Plans, and 3) Governmental Entities subject to the Public Health Service Act. Chances are that the majority of your clients must comply.

Since ERISA not only applies to the medical insurance plan but to surgical, hospital, accident, HRA, FSA, dental, Rx, vision, life and AD&D, disability plans, and many voluntary plans, the health plan SPD does not cover all ERISA requirements for these additional benefits often written through various insurance companies. A written contract of insurance with an insurance company does not normally contain all of the rules required by ERISA and therefore is not a plan document. Estimates from the Department of Labor (who hold authority over employers offering these group benefit plans) show that three out of four plans audited have an ERISA violation. 70 percent of those audits result in monetary fines, many of which are significant, up to $110 per day, per affected individual for failure to comply.

Because most SPDs do not fully comply with ERISA, a wrap SPD is necessary. It is designed to “wrap” around all existing certificates of insurance and benefit plan booklets for each fully insured or self-funded plan and provides the information necessary to comply with ERISA’s reporting and disclosure requirements, HIPAA, and other federal laws. The wrap supplements the SPD with any additional ERISA required documentation, while also combining multiple benefits into a single plan for filing purposes. When a wrap document is used, the insurance policy or contract remains part of the plan document.

Therefore, the wrap and the insurance policy or contract together comprise the complete plan document and consequently meet the requirements of an ERISA plan document.

Various sources are available to prepare these wrap documents with prices ranging from $600 to $1,500. Contact your Cornerstone representative for more information.

If your clients do not currently have a wrap document in place, you have a chance to provide real value by keeping them compliant. Contact us today! Your E & O carrier will appreciate it!

Important News From Humana Med Supp!

Did you know?

Humana Marketpoint

Humana Marketpoint offers plans G & N on a GI basis along with the typical plans (A, B, C, F, K, & L) for clients who are coming off of a group health plan and if they have had Medicare Part B over a six month time frame, along with Silver Sneakers!

For more information, view the 2019 Humana Medicare Supplement Sales Guide.

Questions? Reach out to your Cornerstone Senior Marketing representative today!

Updates from Dental Care Plus: Shelf Rates, Sales Incentives, and More

Deadline for 1/1 Business

To ensure that member ID cards for January 1, 2019, groups are in the mail by January 1, Dental Care Plus Group (DCPG) must be in receipt of the group’s complete sold case submission, including employee enrollment forms or enrollment spreadsheet, by Friday, December 7, 2018.

Sales Incentive for 25+ Members

​Any DCPG group dental sale with 25 or more members will earn you a Visa gift card. DCPG has extended this program to include January 1, 2019, effective dates.

  • 25–50 members = $50
  • 51–99 members = $100
  • 100–249 members = $250
  • 250+ members = $500

Click here to learn more.

 

2019 Shelf Rates

Dental shelf rates:

Cincinnati/Northern Kentucky HMO
*NEW* Cincinnati/Northern Kentucky PPO
Ohio PPO
Kentucky PPO
Indiana PPO
Tennessee PPO

Vision shelf rates:

Ohio
Kentucky, Indiana and Tennessee

Ohio Essential Health Benefit (EHB) compliant rates:

Ohio PPO EHB (not available in Hamilton, Butler, Clermont and Warren counties)

Ohio HMO EHB

 

Qualification Period for Overrides

Starting this year, DCPG’s override compensation program will be calculated from February to January. So overrides will be effective from February 1, 2018, through January 1, 2019, on new sales and retention. Overrides will be payable in April of 2019.