University Hospital Joins Medical Mutual SuperMed Networks

Medical Mutual has announced that, effective October 1, 2017, University Hospitals main campus will join the Medical Mutual SuperMed network (PPO, POS, HMO, Preferred, and OhioMed) in Northeast Ohio. The following facilities will be in network:

  • UH Cleveland Medical Center—including MacDonald Women’s Hospital
  • UH Seidman Cancer Center
  • UH Rainbow Babies & Children’s Hospital
  • UH Bedford Medical Center

All other UH facilities remain in the SuperMed network.

Effective October 1, 2017, all UH facilities will also be part of Medical Mutual’s Medicare Advantage and individual product networks (with the exception of OhioHealth HMO, Mercy HMO, and ProMedica HMO). Members in these networks will no longer be required to obtain a waiver or go through an exception process to obtain services at UH’s facilities.

 

Not appointed with Medical Mutual? Contact us today to get started!

Employee Benefits: CE Training and Product Update Opportunity in Northwest Ohio!

 

Cornerstone and Anthem BlueCross BlueShield invite  you for training on Voluntary Benefits (CE credit) and Anthem Small Group Specialty plans!

Disclaimer: Locations are subject to change.


DATE: August 16, 2017

TIME: 10:30–12:30

LOCATION: Toledo, OH

4444 Keystone Drive Suite F | Maumee, OH 43537

DATE: August 17, 2017

TIME: 10:30–12:30

LOCATION: Lima, OH

3745 Shawnee Road Suite 104 | Lima, OH 45806

Click here to RSVP.

Not contracted with Anthem? Contact Cornerstone today to get started!

1-800-248-7675

Humana Browser Compatibility Tool

Humana has recently reported that its PDFs and Humana MarketPOINT University Computer-Based Training modules are not compatible with Google Chrome because it no longer supports flash. Humana recommends using any of the following browsers to access these documents and links:

  • Internet Explorer
  • Edge
  • Firefox
  • Safari

The company has developed a browser compatibility tool that will help you determine which browsers you have on your laptop, smartphone, etc. that are compatible and provide links to download the appropriate browsers.

Click here to access HMU Browser Capability Check.

 

RESOURCES

Google Chrome Browser Issues

 

Join Cornerstone and Anthem for Lunch and Learn Specialty Benefits Training in Columbus (CE Credit)

Join Cornerstone and Anthem for a lunch and learn training session discussing small group specialty benefits for CE credit.

We will discuss:

  • What are voluntary insurance products
  • What employers are considering voluntary insurance products
  • Who purchases voluntary insurance products
  • Key success factors with regards to enrollment and re-enrollment in voluntary insurance products

 

DATE: August 24, 2017
TIME: 10:30 am–12:30 pm
LOCATION: Anthem’s Columbus Office
6740 North High Street
Columbus, OH 43085

Click here to RSVP.

RSVP: Selling Washington National Worksite presented by Mike Judge

Join Cornerstone and Washington National’s Mike Judge for a look at how their suite of worksite products can benefit your business.

Receive a free CE VOUCHER for attending!

 

Reasons to attend: 

  1. Gain wider sales opportunities from clients through alternative enrollment choices.
  2. Benefits of an agency force commission structure that attracts talent.
  3. Advantages of direct carrier home office case building and decision making support.
  4. Receive access to product selections for individual and small case markets

Click here for more information.

 

Thursday, August 10, 2017 | 1:30 pm

Cornerstone Media Center

2101 Florence Avenue | Cincinnati, OH 45206

Click here to RSVP.

Humana July Updates

Effective June 16th, Humana discontinued the claims cost transparency tools for Group Commercial and Humana One members.  The tool was underutilized by Humana members (based on web hits) and there was little to no evidence that members who did use the tool were ultimately selecting a more cost effective provider or place of service to receive their care.

Humana’s 4 popular bonus programs have been extended: Level Funded Premium bonus, Specialty Bundling Bonus, 100+ medical bonus, and Workplace Voluntary Benefits Bonus. See the resources below for more details.

In an effort to focus on core wellness solutions, Humana will only be offering EAP/Work-life Solutions and Go365 on a standalone basis.  As of 7/1 Goal Guru, Kurbo, eMindful, Health coaching, Health Promotions Consultants, Weight Watchers, and biometric screenings will no longer be sold as standalone.

Resources:

WVB Bonus

LFP Bonus

Bundling Bonus

100+ Bonus

 

Click here to request access to Broker Centric for 24/7, immediate access to customizable marketing materials, promotional items, and carrier product resources.

Service Without Borders: Aetna’s new servicing framwork program

Aetna has redesigned their internal workflow to increase efficiency and provide members with a better customer service experience. See highlights of this redesign below:

  • Issues resolved faster, the first time. Aetna Customer Service Representatives will use lifelines that give them real-time access to support areas.
  • Those representatives will also educate and guide members on the benefits of Aetna’s digital tools and programs.
  • Aetna Customer Service Representatives are now empowered to make claim decisions* in certain situations while giving guidance on how to make the best use of plan benefits.  For example:
    • They will be able to allow payment at the in-network benefit level for an out-of-network provider for the first visit.
    • If a participating provider orders a covered service, they will honor it at the network benefit level (with proper limits for extremely expensive services).
    • If a benefit was misquoted (par/no par), an Aetna Customer Service Representative can send the claim for payment.
    • Aetna Customer Service Representatives will even be able to retroactively approve two associated visits in the past three months to an out-of-network provider with documented clinical decision (network deficiency). This helps to resolve issues earlier.

*Members will automatically be provided this service model. Self-funded plan sponsors have the option to opt-out of this service. Aetna assumes Self-funded plan sponsors are participating unless they choose to opt-out by 7/17/17. 

Resources:

Aetna Servicing Framework Program

 

Not contracted with Aetna?

Contact Cornerstone today!  1-800-248-7675

Medicare Cost Reference-Based Pricing Product

Nelson Culp | Director, Employee Benefits

Nelson Culp | Director, Employee Benefits

As the cost of healthcare continues to increase, employers are seeking effective solutions to control the expense of healthcare benefits, while providing valuable offerings to their employees. Traditional healthcare options, such as PPO and High Deductible Health Plans using PPO networks, can be ineffective cost containment solutions in the long run. The consistent increases when an employer renews their health benefits coverage often lead to additional cost shifting in the form of greater employee contributions, higher deductibles, and higher coinsurance, sometimes making access to affordable healthcare a challenge for employees.

There is a health insurance product that is becoming more and more popular for larger employers that want to stay away from these traditional products. Medicare cost reference-based pricing is a self-funded health plan built upon a reference-based payment formula. Reference-based pricing is a method of reimbursement that collects data on prevailing costs for medical services and benchmarks them against CMS Medicare filings. Medicare bases provider reimbursement on the actual cost plus a moderate profit margin. Reference-based pricing offers group health plans the ability to place limits on what will be paid by the health plan, making it a good alternative to your traditional PPO plan. This product enables employees to go to any provider they choose, without having to worry about in- and out-of-network coverage.

Sometimes balance billing can become an issue, but a reputable TPA will have a procedure in place to deal with these situations if they occur. Employees like the freedom to go to any provider without network limits. They also like the lower out-of-pocket contributions and the easy-to-understand plan deigns. The employer is confident they are paying a consistent and fair amount regardless of which provider(s) the employee chooses. Employers appreciate the simple plan designs, ability to recruit and retain employees with better benefits, lower costs and stabilized claims, as well as complete transparency of claims. Providers are satisfied with predictable reimbursement, elimination of the administrative burden of backend collections, and the direct relationships with area employers.

To learn more about Medicare cost reference-based pricing products, please contact your local Cornerstone representative.

Anthem Monthly Broker Updates (Small Group 1–50)

Reminder: Attestation Forms due December and January renewals

Groups with more than 50 total employees (full time, part time, seasonal) averaged over the preceding calendar year should be renewed by large group. Anthem has proactively reached out to brokers on all groups that have at least 21 enrolled on the plan to verify the group size. Please be sure you are responding with this information. Once a small group renewal has been released, Anthem cannot move the group to large group until the following year. Please return attestations timely for groups that need to change market segments.

 

Reminder: July, August and September Grandmothered Renewals

These renewals are able to move to January 1, 2018 renewal date as long as the group is not on a plan year plan. Groups that do so will only see demographic rate changes at their January renewal (age band changes). Early renewals forms signed by the group are due no later than August 1, 2018. Otherwise they will renew next year to ACA plans (unless there is another extension granted by HHS).

 

Reminder: Dual Option down to 5 lives—New for ACA Groups

All NEW groups are now eligible for dual option down to 5 enrolled lives starting for May 1, 2017 effective dates for ACA.

  • You must have 5 enrolled in plan to eligible.
  • This is for dual option only.
  • You must have at least one member enrolled in each plan.
  • 10 percent difference in premium between plans

There is no change to the requirements to add a triple option. 10+ enrolled is still required. Please contact your Cornerstone representative with questions.

 

Updated New Business Checklist Available

Want a smoother implementation process—make sure you are using the updated new business checklist.

 

Promote Wellbeing in the Workplace with a new Healthy Workplace website

A new resource is available to help Small Group employers build a comprehensive well being strategy from start to finish—Healthy Workplace. This is an interactive website for employers who lack a dedicated wellness consultant and walks the user through a step-by-step process and provides documents and assessments to help along the way. Check it out and see how easy to use it is! Available to any group size, but please note it works best in newer browsers like Chrome or Firefox.

 

Date for move to new Employer Portal is July 28

The Employer Portal, also known as Employer Access is moving to a new and improved platform as part of a technical upgrade. The move was supposed to happen June 16 but has been delayed until July 28.
The new site has the same functions as before plus updated technology, it’s more secure, and has an improved look & feel – it’s easier to use. Here are the highlights:

  • New flow for self-registration
  • Enhanced Menu of Resources (MOR) including Client Information Insights* (CII) reports
  • Enhanced Online Group Billing (OGB) dashboard
  • Allows for more flexible improvements in the future
  • Employer Group Site Administrators can use their existing username/ password, but will be required to sign a new internet Group Usage Agreement and User Usage Agreement the first time they access the portal.
  • Brokers can use their existing username/password too. Similar to Employer Group Site Administrators, brokers will be required to sign a new internet User Usage Agreement the first time they access the portal after the upgrade. Note: If there isn’t an internet Group Usage Agreement on file for their Employer Group(s), Brokers will have a 30 day grace period in which to contact the group to request they complete the online Group Usage Agreement.

To experience the new look and feel, Employer Group Site Administrator/Users can log in to the portal after July 28 and bookmark the new login page. When users log in after July 28, they will be redirected to the new and improved site.

 

2017 MLR Survey Timing Clarification

The annual medical loss ratio survey’s began mailing May 25 and will be staggered over several weeks. This has resulted in increased call volumes from Anthem’s groups since a reminder communication was released prematurely.

Anthem has sent out a clarifying message to brokers and employers. In the meantime, if your groups have not yet received their mailing, please let them know that the mailing has been staggered over several weeks. When groups receive the survey notice, they will be prompted to visit a link and complete the survey. As a reminder, responses are not due until July 31.

NOTE: Although most fully-insured small and large group customers will receive the survey, a small subset of customers will not if it does not apply to them. If a customer has not received the survey by the end of June, it is most likely the survey does not apply to them.

 

Anthem reduces its individual health plan offerings in Ohio for 2018

Anthem will no longer offer Affordable Care Act (ACA) compliant Individual health plans through the Health Insurance Marketplace (also called the exchange) and will reduce our off-exchange plan offerings in Ohio for 2018. This means health benefits for these members will end on December 31, 2017. Soon, Anthem will send Individual members an email sharing this news. Then, in a couple of weeks, Anthem will begin sending impacted members a packet with more details. Members on a PPO plan will receive their packets in June. HMO members will receive theirs closer to the fall open enrollment period.

Anthem will continue to offer one off-exchange Catastrophic health plan in Pike County only. Details about this plan are coming soon. Members who receive their health insurance benefits through their employer and members on Grandfathered and Grandmothered Individual plans are not impacted by this decision. Likewise, Medicare Advantage and Medicare Supplemental plans are not impacted by this decision.

Plan offerings for dental, vision, and life benefits will not change, and will be available to current members and new customers in 2018. Members with dental and/or vision benefits will get renewal details in the fall.

 

Cuidado Médico on Life Health Online Now Available in 49 States

Cuidado Médico on Life Health Online is expanding access to 48 States to provide access to in network Spanish-speaking doctors from the comfort of home. Starting June 1st, members will be able to use the Live Health Online app to access in network Spanish speaking doctors via private and secure video visits using their smartphone or tablet. Spanish speaking doctors are available by appointment from 7 am to 11 pm, seven days a week. Same day appointments are available in most States.

Contact your Cornerstone representative for details.

 

New Dental Prime and/or Complete online member guides available

Anthem has developed a demo that guides Dental Prime and Complete members through the various online tools available to them including coverage details, how to perform a Dentist search, Dental Cost Estimator, Ask a Hygienist (email access) and Dental Health Assessment. Share this demo with your clients so they can engage their employees in their dental benefits.

 

Aetna to Update Mammography Clinical Policy

Effective July 1, 2017, Aetna’s Mammography clinical policy will be updated to allow coverage for breast tomosynthesis (3D mammograms), including coverage for preventive and diagnostic use. This is because, in some parts of the country, this is the only screening technology available. This tool is considered a medically necessary acceptable alternative to standard (2D) mammography.

This technology is said to:

  • Reduce recall rates
  • Reduce the radiation dose compared to previous technology