Medical Mutual’s SuperDental Network Expands Provider Options

Effective January 1, 2020, Medical Mutual will combine Superior Dental Care’s dental network with their DenteMax network to create the SuperDental Network, which will provide dental members with nearly 1,600 more dental providers than the current network. This network will give members access to more than 4,000 dentists, orthodontists, periodontists, and other dental professionals.

Members can view the expanded selection of participating SuperDental dentists and specialists in their area by visiting ProviderSearch.MedMutual.com.

Emergency Medicine Physicians of Cincinnati is Leaving Anthem’s Networks

Pending final negotiations, Emergency Medicine Physicians of Cincinnati will leave Anthem’s networks effective December 24, 2019. Consequently, Emergency Medicine Physicians of Cincinnati may choose to balance bill Anthem members for amounts above and beyond Anthem’s reimbursement. Because Anthem members do not have a choice of emergency room doctors at these hospitals, Anthem will apply the equivalent of any member liability amounts such as copays, deductibles, etc., at the member’s in-network level (rather than the out-of-network benefit level equivalent). In most circumstances, payment for services will be issued directly to the member, who will then be responsible for paying Emergency Medicine Physicians of Cincinnati.

The Emergency Medicine Physicians of Cincinnati is a group of emergency room doctors that provides emergency services at Mercy Health’s Anderson, Fairfield, West, and Clermont hospitals and Mercy Health’s Rookwood, Mt. Orab, Queen City, and Harrison medical centers.

Contact your Cornerstone representative with any questions.

CMS: Marketplace Agent and Broker Open Enrollment Office Hours

CMS will hold an informational session regarding Marketplace operations that may impact agents and brokers who are providing enrollment assistance to consumers. There will also be an open forum for participants to ask questions and share their observations from the Open Enrollment period.

DATE: Monday, November 25, 2019

TIME: 2:30 pm–3:30 pm

Register.

Shopper’s Guide to Navigating Discount Drug Programs

It’s no secret that the cost of pharmaceuticals in the US is soaring. According a report published by Health Affairs in January 2019, the cost of oral and injectable brand-name drugs has increased annually by 9 and 15 percent, respectively, between 2008 and 2016. The research concluded that the rising cost of generic and specialty drugs were driven mostly by new product entry while the rising costs of brand-name drugs were a result of existing drug price inflation.

In the face of soaring drug prices, consumers have found an ally in their local big box stores, such as Walgreens, Walmart, Kroger, Target, etc. Roughly 4 out of 10 Americans rely on these programs to find savings for their prescription drugs. Generic drugs are often the focus, though brand-name and specialty drugs are also offered. Recent data shows that these drugs account for 85 percent of the retail pharmacy medicines prescribed in the US.

Retailers are able to sell pharmaceuticals at such deep discounts because they buy in bulk or they use membership fees to offset costs. Some stores say they will lose money through their pharmacy programs, but expect to make up the difference through sales elsewhere in the store, especially with big ticket items like jewelry and electronics.

There are numerous differences among the programs offered by each retailer. Some pharmacies require a membership or an annual fee, while others require only a doctor’s prescription. Some memberships need to be renewed annually, while others are more open-ended. Learning the differences among each can be vital in finding the cheapest and most convenient retailer.

Generic medications included in these programs may even be cheaper than an insurance co-payment. For example, if there is a $10 co-pay, but the drug needed is offered by a pharmacy for $4, the consumer  should be eligible for the cheaper price. Consumers should also ask the pharmacist how this coordinates with Medicaid and Medicare.

Consumers who prefer to shop at their local drug store should check and see if their corner pharmacy will match the price of the big box store.

When it comes to price matching medications, it’s important to do your homework. Determine which retailers offer the best value by asking what and who is covered and whether or not there is a membership fee. The savings can be significant.

Resources

https://www.consumerreports.org/drug-prices/drug-discount-programs-can-save-you-big-on-generics/

https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00520

October Medical Mutual Updates: Changing Payments, Deadlines, and Individual Market Updates

Medical MutualUpdating Medical Mutual Payments to Huntington Bank

Medical Mutual recently switched from PNC Bank to Huntington Bank for processing of premium and ASO-related payments. Group customers should now send payments to Huntington. Reminder letters will be sent to all affected groups ahead of shutting down the PNC Bank accounts prior to the end of the year.

COSE MEWA Columbus Territory Change

Effective November 1, 2019, the exclusive territory for the Columbus Chamber MEWA plan will expand beyond Franklin County and will include Union, Delaware and Licking counties. Any new group sold in those counties must be a member of the Columbus Chamber in order to enroll in the COSE MEWA health plan.

Two-Year Moratorium on Re-Entry to the COSE MEWA

Small groups choosing to leave the COSE MEWA and obtain other coverage will not be able to return to the COSE MEWA for two years. If a group wishes to return to the COSE MEWA before two years have elapsed, they will be charged a one-time fee of $1,000 per subscriber.

Pre-Submission Checklists

To help with submissions during the busy season, please complete your pre-submission checklist and send it in with your sold case documentation. Any submissions that are made after December 5, 2019, may not receive approval letters prior to the January 1, 2020, start date.

Health Insurance Tax

The federal government has not suspended the Health Insurance Tax for 2020, as they did in 2019. That means Medical Mutual will need to pass this tax along to their customers.

Medical Mutual Individual Market Updates

Medical Mutual will be offering ACA coverage in 12 new counties during plan year 2020. Click here to review the updated service area map. They have also added new $5,000 silver and $8,000 bronze deductible options that include office visit and Rx copays. Click here for the 2020 Plan Highlights flier for full details.

In addition, Medical Mutual has added statewide convenience walk-in clinics across Ohio and has expanded their Mercy HMO network with the addition of St. Luke’s hospital and more physicians.

Medical Mutual will discontinue the Promedica HMO network in Northwest Ohio. All members of that network will be moved to the Mercy HMO network.

Lastly, Knox Community hospital will no longer be a part of the OhioHealth HMO in Central Ohio.

Don’t forget to re-certify by the end of 2019 to receive renewal compensation for on-exchange plans!

Federally Mandated Fee Updated for 2020 Renewals

Since the Affordable Care Act went into effect in 2014, Medical Mutual has been subject to the Health Insurance Providers Fee, often referred to as the Health Insurance Tax or the Market Share fee. As a result, Medical Mutual has applied the Health Insurance Providers fee to all 2020 renewals.

Contact your Cornerstone representative with any questions about these updates.

State Anthem Individual and ACA Groups Rx Change Coming

Members of Anthem’s Individual and Small Group Affordable Care Act health plans will move to their new pharmacy benefit manager, IngenioRx. Clients will receive letters regarding the change in November.

All Anthem members will use IngenioRx on January 1, 2020. Their pharmacy benefits don’t change as a result of the move to IngenioRx.

Members in most other plans, including grandfathered and/or grandmothered plans, already switched to IngenioRx.

Contact your Cornerstone representative with any questions.

Earn Up to $25,000 With Oscar’s National Open Enrollment Broker Bonus Program

With Oscar’s National Open Enrollment Broker Bonus Program, you can earn a one-time bonus of up to $25,000 on top of your regular commission. Here’s how it works:

  • Enroll or renew 50 to 249 policies and earn $20 per policy.
  • Enroll or renew 250 policies or more and earn $40 per policy for all policies.

That means that enrolling 250 policies can get you a bonus of $10,000!

Click here to learn more about the program.

Contact your Cornerstone representative with any additional questions.

Earn Cash with IHC’s Short-Term Medical Bonus

Earn a cash bonus for your short-term medical sales with IHC Group’s Short-Term Medical Bonus.

Sell any Independence American Insurance Company (IAIC) short-term medical policy for a duration of 7 months or more and receive a bonus.

Duration

Bonus

7 months – 364 days

$25

13 months – 18 months

$50

19 months – 24 months

$75

25 months – 36 months

$125

There are no maximums. The more you sell, the more you earn.

Click here for more information.

ATTENTION: ACA FFM Certification Reminder

Agents with active on-exchange plans who want to receive renewal compensation must re-certify by the end of 2019. In addition, agents offering on-exchange coverage must certify prior to selling any plans during the 2020 open enrollment period.

Follow these steps to certify:

  1. Go to the CMS Enterprise Portal and log in
  2. Update your information on your Marketplace Learning Management System (MLMS) agent/broker profile
  3. Complete the Marketplace training requirement.
  4. Read and accept the applicable Marketplace Agreement(s)
  5. Print your 2020 Registration Completion Certificate
  6. Confirm your registration by using the Registration Completion List
  7. Please forward a copy of the registration completion certificate to Geoff Beglen at Cornerstone

Questions? Contact individual expert Geoff Beglen.