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Principal Removes Missing Tooth Clause
Principal recently made an update to dental policies effective January 1, 2025, to remove the “Missing Tooth Clause,” which is a provision in the Dental contract that states it will not cover any dental treatment that replaces a tooth (or teeth) that was extracted or missing prior to the date the insurance coverage started, including crowns, bridges or implants.
Easy-to-Use Cheat Sheets for Anthem OH Small Group
Anthem OH recently released all the details of a small group platform in one place. Each page has live links to things like pharmacy network, formulary, plan charts, well-being resources and more!
Anthem SOCA MEWA and Ohio Farm Bureau MEWA to File 1094/1095 Data Electronically
Based on popular broker request, Anthem will prepare the 1094B and 1095B forms for the 2024 tax filing year and post to Employer Access.
Gag Clause Attestations are Due December 31! Here is Your How-To Guide
The annual Gag Clause Prohibition Compliance Attestation is a new requirement that prohibits group health plans and health insurance issuers offering group health coverage from entering into an agreement with a provider or TPA that would restrict the plan from providing cost or care information to plan participants, accessing de-identified claims data, and sharing information per privacy regulations with a business associate.
Download Anthem KY’s Broker Cheatsheet for Essential Information
Anthem KY has created a comprehensive broker cheat sheet that provides essential information to address client inquiries, including links to plan grids for ACA, Anthem Balanced Funding (ABF), and ChamberAdvantage (MEWA) portfolios.
SummaCare Updates: Large Group and MEWA Broker Bonuses and a New Captive Product
Earn more for your sales and enhance your group product portfolio with these SummaCare updates for 2025.
Important October Medical Mutual Updates: New Small Group Dental Plans
This update includes upcoming mailings, coverage limit updates, and new small group dental plans effective January 1, 2025.
REMINDER: Important Marketplace System Changes
Understanding these changes listed below can empower you to implement an actionable plan to ensure you’re ready to assist consumers this Open Enrollment.
Increase in New Sale Commission for Medical Mutual COSE Benefit Plan Groups with January 1 Effective Date
Medical Mutual recently announced an increase to the health commission rates on new COSE Benefit Plan accounts with an effective date of January 1, 2025.
Humana Dental Network Crosses Over 135,000 Providers
Offering a broader network with greater convenience and cost savings is a key differentiator that you can highlight when speaking to your clients.
Medical Mutual’s SmartShopper is Now Included for Fully Insured, MEWA and Balanced Solutions Groups
Medical Mutual's SmartShopper (a product of Zelis) is now automatically included for all fully insured, MEWA, and Balanced Solutions groups starting October 1, 2024.
Review Medical Mutual’s Reducing Deductible Plan Grid
Medical Mutual’s Reducing Deductible health plans provide organizations with 51 to 99 employees the opportunity to lower their annual deductibles by completing wellness activities.
Enhanced One Healthcare ID Security Coming Soon from UnitedHealthcare
Users will have to set up there of the four options: set up a password, add a passkey through web authenticator, set up MS or Google Authenticator on your phone, or add a phone number.
Earn More with Humana’s Small Group Bundling Bonus Enhancement!
Humana recently announced an enhancement to their 5 to 49 Small Group Bundling Bonus program that doubles the payout for a disability sale, increasing the line bonus from $200 to $400.
Delta Dental of Kentucky’s New System Date for Individual Clients and Brokers
Effective the end of this month, Delta Dental will be implementing a new Individual Enrollment Portal for individual plans and a new Producer Portal for brokers selling individual plans. These new portals will be fully administered by Delta Dental and will allow you to easily enroll subscribers as well as maintain subscriber eligibility throughout the year.
Anthem KY’s Small Group and Individual MLR Rebates Update
Anthem pays annual rebates to fully insured groups when their medical loss ratio (MLR) is less than 80 percent for small groups and individuals. For 2023, the KY small group and individual market is in a rebate position.
Anthem Cornerstone Vision Plans Available for January 1 Effective Dates
Enrollees added between November 25, 2024, and December 13, 2024, will become effective on the vision plan January 1, 2025.
Aetna Announces County Expansions in Ohio and Indiana in 2025
Aetna recently announced it will be expanding to 15 counties in Ohio and 15 counties in Indiana for their 2025 individual and family plans. Download their full county list and register for our upcoming webinar!
UnitedHealthcare Will Begin Mailing MLR Premium Rebate Checks to Impacted Groups in September
Premium rebate checks begin to go out mid-September and will be staggered over a three-week period. Fully insured customers who are qualified to receive premium rebates for the 2024 MLR Payout Year will receive their checks by the September 30, 2024, deadline.
New Enhancement Makes Anthem MEWA’s Quoting Process More Efficient
The latest enhancement to Anthem MEWA's digital quoting process allows you to add comments to a quote on the "upload document" screen. Previously, any additional comments had to be emailed to underwriters separately.
Pay-or-Play Affordability Percentage Will Increase for 2025
For plan years beginning in 2025, employer-sponsored coverage will be considered affordable under the ACA’s “pay-or-play” rules if the employee’s required contribution for self-only coverage does not exceed 9.02 percent of their household income for the year.
Employer Action Required: Distribute Medicare Part D Notices by October 15, 2024
Group health plan sponsors must provide Medicare Part D “creditable coverage” notices prior to October 15, the start date of the Medicare annual enrollment period for Part D, Prescription Drug coverage.
CMS and DE/EDE System Access Requirements
As a reminder, section IV.c. of the Agent and Broker General Agreement documents proper uses of CMS systems, including Direct Enrollment (DE) systems, and DOES NOT ALLOW these activities.
Anthem’s New “Building Healthy Families” Program
Every family is unique, and Anthem’s new, all-in-one Building Healthy Families program has the resources to help each one grow strong.
Medical Mutual Balanced Solutions Expands to the 51 to 99 Market
Medical Mutual's level-funded product, Balanced Solutions, will be extended to serve the 51 to 99 market segment for effective dates starting October 1, 2024. This product is a popular hybrid that combines the advantages of fully insured and self-funded health plans.
Anthem KY to Send Out MLR Surveys Soon
Anthem pays annual rebates to fully insured groups when their medical loss ratio (MLR) is less than 85 percent for large groups or 80 percent for small groups and individuals. Anthem will start emailing the surveys to qualifying small and large group clients soon to verify group size.
Medical Mutual Plans to Divest Bravo Wellness Over the Course of 2025
After evaluating the long-term financial model for Bravo, Medical Mutual made the decision to divest and move to contracting with a third-party wellness supplier over the course of 2025.
UnitedHealthcare’s 24/7 Virtual Visits Zero Cost-Share Available to Some Full Insured Members
Current HSA plan design includes a waiver of deductible and coinsurance for 24/7 virtual visits, which will no longer be permitted as of your next renewal.
UnitedHealthcare Level Funded Enhancements for High-Quality, Affordable Health Plans
UnitedHealthcare Level Funded stands out with built-in value-added services like HealthiestYou, UHC Rewards, Real Appeal, and Mineral.
A Quick View of Anthem’s Behavioral Health Programs
Anthem Blue Cross and Blue Shield and SOCA have teamed up to offer the SOCA Benefit Plan. Providing access to quality care is one of the ways Anthem is focused on improving employees’ well-being while saving money.
Plan Year 2025 Marketplace Registration and Training is Now LIVE
Plan Year 2025 Marketplace registration and training is now available for returning agents and brokers who were registered for Plan Year 2024! The optional Small Business Health Options Program (SHOP) training and SHOP agreement are also available.
Updates Regarding UnitedHealthcare’s GRa Member-Level Census
UnitedHealthcare recently shared an update that, starting with quotes received after August 1, 2024, UHC OH MEWA in Ohio is now allowing GRa member-level census underwriting for groups with 5 or more enrolled employees.
Anthem KY ChamberAdvantage Bundling Discount Updates
Because life and disability products are now through Standard Life now, Anthem is giving a 1.5 percent discount off of medical for adding dental and 0.5 percent off medical for adding vision, effective immediately.
Coming Soon: FFM Account Integration is Changing to Every 12 Hours
Starting on July 12, 2024, agents using HealthSherpa or other EDE platforms will need to extend their FFM account integration every 12 hours instead of the current 30-day period.
UnitedHealthcare Short-Term Updates with Final Rule
UnitedHealthcare recently announced their next steps in response to the Final Rule from this past spring, which limits the length short-term plans after September 1.
PCORI Fees Due to IRS No Later Than July 31, 2024
Fees to fund the Patient-Centered Outcomes Research Institute (PCORI) are due to the IRS no later than July 31, 2024, from employers who sponsor certain self-insured health plans such as level funded and HRAs that are not treated as excepted benefits.
Anthem Enhanced Coverage Plans to Be Discontinued Due to Final Federal Rule
You can continue to sell AEC plans until July 25, 2024. The last effective date for these new sales will be August 2, 2024. These plans offer coverage for one year only and cannot be renewed.
UnitedHealthcare’s Activate the Savings Bundling Discount
Effective June 1, 2024 to January 1, 2025, UnitedHealthcare is offering a bundling discount when groups add ancillary with the medical. This includes MEWA, level-funded for groups outside of Ohio, and ACA.
IRS Releases HSA Limits for 2025
Recently, the IRS issued Revenue Procedure 2024-25, which provides the 2025 cost-of-living contribution and coverage adjustments for HSAs, as required under Code Section 223(g). It also includes the 2025 limit for Excepted Benefit HRAs.
Molina Now Requires Background Checks for Active Agents
Molina Healthcare is initiating a new background check on all agents who have been appointed with them for two years and have active enrollments.