In this issue of BlueLinks eNews: |
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April 2009 Dear Business Partner: In order to streamline our management structure in support of our valued broker channel, I recently announced that we were combining the individual/small group and mid-sized group markets in a sales unit led by Larry Croes, sales vice president, Commercial Markets. Larry will have full responsibility for new sales and retention in the individual, small group, and middle markets, and he is accountable for our broker distribution channel. Since joining Blue Cross Blue Shield of Massachusetts in 1999, Larry has successfully led new sales, regional sales, and account management teams in Middle Markets, and he has helped to define our strong sales presence in the health care reform market. An experienced sales manager before joining Blue Cross Blue Shield of Massachusetts, Larry is a recognized leader in our industry for his knowledge of our business and customers, his ability to strategically leverage sales organizational design, and his creativity in launching new technology to enhance our distribution channels. Barbara Tierney and Jeanne McLaughlin now report to Larry. This change will ensure that Blue Cross Blue Shield of Massachusetts is aligned with our best opportunities for future growth. As a result of this change, Vice President Carlos Cubia is taking on a new role of vice president of public affairs in the Public, Government, and Regulatory Affairs division. This edition of BlueLinks eNews is packed with important information that will help you throughout the spring selling season, including a minimum creditable coverage (MCC) overview, State Children's Health Insurance Program Reauthorization Act details, and April product and benefit changes. Thank you in advance for your support of Larry and of Blue Cross Blue Cross Blue Shield of Massachusetts. If you have any questions or comments, please don't hesitate to share them with your account executive. Sincerely, Tim O'Brien |
Attending a broker training/information session is a great way to get the latest news about our industry and products. Please extend this invitation to others in your office who may benefit from this training.
Please select one of the five session locations and RSVP by Friday, May 1st to brokertraining@bcbsma.com.
Sessions are scheduled as follows:
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Quincy |
Boston |
Westborough |
Springfield - Holyoke |
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Blue Cross Blue Shield of Massachusetts One Enterprise Drive Tuesday, |
Blue Cross Blue Shield of Massachusetts Landmark Center Tuesday, |
Doubletree Hotel Wednesday, Wednesday, |
Holiday Inn Thursday, |
National Health Care Reform Update
Many policymakers are supporting a new government health insurance plan to compete with private health plans for the non-Medicare population. In most proposals, the government plan would be structured like Medicare and pay health care providers Medicare rates. Comprehensive health care reform should build on today's employer-based system to extend coverage to everyone, manage costs, and improve quality. At Blue Cross Blue Shield of Massachusetts, this new government plan would undermine an important cornerstone of the U.S. health care system.
We have written to members of the Massachusetts Congressional delegation to state our position on this vital issue.
We ask you to contact your Congressional representatives and urge them to preserve the integrity of employer coverage and private health insurance while protecting the historic and far-reaching expansions our Commonwealth has made in recent years. View talking points to help you communicate this important message.
Health Insurance Responsibility Disclosure Amendments
As you may be aware, the Massachusetts Health and Human Services Division of Health Care Finance and Policy has made several changes to the Health Insurance Responsibility Disclosure (HIRD) form, effective April 1, 2009. The HIRD form has been updated to eliminate information that the Division of Health Care Finance and Policy deemed unnecessary, and added new questions regarding employer disclosures. Below is a brief summary of the changes to the HIRD requirements:
- Employer HIRD forms are now due at the same time as the Fair Share Contribution filings. For some employers this means that they are limited to submitting one employer HIRD report per year.
- In designating whether an employer has 11 or more full-time employees, the determination is now based on quarterly payroll hours rather than annual payroll hours.
- Employers are required to report new information, including details about the employer's full-time criteria, and whether the employer collects employee HIRD forms from employees that decline to participate in the group health plan or Section 125 plan.
- Employers would be required to collect signed employee HIRD forms if they have either 5,500 payroll hours in any quarter or 22,000 payroll hours in a year.
If you have any questions about HIRD or these new changes, please contact your account executive.
Minimum Creditable Coverage Standards Overview
Minimum Creditable Coverage (MCC) establishes the lowest level of health plan benefits Massachusetts residents must have in order to meet the requirement for residents to have for health insurance. For an overview of the core requirements that a health plan must include in order to meet MCC standards, view the MCC fact sheet.
State Children's Health Insurance Program Reauthorization Act
On February 4, 2009, the Children's Health Insurance Program Reauthorization Act of 2009 was signed into law. It extends and expands the State Children's Health Insurance Program (known as SCHIP).
Please note: This article is for informational purposes and does not contain legal advice. Employers may wish to speak with their own legal counsel to ensure their compliance with requirements under this new law.
Key Requirements Related to Special Enrollment Rights:
- Individuals have the right to enroll in an available employer group health plan either: 1) when they become eligible for premium assistance through a state Medicaid or SCHIP program; or 2) when they lose coverage under one of these programs.
- Individuals must request the special enrollment from their employer not later than 60 days of either 1) the date the individual becomes eligible for premium assistance through the Medicaid or SCHIP program; or 2) the date the individual loses coverage under the Medicaid or SCHIP program.
- Employers are required to provide written notice to their employees of the rights under these new provisions and to disclose certain health plan information to the state upon request.
What is Blue Cross Blue Shield of Massachusetts doing to support this change?
Beginning April 1, 2009, Blue Cross Blue Shield of Massachusetts is prepared to honor an account's request to enroll a member who is entitled to special enrollment rights under this new federal law.
- Accounts should submit enrollment requests for these special enrollment situations using the current process for enrolling new members.
- Enrollment requests should include written documentation confirming the date an individual becomes eligible for premium assistance through, or loses coverage under a state Medicaid or SCHIP program.
- Requests to add members as a result of these qualifying events must be received within 90 days of the qualifying event (or within other time frames as permitted by the employer's account agreement or member's benefit design).
- Subscriber certificates and benefit descriptions will include language about these new special enrollment rights as of the employer's account renewal date, beginning on or after October 1, 2009.
- For individuals covered by a group health plan and a Medicaid or CHIP program, Blue Cross Blue Shield of Massachusetts will continue to make the group health plan the primary payer.
We will share additional information with you as it becomes available.
As part of our continued effort to provide effective disease management programs to our accounts, Blue Cross Blue Shield of Massachusetts will take over the management of certain members with asthma from Healthways, Inc. The program offered by Blue Cross Blue Shield of Massachusetts will continue to provide education and support to members and will also include enhanced features, such as earlier identification of members and educational materials online. The Healthways program will be in place until September 1, 2009; however, Blue Cross Blue Shield of Massachusetts will begin the transition by contacting newly identified high-risk members by telephone, beginning on May 1, 2009.
April 1, 2009 Product and Benefit Updates
At Blue Cross Blue Shield of Massachusetts, our comprehensive product portfolio provides many options to meet the varied health coverage and budget needs of individuals and employer groups in Massachusetts. We also continue to enhance our portfolio to meet changing customer needs. Therefore, as of April 1, 2009, we are introducing two new products and making some changes to our product portfolio.
HMO Blue® Premier Value with Co-insurance
This plan offers the same benefits as HMO Blue Premier Value while incorporating co-insurance and deductible features. HMO Blue Premier Value with Co-insurance offers groups and individuals a lower premium than HMO Blue Premier Value, in addition to coverage for primary care and specialist office visits at low copayments. This plan is being made available to the individual and small-group markets, effective April 1, 2009.
Benefits Overview
| Network | HMO Blue |
| Deductible | $1,000 individual plan year deductible $2,500 family plan year deductible Applies to inpatient admissions only |
| Out-of-Pocket Maximum | $2,000 individual plan year OOP max $4,000 family Includes medical deductibles, co-insurance, and copays > $100 |
| Emergency Room | $150 per visit, no deductible |
| Inpatient Care | $1,000 individual plan year deductible per admission $2,500 family plan year deductible per admission |
| Outpatient Day Surgery | 35% co-insurance per visit, no deductible |
| Primary Care Physician Office Visit | $25 per visit, no deductible |
| Specialist Office Visit (including chiropractic services) |
$40 per visit, no deductible |
| Preventive Care Office Visit | $15 per visit, no deductible |
| Diagnostic Labs and X-Rays | 35% co-insurance, no deductible |
| CT, MRI, and PET Scans | 35% co-insurance, no deductible |
| Pharmacy | Retail—$15/$30/$50 Mail Service—$30/$60/$150 |
HMO Blue New EnglandSM Premier Value with Co-insurance
This plan offers the same benefits as our HMO Blue New England Premier Value plan while incorporating co-insurance and deductible features. HMO Blue New England Premier Value with Co-insurance offers groups and individuals a lower premium than HMO Blue New England Premier Value, in addition to coverage for primary care and specialist office visits at low copayments. The plan gives members the flexibility to access providers throughout New England. This plan is being made available to the individual and small-group markets as of April 1, 2009.
Benefit Overview
| Network | HMO Blue New England |
| Deductible | $1,000 individual plan year deductible $2,500 family plan year deductible Applies to inpatient admissions only |
| Out-of-Pocket Maximum | $2,000 individual plan year OOP max $4,000 family Includes medical deductibles, co-insurance, and copays > $100 |
| Emergency Room | $150 per visit, no deductible |
| Inpatient Care | $1,000 individual plan year deductible per admission $2,500 family plan year deductible per admission |
| Outpatient Day Surgery | 35% co-insurance per visit, no deductible |
| Primary Care Physician Office Visit | $25 per visit, no deductible |
| Specialist Office Visit (including chiropractic services) |
$40 per visit, no deductible |
| Preventive Care Office Visit | $15 per visit, no deductible |
| Diagnostic Labs and X-Rays | 35% co-insurance, no deductible |
| CT, MRI, and PET Scans | 35% co-insurance, no deductible |
| Pharmacy | Retail—$15/$30/$50 Mail Service—$30/$60/$150 |
Plans Closing
The following products are being closed for new sales to employer groups with fewer than 50 employees and for individuals for effective dates on or after April 1, 2009:
- HMO Blue $10
- HMO Blue New England $10
- HMO Blue PreferencesSM $600 Plan
- Blue Care Elect PreferredSM (100/80)
Employer groups currently enrolled in these products may continue to renew their coverage. If you have any questions about the new or closing products, please contact your account executive.
Non-Group Enrollment Policy Modification
Blue Cross Blue Shield of Massachusetts is modifying its policy for enrollment effective dates for individuals. The current policy allows individual coverage to become effective any day of the month (including the same day as they submit their application). Beginning March 7, 2009, coverage for individuals who apply for enrollment directly with Blue Cross Blue Shield of Massachusetts will become effective on either the 1st or the 15th of the month, depending on the date of the month during which they apply. For example, individuals will be allowed to purchase a plan that will be effective May 1st, up until the end of the day on April 15th. Individuals will be allowed to purchase a plan that will be effective May 15th up until the end of day on the May 1st. If you have any questions about this change, please contact your account executive.
March IAI: Broker and Employer Updates
Each quarter we mail a printed version of the IAI to accounts and brokers across Massachusetts. It delivers the news and information that helps benefits administrators and brokers like you stay current. Check out the March IAI for articles on limited services clinics, changes for coverage for biologically based mental conditions, products and benefit updates, and more.
Blue Cross Blue Shield of Massachusetts formed Indigo Insurance Services, LLC (Indigo), a wholly owned subsidiary, to provide your clients with the comprehensive Life and Disability coverage they're looking for with the highest degree of customer care and convenience. Secure, reliable, and easy-to-administer through a single point of contact, Indigo products add real value to your clients' benefits portfolios.
Indigo products are underwritten by USAble Life, one of the nation's premier providers of life and disability insurance. Rated "A" by A.M. Best and Standard & Poor's and recognized as one of the U.S.'s top insurance companies by the Ward's 50®', this alliance provides flexible coverage and the peace of mind of knowing that Indigo products are backed by a strong company with secure ownership.
Learn more about Indigo and USAble Life.
If the above links are not functioning in your email, copy and paste the URLs listed below into a browser window:
MCC Fact Sheet
http://mailcenter.newmediagateway.com/bluecrossma/dsc/collateral/april2009_mcc_fact_sheet.pdf
Government Talking Points
http://mailcenter.newmediagateway.com/bluecrossma/dsc/collateral/april2009_talking_points.pdf
BlueLinks for Brokers
http://www.bluecrossma.com/bluelinks-for-brokers/
March IAI
http://www.bluecrossma.com/common/en_US/pdfs/New_SOB/iai/March_09_IAI.pdf
Indigo Information
http://mailcenter.newmediagateway.com/bluecrossma/dsc/collateral/april2009_indigo_abc.pdf
USAble Life Information
http://mailcenter.newmediagateway.com/bluecrossma/dsc/collateral/april2009_usable_life.pdf
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2009 Blue Cross and Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross Blue Shield Association. |