Health care reform update: new proposed guidance on employer activities

We are writing to provide you with an overview of recent notices issued by the Department of Labor (DOL) and the Internal Revenue Service (IRS) regarding the proposed guidance for provisions of health care reform that impact employer activities. Additionally, we are sharing details about a new research fee that will be assessed to health insurers and employers sponsoring certain group health plans.

Proposed guidance on employer activities: Key details, new information, effective dates

Below are highlights of the proposed guidance for automatic enrollment of full-time employees in an employer’s health plan, shared responsibility of employers regarding health coverage, and 90-day limitation on waiting periods. The public comment phase ended on April 9, 2012. Independence Blue Cross (IBC) will continue to monitor these notices and communicate any final guidance as it is released.

• Automatic enrollment
  
  Key details: An employer that has more than 200 full-time employees and is subject to the Fair Labor Standards Act is required to automatically enroll new full-time employees in one of the employer’s health benefits plans.
  New information: The regulations will not be ready to take effect by 2014.
  What does this mean to impacted employers? The original effective date for this activity was 2014. The effective date is now deferred. Compliance is not required until regulations are issued.
   
• Employer shared responsibility (affordability of employer coverage)
  
  Key details: All large group employers (50 or more full-time equivalent employees) are required to provide coverage that meets minimum essential coverage requirements and is “affordable” relative to an employee’s household income. Employers who do not comply will be subject to an assessable payment (i.e., a penalty) if any full-time employee is certified to receive an individual federal subsidy (advance premium tax credit or cost-sharing reduction payment).
  New information: An employee’s Form W-2 wages (instead of household income) may be used to determine coverage affordability.
  What does this mean to impacted employers? Beginning in 2014, 50+ employers may use an employee’s Form W-2 wages to determine coverage affordability.
   
• 90-day limitation on waiting periods
  
  Key details: A group health plan or group health insurance issuer cannot apply any waiting period that exceeds 90 days.
  New information:
  • Waiting periods will not impact employer shared responsibility provisions. Employers will not be subject to an employer responsibility payment for at least the first three months following an employee’s date of hire.
  • Limits on waiting periods will not require coverage to be offered to any class of employees. The provision prohibits requiring an eligible employee to wait more than 90 days before coverage is effective
  • Existing regulations will apply to an employer’s offer of coverage (e.g., eligibility conditions such as full-time status or receipt of a license)

What does this mean to impacted employers? Clarifications provide guidance for employers’ use of waiting periods for health coverage.

Read the full notices for these employer provisions:

Read DOL Technical Release 2012-01
Read IRS Notice 2012-17

Details on the new comparative effectiveness research fee

The health care reform law includes a new comparative effectiveness research fee on plan sponsors and issuers of individual and group health insurance policies. The assessed fee contributes to the Patient-Centered Outcomes Research Trust Fund. This fund establishes the Patient-Centered Outcomes Research Institute, a nonprofit corporation, to undertake clinical effectiveness research relating to patient-centered outcomes. These outcomes may include research to evaluate risks and benefits of medical treatments, services, procedures, and drugs that treat, manage, diagnose, or prevent illness or injury.

For any policy or plan years ending after September 30, 2012, issuers and employers sponsoring certain group health plans must pay a fee of $1 per average number of covered lives per year. The fee increases to $2 per average number of covered lives per year for policy years ending after September 30, 2013. Therefore, the first policy year to which the fee applies would be a policy year that ends on or after October 1, 2012. If the policy or employer plan is a calendar year plan, the first fee would apply for the 2012 calendar year. The first fees will be paid in July of 2013.

The fee will be the subject of hearings and eventually proposed regulations addressing, among other things, how to count the number of employees, spouses and children that are subject to the fee. Read the IRS Notice of Proposed Rulemaking.

Who pays this fee?

• For fully insured plans, IBC will be responsible for paying this fee.
• For self-funded plans, the plan sponsor (group) is responsible for paying this fee.

For more information, contact your Independence Blue Cross account executive.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

To ensure you receive your AmeriHealth New Jersey emails, please add brokerbriefs@amerihealth.com to your address book.
If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

259 Prospect Plains Road, Bldg. M, Cranbury, NJ 08512-3706 | amerihealthnj.com
©2012 AmeriHealth Insurance Company of New Jersey. All rights reserved.
©2012 AmeriHealth HMO, Inc. All rights reserved.

Reminder: Lipitor coverage to change June 1, 2012

Effective June 1, 2012, Lipitor, a brand-name drug used to treat high cholesterol, will become a non-preferred drug and will move from formulary Tier 1, the lowest cost-sharing level, to Tier 3, the highest cost-sharing level. Members with a copay prescription drug plan and who wish to refill their Lipitor prescription are encouraged to fill it with atorvastatin, the generic equivalent of Lipitor, so that they can continue to pay at the lowest cost-sharing level. Members who have deductible prescription programs, discount card plans, or coinsurance plans are not affected by this change.

We originally notified you and members about this change in November 2011 when atorvastatin became available in the marketplace. Beginning November 30, 2011, Independence Blue Cross (IBC) offered a special, limited-time program in which we moved Lipitor to the formulary’s Tier 1, so members paid the lowest copayment.

Communicating about the Lipitor change

Members who take Lipitor and have a copay prescription program will receive a letter reminding them about this upcoming change. As this communication is only being mailed to members, we encourage you to notify group administrators of this change.

If you have any questions, please contact your IBC account executive.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

To ensure you receive your AmeriHealth New Jersey emails, please add brokerbriefs@amerihealth.com to your address book.
If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

259 Prospect Plains Road, Bldg. M, Cranbury, NJ 08512-3706 | amerihealthnj.com
©2012 AmeriHealth Insurance Company of New Jersey. All rights reserved.
©2012 AmeriHealth HMO, Inc. All rights reserved.

Introducing the Blue Solutions^® eNewsletter for small and mid group customers

Independence Blue Cross (IBC) values our customers and wants to make sure they are getting the most from their health care plans. Every month, we will send the Blue Solutions eNewsletter to our small and mid-size group customers.

The Blue Solutions eNewsletter will feature articles about membership advantages, benefits information, health care reform updates, and other news that speaks to the needs of small business owners and their employees. We will also include a survey question to engage readers, a tip of the month, and a list of upcoming events.

May's eNewsletter will center on wellness and encourage customers to promote our online tools and reimbursements for engaging in healthy activities. Small and mid-size groups will receive separate emails with corresponding Blue Solutions logos. The messaging will typically be the same; however, if we ever need to target messaging to specific audiences, separate emails will allow us to do so.

Please Note: We are only sending emails to customers for which we have email addresses. Also, if your customer doesn't receive the email, please update their email address in ROAM.

Small Group Blue Solutions eNewsletter

Mid Group Blue Solutions eNewsletter

In future editions, we would like to highlight customers who have found successful ways to promote wellness in the workplace. If you have a customer in mind that may want to be featured, have any questions about the eNewsletter, or if you have topics you think we should feature, please contact your Independence Blue Cross account executive.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

Please Note: Producers will receive this notice in two business days

Important changes to IBC's individual plans

We want to let you know about two upcoming changes to our individual medically underwritten HMO and PPO products that will impact our members. The first change is that we are implementing a monthly rate increase for our individual medically underwritten HMO plans, effective July 1, 2012. Additionally, we are notifying members enrolled in our HMO and PPO products who have moved into a new age bracket about an adjustment to their premiums.

Why are rates increasing for individual HMO plans?

Increasing premiums is not a decision we make without carefully considering all options. To continue to provide our members with high-quality coverage in the face of rising health care costs, it is necessary for Independence Blue Cross (IBC) to implement a 9 percent rate increase for all of our individual medically underwritten HMO plans only, effective July 1, 2012. This rate increase has been approved by the Pennsylvania Insurance Department and affects monthly premiums.

Rates for our individual plans are based on five-year age brackets. As a result, some members will experience an additional increase if they or the oldest family member covered under their policy:

• have entered a new age bracket since July 2011, when IBC last adjusted premiums based on age;
• or will enter a new age bracket when the rate increase goes into effect on July 1, 2012.

We anticipate that about 18 percent of our HMO members will experience a base rate increase coupled with a change in age bracket.

The base rates for our individual medically underwritten PPO plans are not increasing. However, we will adjust rates for PPO members who have moved into a new age bracket. Similar to our HMO plans, rates for our PPO plans are based on the age of the oldest family member covered under the policy.

Will members be able to select a lower-cost coverage option?

Yes. Because we understand that some members may want to consider changing their current coverage, we are providing members with information about lower-cost coverage options available to them. The letter members will receive includes a benefits overview to help them compare plans along with a Plan Change Request Form that they need to complete and return if they want to choose a step-down option. Members enrolled in our lowest-cost option, PPO 8000 Deductible, and our Medicare eligible members, will not receive step-down options.

Are there any members who will not experience a rate increase in July?

Yes. New individual medically underwritten plan members are entitled to a rate guarantee for the first six months of their coverage. The following chart shows the effective dates for new members subject to the rate guarantee, and when their rate increase/age bracket adjustment will be implemented.

When will HMO and PPO members see the rate adjustment on their bill?

All HMO and PPO members will see the adjustment to their monthly premium reflected in their July billing notice. Members who mail their payment to IBC do not need to take any action other than to pay the new premium. We are asking members who pay their premiums through a monthly automatic bank withdrawal to make note of the new amount that will be deducted from their account beginning on July 1.

Communications

In mid-May, we are sending a letter to HMO and PPO members with details about the rate increase. Members who receive the six-month rate guarantee will be notified about the rate increase 45 days prior to the expiration of their rate guarantee and the effective date of their new rate.

Members who are 65 or older by July 1, 2012, will receive a custom letter explaining that their rate may be lower if they also currently have Medicare coverage. These members will not receive alternate plan options.

If they have questions, members can visit the Change My Plan website, contact their broker, or call 1-888-249-2118.

The Change My Plan website provides members with step-down coverage options, answers to frequently asked questions, and instructions for adding or removing a dependent from a policy.

View the member letters:
HMO rate increase
HMO rate increase with age banding
HMO Medicare rate increase with age banding
PPO age banding
PPO 8000 (lowest-cost option)
PPO Medicare age banding
July 1, 2012 Tier 1 Rate Sheet

If you have any questions, please contact your IBC account executive.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

Please Note: Producers will receive this notice in two business days

Redesign of IBX.com debuts

We're pleased to announce that the newly redesigned ibx.com is now live.

Improved Interface, User Experience

The new ibx.com is built to be more user-friendly with improved navigation, customer-specific features, and simplified information. Brokers, health insurance consumers, members, and providers will find it easier to locate pertinent information and perform popular tasks.

Aligning our public websites

The redesign makes ibx.com the cornerstone of Independence Blue Cross's online corporate identity. Our websites now share a similar look plus the same ease of use, providing unity and brand consistency.

Although the most obvious change is in how ibx.com looks, we've also refreshed the content and added some new sections, like Health Insurance 360, a comprehensive overview for anyone who wants to know more about health insurance.

Introducing our new Broker section

As part of the redesign, we're excited to announce a new section of ibx.com exclusively for brokers. The Brokers tab, located at the top right-hand side of the page, allows you to easily access:

• the Broker Care Center;
• group plan information;
• ROAM;
• a Quick Links section with helpful information about individual and Medicare plans, online account management, and provider searches.

We've also included a Broker News & Announcements section, so you will always know the latest developments from IBX.

Have the locations of my favorite links changed?

We worked hard to make sure the links you've been using were updated in the redesign. If we eliminated or moved a page, when you visit it you'll receive a message or automatically be redirected to the new version page.

Tell us what you think

If you have questions about the redesign of IBX.com, please contact your IBC account executive or send a message to IBC's web team.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

IBC is working to update small group invoices

We are aware that you have been receiving calls from your small group customers about an error on their May invoice from Independence Blue Cross (IBC). This only applies to small groups with copayment plans and fewer than 50 contracts. We are writing to explain the reason for the error and to let you know that we are working to resolve this issue as quickly as possible.

An explanation for the error

As you know, we began moving our small group customers from calendar year to contract year benefits beginning with February 2012 renewals. As part of this transition, it was necessary for IBC to issue new account numbers. This also generated new group numbers.

When we processed the May invoices for your customers, our billing system did not properly transfer the payments from the original account number to the new account number. As a result, the total due amount on the invoices is incorrect.

Communications

Please note that this is a billing issue only and has not affected access to care. We are sending a letter to your customers in the next few days to let them know that we are working to resolve this issue in a timely manner. We are instructing them that they are required to pay only the current charges amount shown on the invoice.

We are also advising them that they may receive their June invoice a few days later than usual so that we may verify that all invoices are correct before issuing them. If your customer submits payment to IBC by mail, the new account number appears on the payment coupon. If your customer submits payment to IBC electronically, we are asking them to update their electronic funds transfer account with their new account number.

To assist you in notifying your customers of their new group and account numbers, each General Agent will receive a report via email today. This report will provide the original group number, the new group number, and the new account number for all affected customers with February, March, and April renewal dates. A communications plan is being developed to address the change in group and account numbers moving forward. We will provide you with an update once this is completed.

On behalf of IBC, please accept our sincere apologies for the inconvenience this has caused you and your customers.

If you have any questions, please contact your IBC account executive.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

Closure of Peninsula Hospital Center

Closure of Peninsula Hospital Center

Independence Blue Cross Sustains Positive Financial
Results in 2011

Independence Blue Cross (IBC) reported positive financial results in 2011 with a net profit margin of 3.4 percent and a net after-tax income of $314.8 million, achieved by offering new capabilities and services to customers, attracting new customers, reducing operating costs, and working collaboratively with hospitals and physicians to enhance health care delivery.

"A few years ago when the overall economy weakened and health care reform was creating uncertainty, IBC experienced financial hardship as did many other companies. It was critical that we regain financial stability so we could invest in the capabilities our customers expect from us and prepare for the future," said Independence Blue Cross president and CEO, Daniel J. Hilferty. "Our positive 2010 results were a catalyst for our successful 2011. Today, we are proudly heading in the right direction and making great progress. However, we won't rest – we know there's more to be done in the health care system in our region."

IBC's successful 2011 was attributed to multiple factors

By developing new, more flexible, lower cost health plans, the company attracted more than 45,000 new members. Overall, IBC and its affiliated companies had 3.1 million members nationwide in 2011, a 1.4 percent increase above 2010.

To reward physicians and hospitals for providing excellent, cost-effective care, IBC enhanced its nationally-recognized physician and hospital incentive programs. At the same time, the company deepened its commitment to a remarkable new patient care model, called patient-centered medical homes, that now delivers care to 500,000 members in southeastern Pennsylvania.

To expand IBC's capabilities, the company pursued relationships with like-minded organizations also focused on transforming the health care system. In August 2011, the company entered into an agreement with Blue Cross Blue Shield of Michigan to acquire AmeriHealth Mercy, a top-tier Medicaid managed care organization headquartered in Philadelphia, with the goal of further expanding services to Medicaid beneficiaries across the country.

The company also launched the Independence Blue Cross Foundation with a total investment to date of $45 million. The foundation is committed to transforming health care through innovation in the Philadelphia region.

2011 was a time of remarkable transformation for the health care industry and IBC will continue exploring new ways of doing business to anticipate the demands of consumers in a changing environment.

We extend our sincere thanks and appreciation to you, our loyal brokers, for your strong support and business in 2011. Your steadfast commitment and drive toward our shared goals were key components of our success and we look forward to even greater achievements with you in 2012.

IBC's 2011 financial details

Total 2011 revenues were $9.2 billion, compared to $9.6 billion in 2010. Net income after taxes was $314.8 million, compared to $211.2 million in 2010. Investment and other income was $138 million in 2011, compared to investment and other income of $127.4 million in 2010.

In 2011, IBC paid $210.4 million in federal, state, and local non payroll taxes.

The company's surplus for 2011 was $2.1 billion, which is in the sufficient range, according to the Pennsylvania Insurance Department's guidelines, which means that IBC maintains a surplus level that is appropriate to ensure its long-term stability.

For more information, read the press release.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

Introducing...

Oxfordhealth.com mobile

IBC offers frequent health care reform updates:
New - Supreme Court hearings

You told us that you would like regular communications from Independence Blue Cross (IBC) about health care reform and how the provisions of the current law may affect your customers. We listened, and you can be assured that we will be sending you more frequent information, beginning with the recent Supreme Court hearing information below.

The Supreme Court scrutinizes the health care reform law

Last week, the Supreme Court held hearings on the constitutionality of the health care reform law. The hearings earned wide coverage from the news media, with much public speculation about possible decisions and what they could mean for health care in our country. The final decision is expected by the end of June.

We continue to support health care reform

We believe that all Americans deserve the peace of mind of having access to affordable, quality care. The 2010 health care reform law expands coverage to millions of Americans. For example, it has expanded coverage of preventive care and extended coverage for adult children to age 26. The law also expands coverage to an estimated 30 million uninsured Americans , through Medicaid and government subsidies.

However, it does little to raise the quality of care or lower costs. Much more still needs to be done. Additional reforms need to raise the quality of U.S. health care, which is inconsistent. Equally important, future reforms must help reduce ever-increasing health costs, which represent 17 percent of our gross domestic product. All stakeholders in health care – doctors, hospitals, pharmaceutical companies, insurers, government, and consumers – must work together toward these goals.

Our position on the individual coverage mandate

There has been much discussion in the news media about the individual coverage mandate and how the Court may rule on this aspect of the law. If insurers are required to accept anyone who applies for coverage, we believe that the law must require that everyone have insurance. Without this important mandate, people would be able to buy insurance when they are sick and drop it when they are well. And that will drive up premiums for everyone, making coverage unaffordable.

We are helping customers comply with the law

We are working closely with our customers to help them prepare for reform and smoothly implement the changes required by law. For example:

• We are complying with regulations already in place and educating customers about provisions such as keeping their existing benefit plans intact, which is allowed through the law's "grandfathering" rules.
• We are working on providing new benefit summaries – required under the law – to our customers that may make it easier for them to compare and understand their coverage. These summaries will be similar across all health plans.
• We're working with the Commonwealth of Pennsylvania to create a state exchange, where consumers and small businesses could shop for health coverage, obtain subsidies, and compare products and prices.

We are working to improve care and lower costs

No matter how the Court rules, IBC will continue to be a leader in transforming the delivery of health care. We are collaborating with physicians, hospitals, customers, and other partners to find ways to increase access to care, improve quality, and rein in rising medical costs. Here are a few examples:

• We are promoting better primary care through continued support of patient-centered medical homes, and providing new incentives to doctors and hospitals to transition our reimbursement system toward one that rewards superior quality and safety.
• We have worked with Lumeris and other Blue plans on the joint acquisition of NaviNet^®, one of the nation's leading health care communications systems that allows hospitals, doctors, and insurers to work together more closely and improve the quality and lower the cost of care.
• We are helping our region's most vulnerable people, by funding the IBC Foundation, which supports non-profit medical clinics and 145,000 underserved people in the Philadelphia area.

This is a time of remarkable transformation for the health care industry. We will continue exploring new ways of doing business to anticipate the demands of consumers in a changing environment. We are enhancing our technology to provide increased transparency and more real-time tools, such as mobile applications, to help physicians and consumers make more informed decisions. Count on us to keep you posted on health care reform and its provisions, as the Supreme Court reaches its decision, and beyond.

If you have any questions, please contact your IBC account executive.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

Update –Medical Loss Ratio Provision

We are writing to update you on the Medical Loss Ratio (MLR) provision of the Affordable Care Act. This requires that health insurance carriers must pay rebates to customers in the event that their Medical Loss Ratio (as defined by the Act) is below the prescribed levels.

On April 1, 2012, we submitted a Supplemental Health Care Exhibit report to the National Association of Insurance Commissioners (NAIC) and the Pennsylvania Insurance Department (PID) to approximate our medical loss ratio. The report will assist the PID in tracking and comparing enrollment and financial results of insurance companies. While the filing provides some information related to future MLR rebates, the report and MLR rebate forms are different. Therefore, the Supplemental Health Care Exhibit is illustrative only and will not be the basis of any possible MLR rebate payments.

Reported in the filing are premium claims, quality improvements, taxes and fees, and a preliminary MLR rate by legal entity, by state, and by market segment.

To help answer any questions about the report or rebates, please review our recently updated Frequently Asked Questions.

The final amount of rebates we will be paying will not be known until we file our report with the Department of Health and Human Services on June 1, 2012. If a group is eligible for a rebate, they will receive notification of that rebate along with the rebate by August 1, 2012.

Some customers will receive communications about the
MLR provision

In April, we will be communicating to a small number of customers who are non-ERISA and non-government entities (such as church groups). This communication will request that these employer groups provide written assurance that any potential MLR rebate paid to them will be used for the benefit of their employees. If IBC does not receive written assurance by these groups, the entire amount of any potential rebate applicable to these policies will be paid directly to their employees.

If you have any questions, please contact your Independence Blue Cross account executive.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

We are committed to providing your clients and their employees with access to comprehensive and affordable health care services. As part of this strategy, we are currently negotiating a new agreement with Westchester Medical Center (including Maria Fareri Children's Hospital) in Valhalla, New York.
 

Our current agreement with Westchester Medical Center, which affects both UnitedHealthcare and Oxford commercial products, may terminate on May 1, 2012. We are employing good faith efforts to negotiate a new contract that is acceptable to both parties and meets our commitment to keep health care affordable.
 

In the event of a contract termination, the State of New York requires insurance carriers and hospitals to observe a two month "cooling off period," which is simply a period of time after the termination of a contract when fully insured commercial members can still access the terminated hospitals on an in-network basis in the hopes that the hospital and the carrier can reach a new agreement.
 

Since this cooling off period does not apply to commercial self-funded groups and plan participants (members), in the event of a termination, Westchester Medical Center would become non-participating for those members on May 1, 2012. For fully insured commercial members, Westchester Medical Center, and physicians without admitting privileges somewhere other than Westchester Medical Center, would become non-participating on July 1, 2012.
 

When speaking with your clients, please keep in mind the following points:
 

·         We will have Transitional Care guidelines in place so members who are eligible for Transitional Care and who have scheduled or ongoing medical treatments at Westchester Medical Center will continue to get care as appropriate.
 

·         Fully insured commercial members would continue to have access to Westchester Medical Center on an in-network basis through the New York State cooling off period, which would end June 30, 2012. Transitional Care may be available after the cooling off period in accordance with the member's Certificate of Coverage.
 

·         After April 30, 2012, a primary care physician or specialist should not refer self-funded members to Westchester Medical Center for any treatment or test. Instead, members should be referred to one of the major neighboring hospitals in our network, as listed below.

We are sending communications to members who may be affected should Westchester Medical Center terminate from our networks. To view samples of the communications to self-funded members, which will be mailed on April 2, 2012, please click the links below.
 

·         UnitedHealthcare Member Letter

• Oxford Member Letter

We will continue to work toward a positive outcome of affordable health care for our employers and their employees and will keep you informed about the status of the negotiations. If you would like more information or have questions, please contact your sales representative.
 

To unsubscribe from future email communications, please send an email with 'unsubscribe email' noted in the subject line to NortheastMarketing@uhc.com. Please include your full name and the name of your company in your request.
 

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by UnitedHealthcare Insurance Company, United HealthCare Services, Inc. or their affiliates. Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. © 2012. Oxford Health Plans LLC. All rights reserved.

NY-12-271

4/02/12

FutureScripts corrects pharmacy benefits error

We are writing to inform you that FutureScripts^® has corrected an error that permitted some members to fill a prescription that requires prior authorization (without receiving the necessary prior authorization), or fill a prescription that is not a covered benefit. Please note that credit adjustments will be made to invoices for self-funded customers accordingly.

Prior authorization

If a member needs to fill a new prescription or refill a current prescription that requires prior authorization, the member will need to ask his or her doctor to obtain prior authorization first. The doctor may decide to prescribe an alternative medication that does not require prior authorization or complete a prior authorization form and fax the necessary paperwork to FutureScripts for review.

If the medication is approved, the doctor will be notified of the approval by phone or fax within two business days of the approval decision. Once the member's record shows the drug has been made available, a pharmacist can fill the prescription. If members are unable to obtain prior authorization before their current supply of medication runs out, they will receive a temporary, four-day supply according to the standard prior authorization process.

If the medication is denied, the member will receive written notification, and we will notify the doctor of the denial by phone or fax within two business days of the denial decision. The member may appeal this decision. The appeals process is explained in detail on all denial letters.

Covered benefits

Moving forward, members who have recently filled a prescription that is not a covered pharmacy benefit according to the terms of their benefits contract will no longer be able to fill these prescriptions. Independence Blue Cross (IBC) will not seek repayment from members for the cost of the prescription drug that was paid for in error. You can access the list of covered prescription drugs as well as those that require prior authorization by logging into ibxpress.com and clicking Find a Prescription Drug.

Communications

We will be notifying affected groups and members this week.

View the letter to fully insured groups with affected members.

View the letter to self-funded groups with affected members.

View the letter to members who filled a prescription which had a prior authorization.

View the letter to members who filled a prescription that was not a standard covered benefit.

If you have any questions, please contact your IBC account executive.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

IBC joins HM Insurance Group to offer Stop-Loss products to self-funded customers

Independence Blue Cross (IBC) has entered into a long-term agreement with HM Insurance Group (HMIG) to offer best-in-class stop-loss products to self-funded customers. HMIG is one of the nation's leading stop-loss carriers, with more than a $650 million book of business. As part of the agreement with IBC, HMIG will perform all stop loss related services, including underwriting.

Value of the new Stop-Loss agreement

Your groups will receive excellent stop loss rates because of their access to IBC's provider network discounts, and because of HMIG's national presence. Your clients will also benefit from innovative product designs and simplicity at renewal — no additional disclosures or new lasers required. Covered services, exclusions, and limitations on coverage under the stop-loss agreement will align with the group's self-funded health benefits program. Conducting business will become even easier as new plans are developed and further efficiencies are established between IBC and HMIG.

Other benefits include:

• Streamlined administration, quicker turnarounds, and prompt claims adjudication.
• "Best in Class" reporting. Stop-loss notification and reporting services are provided to your customers at no additional charge.
• Stop-Loss resources. Self-funded seminars and materials are available to you and your office.

We believe the agreement between IBC and HMIG will bring substantial benefits to you, your producers, and your customers. Please share this new information with your self-funded customers.

If you have any questions, please contact your Independence Blue Cross account executive.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

Broker Alert

Aetna offers new product suite to help employer groups with up to 100 employees position for health care reform

We are pleased to announce that effective May 1, 2012, we will be providing new plan options for Pennsylvania and Delaware employers with up to 100 eligible employees.

The health care environment is changing

To help our customers with up to 100 employees adapt to the new health care law, Aetna is introducing a new portfolio of products. These new plans provide:

• A simpler and easier way to choose the plan that is right for them
• Benefits plans that are designed to meet the needs of their employees
• A consistent and engaging service experience
• A range of plans to meet their financial needs

While both Pennsylvania and Delaware will transition to these new plans, the portfolios remain distinct for each state.

What you and your clients can expect

• At renewal, Pennsylvania groups with 2-50 employees, and Delaware groups with up to 100 employees will transition to the new product portfolio beginning with the 5/1/12 renewing cases.
• Impacted customers and members will receive letters notifying them of these plan changes 90 days prior to the renewal date, per Pennsylvania and Delaware state requirements. We've included copies of the letters for your reference.
  – Pennsylvania (2–50): plan sponsor letter | member letter
  – Delaware (1–100): plan sponsor letter | member letter
• In March, you can obtain your new business quotes through HealthConnect via Producer World. In order to access this system, you must first be registered for Producer World. Once you have registered, take a moment to view the TOUR today!
• New plan guides featuring our expanded portfolio of options and new underwriting guidelines are also available on Producer World.
• e-Enrollment will also be available through these new plans.

Compensation is changing for your 51–100 clients

Broker compensation for these new plans will be based on a commission-based model. Effective May 1, 2012, commissions will be:

The compensation for your Pennsylvania (2-50) and Delaware (1-50) clients will not be impacted. As your 51-100 customers transition into the new plans, the compensation you receive will transition from the current Producer Service Fee model to the commission-based compensation model.

Looking Forward

We recognize the important role that you play as an independent and trusted resource for customers who are making health insurance decisions. We are excited about the opportunities our new plans provide to improve the quality and affordability of the services we are able to provide to customers with up to 100 employees. We look forward to continuing to work with you to meet the needs of our customers now, and in the future. If you have questions, feel free to contact your Aetna Account Manager or Account Executive.

Modification of Aetna Producer Agreement – 51-100 customers

This letter serves as notice pursuant to Section F(13) of the Aetna Producer Agreement that effective May 1, 2012, for the medical products for your clients with up to 100 employees, Aetna will pay base commissions on new or renewal business pursuant to a new commission schedule and will no longer collect and forward any producer service fees. Accordingly, we will be terminating any Billing and Collection Agreement that may apply to your clients with up to 100 eligible employees effective as of the renewal date on or after May 1, 2012.

This change to your existing Aetna Producer Agreement includes the modification of your current commission schedule, Addendum B, to remove the 0% commissions payable by Aetna. The amended Addendum B can be found on Producer World. All other terms and conditions of the Aetna Producer Agreement shall remain in full force and effect.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. Those companies include Aetna Life Insurance Company, Aetna Health Inc. and Aetna Health Insurance Company of New York (Aetna).

Legal statement   Program provisions   Privacy Information   Member disclosure   Aetna Companies: State Directory

If you have any questions, please Contact Us.

You are receiving this because you have elected to communicate with Aetna through e-mail. If you no longer wish to receive these particular messages via e-mail, you may unsubscribe at any time.

We are located at 151 Farmington Ave, Hartford, Connecticut 06156.

© 2012 Aetna, Inc. The Aetna name and logo are registered trademarks. 

Davis Vision resolves contract dispute

On Saturday, February 18, 2012, the local union of Davis Vision’s eyeglass manufacturing facility in Newtown Square, Pa., agreed to terms of a new contract and concluded their strike. We sent you an eBulletin immediately upon notification of the strike in late January to ensure that you were promptly informed and to assure you that service would not be interrupted.

We are now pleased to confirm that the contract dispute has been resolved and that the member service experience was not impacted.

For more details, please refer to the press release issued by Davis Vision.

If you have any questions, please contact your Independence Blue Cross account executive.

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.

Health Care Reform Regulations on Rescission of Coverage

The Patient Protection and Affordable Care Act of 2010 includes a provision designed to prohibit health insurance issuers and group health plans from rescinding coverage except in the case of fraud, an intentional misrepresentation of a material fact, or failure to pay a required premium. A rescission is defined as a cancellation of coverage that has a retroactive effective date. This provision applies to all group and individual health plans and is consistent with the consumer rights and protections that are the foundation for health care reform.

The following are several examples that illustrate this health care reform provision:

• If a member paid premium or contributed to the cost of the plan, coverage may not be terminated with a past effective date – except in the case of fraud or a misrepresentation of a material fact. The group health plan or health insurance issuer must provide a 30 day written notice of coverage termination to each individual affected by the termination before coverage may be rescinded. The member has the right to appeal the rescission of coverage.
  
  Example: If it was discovered that the insured individual intentionally omitted significant health related issues from the application, coverage may be terminated back to the effective date of coverage. However, the group health plan or health insurance issuer must provide 30 days prior written notice to each individual who would be affected by the termination before the coverage may be rescinded.
   
• If a member paid premium or contributed to the cost of the plan and it is subsequently determined he or she was ineligible for coverage, the group health plan may terminate coverage with a prospective (future) termination date only.
  
  Example: If an employer group covers full-time employees only and later discovers that, due to administrative error, a part-time employee was added to the plan and paid premium or contributed to the cost of the plan, then the employee can only be terminated using a future effective date.
   
• If a member did not pay premium or contribute to the cost of the plan after the termination date, an employer may terminate coverage with a past effective date as part of their administrative record keeping to reconcile eligibility data. The Departments of Health and Human Services and Labor and Treasury have issued guidance that they do not consider retroactive terminations back to the date of termination of employment, due to a delay in record keeping, to be a rescission under the health care reform provision. The retroactive termination date must coincide with the IBC retroactive termination policy.
  
  Example: Human resources reconciles the list of eligible individuals with the health insurance issuer or group health plan via a data feed only once per month. In this case, if the member did not pay premium or contribute to the cost of the plan, the retroactive termination is considered a delay in record keeping and part of the normal course of business.

IBC Retroactive Termination Policy

In connection with the implementation of this health care reform provision, IBC is revising our retroactive termination policy. Read more.

For more information

For more information regarding Health Care Reform or the rescission policy, please contact your IBC account executive or visit the following websites:
http://www.dol.gov/ebsa/faqs/faq-aca2.html
http://www.healthcare.gov/law/features/rights/cancellations/

Independence Blue Cross | 1901 Market Street | Philadelphia, PA 19103

To ensure you receive your Independence Blue Cross emails, please add mcomm.ibx@comm.ibx.com to your address book. If you received this email in error, or do not wish to receive future emails from us, unsubscribe.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent licensees of the Blue Cross and Blue Shield Association.

View our Privacy Policy.