Carrier Corner: KY & OH

Posted on: October 12, 2015 3:20 pm
Tags: May/june newsletter


  • Due to the availability of Nexium 24HR (esomeprazole 20mg) over-the-counter for frequent heartburn, Anthem has changed their Rx formulary, effective October 1, 2015. Nexium 40 mg moves from Tier 2 to Tier 3 and has been added to the Clinically Equivalent Medications program. Esomeprazole 40 mg moves from Tier 2 to Tier 3. Lansoprazole moves from Tier 1 to Tier 3.
  • Age limits will be removed from Hearing Aid Benefits in Kentucky. The benefit is on Hearing Aid per ear every 36 months.
  • Anthem will offer several plans that will include either the Get Active Package or Get Active with Dental Package. This includes: Webinars (Doc Talk), Gym Reimbursement, Healthy Lifestyles Incentives and the chance to earn gift cards for Tobacco Free Certification, Adult Wellness Exams and Annual Flu Shots.
  • Some plans will use the National Rx drug list and some will use the Select Rx drug list.
  • All KY small group Off-Exchange plans will include an Adult Vision Exam only benefit. The benefit will be a $20 copay in-network and $30 out-of-network.
  • Starting November 1, 2015, OrthoNet will manage outpatient physical therapy and occupational therapy services in and out of network. After the first evaluation as an outpatient, members must get prior authorization from OrthoNet for all physical and occupational therapy services for the services to be covered.

Assurant/Sun Life

  • Sun Life Financial will be purchasing Assurant Employee Benefits. The transaction is expected to close by the end of the first quarter 2016, pending regulatory approval. Until then, Assurant Employee Benefits and Sun Life Financial will continue to operate separately.

BlueCross BlueShield of Illinois

  • Some pharmacy benefit plans will have a formulary change.  Certain agents or medication categories may no longer be covered under the group’s pharmacy benefit plan.
  • The Member Pay the Difference program may be added to pharmacy benefit plans where not already implemented.
  • To mitigate rising costs of specialty drugs and promote appropriate patient management, some groups will have the Mandatory Specialty Pharmacy Program. Members will be required to fill specialty medications through Prime Specialty Pharmacy, or another preferred specialty pharmacy, at the specialty copay/coinsurance.

Bluegrass Family Health

  • Bluegrass Family Health is changing its name to Baptist Health Plan.


  • The University of Tennessee Medical Center and affiliated doctors, and other healthcare professionals who are part of University Physicians Association, are part of Cigna LocalPlus network, beginning January 1, 2016.


  • As of August 1, 2015 effective dates, Humana Dental commercial group members will have the convenience of a digital member ID card. This means that renewing and new business clients with Humana Dental commercial coverage will no longer receive a physical member ID card. Members simply log into and use the ACCESS ID CARD link to a paper version or email their ID card to their dental provider. They may also use a smartphone to access their digital ID card through the MyHumana mobile app and fax a copy to their provider.
  • Humana sent creditable coverage information electronically, via Humana Focus news articles. The articles were included in the August editions of each publication.
  • Starting January 1, 2016, some medications covered by Humana’s prescription drug plan may change. Some medicines will now require: Prior Authorization; Step Therapy; Quantity Limits; and/or Tier Changes. There are also some medications that will no longer be covered.
  • Beginning January 1, 2016, if a member is eligible for Medicare Part B, but is not enrolled, and if Medicare is the primary payer, Humana may reduce the member’s benefits by the amount that would have been covered under Medicare Part B had the member been enrolled.

Kansas City Life

  • Due to changing market trends and to better align with medical coverage, KCL will be modifying their procedure so as to terminate applicable dental and vision dependent coverage at the end of the month of the dependent’s 26th birthday. Any dependents terminated prior to October 1, 2015 due to dependent age may be re-enrolled with an effective date of October 1, 2015 if the re-enrollment is received by October 31, 2015.

KY Health Cooperative

  • KY Health Cooperative WILL NOT be offering health plans in 2016. All members currently on KY Health Cooperative plans will be termed effective December 31, 2015. Please contact Mike Williams, Adam Cahill or Joe Jones at SHERRILL MORGAN at 859-291-6600 or 800-291-4222 to find out about your options.


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