Carrier Corner: TN

Posted on: October 12, 2015 4:00 pm
Tags: May/june newsletter

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 Tennessee

  • BCBST launched a new financial planning tool which delivers cost estimates on common medical procedures, based on historical claims data from BlueCross BlueShield plans nationwide. The new “Financial Planner” tool is located within the Find A Doctor tool, making it simpler for members to compare in-network doctors, assess quality ratings and compare estimates procedure costs.
  • Advanced Diagnostic Imaging to leave Blue Networks P, S and E November 1. As of this publication date a agreement has not been reached. Impacted groups/members should have received a letter  at the beginning of September.
  • A redesigned Member Wellness Portal was launched in late August. It features a clean and simple design, members can complete a personal health assessment, connect with a health coach, set their health goals or track current progress. Additional features in the fourth quarter of 2015 include the AlwaysOn app—a free app available for iPhones used to sync all their data and receive health messages and information through their preferred form of contact. The app allows users access to the same services available through the Member Wellness Portal. The new portal also provides new and updated marketing materials as well as allowing users to add their data for over 80 fitness-tracking devices, such as Fitbit and Garmin.
  • BCBST and HCA have reached a mutual agreement for out-of-network emergency care services at Tri-Star Health facilities in Middle Tennessee and Parkridge Health System facilities in the Chattanooga area. Members in Blue Network E, M and S who were balanced-billed for out-of-network emergency care they received from any of these facilities between May 1, 2013 and December 31, 2014 should receive letters. Under this agreement, members will not be balanced billed for any remaining charges related to the out-of-network care they received. Members will, however, still be responsible for copays, deductibles or out-of-pocket amounts for those dates and may receive an adjusted bill. Any services provided from January 1, 2015 until now will simply be subject to the expected copay or coinsurance and deductible amounts.
  • BCBST guidelines regarding adding spouses to coverage after the Supreme Court ruling legalizing same-sex marriage vary depending on the policy. Member with individual coverage have 60 days from the date of marriage to enroll their spouses, or wait until open enrollment. For insured group coverage, employers must have standard spousal eligibility language in their policy for members to enroll their spouses. For members married after the ruling, they have 31 days from the date of marriage to enroll their spouses. Whether self-funded groups allow coverage for same-sex spouses is at the discretion of each self-funded group. Currently neither federal or Tennessee law requires coverage of domestic partners.

CIGNA

  • 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.

Humana

  • 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 Humana.com 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.

 

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