Carrier Corner: Fall 2018

October 4, 2018  |  Carrier Corner


· Anthem has redesigned their Explanation of Benefits (EOBs) to make them easier to read and understand. The new Health Care Summary will include a comprehensive view of all claims activity over approximately a 20-day period. It includes a look at member preventive care gaps, savings opportunities and appropriate site of care.


BlueCross BlueShield TN

· BCBST has implemented a shared savings program, in which BCBST keeps 29% of any subrogations, mass tort recoveries, class action recoveries, Rx rebates (if groups use BCBST as their PBM), as well as a medical drug rebate program where they keep 100% of 4 medications dispensed in the hospital. Groups may opt out of this program, however, BCBST still retains 15% of recoveries for subrogation and mass torts, but they provide 100% of monies fro Rx and class action recoveries. The opt out increases administration fees by approximately 3 percent.


Davis Vision

· Davis Vision has been acquired by Centerbridge Partners, a private equity group and current owner of Superior Vision.



· Beginning with 9/1/18 effective dates, new business groups with 10-99 employees can obtain underwritten Fully Insured and Level Funded Premium quotes using the new Humana Risk Analytic Engine (HRAE). The HRAE required information includes: agent information, legal group name/address/SIC code, payroll/eligible/enrolled employee count, full-time equivalent count (CO, GA, MI, UT), non-standard commission (if applicable), and number of years with current carrier.

· Humana has partnered with Walgreens to get “Close to Home”. They are testing a new retail-based primary care approach in the Kansas City, Mo., area beginning this fall. The “neighborhood” approach will feature “health navigation” through which Human representatives will be available in stores to assist seniors in accessing numerous health-related issues.

· Go365 Monthly Challenge Points will now receive points for participating a challenge, not by just enrolling. Members can receive up to 100 points per month (50 points per challenge).


Sun Life

· Sun Life has acquired Maxwell Health, an innovative technology business that offers an advanced employee benefits platform to make benefits and HR simple for employers and their employees. Built especially for small and mid-sized employers who need simple benefits and leading enrollment solutions, the addition of Maxwell Health adds a total benefits solution to the Sun Life portfolio.