MA/PDP Bank Drafts:

A voided check has always been required to set up EFT on these contracts. It could take up to 2 billing cycles for the draft to go in effect so members can expect a bill the first month. PDP members who fall out of the automation process and who have not submitted a voided check are receiving letters requesting a voided check. Unfortunately, IT is unable to retrieve the electronic banking info from the system due to how the info is encrypted.  The voided checks need to be submitted until a fix is identified.

February bills are being dropped between 1/3 and 1/9 so please make members aware that they could receive another bill.

HOW to submit voided check info?

1. If the draft info is in-house, but they just need to confirm if it is a checking or savings account,  work through Agent Services.
2. Submit the correct EFT form with data via fax: 800 833 8554

Open Enrollment Period (OEP): 

The Centers for Medicare & Medicaid Services (CMS) has re-established an Open Enrollment Period (OEP).  OEP will begin January 1 and end March 31, 2020.

This enrollment opportunity is available to beneficiaries who are currently enrolled in a Medicare Advantage Plan (with or without drug coverage) and allows the following:

• Switch to another Medicare Advantage Plan (with or without drug coverage).
• Disenrollment from the Medicare Advantage Plan and return to Original Medicare and enrollment into a standalone Prescription Drug Plan.

During this period, beneficiaries may not:

• Switch from Original Medicare to a Medicare Advantage Plan.
• Join a Medicare Prescription Drug Plan (if currently enrolled in Original Medicare).
• Switch from one standalone Medicare Prescription Drug Plan to another.

One change is permissible during this period, and any changes made will be effective the first of the month after receipt of the enrollment application.

Marketing Guidance

Plans, including agents/brokers, may NOT knowingly conduct any OEP marketing to Medicare Advantage members during the OEP timeframe. This prohibition includes knowingly targeting or sending any unsolicited marketing materials, by telephone, direct mail and/or e-mail.

Examples of ‘knowingly’ targeting for OEP:

• Sending unsolicited materials advertising the ability/opportunity to make an additional enrollment change or referencing the OEP.
• Messaging specifically calling out the OEP; including dates/timeframe – even in an ‘educational’ context for existing members/clients.
• Marketing to beneficiaries who are in the OEP because they made a choice during the Annual Enrollment Period (AEP) by purchase of mailing lists or other means of identification.
• Engage in or promote agent/broker activities that intend to leverage the OEP as an opportunity to make further sales.
• Call/Contact former enrollees who elected a new plan during the AEP.

Marketing activities focused on other enrollment opportunities may continue to be conducted, such as (but not limited to):

• Age-Ins
• 5-star Plans (if available)
• Dual-eligible and LIS beneficiaries

Agents/Brokers may also, upon beneficiary request, send marketing materials, schedule one-on-one meetings and provide information regarding OEP via telephone.

Note: The unintentional receipt of other marketing materials by beneficiaries who have already made an enrollment decision is not be considered knowingly targeting.

Additionally, if a beneficiary contacts an agent/broker and asks about their eligibility to enroll into the plan — but makes no explicit reference to OEP — the agent/broker can and should review their information and utilize an eligible enrollment period, including OEP, to assist the beneficiary with the desired plan change.

For example, if an agent/broker sends mailers to a list of age-ins discussing the Initial Coverage Election Period (ICEP), it is possible that some recipients may have already made an enrollment decision; however, the content of the message to the intended audience of age-ins is not prohibited OEP marketing.

OEP activity must be initiated by the member.

Any proactive marketing or unsolicited contact by an agent/broker during the OEP will be subject to a Sales Allegations and subsequent corrective action.

The Centers for Medicare & Medicaid Services (CMS) has re-established an Open Enrollment Period (OEP).  OEP will begin January 1 and end March 31, 2020. This enrollment opportunity is available to beneficiaries who are currently enrolled in a Medicare Advantage Plan (with or without drug coverage) and allows the following: Switch to another Medicare Advantage Plan (with or without drug coverage). Disenrollment from the Medicare Advantage Plan and return to Original Medicare and enrollment into a standalone Prescription Drug Plan. During this period, beneficiaries may not: Switch from Original Medicare to a Medicare Advantage Plan. Join a Medicare Prescription Drug Plan (if currently enrolled in Original Medicare). Switch from one standalone Medicare Prescription Drug Plan to another. One change is permissible during this period, and any changes made will be effective the first of the month after receipt of the enrollment application. Marketing Guidance Plans, including agents/brokers, may NOT knowingly conduct any OEP marketing to Medicare Advantage members during the OEP timeframe. This prohibition includes knowingly targeting or sending any unsolicited marketing materials, by telephone, direct mail and/or e-mail. Examples of ‘knowingly’ targeting for OEP: Sending unsolicited materials advertising the ability/opportunity to make an additional enrollment change or referencing the OEP. Messaging specifically calling out the OEP; including dates/timeframe – even in an ‘educational’ context for existing members/clients. Marketing to beneficiaries who are in the OEP because they made a choice during the Annual Enrollment Period (AEP) by purchase of mailing lists or other means of identification. Engage in or promote agent/broker activities that intend to leverage the OEP as an opportunity to make further sales. Call/Contact former enrollees who elected a new plan during the AEP. Marketing activities focused on other enrollment opportunities may continue to be conducted, such as (but not limited to): Age-Ins 5-star Plans (if available) Dual-eligible and LIS beneficiaries Agents/Brokers may also, upon beneficiary request, send marketing materials, schedule one-on-one meetings and provide information regarding OEP via telephone. Note The unintentional receipt of other marketing materials by beneficiaries who have already made an enrollment decision is not be considered knowingly targeting. Additionally, if a beneficiary contacts an agent/broker and asks about their eligibility to enroll into the plan — but makes no explicit reference to OEP — the agent/broker can and should review their information and utilize an eligible enrollment period, including OEP, to assist the beneficiary with the desired plan change.   For example, if an agent/broker sends mailers to a list of age-ins discussing the Initial Coverage Election Period (ICEP), it is possible that some recipients may have already made an enrollment decision; however, the content of the message to the intended audience of age-ins is not prohibited OEP marketing. OEP activity must be initiated by the member. Any proactive marketing or unsolicited contact by an agent/broker during the OEP will be subject to a Sales Allegations and subsequent corrective action.

Medicare Supplement Plan F:

Due to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), we made changes to our portfolio of plan offerings. For members effective 1/1/2020 or later, Plan F that we offered through our Anthem Insurance Companies, Inc. (AICI) legal entity, will not be available. This change is reflected on the current Outline of Coverage, included with the sales kits in the market to support 2020 products and rates as of September 2019, and will be available through the Online Store and mProducer on January 24, 2020.

Importantly, Plan F and Select Plan F are still available for eligible enrollees through Community Insurance Companies, Inc. (CIC) dba Anthem Blue Cross and Blue Shield.  This change does not impact those currently enrolled in either plan.  Any applications for Plan F/Select F and 1/1/2020 effective dates using the OLD 2019 application will need to be resubmitted using the new application that supports the 2020 portfolio through Community Insurance Companies, Inc., or select a coverage effective date of 12/31/2019 if allowed under the applicants enrollment period.

Med Supp Kits are available with new 2020 Medicare Amounts. Rates have been updated to reflect the changes as noted above. See attached for current rates.

Medicare Supplement Bonus:

Our Medicare Supplement Broker Bonus is extended and increased for January, February & March 2020 Effective Dates!

• If you sell 3-4 approved Medicare Supplement plan enrollments, you’ll receive an additional $150 bonus per sale!
• If you sell 5-9 approved Medicare Supplement plan enrollments, you’ll receive an additional $200 bonus per sale!
• But if you sell 10 or more approved Medicare Supplement plan enrollments, you’ll receive an additional $250 bonus per sale!
• Anthem Medicare plans currently marketed include SilverSneakers and are designed with your clients in mind!
• Our commission schedule pays lifetime renewals! You can earn 21% commission years 1-6 and 4% commission years 7+! (applies to new business only)

PDP AOR:

The AOR procedure applies to PDP plans along with Medicare Advantage, Medicare Supplement, and Anthem Extras policies.

The letter must include:

1. The member’s name and policy number,
2. The name and encrypted tax ID or agent ID of the new Agent of Record, and
3. Must include a signature date indicated in the letter.

Ingenio RX replacing Express Scripts for 2020:

Attached are the IngenioRx mail order form and a claim form.

• Improves affordability for our members.
• Provides a more seamless member experience.  Anthem will leverage our provider relationships to ensure confident, informed decision making which will lead to better health of your members.
• Simplified, consistent, and coordinated experience for the member.
• Will help in keeping MAPD benefits consistent by driving total costs down.
• 24/7 access pharmacy via toll free number on the back of their membership card.
• Electronic Prior Authorizations.
• Active mail-order and specialty scripts will automatically transfer 1/1/2020. Member will need to update payment information before a mail order prescription can be shipped.

MBI Only:

Effective 01/01, only the MBI format will be accepted in the online tools. You can help your prospects locate their MBI on www.SSA.gov if they do not have their card handy.  Incorrect MBIs will result in RFIs (Request for Information) whether paper or electronic apps. You can track the progress of the application in mProducer. RFI status will display what information is needed.

Transportation:

The transportation vendor in Ohio has changed effective 1.1.20. The new vendor is Access2Care.

• Access2Care  Reservations: 877-478-5120 TTY: 866-874-3972

Optional Supplemental Benefits:

• Optional Supplemental Benefits can only be added during certain times of the year. During AEP from October 15 – December 7, during OSB Open Enrollment Period from December 8 – March 31 or if you are a new member, you can add OSB within the first 90 days of your initial enrollment.
• Fax the completed form to: 1-800-833-8554 or, mail to: Anthem Blue Cross and Blue Shield, P.O. Box 659403, San Antonio, TX 78265-9714

Medicare Validation is Now Available on mProducer with Anthem

Starting Saturday, 12/14/2019, Brokers can perform Medicare validation using mProducer.  mProducer will return the following information: 

• Medicare Part A Effective Date
• Medicare Part B Effective Date
• Current Contract Code
• Drug Gap in Months
• LIS Validation
• LIS Level
• Date LIS Last Used as an SEP

 

It’s simple!  Just click on the landing page tile Eligibility Check: Medicare and Medicaid, enter the client’s name, date of birth, proposed effective date, and Medicare Beneficiary Identifier (MBI).  Then click Check Eligibility.

 

If you have been requesting D-SNP validation using mProducer, take note!

• The DSNP Eligibility Check tile has been renamed Eligibility Check: Medicare and Medicaid to reflect the enhancement for Medicare only validation.
• When performing DSNP validation, you will now click on the Eligibility Check: Medicare and Medicaid tile and then click on the DSNP Eligibility Check tab.

Medicare Only Validation and D-SNP Validation Updates

• The field titled Do they have LIS? has been renamed Do they have LIS for the Proposed Effective Date? to make that clear.

• You can no longer perform validations with HICN due to CMS replacing HICN with MBI.  You MUST use the MBI.

 

D-SNP Validation Updates

• When your client is ineligible for a D-SNP plan, it is because he does not have an eligible Medicaid level, or does not have Medicaid.  The values for MEDICAID LEVEL have been updated to differentiate between these two scenarios.
  • If a client does not have an active Medicaid policy, the MEDICAID LEVEL will indicate No Medicaid.
  • If the client does have an active Medicaid policy, the response will display the Medicaid level, or Unqualified if the Medicaid level cannot be interpreted from the state data.
• Submitting DSNP applications is quicker than ever!  When you submit the application directly after performing the D-SNP validation, mProducer will automatically populate the application with Medicare Part A and Part B effective dates, MBI, and Medicaid Number or SS, reducing data entry!