ODI’s Month in Review: March

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Ohio Department of Insurance | March in Review

We Are in This Together Ohio

April 3 , 2020

By Director Jillian Froment

What a historic time in our lives. Every Ohioan is working through challenges personally and professionally that we probably never thought would become the new normal. A new normal that we can’t wait to end. With Governor Mike DeWine’s leadership, the unwavering dedication of those on the front lines, and so many other hard-working and resilient people of our great state fighting COVID-19, we will get back to what we know. But we have adjustments to make and hurdles to clear first.

For consumers, insurance companies and other entities, and agents that the Ohio Department of Insurance serves, protects, and regulates, we are conducting business as usual, but working remotely. We’ve closed our building as part of the push to help flatten the COVID-19 curve. If you need to reach any of our business units please initiate that process through these channels.

To help Ohioans work through this transition, we are working to provide flexibility in a number of areas. We have issued guidance to the industry requesting they:

• Ensure consumer accessibility to healthcare services to test and treat the virus (2020-02);
• Provide health insurance coverage flexibility through employers for employees (2020-03);
• Suspend audits so pharmacies can focus on providing medicine (2020-04);
• Treat out-of-network costs the same as in-network for COVID-19 testing and treatment (2020-05),
• Not take insurance coverage action on a consumer unable to timely renew their driver license due to BMV closures (2020-06), and:
• Provide payment accomodations to insureds that are experiencing financial difficulties (2020-07).

You can sign up to receive our bulletins in this section of our website.

On the resources front we’ve created an insurance and coronavirus toolkit for consumers and the industry, and also encourage you to utilize the state of Ohio’s coronavirus.ohio.gov website. The National Association of Insurance Commissioners also has a coronavirus resource center. Finally, and as a reminder, the Governor is encouraging people with coronavirus questions that are medical in nature to call the state’s call center at 1-833-4-ASK-ODH (1-833-427-5634).

At the Ohio Department of Insurance we’re doing all we can to be part of the solution. We are here to answer any questions you may have concerning COVID-19 and insurance, and I urge you to reach out for our assistance whether you are an insurance consumer or an insurance professional. In the meantime, take good care of yourself and your loved ones. We are #InThisTogetherOhio.

OSHIIP Providing Medicare COVID-19 Information
The department’s Ohio Senior Health Insurance Information Program (OSHIIP) is sharing Medicare information to beneficiaries as it relates to COVID-19. Ohioans are reminded that Medicare Part B (medical insurance) covers COVID-19 tests when ordered by a person’s doctor or health care provider on or after February 4, 2020. In addition, Medicare covers all medically necessary hospitalizations, including extra days in the hospital for patients who had to stay longer under COVID-19 quarantine. And lastly, Medicare will cover a COVID-19 vaccine if one becomes available. If you have questions please contact OSHIIP.

Ohio Agent and Agency License Expiration Date Extension
Insurance agent and agencies whose licenses expire during the COVID-19 state of emergency declared by Governor DeWine have been granted a renewal extension. A license will remain valid and may be renewed until no later than 90 days after the state of emergency ends or December 1, 2020, whichever comes first.

Financially Protect Against Severe Spring Weather
Severe rain and flooding has already hit parts of our state this spring causing damage. Ohioans are reminded to review their insurance with an agent to ensure they are financially protected against the different types of destruction spring weather can inflict. Be sure to discuss flood insurance with an agent. This coverage is not commonly included in standard property insurance coverage and has to be purchased separately.

Important Special Enrollment Period Announcement from NAHU

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As of April 3,2020

Medicare Advantage SEP Delayed

CMS told NAHU that the plan to provide an official notice for MA SEP will slip into next week. Beneficiaries rely on agents and NAHU requested CMS consider agents of record in any SEP plan. We also requested extending the OEP through June. You can monitor this link for A/B enrollment updates.

Here are links for C/D to watch for SEP or other enrollment guidance:

https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/index

https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicarePresDrugEligEnrol/index

 

Part B enrollment and SSA

CMS is working closely with SSA to coordinate and push out information regarding Part B to ease enrollment challenges. NAHU has let CMS know that local SSA offices appear to operate differently with respect to handling enrollment cases.

 

As of now, CMS will  relax the requirement for wet signatures.  In addition, if the beneficiary is unable to obtain the completed employer form there are alternate forms of documentation that are acceptable. These are documents that they are likely to have in their possession such as tax returns, paystubs, health insurance cards. SSA is also working on creating methods to submit this information via a dedicated fax number and a few other ideas they are considering.

 

Be sure to monitor these web links to get the latest changes in Medicare enrollment. NAHU will continue to be your source for the latest information and we will continue to send out information as event warrant.

UHC’s Advance Renewal Payments- May & June

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UnitedHealthcare wants to continue to support you. Due to a planned system upgrade to the sales operations system, and the financial challenges COVID-19 has presented—UHC will be advancing May and June renewal payments in April.

Renewal Payments
• The April renewal commission payment schedule will remain as planned:
o Medicare Supplement: April 13, 2020
o Medicare Advantage: April 20, 2020
o Prescription Drug Plans: April 27, 2020

Advanced payment of renewals for May and June are as follows:
o Medicare Supplement: April 15, 2020, and April 17, 2020
o Medicare Advantage payments: April 22, 2020, and April 24, 2020
o Prescription Drug Plans (combined payment for April, May, June): April 27, 2020

New to UnitedHealthcare Payments
• New to UnitedHealthcare second quarter payment to agencies is targeted to be included in the April Medicare Advantage renewal payment as normal, April 20, 2020.

UHC is working closely with  IT partners on details of the planned upgrade. More information will be coming soon about what you can expect during this time.

 

NEW! UHC’s Enhanced Underwriting Function for AARP Med Sup Plans

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UnitedHealthcare has made improvements to the underwriting process for AARP® Medicare Supplement Insurance Plans, insured by UnitedHealthcare® Insurance Company.
Enhanced functionality allows automatic acceptance of certain underwritten applications that qualify for the best eligible rate!

HOW DOES IT WORK?

Agents who submit an application through LEAN™ will see a “Processing, please wait” message as the system works to determine if the applicant is eligible to receive the best rate, without further review.

If immediately accepted at the best rate, LEAN will display “APPROVED” on the confirmation page. If not, LEAN will display “PENDING” on the confirmation page. Underwriting will then continue to evaluate the application.

Once received, underwritten paper applications, such as those submitted via US mail or fax, will also be considered for automatic acceptance. Agents may check the status of applications, no matter the submission method, in Jarvis. Simply navigate to Enrollment > Application Status.

Please note the process has not changed for applications that do not require underwriting.

More changes are coming, so keep an eye out for future enhancements!

UHC Renew Active – Update through COVID-19

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In rapid response to gyms temporary closing due to COVID-19, Renew Active has enhanced its offering to include Fitbit Premium, as well as a “Staycation” feature with our cognitive partner, AARP Staying Sharp.

Fitbit Premium is now available to take advantage of for all members with Renew Active when they join the Fitbit Community for Renew Active (screenshot below). Fitbit Premium offers premium content and thousands of workout videos for all levels and intensity. The premium content and workout videos include;

  • A vast selection of yoga, weight training, low impact and equipment optional workout videos
  • Guided programs
  • Advanced sleep tools
  • Personalized insights
  • Mindfulness sessions 

Please note a Fitbit device is not required to access these workout videos.

In addition to Fitbit Premium, AARP Staying Sharp, our cognitive partner, launched a Staycation tile on their website. Here Renew Active members can access various content, including 17 quick in-home workout videos for members to stay active while in their home.

Additional information:

  • Member access: For access to the Fitbit Community and/or AARP Staying Sharp, Renew Active members can visit the Health and Wellness tab in their portal and begin the process of either joining the Fitbit group or registering on AARP Staying Sharp.
  • Renew Active Fitbit Community: Digital community where members can engage in health & wellness discussions and participate in step challenges with other Renew Active members
  • AARP Staying Sharp: Members can engage in a brain-health assessment, articles, recipes and even several short exercise videos. The videos vary between stretching, showcasing different types of yoga poses and strength exercises.
  • Many of our gym partners are offering digital classes and workouts to members during the time of their closure.

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CMS OPEN PAYMENTS COVID-19 ANNOUNCMENT

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Wednesday, March 25, 2020

Open Payments COVID-19 Announcement

Open Payments COVID-19 Announcement

CMS is aware that the COVID-19 pandemic may impact some reporting entities and may affect their ability to submit records to the Open Payments Program on or before March 31st 2020.

CMS does not have the authority to waive the statutorily mandated requirement that Open Payments reporting be completed by the 90th day of the calendar year (see 42 U.S.C. § 1320a–7h(a)(1)(A) and 42 U.S.C § 1320a–7h(a)(2)) or to postpone the publication deadline of June 30 (42 U.S.C § 1320a–7h(c)(1)(C)). As such, CMS is unable to extend the submission window past the March 31st deadline.

However, CMS is sensitive to the challenges caused by the pandemic and will consider the impact that these circumstances have on reporting entities’ ability to report in a timely, accurate, and complete manner.

CMS will exercise enforcement discretion with respect to submissions completed after the statutory deadline due to circumstances beyond the reporting entity’s control associated with the pandemic. In an assumptions statement, you may explain your organization’s reporting methodologies or reasons for unusual or partial submissions.

If the pandemic has impacted your reporting processes, please include the phrase “COVID-19 Impact” in your assumptions statement alongside the explanation of the circumstances and, if applicable, include reference to any related help desk ticket numbers.

Questions—Contact Live Help Desk

Need help or have more questions? Contact the Open Payments Help Desk at openpayments@cms.hhs.gov or call 1-855-326-8366 (TTY Line: 1-844-649-2766).The Help Desk is available Monday through Friday, from 8:30 a.m. to 7:30 p.m. (ET), excluding Federal holidays.

The Help Desk refers media inquiries to CMS’ Press Office for response.

UHC’s New Base Contract Requires Agent & Agencies Signature- Please Read!

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UHC’s New Base Contract Requiring Agent/Agency Signature

March 25, 2020

Beginning April 2, 2020, and continuing through May, UnitedHealthcare will begin sending new base contracts in an email from UnitedHealthcare Medicare Solutions Contracting. The new consolidated contract incorporates all contract changes incorporated in recent years by amendments, and contains minor changes to clarify terms.

Please look for an email from UnitedHealthcare Medicare Solutions Contracting and review and sign your new contract using DocuSign® within 30 days of receipt. Once you have completed the re-contracting process you will receive a confirmation email.

 

Remember to check your spam folder throughout April and May if you do not see an email with the new contract.

For more information and assistance with reviewing and signing the new contract please review the attached Job Aid and FAQ

MMO Broker Update – Telehealth/Telemedicine Coverage

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Important Clarifications on Telehealth (Telemedicine) Coverage
 
Date: March 24, 2020
Category: News
Applies to: All

In efforts to help slow the spread of the coronavirus disease known as COVID-19, health professionals and their patients may turn more frequently to the use of telehealth (telemedicine) visits. Please review the summaries below: to better understand the coverage for these services.

Telehealth (telemedicine) visits (covered by all plans)

  • Telehealth (telemedicine) visits are primarily scheduled visits between patients and healthcare providers with an established relationship, and may be handled by computer, tablet or smartphone.
  • Telehealth (telemedicine) visits are for patients needing routine care for chronic or general health conditions. They are covered just like any other medically necessary office visit.
  • They are billed with office visit codes; modifiers are not required.
  • Behavioral health visits are included.

On-demand virtual visits (covered by most plans)

  • On-demand virtual visits are a subset of telehealth (telemedicine). These types of visits typically include 24/7 virtual access to licensed healthcare professionals with whom the patients do not have an established relationship.
  • They are similar to visits to an urgent care facility and are typically needed due to an acute health issue.
  • Visits are typically covered like primary care provider visits unless otherwise specified.
  • Behavioral health visits are not covered as on-demand virtual visits.
  • Examples of plan-specific covered on-demand virtual visit providers include the Cleveland Clinic’s Express Care online services and Teladoc.

If you have any questions about telehealth (telemedicine) benefits, please contact your Cornerstone Senior Marketing Representative

 

The Health Plan – Member Costs Waived for COVID-19 Testing

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The Health Plan Will Waive Member Costs for COVID-19 Testing

 

The Health Plan announced today it will cover the cost of copays, co-insurance, and deductibles for COVID-19 testing for all Commercial, Medicare and Medicaid lines of business when recommended by a medical professional. Our exclusive independent lab provider, LabCorp is making its NAA test available for ordering by physicians or authorized healthcare providers anywhere in the United States.

For The Health Plan’s self-funded (ASO) members, they will also waive cost-sharing for diagnostic testing related to COVID-19, unless they receive notice in writing of the group’s intent not to implement this temporary relief option.

The Health Plan wants to provide members with peace of mind. “Supporting the health and well-being of our members is important to us. We want to assure our members that we will do all we can to make health care treatment and services available to them at no additional cost, especially for seniors and people with chronic conditions,” said Jeff Knight, Interim President/COO of The Health Plan.

At this time, the Centers for Disease Control and Prevention (CDC) and state labs currently performing the testing are not billing for COVID-19 testing, so members should not incur costs when tested by these labs.

The Health Plan remains committed to ensuring access to medications is available during this time. Members have multiple options to obtain medication through The Health Plan, including the ability for Medicare and fully-insured members to fill 90-day supplies of long-term medications via mail order or local retail pharmacies. The Pharmacy Services Department will be available to assist with any extenuating circumstances such as ensuring formulary flexibility if medication shortages or access issues arise.

The Health Plan recommends contacting your doctor’s office first if you suspect you might have a flu or coronavirus infection. But to help reduce potential exposure, The Health Plan also encourages members to utilize telemedicine services if they are available as part of a member’s plan. The Health Plan will waive member cost share where applicable for telemedicine visits for the next 90 days. Telemedicine is a safe and effective way for members to see a doctor to receive health guidance related to COVID-19 from their homes via smart phone, tablet or computer-enabled web cam.

The Health Plan is providing the latest information on precautions members should take to help prevent the spread of COVID-19 and who should seek medical attention on their website. Visit healthplan.org for more information.

Update – Humana’s Agent Technology Tools

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Update on Humana’s Agent Technology Tools

In these unique times, we have provided guidance to our agents to avoid face-to-face meetings and appointments with our consumers. Last week, we sent a communication outlining our request to reduce paper applications. Today we want to reiterate that Humana has an approved telephonic sales presentation process and electronic tools that will enable you to continue to sell and service consumers, which will further reduce our reliance on paper.

  • For career and field-based external partners, you should be leveraging Enrollment Hub now more than ever! This tool offers streamlined enrollment applications that allow electronic signatures, so the need to meet face-to-face can be alleviated, and links to Med Supp and IDV are also available within this tool.
  • Agents can also leverage Direct Marketing Materials (DMM) for Medicare and Agent Online Application (AOA) for Medicare and IDV applications when working virtually.
  • We also want to take this opportunity to remind you of the important steps you must follow to conduct a compliant telephonic sales presentation. Click here to learn more.
  • For English speaking consumers that do not have email addresses or want to enroll in a CarePlus plan, agents may now leverage IVR signature within FastApp.
    • On Step 8 of the application, career agents should select Affinity ID “Field Agent IVR” and that will offer the correct signature types. External Agents should select the Affinity Code based on the partner you are aligned with. If your agency is not listed, please select “Field Agent IVR”
    • Agents should elect to be notified about abandoned or successful IVRs via the checkbox under Agent Email Address. You can also look for these applications in VANTAGE Business Center 24-72 hours after submission.
    • Job Aid with More Details: FastAPP IVR Process for Career and Partner Agents
  • Beginning at 9am EST on 3/24/20, for Spanish speaking consumers, please leverage the assisted telephonic signature (T-sig) process via Direct Marketing Services (DMS). The field agent will complete the electronic application, save it, and then call DMS to do the telephonic signature.  Below are the steps that will take place:
    • Field agent makes sales presentation over the phone.
    • If consumer consents to enroll, field agent fills out the application in FastApp through the link in Vantage, and then saves it.
    • Field agent will call & conference with DMS via 1-800-833-6573 with the enrollee on the line. THIS NUMBER IS ONLY TO BE USED FOR SPANISH ENROLLEES.
    • Once all three parties are on the line (field agent, DMS agent and the enrollee), DMS will complete the signature using T-sig, and drop from the call. The field agent will then complete the call.
    • Compliance Reminder!  Agents may not coach the enrollee through the T-sig process by telling them to “just say yes to everything”, for example.