Update from Anthem Ohio Regarding Welcome Kits & ID Cards

Anthem updates on the welcome kits and cards that are being sent out to Ohio clients.

Member Welcome Kit Includes (See link below for more details):

  • Member ID card
  • New member checklist
  • Instructions on how to set up their introduction call

OTC Welcome Kit Includes (See link below for more details):

  • OTC card
  • Important tips on using the OTC card
  • How to use the OTC card guide
  • List of retail stores where members can use their OTC cards

Flex Card:

  • Pre-activated Mastercard that is ready to use when delivered
  • To check the balance of their account members can visit https://mymedicareflexaccount.com or call member services at 1-833-299-5088 and choose the option to hear their current balance.

 

DOWNLOAD ANTHEM GUIDE HERE

 

Lastly, Please be sure to visit Anthem Broker Connection website (using Google Chrome) to register for upcoming trainings https://www.anthembrokerconnection.com/#/home.

 

 

 

IMPORTANT AETNA OHIO NETWORK UPDATE: TRINITY – MOUNT CARMEL HEALTH SYSTEM

Negotiations Completed with Trinity – Mount Carmel Health System – OH in the Central Ohio network

Aetna announced they have reached a new multi-year agreement with Trinity – Mount Carmel Health System – OH effective 01/01/2022. Trinity will be sending out a patient letter. As a result of this successful negotiation process, Trinity – Mount Carmel Health System – OH will continue to participate in Aetna’s Central Ohio network for the following products:

• Open Choice® PPO
• Aetna Open Access® Managed Choice® POS
• Aetna Select℠
• Aetna Open Access® Elect Choice® EPO
• Quality Point-of-Service® (QPOS®)
• Aetna Health Network Only℠ (HNO)
• Aetna Medicare℠ Plan (HMO)
• National Advantage Program (NAP)
• Mount Carmel Neighborhood Network
• Central Ohio Primary Care Managed Choice • Aetna Choice® POS II
• Managed Choice® POS
• Open Access Aetna Select℠
• HMO
• Aetna Choice® POS
• Aetna Health Network Option℠ (HNO)
• Aetna Medicare℠ Plan (PPO)
• Aetna Premier Care Network℠
• Aetna Whole Health℠ – (NAME OF ACO
• National Advantage™ Program

There has been no interruption to member access because an agreement was reached before the contract’s termination date. Member letters were never released; therefore, retraction member letters are not necessary.

 

Provider Search/directory information
Trinity – Mount Carmel Health System – OH is included in Aetna’s online provider search tool and in their current printed provider directories.

Click HERE to read Trinity- Mount Carmel Health’s announcement regarding the completed negotiations.

 

 

Questions? Reach out to your Sales or Service Rep at any time!

614-763-2255

or by email:  service@ornerstoneseniormarketing.com

Best Practices from Devoted Health on Member Retention

Sourced from Devoted Broker Email Communication from 1/7/2022: 

 

Happy 2022!  We hope that you had a relaxing holiday season.  Our team is prepared to support you in another successful selling season and provide tools that will help reduce risk of member disenrollments after your hard-earned AEP efforts.  

As you know, disenrollments are highly unfavorable in many ways. It may not only lead to commission chargebacks and poor compliance performance, but also poor overall member experience.  As such, here are some best practices to help with member retention we’d like to share.

What you can do

  1. Call members to check in:
    • Check in on members who recently enrolled during AEP to ensure smooth onboarding, pre-authorizations were taken care of and PCP appointments were made — you could even transfer them to one of our Guides at 1-800-DEVOTED to make sure we take good care of them
    • Check to make sure they’ve received their Welcome Kits in the mail and their info (phone number, email, address) are correct
    • Make sure they know how to find and use our online tools: Benefits Info, Provider Directory, Drug / Formulary Search
  2. Member education events
    • Encourage members to keep an eye on their email (and our website) for more information about our New Member Orientation (NMO) events, which we call “Music & More” series.  We’re planning virtual events this year to continue keeping everyone safe
  3. Help members utilize their benefits: Members that use their benefits tend to be happier and stay with their plan year over year

Members who are at higher risk of disenrollment:

  • PCP Experience: Members who do not see their PCP or have a negative experience with a new PCP
  • Plan Engagement: Members who do not engage with Devoted Health
  • Benefits: Members with mismatched expectations or were not enrolled in a plan that best fits their needs
  • Higher-need members: Beneficiaries who qualify for Extra Help

What are we doing to help retain members?

  • Targeted member calls based on their needs
  • Virtual member education events: how to utilize benefits + music series
  • Member communications (SMS, email, mail)
  • All members receive a digital ID card via SMS within a few days of confirmed enrollment so they do not have to wait for the Welcome Kit or Confirmation Letter

Encourage members to call our Member Guides at 1-800-Devoted. Our Guide team is able to answer most of our members’ questions, but there are times when our vendors need to be involved to more appropriately help our members. Here’s a list of vendors that our members will speak with instead of our Guides when they have benefit questions – in these scenarios we delegate call services to these vendors:

  • Pharmacy (CVS Caremark): Handles our prescription questions and mail order requests (Members can access through our IVR when they call into 1-800-Devoted and the CVS phone number is also included on the member ID card)
  • Healthy Foods Card (Solutran): This vendor is responsible for helping with member questions related to their healthy foods card benefit. (Members can access through our IVR when they call into 1-800-Devoted and the Solutran phone number is also included directly on the healthy foods card)
  • Transportation (Alivi – FL, OH, TX or Kaizen – AZ, IL): Will help our members set up their non-emergent transportation rides. (Members can access through our IVR when they call into 1-800-Devoted)
  • Behavioral Health (Magellan): If members have questions related to behavioral health benefits and providers, they will work directly with Magellan.  (The phone number for Magellan is listed on the member’s ID card and on our website – 1-800-776-8684)

Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests

Posted by CMS Jan 10, 2022:
As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15th.  The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan. This requirement incentivizes insurers to cover these costs up front and ensures individuals do not need an order from their health care provider to access these tests for free.

Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.

“Under President Biden’s leadership, we are requiring insurers and group health plans to make tests free for millions of Americans. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” said HHS Secretary Xavier Becerra. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans who need them. By requiring private health plans to cover people’s at-home tests, we are further expanding Americans’ ability to get tests for free when they need them.”

Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.

As part of the requirement, the Administration is incentivizing insurers and group health plans to set up programs that allow people to get the over-the-counter tests directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs.  Insurers and plans would cover the costs upfront, eliminating the need for consumers to submit a claim for reimbursement.  When plans and insurers make tests available for upfront coverage through preferred pharmacies or retailers, they are still required to reimburse tests purchased by consumers outside of that network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12). For example, if an individual has a plan that offers direct coverage through their preferred pharmacy but that individual instead purchases tests through an online retailer, the plan is still required to reimburse them up to $12 per individual test. Consumers can find out more information from their plan about how their plan or insurer will cover over-the-counter tests.

“Testing is critically important to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be effectively treated. Today’s action further removes financial barriers and expands access to COVID-19 tests for millions of people,” said CMS Administrator Chiquita Brooks-LaSure.

State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. In 2021, the Biden-Harris Administration issued guidance explaining that State Medicaid and Children’s Health Insurance Program (CHIP) programs must cover all types of FDA-authorized COVID-19 tests without cost sharing under CMS’s interpretation of the American Rescue Plan Act of 2019 (ARP). Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional. People enrolled in a Medicare Advantage plan should check with their plan to see if their plan offers coverage and payment for at-home over-the-counter COVID-19 tests.

This effort is in addition to a number of actions the Biden Administration is taking to expand access to testing for all Americans. The U.S. Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified rural health clinics for distribution at no cost to patients and community members. The program is intended to ensure COVID-19 tests are made available to populations and settings in need of testing. HHS also has established more than 10,000 free community-based pharmacy testing sites around the country.  To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation.

WellCare: Declared Special Enrollment Period for Kentucky

Special Enrollment Period: Kentucky Emergency Declaration – Inclement Weather, Flooding

Please be advised that a state of emergency was declared, impacting the individuals in all Kentucky counties. This declaration allows for a one-time Special Enrollment Period (SEP), in the event beneficiaries were unable to make an election during another qualifying election period. Please reference the following guidelines for the incident period. This SEP applies to all the impacted counties in Kentucky.

Important Compliance Information

Who is eligible:

This SEP opportunity is ONLY available to beneficiaries who:

• Reside, or resided at the start of the SEP eligibility period described in this guidance, in an area for which a federal, state or local government entity has declared a disaster or other emergency or they do not reside in an affected area but rely on help making healthcare decisions from one or more individuals who reside in an affected area; and
• Were eligible for another election period at the time of the SEP eligibility period, and;
• Did not make an election during that other valid election period due to the disaster or other emergency.

Details:
Impacted Counties: All Counties

Incident Period: The incident period occurred on December 31, 2021. The declaration was announced on January 1, 2022.

Timeframe: Effective immediately, individuals meeting the requirements listed above can enroll, dis-enroll, or switch MAPD plans until March 31, 2022.

*Note: Eligible enrollments will be effective the first of the month after the application has been processed.

Reminders:
Agents can accept/submit an application by the beneficiary’s request through the following steps:
1. Obtain a compliant Consent to Contact (C2C).
2. Capture a compliant Scope of Appointment (SOA).
3. Host a compliant 1:1 appointment.
4. If the beneficiary is prepared to enroll, complete an application noting this SEP, either by selecting the “Emergency or Major Disaster” option or writing “Severe Weather” in the “Other” option. WARNING! Only select one election type.

Centene will communicate any changes to this SEP, if necessary, when they become available.

 

Tech Tip: Keep Devices and Software Up to Date

You know that little pop-up prompting you to restart your computer for a software update? The one that only seems to come up when you’re in the middle of something important? As annoying as it may seem, this notification is actually a valuable asset to your cybersecurity. So, before you click the “Later” option, let’s take a closer look!

What is a software update?
A software update is a new and improved version of a program, application, or operating system that you are already using. The update may include new features, bug fixes, or important security patches.
Why are updates important for cybersecurity?

Do you ever wonder how secure the programs installed on your device are? Cybercriminals do. They look for cracks in the security of programs and use these vulnerabilities to gain access to your device. With this access, they could enable a keylogger to track what you type, steal confidential information, or even install ransomware to lock you out of your files and demand payment for access. Developers help prevent this by fixing vulnerabilities as soon as possible. These fixes are included in software updates. Meaning, the longer you wait to install the update, the longer your system is at risk.

How do I check for software updates?
Any device that runs software, be it a computer, tablet, or even a smart tv, can release updates. Most software will prompt you when an update is available, but it’s good practice to check periodically. Here is a general guide to checking for updates on common platforms:

Mac System Updates (for macOS Catalina)
1. Open the Apple menu and select About this Mac.
2. Click Software Updates….
3. If any are available, you will have the option to install it.

Windows System Updates (for Windows 10)
1. Open the start menu and select Settings.
2. Select Update & Security Settings then select Windows Update.
3. Click Check for Updates. If any are available, you will have the option to install it.

iOS Updates
1. Open the Settings app and tap General.
2. Tap Software Update.
3. If any are available, you will have the option to install it.

Android Updates (for most devices running Android 10 or higher)
1. Open the Settings app and go to the System section.
2. Tap About Phone. (If this is not an option, skip to step 3.)
3. Tap System Updates.
4. Tap Check for Update. If any are available, you will have the option to install it.
Don’t see what you’re looking for? Please consult the user manual or online support for your specific device.

AultCare: New Payment Option for Prime Time Members

Sourced from AultCare Broker Bulletin on 12/29/21:

We are excited to announce a new, convenient payment feature for Primetime Health Plan and PrimeTime Choices’ members. As of Dec. 15, 2021, we implemented automated payment phone lines members can call to check their balance and make payments.

 

As you share this information with members, please advise them they will need to have their member ID number, date of birth, and zip code readily available. Acceptable forms of payment are Mastercard, Visa, and Discover. The phone numbers are listed below.

 

PrimeTime Health Plan 330-286-6067
PrimeTime Choices 330-286-6068

Aetna OH Network Update: Negotiations with Trinity – Mount Carmel Health System

Sourced from Aetna Broker Communication on 12/22/21:

Network Update                

December 22, 2021

       

Update on negotiations with Trinity – Mount Carmel Health System – OH

Highlights

As promised, we are keeping you informed on the progress made during Aetna’s negotiations with Trinity – Mount Carmel Health System – OH. This update, and the ones that follow, will supplement the original network communication you received on 10/26/2021. We will keep you informed of updates until negotiations are complete and/or concluded.

Update #

Date of Update

Update Description

2

12/22/2021

Negotiations were to be concluded and continue with a positive tone for Trinity nationally as well as in the local markets.

Trinity has made a slight modification to one state fee schedule and due to the holidays, we have been given an extension until 2/15/2022 to finalize the contracts with Trinity.

1

11/09/2021

Trinity Health has provided Aetna with a contract extension to 1/31/22 – for the Commercial and Medicare products.

The parties agree to continue to work through the local market negotiations and memorialize the terms and conditions of a new National LOA over the next several weeks.   This National LOA will memorialize the new national template contract language, the respective rate increases for the respective markets and a commitment to utilize a Trinity-specific national contract template for all of their Trinity Ministries by January 1, 2023 or sooner.

Aetna and Trinity Health have signed a contract extension, assuring continued in-network access for its members in NY, OH, MI, and IL.  We’re pleased that our members will be able to continue receiving in-network care from their hospitals and doctors with the intent to limit further disruption during open enrollment.

Trinity Health extended the termination date of the following NY, Ohio, Illinois and Michigan hospitals to 1/31/22:

  • Samaritan (Troy)
  • Samaritan / Albany Memorial (Albany)
  • St. Josephs (Syracuse)
  • Mt. Carmel East Hospital (Columbus)
  • Mt. Carmel New Albany Surgical Hospital (New Albany)
  • Mt. Carmel St. Ann’s Hospital (Westerville)
  • Mt. Carmel Health System Grove City (Grove City)
  • Diley Ridge Medical Center (Canal Winchester)
  • Loyola University Medical Center (Chicago)
  • MacNeal Hospital (Chicago)
  • Gottlieb Hospital (Chicago)
  • Mercy St. Mary (Grand Rapid)
  • MHP Mercy Campus (Muskegon)
  • MHP Hackley
  • Lakeshore (Shelby)
  • St. Joseph Mercy (Chelsea)
  • St. Joseph Mercy (Ann Arbor)
  • St. Joseph Mercy (Oakland)
  • St. Mary Mercy (Livonia)
  • St. Joseph Mercy (Livingston)

We appreciate your support in this matter, as we continue to try to address the rising cost of health care services for Central Ohio area employers and residents.  We will continue to keep you informed of any changes in our local network.

 

If you have questions regarding Aetna’s Ohio network, please contact your CSM representative.

Devoted Health HRA Update – 12/20/21

Sourced from Devoted Health Broker Communication on 12/20/21:

 

If you have any questions regarding Devoted HRA’s please contact your Cornerstone Senior Marketing rep.

 

 

Cigna News: New AMPLIFY Agent Dashboard To Track HRA Submissions

Sourced from Cigna Broker Communication from 12/20/21:

As we continue to upgrade your experience when facilitating health risk assessments (HRAs) with your customers, today we’re making it easier to keep track of your submission history with our new dashboard.

When you log in to your Amplify account, you will see a dashboard. Select the phone book icon in the left navigation panel to add a new enrollee or view your HRA submission history. You can search and filter the list or export it into an Excel spreadsheet.

A one-page guide* is available on Producers’ University under Sale>Sales Aids. Scroll to the bottom and click on Value Based Enrollment-Amplify Agent Dashboard.

Still haven’t completed training to facilitate HRAs with your customers? Simply log in to Producers University and click My Learning to complete the training and to begin earning $75 for each HRA.

 

Questions? Reach out to your Cornerstone Senior Marketing representative