The Transparency in Coverage Final Rule and the Consolidated Appropriations Act set requirements around pricing transparency related to health insurance coverage. While most of the requirements apply to insurers and plans, we’ve created educational communications to inform members about parts of the law that may affect them.
What you need to know: In late December, we provided samples of the Explanation of Benefits (EOB) language that will be included with No Surprises Act-related claims. However, we didn’t include the surprise billing notice for fully insured groups that will be included with those EOBs.
The Affordable Care Act set reporting requirements related to minimum essential coverage. Individuals no longer have to show proof of health coverage, but insurers and employers are still required to report to the Internal Revenue Service (IRS) about the coverage they provide or offer.
Member notices: Targeted mailings were sent to members affected by drug list revisions and/or exclusions, prior authorization program and dispensing limit changes.
Note: This is Part 1 of the update. Look for Part 2 later this quarter for more recent coverage additions, utilization management updates and any other pharmacy program updates.
News from the Blues
Galesburg Cottage Hospital Is Out-of-Network for BCBSIL Members
Blue Cross and Blue Shield of Illinois (BCBSIL) terminated contracts with Galesburg Cottage Hospital effective Jan. 12. The Centers for Medicare & Medicaid Services terminated its agreement with Galesburg Cottage Hospital as a hospital in the Medicare program effective Jan. 14. The hospital, located at 695 N. Kellogg Street in Galesburg, Illinois, has temporarily closed.
Next steps: We are doing all we can to help our members find new hospitals in our networks. See the affected networks.
BlueVISION
Health and Wellness
News from the Blues
Fitness Program Promotion: Waived Enrollment Fee for New Members in February
Eligible new members can save $19 when they sign up between Feb. 1 to 28. The waived enrollment promotion is only available to groups with the Fitness Program, included in the Well onTarget® program.
When people make New Year’s resolutions, they often set goals to become healthier. Eat better. Exercise more. Lose weight. Quit smoking.
But here’s another idea that can go a long way toward improving their health. Take the time to schedule preventive health/wellness visits with a health care provider. Early detection of diseases such as heart disease or diabetes can help slow or stop them from becoming bigger problems.
How you can help: Share our adult, child and perinatal wellness guidelines with your employees. And then encourage them to take advantage of their preventive care benefits. Available in English and Spanish, the guidelines offer age-specific recommended screenings, checkups and immunizations.
Next steps: After employees review the guidelines, they should talk to their doctor about their health care needs and screenings. Then they can make plans to get the services they and their family members need. These include checkups and may include screenings for cervical, colorectal and breast cancer.
News from the Blues
Get Fit, Stay Well with Blue365® Discounts
Help your employees work on their 2022 wellness goals by reminding them about Blue365 discounts. They can save money on fitness products and wellness services not usually covered by their medical insurance.
Top national and local retailers offer deals on gym shoes and workout apparel, wearables, healthy eating options and more.
News from the Blues
Blue Cross and Blue Cross of Illinois (BCBSIL) contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. MyPrime.com is an online resource offered by Prime Therapeutics.
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