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Carrier & Compliance Updates 9.11.17
by Rosa Tessandori » Tuesday, September 12, 2017 11:06 AM


COVERED CA

       Partner Alert

  • Membership Growth: 25% growth over prior year.
  • 2018 Rate Action: The weighted average rate change for 2018 is 5.6%. 
  • 2018 Carriers: Blue Shield, Health Net, Kaiser, Sharp Health Plan and Chinese Community Health Plan in San Francisco will continue to be participating carriers.
  • Discontinued Carrier effective 1/1/2018: CCSB will not be offering Western Health Advantage in 2018, a move that will affect approximately 350 consumers.


KAISER PERMANENTE


       Broker Briefing
  • Mobile Bill Pay: Now available for paying bills and viewing payment history.
  • Optical Plans: Four new plans are being added for large group in 2018.
  • Q4 Service Tips: Avoid common mistakes, click here.
  • Current Email Addresses: Update client email addresses, click here for instructions.


HR ANSWERLINK

      1-Minute Sales Tip
  • Job Descriptions: Help your clients and prospects by taking a large project off of their plates – job descriptions.

      Federal Law Alerts
  • EEO-1 Pay Data Reporting: The Office of Management and Budget put an indefinite hold on the pay data collection portion of the EEO-1 form. 
  • Overtime Rule for White Collar Workers: A federal judge ruled that the DOL overstepped its authority. 
  • Predictive Scheduling Laws: The states of Oregon and New York City have joined San Francisco, Emeryville, and Seattle in passing predictive scheduling laws, which require certain employers to give employees a minimum amount of advance notice of their work schedule.

 

 



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Carrier & Compliance Updates 9.5.17
by Rosa Tessandori » Tuesday, September 12, 2017 10:46 AM


BLUE SHIELD OF CA
  • Express Enrollment: View the simplified underwriting guidelines, click here.

METLIFE
  • Multi-Product Advantage: Sell a dental plan and at least two new coverages from two or more of the different product groups, verify the group meets the qualifying criteria and earn an additional one-time payment of 1.5% of the annualized premium for each product sold. For more information, click here.

BENEFIT RESOURCE

COBRA Compliance
  • Webinar: "Pitfalls to Avoid with COBRA" on Sept. 14, 2017 at 1:00 EDT. This event will help you: (1) understand COBRA rules and regulations, (2) recognize the pitfalls and consequences of improper COBRA management and (3) identify key questions you should be asking regarding COBRA services. Register now.
  • eBook: What makes a great COBRA partner?" The eBook outlines several items to consider when evaluating COBRA services and what really differentiates partners that truly excel at COBRA services. Download a copy.


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Carrier & Compliance Updates 8.21.17
by Rosa Tessandori » Thursday, August 24, 2017 8:31 AM


BLUE SHIELD OF CA

Producer Alert

  • New - Enrollment Spreadsheet: For groups effective September 1, 2017, and later, the new Enrollment Spreadsheet is available to all brokers enrolling new groups in medical and/or specialty benefits.  Download the spreadsheet on Broker Connection and it will also soon be available through EaseCentral.
 
COVERED CA


Partner News - August

  • IFP Open Enrollment:  Join Covered CA at one of their scheduled “In It, To Win It” kickoff tour meetings, which start on Wednesday, September 6th and run throughout the state, ending on Tuesday, October 3rd in Sacramento.
  • Revised Agency Agreement:  When completing your new agreement, keep in mind that the designated Agency Manager will act in an administrative and operational role for your Agency within the CalHEERS Agency Portal.
  • Agency Portal Update:  Learn More about the two phase process of the portal rollout. CCSB anticipates launching the 1st phase of the rollout for use with fourth quarter renewals.
  • Q4 Update:  New plans and rates are available for quoting.  The Blue Shield HMO Trio plans are experiencing a rate reduction.  Health Net has added their Value PPO plans on the Silver and Gold levels and a Health Net HSA PPO plan at the Bronze level.
  • Website:  Visit their updated pages.
  • Educational Video:   View the, “CCSB Health Plan Budget Control | Reference Plan Strategy.”  This video clarifies the importance of a reference plan and ways to best leverage the exchange.

 

KAISER PERMANENTE

Broker Briefing

  • Website Resources:  Visit kaiserpermanente.org/deductibleplans for information that helps make deductible plans easier for your clients to understand.
  • Facility Updates:  The Santa Cruz facility is now open, click here to view a list of future sites.
  • Large Group Deductibles: Effective January 1, 2018, the IRS is raising minimum deductible levels and allowable out-of-pocket maximums for large group health savings account (HSA)–qualified plans.
 
 UNITED HEALTHCARE
  • Webcast Invite:  1-100 Northern CA August Webcast 8/23/17 2PM PST.  Updates from UHC on how they are serving you and your clients in 2017 – and far beyond.  For more information, click here.
 
 
 COMPLIANCE CORNER

E IS FOR ERISA

  • Opt-Out Payments:  In the 2016 opinion in Flores v. City of San Gabriel, the Ninth Circuit court held that opt-out payments had to be included in the regular rate of pay used to calculate overtime payments under the federal Fair Labor Standards Act (FLSA). For more information, click here.

 HR ANSWERLINK

HR Snapshot -  Provide your clients with a real time look at trending HR Topics through HR AndswerLink.

 

  • How Do We Calculate Whether We’re Covered Under FMLA?  For more information, click here,

 WAGEWORKS

Compliance Alert

  • Who is a Dependent?  The IRS issued proposed regulations 26 CFR Parts 1 and 301 in January 2017 regarding the definition of a dependent. These proposed regulations provide guidance and clarification for the current definitions under Internal Revenue Code (IRC) IRC Section 152 plus other conditions introduced by the Working Families Tax Relief Act of 2004 (WFTERA) and by the Fostering Connections to Success and Increasing Adoptions Act of 2008 (FCSIAA). To learn more, click here.
 


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Carrier Updates 8.14.17
by Rosa Tessandori » Thursday, August 24, 2017 8:20 AM


ANTHEM BLUE CROSS OF CA

 
       
Producer News Online

  • Q4 Underwriting Promotions:  Relaxed Participation - 30% for 5 or more enrolled, DE9C - not required for groups with existing coverage with 6 or more enrolling, individual coverage counts as a valid waiver, dual HMO network option, same day approval is available for groups submitted by 8.a.m. Mon-Fri that are complete and have utilized the census enrollment tool, 9/1 anniversary date changes are available once in a 12-month period and must be submitted by 8/24 for a 9/1 effective date.
  • 2018 Plan Offerings:  Anthem CA Small Group Plans will continue in all 19 rating regions for 2018. The recent CA Individual announcement does not impact CA Small Group business or regional footprint.
 

BLUE SHIELD OF CA

       
Producer Alert

  • Underwriting Updates:   BSC is increasing access to affordable health care by streamlining the underwriting process for small groups and for brokers with reduced participation requirements, waived DE9C requirements,  flexibility in document requirements, earlier start dates for start-ups and waived participation requirements for Trio.


      
Large Group Broker Update

  • Earned Rewards:  Double your rewards for Trio.
  • Trio Network:  Effective July 1, 2017, Allied Pacific IPA joins the Trio ACO HMO Network in Los Angeles County
  • Narcotics Safety Initiative:  View the 2nd-year report results.

 

HUMANA

  • Bundling Bonuses:  To earn a bonus, place new specialty lines of coverage with the same employer and initial effective dates of coverage between August 1, 2017 and January 31, 2018.  Click here to learn more.


METLIFE

  • Simply Smart Bundles and Bonuses:  MetLife has expanded the flexibility of its small business bundles. Any Dental-plus bundle combination comes with exclusive value-adds to help you close the sale. Bundles with 3+ products can qualify for MetLife's Small Business Multi-Product Advantage, earning you additional one-time broker compensation. Click here to learn more.

UNITED HEALTHCARE

       
Broker Connection

  • Methadone Coverage:  Beginning Jan. 1, 2018, UHC will introduce the Methadone maintenance program for the treatment of opioid use disorder to self-funded plans.
  • Flu Shot Program:  Preventive services, including immunizations, are provided under the standard, fully insured UnitedHealthcare Certificate of Coverage (COC).  Access to flu shots are available through a variety of providers including retailers like CVS, Safeway, Rite-Aid and more; offering a range of convenient options.  
  • Prescription Drug List (PDL) Updates:  View the latest PDL Tracker.


HEALTHIEST YOU

  • Webinar - Solving the Unsolvable in Health Care:  Thursday August 17, 2017 @ 10:00 AM PST.  In July, HealthiestYou joined forces with Best Doctors. Best Doctors solves the unsolvable in healthcare, by identifying and providing solutions to the most complex health conditions.  Click here to learn more.


HR ANSWERLINK

  • HR On-Demand - Document Customization Feature:   Save your clients and prospects time and money by introducing them to the Document Customization feature included with HR On-Demand, the live consulting feature that provides access to certified HR Pros.  Click here to learn more. 


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Carrier Updates 8.7.17
by Rosa Tessandori » Tuesday, August 08, 2017 6:45 PM


AETNA

      
4th Quarter Updates

  • Rate Action:  Rate Pass for HMO, MC, and PPO medical plans for all rating areas
  • Network Updates: Who's new and who's going away.   Access Heal providers for on-demand house calls. Take advantage of Teladoc providers that available for phone or video consultations 24/7/365 days a year.  View the updated CA HMO comparison.  Click here for more information.
  • Springboard:  Aetna's online enrollment platform is available free of charge.
  • Renewal and Plan Changes:  Allow enough time for processing, submit renewal and plan changes no later than the last day of the month prior to the renewal.
  • Sold Case Submissions:  Aetna's underwriting team must receive sold case submissions by the requested effective date: the 1st or the 15th of the month.


ANTHEM BLUE CROSS

      
Producer News Online - Small Group

  • 8/23/17 Webinar:  Reduce tobacco use in the workplace.
  • Employer Access:  The portal has been updated and is now available.
  • Form and Flyers:  The updated 2017 Anniversary Month and Plan Change request forms, and the New "Top 10 Reasons to Sell Anthem" flyer, are now available for Small Groups.

      Producer News Online - Large Group

  • Specialty Account Management:   Michele Bodie has been promoted to Director of Specialty Sales Account Management for California, Colorado, and Nevada.
  • 8/23/17 Webinar:  Reduce tobacco use in the workplace.
  • Online Billing and Payment Effective 9/1:  Anthem is moving Large Groups in California to electronic billing and online payment, starting September 1, 2017.


BLUE SHIELD OF CA

  • Trio ACO HMO:  BSC is waiving their participation requirements for groups of 1 to 100 eligible employees with Trio-only membership!  Click here for additional details.


HEALTH NET

  • Q4 Rate Action:  HMO/HSP Rate pass through December 15, 2017.  PPO/EPO insurance medical plan rates were given a 0.0% quarterly increase . While this is not a rate pass per se, you will find that most of the PPO/EPO Q4 rates are identical to Q3 rates.  Click here for additional details.


EBIX / HEALTH CONNECT:

  • Covered CA:  Rates are available for quoting.


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Carrier Updates 7.31.17
by Rosa Tessandori » Tuesday, August 08, 2017 6:26 PM


ANTHEM BLUE CROSS
  • CA AB7:  Benefit updates have been implemented to meet new guidelines, click here to learn more for individual and small group contracts, click here.  For large group contracts, click here.  

BLUE SHIELD OF CA
  • Nivano Physician IPA:  Blue Shield of California has issued a termination notice to Nivano Physicians IPA (formerly Sierra Nevada Medical Associates IPA) effective August 10, 2017. Blue Shield is notifying affected HMO/POS members that they are being reassigned to alternate network IPAs in the area to help ensure uninterrupted access to care, effective August 10, 2017.  Members can call the Member Services number on their ID card to self-select a PCP or IPA.  Click here for more details.  
  • Digital Roadshow:  The invitation is coming soon, save the date - Wednesday, August 30th. or Thursday, August 31st., click here for more details.

CALIFORNIA CHOICE
  • Q4 Revised Health Net Rates:   Rates effective 7/1/17 will hold through 12/1/17 effective dates.  Please replace the previously published Rate Guide with the revised Rate Guide, click hereto download a copy.  Quotes processed prior to 7/20/17 will need to be requoted.

HEALTH NET
  • Choice Pharmacy Network:  Health Net is introducing their new, tailored pharmacy network designed for cost control.  Learn more, click here.

UNITED HEALTHCARE
  • Northern CA SG 1-100 Webcast:  If you missed the webcast, click here for a copy of the presentation 7.21.17.  Get up to speed on UHC4Me, click here.  Check out the ancillary plan recommendations, in particular the dental $5K Max DPPO plan, click here.
    .
CALIFORNIA ASSOCIATION OF HEALTH UNDERWRITERS (CAHU)
  • CAHU SB 562  Tool Kit:  SB 562 would establish a state-run single-payer health care system.  Please review the CAHU Tool Kit for resources to use in your discussions with clients, colleagues and friendsClick here for more information.

HEALTHIEST YOU
  • Earn a Reward and Win A Trip:  Any broker that brings in 6 or more new clients (or 2 or more clients with >2500 lives) between 8/1 and 12/1, will get either an Apple Watch or $400 Amazon gift certificate,  plus a plaque as HY Top Performer and you could also win the Grand Prize! Click here for more details.   


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Carrier & Compliance Updates 7.24.17 - part 1
by Rosa Tessandori » Monday, August 07, 2017 11:29 AM


ANTHEM BLUE CROSS

      Producer Online News  - Small Group

  •  Q4 Rate Action:  The average quarterly rate increase for medical plans are PPO 3.2% and HMO 2.2%.  Dental, vision and life products, no rate increase. 

        Producer Online News  - Large Group

  •  Whole Health Savings Guarantee:  Some ASO large group clients that choose to combine Anthem medical, pharmacy, dental, vision, and behavioral health products,  may be eligible up to $30 PMPM savings guarantee.  
  • Vivity Broker Bonus Program:  Anthem brokers are eligible to receive a $100 bonus per subscriber for each new Vivity case sold!
  • Employer Access Enhancements: With the introduction of the new enhanced Employer Access benefit management resource tool will result in changes to Plansource arrangements for Large Groups effective 10/1/2017.

 BLUE SHIELD OF CA

  •  Q4 Master Application:  Download a copy of the revised Master Group Application effective 10/1/17.   
  • Q4 Employee Enrollment Form:  Download a copy of the revised Employee Enrollment Form effective 10/1/17.

 CALIFORNIA CHOICE

  •  Q4 Revised Health Net Rates:   Rates effective 7/1/17 will hold through 12/1/17 effective dates.  Please replace the previously published Rate Guide with the revised Rate Guide, click here to download a copy.  Quotes processed prior to 7/20/17 will need to be requoted.

  COVERED CALIFORNIA

       Partner News - July

  •  Agent Portal Access:  Via DocuSign, CCSB will reach out to all agencies to obtain a new signed Agency Agreement and/or Non-Monetary Agreement, this will be required to be able to sign in to the new Agency Portal.       
  • LinkedIn:  Use LinkedIn to gain immediate access to informational articles and education posting to share with your clients and followers.
  • First Month's Payment:  Please inform new groups to only submit the first month's payment after receipt of their first invoice.
  • Redesigned Invoice:   For details on the changes, see the CCSB Employer Invoice Redesign Tutorial.
  • 2017 Employer Guide:  The CCSB Employer Guide has been updated and is now available on the Resources for Participating Employers page on the CCSB website.
  •  Late Submissions:  If a new group is submitted after the 25th of the month prior to the effective date, a late submission form must be completed. Late submissions are accepted up to the 5th day of the requested effective month and are subject to management approval.


View Document
Carrier & Compliance Updates 7.24.17 - part 2
by Rosa Tessandori » Monday, August 07, 2017 11:19 AM


UNITED HEALTHCARE

  • 7/26 Webcast - Q4 updates and more:   Registration is not required but space is limited so join early!  July webcast on 7/26/17 at 2:00 p.m.  Click here to learn more.  Add it to your calendar, click here.

     Broker Connection - July
  • Digital Onboarding Webinars: For new and renewing groups with 101+ employees, Join a UHC webinar on July 26, 28 and August 1. For more details about Digital Onboarding and to register for a webinar, go to broker.uhc.com/digital-onboarding
  • Wellness Program:  Employers Honored by UnitedHealthcare for Creating a Culture of Wellness.
  • Prescription Drug List Changes:  View the latesPDL Tracker for a recap of changes outside the Jan. 1 and July 1 pharmacy benefit updates.
  • Prior Authorization Required for Renflexis and Brineura: For dates of service on or after Aug. 1, 2017, UHC require notification/prior authorization for Renflexis and Oct. 1, 2017 for Brineura.
  • Premium (Physician) Program:  This program evaluates physicians in 16 specialties for quality and cost efficiency.  UHC is changing the timing of the UnitedHealth Premium designation release from the end of the year to September. The ability to identify Physicians with Tier 1 status designation will be available during the standard fourth quarter Open Enrollment period. 
  • PCORI Fee Reminder: All Savers Alternate Funding plan sponsors must file a Form 720 and pay the PCORI fee directly to the IRS by July 31, 2017 of the calendar year following the last day of the plan year.

WESTERN HEALTH ADVANTAGE
  • Expansion into Bay Area:    Effective 1, 2018, WHA is partnering with Canopy Health as part of their expansion into four additional Bay Area counties: San Francisco, San Mateo, Alameda and Contra Costa.  Click here for more details.

HR ANSWERLINK

     HR Support Center Update
  • Use the HR Fitness Test to Grow Your Business:  Connect with your prospects and generate new leads, use this tool to identify their organization’s HR  strengths and weaknesses.  
  • Offer Branded "Insight" HR Webinars:  Presentations are 30 and 60 minute webinars on popular HR topics presented by one of their certified HR professionals. Take advantage of their Summer Insight Savings offer. 
  • Enhance your website: Use eAlert to bring cutting edge HR content directly onto your website to keep clients informed of federal and state employment law changes.
  • HR Support Center Enhancements:  Filter HR Topics by employee count.
  • Interested in HR AnswerLink?  Email us at Sacaramento@rogersbenefit.com to request additional information.

WAGEWORKS
  • Does a Domestic Partner have COBRA Rights?  Read more about the complexities of when a domestic partner can or cannot be covered under COBRA,click here for more details. 


View Document
Carrier Rate Update 7.20.17
by Rosa Tessandori » Friday, July 21, 2017 9:25 AM


EBIX/HEALTH CONNECT

Q4 Released Rates as of 7/20/17:
 


Carrier & Compliance Updates 7/17/17
by Rosa Tessandori » Thursday, July 20, 2017 10:50 AM


ANTHEM BLUE CROSS

       Producer News Online

  • Medical Specialty Precertification:  Anthem is expanding their precertification program to include medical specialty edits.
  • MyAnthem News:  The July issue is available for your California Small Group clients.
  • Updated 2017 Small Group HMO Network Guide:  The updated HMO Guide includes 6 new Sutter Providers added in Northern California effective July 1, 2017,  view the updated 2017 Small Group HMO Network Guide*. 

 BLUE SHIELD OF CA

       Producer Alert 

  • Trio ACO HMO: Trio leads the way in Q4 with an average 4.8% rate decrease across the state.  
  • Q4 Rate Action:  HMO OffEx plans are experiencing on average a -0.9% rate change and PPO plans +0.5%.  The average overall rate action for renewals is 1.1%.  Click here to view the Alert.
  • Specialty:  No change to dental, vision or age banded life insurance rates from Q1 2017
  • Relaxed Participation OffEx Medical and Specialty:  BSC has extended their Relaxed Participation Guidelines through the end of 2017, requiring only 25% employee participation (minimum of five enrolled employees for medical plans).
  • Streamlined Life Underwriting - BSC has extended their promotion through the end of the year.  The  Small Business Quick MatchSM  matches renewal rates from the group's current life insurance company
  • Trio - Participation Requirement Waived:  Effective 7/1, Trio-only groups may enroll in a Blue Shield small business plan with just one eligible member.  Click here to learn more.
  • October & November Renewal Kits:  Visit the Shield Renewals site to download kits starting Monday, July 17.  Group-level changes will be available on SGOR starting July 20.
  • Health Equity:  Offer HSA administration through Health Equity for all of the BSC HSA qualified plans, now including the Silver Full PPO Savings 2000/20% OffEx plan.
  • Teladoc:  Renewing existing members,  they can begin using this program at renewal.  For new groups, no wait required.  View the flier.
  • Trio Bonus:  Earn an additional $250 per group and $25 per member for adding Trio to your fourth quarter groups with the Trio Incentive Program (TIP).
  • Bundled Savings:  As of May 1, 2017, anytime you add dental and/or vision to a new or existing small business client's medical coverage – a 5% discount applies, view the Small Business Bundled Savings.
  • Value Add Services:  Clients have access to Wellvolution, ID protection, HealthEquity, and Blue Shield's updated mobile app. Learn more by by visitingblueshieldca.com.

CALIFORNIA CHOICE

  • Q4 Rates:  Quoting is now available on the California Choice Website.  Quoting through EBIX/HealthConnect is expected to be available 7/17.  Click here for the 4th Quarter Rate Guide.
  • Q4 Summary of Changes:   For groups renewing 10/1/17 and 1/1/17, distribute a copy of the Summary of Changes to employers and employees, click here to download a copy.
  • Q4 Benefit Summary Guides:  The guides are not yet available.
  • Employer Administrative Guide:  Keep your clients informed on how to best administer their Cal Choice group health plans, click here
    to download a copy.


COVERED CA

  • Get Certified:  Not certified to sell Covered Ca small group insurance policies?  Create an account today, click here to get started.

KAISER

      Broker Briefing

  • Q4 Renewals:  Broker will be able to access renewal packet through the broker portal 105 days prior to the renewal date, 
  • Preventive Care Guidelines:  View the 2017 preventive care guidelines.
  • Updated New Group Application:  Download the  New 7/1/17 group application (PDF).
  • COBRA:  Learn more about small business service tip for COBRA reporting.  
  • Sales Tools:  Support your client discussions with fliers that highlight key benefits included in SG plans like DME, Chiro & Acupuncture and Pediatric Vision.

UNITED HEALTHCARE

  • 7/26 Webcast - Q4 updates and more:   Registration is not required but space is limited so join early!  July webcast on 7/26/17 at 2:00 p.m.  Click here to learn more.  Add it to your calendarclick here.

CONEXIS/WAGEWORKS

  • Rebranding:  The CONEXIS® name and logo is being retired and will be rebranded to WageWorks® over the remainder of 2017.  Click here to learn more.
  • PCORI Fees Due by 7/31/17:  Self-insured groups, groups offering a health Reimbursement Arrangement (HRA) or Flexible Spending Account (FSA) should consult with their Third Party Administrator to determine any applicable PCORI fees.  Click here to learn more. 


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Carrier Updates 7.10.17
by Rosa Tessandori » Tuesday, July 11, 2017 2:41 PM


ANTHEM BLUE CROSS
  • Webinar July 19th:  Invite your groups to join the employer webinar to learn  how Anthem is fighting the opioid epidemic.  Webinar is open to small and large group clients.  For more information, click here.

BLUE SHIELD OF CA - Small Group (1-100)
  • 2018 NEW Summary of Benefits (SOB): The new SOB will replace the current medical Benefit Summary for HMO, PPO, PPO Savings and POS plans.  Get the details, click here.

BLUE SHIELD OF CA - Large Group (101 to 249)
  • Bundling Discount:  With the NEW Benefit Solutions package, your clients can save up to 2.75% off their medical premiums when they bundle dental, vision and life insurance* with their benefits package.  View the Flier.

EBIX/HEALTH CONNECT

Q4 Released Rates as of 7/10/17:
 


View Document
Carrier & HR Update 7.5.17 Part 1
by Rosa Tessandori » Tuesday, July 11, 2017 2:02 PM


ANTHEM BLUE CROSS

June Newsletter

  • Heal & PayForward - Just Launched:  Heal provides on demand doctor house calls.  PayForward lets members earn redeemable rewards.
  • Medical Network Updates:  The Small Group HMO Network now matches the Large Group HMO Network in Northern California with the addition of 6 new Sutter providers effective July 1, 2017.    
  • Health and Wellness:  View a health and wellness on the run webinar, view the calendar.
  • Resources for Brokers:  Access quick links to forms, benefits, underwriting guidelines and more.

Producer News Online - Large Group

  • Manifest MedEx: This organization helps doctors and health plans securely share critical health information, making sure that members get the safest and highest quality health care possible. 
  • Vivity Broker Bonus:  Vivity is one of the most innovative delivery systems to hit the Southern California health care market. 

 BLUE SHIELD OF CA

  • Q4 Rate Action:  Trio ACO rates reduced on average 4.8%; HMO plans -0.9%; PPO plans +0.5% and the average overall rate action for renewals is 1.1%.  Click here to view the Alert.
  • HMO Renewal Packet Error:  August and September renewal packets included a benefits error in the "Changes To" document. This incorrect version of "Changes To" was sent only to customers with HMO plans.  Click here to view the Alert.
  • CA Assembly Bill (AB) 72 - Balance Billing Protection:  Members will receive an EOC endorsement letter informing them of the changes and how it affects them. Click here to view the IFP Alert.


HEALTH NET

  • Reduced Participation:  Through 11.15.17, take advantage of Health Net's reduced participation promotions, view the flier.

 COVERED CA SMALL BUSINESS

  • Master Application Updated:  The Master Group Application now includes a section for designating the Agency FEIN#, see page 2 step 3 #4 under Agent Information.  Click here to download the new application.  The form is available for immediate use.


View Document
Carrier and HR Updates 7.5.17 part 2
by Rosa Tessandori » Tuesday, July 11, 2017 2:01 PM


UNITED HEALTHCARE
     
       
Broker Connection- June

  • New, Required Broker  Questionnaires and Attestations: As part of ongoing efforts to ensure protection of customer data, UHC will be asking agents to confirm that their computer equipment and practices are compliant with certain security standards, where applicable.
  • Specialty Medications:  AxelaCare® Health Solutions has a new name, BriovaRx Infusion Services.
  • Travel Protection Program:  Grow your business while helping to address your clients’ safety and well-being needs throughout their travels.
  • Specialty Broker Bonus Program:  View the requirements for earning a bonus.
  • Broker and Client Training:  Lean more about UHC's quoting tools, broker resources or how clients can better administer their benefit programs by attending an informational webinar.

HR ANSWERLINK

       
HR Support Center - eAlert

  • Minimum Wage Increases:  Seven municipalities in California have passed minimum wages that are higher than the state rate and will go into effect or increase on July 1, 2017.  
  • Domestic Violence Victim Leave Notice:  Employers with 25 or more employees must provide this notice to all new hires (as part of a new hire packet is acceptable) and to any employee upon request.
  • Expanded Protections for Transgender Employees: New regulations going into effect July 1 extend existing protections by requiring that employers take affirmative steps to acknowledge and respect an employee’s gender identity.
  • Further Restrictions on Use of Criminal Histories: The Fair Employment and Housing Council released new rules related to the use of criminal histories in employment decisions, which take effect July 1. 

 



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RBG Now Contracted with CA Health Net Small Group Eff 7/1/17
by Rosa Tessandori » Wednesday, June 28, 2017 1:52 PM


 
We are pleased to announce that CA Health Net Small Group plans are now available through Rogers Benefit Group!


We have enjoyed a successful large group partnership with Health Net for many years and the timing is perfect to expand the partnership to include small group products.

Health Net companies help more than five million people get the health coverage they need.

Whether you're looking for PPO, HMO or EPO coverage; Health Net offers a wide range of plan benefit designs at the right price point for maximum value and accessibility.

We look forward to partnering with YOU on your Health Net small group needs!

Please contact your RBG representative or our office for additional information, or if we can be of service in any way.
 


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Carrier Updates 6.26.17
by Rosa Tessandori » Monday, June 26, 2017 3:59 PM


ANTHEM BLUE CROSS

     Producer News Online
  • Optional PCP:  To engage members in the Anthem value-based model, members are encouraged to pick a PCP even if doing so is not required by their health care plan, click here to learn more.

BLUE SHIELD OF CA

     Broker Update
  • Trio Plans:  5 good reasons to sell Trio... Reasons #1 & #2, no participation requirements for medical and ancillary, click here to learn more.
  • HSA Administration:  Effective October 2017, HealthEquity can now also administer accounts the Silver Full PPO Savings 2000/20% plan in addition to the bronze level plans.
     Broker Update
  • California Assembly Bill (AB) 72:  Effective July 1, 2017, this new state law protects individuals from receiving unexpected "surprise or balance" medical bills from an out-of-network (OON) doctor when receiving inpatient and outpatient non-emergency care and services at an in-network healthcare facility such as a hospital, clinic, lab, imaging center or other healthcare facility.  
    Marketing Bulletin
  • Quick Match:  The program making it easier to sell life insurance has been extended through the end of the year and is available to groups with Groups 51 to 100 eligible employees.
  • Reduced Life Rates:  Effective 7/1/2017, BSC has lowered their composite life rates for groups with 10+ eligible employees.


View Document
Carrier & Compliance Updates 6.19.17
by Rosa Tessandori » Wednesday, June 21, 2017 10:43 AM


AETNA

      Broker Announcement
  • New Venture with Sutter Health: This joint venture will deliver a differentiated, personalized experience for members and is designed to help lower the cost of care, resulting in competitively priced products. Sutter Health and Aetna anticipate offering self-insured commercial products starting mid-2018 in the greater Sacramento, Central Valley and Bay Area communities, as well as fully insured PPO products to follow in early 2019, pending regulatory approval. 

ANTHEM BLUE CROSS OF CA

     Producer News Online -Small Group
     Producer News Online - Large Group

     Small and Large Group:
  • Cash Back Rewards: Members can earn up to 15% cash back from participating retailers
  • Voluntary and Optional Life:  Sell more life, Anthem offers Guarantee Issue up to $100,000.
  • Employer Portal:  Technical upgrade delayed to July 28, 2017.

     Small Group
  • Disability 2-9 Market View the underwriting guidelines 
    for Short Term and Long Term disability for groups with 2-9 eligible employees. Coverage is also available on a voluntary basis for groups with 10+ eligible and 10 enrolled.  A bundling discount with dental does not apply to 2-9 STD or LTD coverage (or voluntary).

     Large Group
  • Integrated Health Care Report - Edition 2:  This new whitepaper contains industry research on Integrated Health Care (IHC), an employee benefits strategy that connects medical, dental, vision, pharmacy and disability data to engage employees in wellness programs and improve health outcomes.
  • Plansource Contract Changes:  Effective 10/1/2017, Anthem will no longer offer Plansource to new customers for free or at a subsidized cost. 


BLUE SHIELD OF CA

     Small Group
  • 4th Quarter Rates:  A formal rate release has not been announced, however rates have been posted 120 days in advance due to recent guideline requirements and the t is expected soon.
  • Q4 Rates are currently available online.  A formal announcemen
     Large Group

COVERED CA 

     Partner News
UNITED HEALTHCARE
  • Broker Bonus Q3 Program: View the flyer to learn more.
  • Broker Bonus Q4 Program: View the flyer to learn more.
  • HMO 2017 Comparison Brochure:  The brochure has been corrected, please discard prior versionsclick here for the latest version.
  • 2017 Strong Presence CA Brochure:  View the flyer to learn more.

       UHC Broker Connection - June
  • MLR Rebate Timetable:  Rebates will be mailed to customers in the final two weeks of September.
  • eServices:  Browser updates will be effective July 21st.
  • Preventive Screenings:  Expanded screenings for colon cancer available beginning July 1st.
  • Vision:  New lense formulary goes into effective July 1st.
  • Rx Drug List Changes:  View the latest PDL Tracker.

E is for ERISA
  • ACA Reporting Penalty Process:  Until ACA is repealed, employers must continue to comply with the requirements of the law. The IRS is currently issuing notices to employers that require them to disclose whether they complied with ACA large employer reporting duties, or their excuse for not doing so, where applicable. This post describes the notices and how to respond to them.  View the article.

WAGEWORKS
  • No More Pre-Tax Commuter Transit Benefit Plans?  Act now to preserve tax savings for you and your employees, click here to learn more.


View Document
Carrier, HR & Legal Updates 6.12.17
by Rosa Tessandori » Friday, June 16, 2017 8:31 AM


ANTHEM BLUE CROSS

Producer News Online

Small and Large Group
  • Employer Portal Update:  On June 16, EmployerAccess, is moving to a new and improved platform as part of a technical upgrade.  Learn more.
  • Required Annual Notices:  Members will receive several required notices such as the Notice of Privacy Practices, Women's Health and Cancer Rights and other important notices.  Learn more.
  • ACA Reminder:  Collection of corrected names and Social Security numbers is currently under way.  Learn more.

Small Group
  • Dental Complete Online Member Guide:  View the Online Dental Guide Demoit includes information on benefit details, how to search for a dentist, a dental cost estimator and more.  Learn more.
  • Real-Time Online Enrollment:  Beginning July 1, 2017, the Anthem standard will be to submit new enrollments, changes and terminations online through EmployerAccessLearn more.

Large Group
  • Mandatory Online Payment:  Effective 9/1/17, the new Anthem standard will be to issue bills (invoices) online and accept premium payments online throughEmployerAccessLearn more.
  • Act Wise CHDP Webinar: Register today for the June 22 webinar. Find out why Act Wise CDHP is the solution for your large group clients. Learn more.
  • Dental Prime and Dental Complete Online Member Guide:  View the Online Dental Guide Demoit includes information on benefit details, how to search for a dentist, a dental cost estimator and more.  Learn more.
  • Disability Claims:  View the Overview Brochure for an explanation of what to do to file a claim, what information is needed and more.

BLUE SHIELD OF CA
  • UCLA PCP Transitions:  Effective July 1, 2017, UCLA Medical Group will be transitioning 24 primary care physicians (PCPs) to Providence Saint John's Health Center, dba Saint John's Health Clinic, a participating IPA/medical group in the Blue Shield HMO network.  Learn more.

HR ANSWERLINK 

Support Center HR Advisor Newletter - June
  • Five Tips for Effective Meetings 
  • Unpaid Internships - DOL's six specific criteria
  • State Defined Protected Classes
  • OSHA Delays Electronic Record-Keeping Rule Compliance Date
  • Working Families Flexibility Act 
  • American Health Care Act (AHCA) - Employer Penalties Reduced to Zero
  • Working with Summer Scheduling Challenges
Want to learn more about HR AnswerLink's Support Center?  Click here or email us at sacramento@rogersbenefit.com  


CAHU / NAHU
 
TASC
  • Special FSA Discount:  Take advantage of this limited time offer available from July 1st -  September 30th,  to learn more, click here!


View Document
Carrier & Compliance Updates 6.5.17
by Rosa Tessandori » Thursday, June 08, 2017 12:31 PM


ANTHEM BLUE CROSS OF CA

  • MLR Survey:  Surveys were mailed beginning May 25th and will be staggered over several weeks. When groups receive the survey notice, they will be prompted to visit a link and complete the survey. As a reminder, responses are not due until July 31. NOTE: Although most fully-insured small and large group customers will receive the survey, a small subset of customers will not if it does not apply to them. If a customer has not received the survey by the end of June, it is most likely the survey does not apply to them. 

 

BLUE SHIELD OF CA
   

       Producer Alert

  • New VP: Blue Shield is pleased to announce Steve Shearer as the Vice President and General Manager for our Small Business market. He joined the company on May 1, 2017.

UNITED HEALTHCARE
   

     Broker Connection

  • 2018 HSA Limits:  Guidelines recently releases by IRS.
  • Pharmacy Update: Updated PPACA/HCR Preventive Care Medication Lists available


EASECENTRAL

  • Earn a trip to Las Vegas:  Sell five (5) EaseCentral subscriptions before August 31, 2017 and you'll qualify for the EaseCentral Partner President's Club celebration in Last Vegas, Nevada this September.  View the flier.


BENEFIT RESOURCE INC,

  • HSA Webinar:  Join Benefit Resource, Inc, Thursday, June 8, 2017 at 1:00 ET for a webinar presentation; Be an HR Superhero: Drive HSA Adoption - Case Studies and Best Practices RevealedRegister now!


WAGEWORKS

  • Wearable Technology:  What are the potential HIPAA compliance requirements that may apply when an employer receives health information that doesn't fall into the definition of Protected Health Information (PHI)? View the Alert.



View Document
Carrier & Compliance Updates 5.30.17
by Rosa Tessandori » Wednesday, June 07, 2017 4:53 PM


ANTHEM BLUE CROSS OF CA

      
Producer Online News

  • ·         Cuidado Medico:  LiveHealth Online expanding.  Now members and consumers in 48 states will have access to Spanish-speaking doctors in their plans from the comfort of their home. 
  • ·         2017 Employer Application and Underwriting Guidelines:  Anthem has updated the language in the 2017 Employer Application in the Company Information, General Agreement, and Agent/Producer/Broker attestation sections.

 

BLUE SHIELD OF CA

     Small Business Broker Update

  • Relaxed Participation:  The employee participation requirement is just 25%, with a minimum of five enrolled employees. This promotion applies to dental, vision, and life* plans as well, as long as Blue Shield is offered as the sole carrier for specialty plans. View the flier.
  • Start-up Underwriting: Effective immediately, BSC has expanded their underwriting guidelines and will view new small business groups as a start-up based on the hire date of their first eligible common law employee.
  • Age Calculation Correction:  The new hire age calculation error for groups with effective dates prior to 9/1/16 has been fixed. Groups will be corrected as they renew.  Corrections will not be retroactive. Look for additional updates in July.

      Employer Connection Plus Update

  • EC+ Upgrade Rollout:  BSC has simplified and streamlined the renewal and benefit administration processes on EC+.  The new services will be available to select groups which renewed in the first quarter of 2017, and their respective brokers. Additional groups will be added through 2018. Eventually, all small business groups and brokers will have full access to the new services and tools.

  

E is for ERISA
 
  • Single-Payer: California is leading the discussion.
  • “Play or Pay”:  It is still in play.
  • Funding: If there are no penalties, revenue has to come from another source.
  • Renewals: 2018 Health insurance renewals will be business as usual.
  • Cost-containment:  Strategies that are gaining in popularity.

 

HEALTHIEST YOU

  • Teladoc Webinar:  Learn more about the telemedicine industry from a doctors' perspective, Teladoc's Senior Medical Director Dr. Kyon Hood.  Click here to view the recording.
  • Free HealthiestYou Membership:  As a thank you to brokers for viewing the Teladoc national webinar, HealthiestYou will provide you with a FREE Healthiest You VIP membership.  Contact sacramento@rogersbenefit.com to request assistance in setting up your free membership.

 



View Document
Carrier Updates 5.22.17
by Rosa Tessandori » Tuesday, May 23, 2017 8:46 AM


AETNA
  • Member Portal:  View the update regarding the features and benefits of the Member tool, called Aetna Navigator. 
  • MC/PPO "HEAL" Benefit:  Aetna has partnered with HEAL to offer on-demand doctor house calls in two hours or less.  Click here for more info.
ANTHEM BLUE CROSS
  • 8/1/17  Renewals:  As of Friday, May 19th, renewals will be available on the broker website and will be mailed out to groups on Thursday, May 25th.  Employers will be able to access a copy of their renewal through Employer Access (EA) as of Tuesday, May 30th.
BLUE SHIELD OF CA
     Producer Alert
  • Trio Only Groups - Participation Waiver Program:  Effective 9/1/17, BSC is waiving their participation requirements for groups of 1 to 100 eligible employees with Trio-only membership.  Frequently asked questions (FAQ’S)  will be sent out as soon as they are available.  Groups selecting Trio only for their medical health plans can also add specialty coverage – dental or vision – with the same minimum participation requirements waived! 
UNITED HEALTHCARE
  • Updated Materials:  View the Q3 updated product guides, underwriting and marketing pieces.   Special underwriting note:  The additional Proof of Ownership requirements (listed based on business type), are ONLY Required for groups with less than 10 eligible employees –or- groups that don’t submit the Participation Certification Form (regardless of length in time in business).  Click here.
  • Quick Reference Sheet:  View a recap of product options, underwriting notes, commissions, Q3 rate action and network updatesClick here.


View Document
Carrier Updates 5.16.17
by Rosa Tessandori » Tuesday, May 23, 2017 8:36 AM


BLUE SHIELD OF CA
  • Athena WISDOM Study:  Members who choose to participate in the Athena Mammogram Study, may qualify for advanced testing options.  Blue Shield will send email invitations to potentially eligible members beginning May 8, 2017. Click Here to learn more.

UNITED HEALTHCARE
     
     Broker Connection
  • Form 1095-B:  A new process will be used for collecting IRS 6055 Aggregate Information for 2-50 Small Group New Business.
  • Self-Funded Plan Sponsors:  A PCORI notice is scheduled for All Savers® Clients.  The employer groups will determine which counting method they wish to use, complete and file the IRS Form 720. The Federal Excise Tax return Form 720 can be found on the IRS website.
  • Vision:  The new vision network includes Target and Sears.
  • Sales Automation Management (SAM): The broker sales tool is now available in new markets.
  • Opiod Abuse:  Learn how UHC invests in a multi-dimensional programs to address opioid abuse.
  • PDL Tracker:  View the latest prescription drug list changes.

WAGEWORKS
  • IRS Announces 2018 HSA Limits: To view the announcement, Click Here. The new annual maximum contributions are $3,450 for Individuals and $6,900 for families.


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Blue Shield of CA 9/1 Renewals - Revised Release Date
by Rosa Tessandori » Tuesday, May 09, 2017 9:23 AM


BLUE SHIELD OF CA
  •  September Renewals: The previously published expected release date for September renewals has been revised from May 12, 2017 to June 16, 2017. Printed copies will be mailed to employers on June 23, 2017. These dates may be subject to further changes. Visit the Renewal Center for future updates.


Carrier Updates 5.8.17
by Rosa Tessandori » Tuesday, May 09, 2017 9:15 AM


ANTHEM BLUE CROSS
  • Producer e-newsletter: View the May 4th, 2017 issue. It includes topics on the Rx 90-day retail network, real-time online enrollment, disability insurance awareness month and encourage employers to learn about wellness incentives.
  • My Anthem (Employer) News: View the May 9th Issue, it includes topics on the wellness webinar updates, tips on choosing a broker, Telahealth insights, unlocking online wellness, Provider Care Management Solutions (PCMS) and the latest in pharmacy news.
  • Wellness Webinar: Invite your employer groups to register for the May 17, 2017, 11:00 a.m. wellness webinar. Small and large group employers are welcome.

BLUE SHIELD
  • September Renewals: Renewals will be available for downloading via the broker website May 12, 2017. Printed copies will be mailed to employers on May 19th.  For more information, visit the Renewal Center

BLUE SHIELD LARGE GROUP
  • Trio Rewards: You can start generating your Earned Rewards bonus with a minimum of two new business cases or 500 new medical members or 200 net new Trio members. Click here to learn more.

CALIFORNIA CHOICE
  • September Renewals: Renewals will be available for downloading via the broker website the last week of June. Printed copies will be mailed to the employer for arrival during the 1st week of July.

UNITED HEALTHCARE
  • Broker Webcast: Join UHC May 24, 2017 2:00 p.m. for an overview of UHC4me Sales Tools (focusing on renewals), 7/1 Underwriting Updates, How to Obtain Deductible Credit and more. Registration is not required but space is limited. Click here for details and click here to add to your calendar.

EASECENTRAL


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Carrier & Compliance Updates 5.1.17
by Rosa Tessandori » Monday, May 01, 2017 6:32 PM


ANTHEM BLUE CROSS

      Producer Online News
  • Provider Care Management Solutions (PCMS): New Video educates members on this web-based program.
  • LiveHealth Online: Starting the week of May 1, Anthem individual and group members will get a series of campaign communications from Anthem about LiveHealth Online. Learn how members who sign up for LiveHealth Online during the campaign get a chance to win the grand prize.
  • Life & Disability Quotes: Producer Toolbox life and disability quotes now include a Group Plan Summary page at the end of their quote.
  • Small Group Ace Broker Program: This brochure highlights the benefits of the Anthem Circle of Excellence (ACE) Broker program.

BLUE SHIELD OF CA
  •  Trio Incentive Program (TIP): Earn an additional $250 for groups and $25 for members enrolling in one of our Trio plans between May 2017 and January 2018. TIP applies to new sales and renewals. View the details and more.
  • AuthAccel Online Tool: There is a new online system for providers to obtain accurate medical and pharmacy authorizations. View the alert.
  • Athena WISDOM Study: This study aims to improve how women are screened for breast cancer. Blue Shield of California is collaborating with UC Medical Centers, and some members may be eligible for benefits to participate in the WISDOM study. To learn more, click here.

WAGEWORKS

     Compliance Update
  • Nondiscrimination Tests: What are they?
  • Form 5500:  is the employer subject to Form 5500 filings?  What is a Welfare Benefit Plan? Who must file a form 5500?


View Document
Carrier Updates 4.24.17
by Rosa Tessandori » Monday, May 01, 2017 6:14 PM


BLUE SHIELD OF CA
BLUE SHIELD OF CA 51-100
UNITED HEALTHCARE
  • 7/1 Rate Action: Average quarterly increase - PPO 3.2% and HMO 7.1%.
  • 7/1 Product Grid: View the updated product grid, which includes the new Silver HSA 2000 (Indv) / 2600 (Fam) Aggregate (Non Embedded) deductible plan.
  • 7/1 Product and Benefit Selection Form: View the updated form.
  • ACEC Program: The American Council of Engineering Companies (association) offers health plans utilizing UHC's National Choice Plus Network. To learn more about this program and benefits for engineering and land surveying based companies, contact your RBG sales representative.


View Document
Carrier Updates 4.17.17
by Rosa Tessandori » Friday, April 21, 2017 6:03 PM


ANTHEM BLUE CROSS

     
 Producer News Online

  • Q3 Rate Action:  Average quarterly rate increase PPO +3.1%, HMO +2.8% and 0% on specialty benefits.  View the rate guide.
  • Emergency Room Member Outreach Campaign: Take a peek at a few of the campaign examples on how to reduce unnecessary ER expenses.
  • Real-Time Enrollment:  Communications begin in April 2017.  Beginning July 1, 2017, the Anthem standard will be to submit new enrollments, changes and terminations online through EmployerAccess, also known as the Employer Portal.
  • Special Benefits Broker Guide:  Your guide to everything about dental, vision, life and disability.
  • Webinar- Health & Wellness:  Invite your clients to a 30-45 minute webinar Wednesday April 19, 2017, 11 a.m. Pacific Time.


BLUE SHIED OF CA

  • Q3 Rate Pass:  No rate increase for medical and specialty plans.
  • "No DE9C":  Program is continued through August 2017.  
  • Relaxed Participation:  Program is continued through August 2017, view the flier.
  • July Renewals:  Kits are available online to download, mailed copies go out to the employer on April 21st.
  • Trio ACO HMO Updates: Incentive program begins in May, dual HMO option alongside Access+ HMO reminder and don't forget to use the Trio Zip Code finder tool.
  • Specialty Benefits:  Additional details coming soon on the Small Business Bundled Savings program.
  • Teladoc: Clients have access to Teladoc upon renewal.  Other value added features include Wellvolution, ID protection, Healthquity and Blue Shields Updated mobile app.


BLUE SHIELD OF CA 100+

      Producer Alert
  • Quoting Package Update:  Multiple options now included in one proposal.
 
UNITED HEALTHCARE
 
  • Preventive Screening Changes:  Updated breast cancer and cholesterol screenings and changes to medications for cholesterol and cardiovascular disease.  ACA update on statins eligible for coverage at zero cost-share.
  • Health Discount Program: UnitedHealth Allies offers savings from 10% to 50% on health and wellness related products.
  • Self Funded Specialty Benefits:  View the updated portfolio.
  • Member Websites Enhanced: View the enhancements. 
  • Pharmacy:  View the PDL Tracker recap of changes.


View Document
Carrier Updates 4.10.17
by Rosa Tessandori » Friday, April 14, 2017 3:40 PM


BLUE SHIELD of CA
  • Reduced Participation: This promotion has officially been extended through September 30, 2017. The official producer alert and flyer are expected to be released soon.
  • Q3 Rate Pass: BSC announced there will be a rate pass for all third quarter 2017 medical and specialty plans. Rates vary by region and rate tables can be found under Plans & Rates on Broker Connection.
SAHU
  • Expo: Wednesday April 19, 2017 – Registration at 7:30 am, event from 8:00 am – 3:30 pm. Attend the Sacramento Association of Health Underwriters Business Development Expo. View the Flier.


View Document
Carrier Updates 4.3.17
by Rosa Tessandori » Tuesday, April 04, 2017 10:31 AM


 BLUE SHIELD OF CA

Producer Alert

 

·         Q2 Amended SOBs and EOCs: Updated documents will reflect endorsements for 15 benefit changes.  Small business customers will only receive endorsements that impact plans to which they subscribe.  A list of the changes is also attached.  

  BLUE SHIELD OF CA 51 – 100

  • Life Insurance Quick Match Program:  Provides streamlined underwriting by matching  renewal rates from the group’s current life insurance company. For New and existing groups adding life with effective dates of April 1 through June 1, 2017.   View the announcement.

UNITED HEALTHCARE

  • UHC’s April Webcast:  Registration is not required but space is limited so join early!  Topics will include: ACA Updates, 7/1 CASB Portfolio Changes, ACEC, Ancillary, UBES Free Services (COBRA, FSA 7 PTP), Wellness.  When? Wednesday, April 12 @ 2 p.m. PDT.  View the Flier for details.

CAHU

  • Single Payer Conference Call/Workshop: CAHU's Vice President of Legislation, Dave Fear, Jr., is calling upon all CAHU members to participate on a conference call/workshop, Thursday, April 6 @ 3:00pm, which will focus on strategies to defeat SB 562 --  current Single Payer legislation.   Please click here and register to ensure your spot on the call!

 



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Carrier & Compliance Updates 3.27.17
by Rosa Tessandori » Friday, March 31, 2017 6:04 PM


BLUE SHIELD OF CA

Website Update
  • New Look for BSC: Blue Shield has updated their website, all new pages means all new links. Visit Producer Connection today and get acquainted.

Broker Update
  • Heal™ - In-Home Care Benefit: Blue Shield introduces Heal™, PPO members can access on-demand visits to a member's home, office or hotel. Available in limited areas: Oakland, Berkeley, San Francisco, the Peninsula, San Jose, San Diego, Los Angeles and Orange County.
  • "No DE9C" Extended: Through June 2017 effective dates, groups with 10 or more enrolling in medical coverage can submit a completed and signed Eligibility/Participation Attestation and the billing statement from the group’s prior carrier in lieu of a DE9C.
  • The Trio Qualification Tool: The quick and easy way to see if the Trio ACO HMO plan is a good fit.
  • Renewal Kits: May and June kits are available for download in Producer Connection site.
  • Member Level Changes: Utilize Employer Connection Plus for your adds, terms and changes.
  • Wellness Discounts: See the list of available discount programs and vendors like ClubSport, Weight Watchers, 24 Hour Fitness and more.
  • BlueCard Services: Provide employees with access to quality care with best-in-class solutions worldwide.
  • "NEW" Blue Shield Global: Introducing the new Blue Shield GeoBlue Plans: Global Core, Global Traveler and Global Expat plans available for purchase by Individuals, employers and academic institutions.
  • Trio for Travelers: With Trio, unlike non-Blue carriers’ narrow network plans, members have access to a national and worldwide provider network through BlueCard.
  • Ethics: The Ethisphere Institute has named Blue Shield of California one of the World’s Most Ethical Companies for 2017.
  • Cal Index Becomes Manifest MedEx: Cal INDEX announced it is merging with the Inland Empire Health Information Exchange to create one of the nation’s most comprehensive health information exchanges (HIEs).

ANTHEM BLUE CROSS

Producer News

HEALTHIESTYOU
  • Zero $0 Consultations: Do you have employees with family members not enrolled in the group medical plan? Offer employees access to unlimited free phone consultations with HeatthiestYou (HY). Offer it on a voluntary basis or on a contributory basis, either way it's a great deal! View the Overview flier and Spring Fever flier.

WAGEWORKS

Compliance Alert
  • Excepted Benefits: Discussion of new guidelines affecting Short-Term, Limited-Duration Insurance, Travel-Insurance and Similar-Supplemental-Health Coverage under Excepted Benefit Rules. Click here, to review.
 


View Document
Carrier Updates 3.20.17
by Rosa Tessandori » Friday, March 31, 2017 5:40 PM


AETNA

Formulary Updates
  • 2017 Formulary Change Reminder: New groups in 2017 will be accessing the Aetna CA Small Group Value Formulary. Existing business will transition upon their 2017 renewal. To view the formularies, go to: https://www.aetna.com/individuals-families/find-a-medication.html
  • 2017 Quarterly Formulary Changes: Drug list updates will now occur January 1, April 1, July 1, and October 1. These changes will apply to all members on the date of the change. Impacted members will be notified of upcoming drug list changes by e-mail or letter, and updating will be posted on Aetna's web pages.

CHOICE BUILDER


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Carrier Updates 3.13.17 Part 2
by Rosa Tessandori » Tuesday, March 14, 2017 3:11 PM


COVERED CALIFORNIA

Partner News
  • Directors Corner: Thanks from CCSB in increasing sales 26% over 2015 numbers. Expect a spring marketing campaign focused on the Small Business Federal Tax Credit designed to drive traffic to the CCSB website and increase engagement with small business owners. Reminder of the recent changes to the delinquency notice policy.
  • New Monthly Direct Client Communications: In February, CCSB kicked off a new communications initiative targeting active inforce groups. This month, clients will receive a message titled, “Navigating Your Company's Monthly Billing Statement” which educates employers on the most asked about sections of the invoice. For a preview of the March message, click here.
  • CCSB Spring Marketing Campaigns: To view a sample of the optimized Facebook, Twitter, and Google Search content as well as supporting research, reference the CCSB Spring 2017 Campaign Strategy Outline.
  • Tax Credit Postcards: The Covered California for Small Business SHOPWorks program has updated its tax credit postcards just in time for the 2017 tax season. Reference the SHOPWorks Flyer for information on how to order your customizable postcards to target small businesses in your area at little to no cost to you! Get leads by working with a tax professional, To search for a list of tax preparers in your area, visit the California Tax Education Council (CTEC) website.
  • Qualifying Life Event Matrix: If employees or their dependents experience a qualifying life event, they can enroll in a CCSB health insurance plan outside of your client’s normal open enrollment period.  For more information on qualifying life events, reference the Qualifying Life Event Matrix on the Covered California website. 
  • CCSB Responds to Concerns Regarding Delinquency Policy Change:   CCSB has revised the initial delinquency notification policy and will send employers the initial notice of delinquency, but not to employees. Read more here
  • Small Business Health Care Tax Credit: Covered California for Small Business is the only place where your small business clients could be eligible for a federal tax credit. For more information, please reference the CCSB Tax Credits Resources.
  • The Future of Technology in Small Group Health Insurance: In case you missed it, check out “The Future of Technology in Small Group Health Insurance,” an article in the February edition of California Broker by Kirk Whelan, Director of Outreach, Sales, and Small Business for Covered California.
UNITEDHEALTHCARE
 
  • 3rd Quarter Rate Update: Effective July 1, 2017 UHC will increase their HMO rates by 7.1% and PPO rates by 3.2%.  To read the full release, click here.
Broker Connection
  • Member Annual Dental Notice: UHC will mail a notice to California health maintenance organization dental subscribers in late March regarding of the procedure for processing and resolving grievances. This mailing is informational only. No action is required from subscribers. 
  • Website Update: Effective April 15, Employer eServices® will no longer support Internet Explorer® (IE) browsers 10 and lower. Newer browsers offer increased security and protection. Users should upgrade their browsers to IE 11 prior to this date. For more information, please contact your UHC representative.
  • New SBC Template Effective April 1: View guidelines for providing the applicability dates and details for the new 2017 Summary of Benefits and Coverage template and uniform glossary. 
  • Annual Privacy Notice: UHC's Financial Information Privacy Notice will be sent to fully insured dental and/or vision plan subscribers beginning late March, as required annually under the Gramm-Leach-Bliley Act. 
  • New "Step-up Preventive" Dental Benefit Design Now Available: A new progressive dental benefit design, "Step-up Preventive," is now available for Dental Preferred Provider Organization and Dental In-Network Only plans.
  • Specialty Medication Prior Authorization Requirement: UHC commercial plans are implementing new notification/Prior Authorization requirements for administration of Exondys-51, Xolair, and Inflectra.


View Document
Carrier Updates 3.13.17 Part 1
by Rosa Tessandori » Tuesday, March 14, 2017 2:23 PM


AETNA


2nd Quarter 2017 Updates

  • Rate Impact Updates: View details regarding the medical quarterly and annual rate impact, as well as the dental rate changes.
  • Aetna Providence Network: In addition to Santa Clara County IPA and MemorialCare, Aetna is introducing a new collaboration between Aetna and Providence Health & Services that brings the triple aim of accountable care (better health, better care, and better cost) to more members in the greater Los Angeles area for May 1 effective dates.  
  • Open Access Managed Choice Network (OAMC/MC):  View the latest network additions in the Los Angeles area.
  • Underwriting: No current underwriting updates.
  • New Business Submission Deadlines:   The cut-off date is the 1st of the month, groups received after the 1st of the month are considered a late submission and will be moved to the next effective date. 


ANTHEM

  • Anthem Broker News Sign-Up:  Sign up to receive any new or late breaking news via email by clicking on the below link and entering your name and email address.  Visit the Anthem Email Preference Center to sign up or update/change your email preferences at anytime.
  • Formulary Update:  Beginning March 1, Anthem individual and employer-sponsored health plans will cover the authorized generic (AG) form of EpiPen on Tier 1. This change applies to the National, Essential, Preferred, Generic Premium and Select Drug Lists.  Epinephrine coverage for emergency treatment of allergic reactions, including anaphylaxis.  For additional information,  click here to view the full Sales Call announcement.

BLUE SHIELD OF CA

Producer Alert

  • The Trio Qualification Tool:   Trio ACO HMO plans offer integrated care with lower premiums and out-of-pocket costs than most of their non-ACO plans. Also, you now have an easy way to check if the Trio service area is a fit for your clients – the Trio qualification tool. Watch the one-and-a-half minute video demo to see how quickly and easily the Trio qualification tool can match the Trio service area to your client's employee census. The tool also displays which medical groups would be assigned to employees based on their ZIP code.  Learn more about Blue Shield’s Trio plans and use the tool at www.blueshieldca.com/aco

Producer Alert

  • Corporate Office is Moving:  Blue Shield will move its corporate headquarters from San Francisco to Oakland.   The move will take place in mid-2019, and nearly all executives and staff will move from 50 Beale Street in San Francisco to the new location at 601 12th Street in Oakland.   This move is designed to reduce administrative costs while we position ourselves to grow in membership. 



View Document
Carrier Updates 3.6.17
by Rosa Tessandori » Wednesday, March 08, 2017 10:53 AM


 ANTHEM BLUE CROSS

  • Easy Renew:    Visit www.anthem.com/easyrenew, your one stop shop to access the 2017 Underwriting Guidelines and so much more.
  • Dual PPO Network Option:  Reminder that the promotion ends 3/15/17.
  • Renewing Groups:  Want to add or downgrade a medical plan?  Change the anniversary month? Want to know when the changes can be effective and what forms to use?  Refer to pages 19-22 of the January 2017 Underwriting Guidelines for general instructions.  Reminder, requests for anniversary changes must be received by Anthem generally no later than the 15th of the month prior to the requested effective date. 


BLUE SHIELD of CA

     
Broker Update -Small Group

 
  • Message from the Senior Vice President
  • Bronze Plans Highlights:  The Bronze 5100 PPO now includes three office visits prior to the deductible, providing greater value for your clients. Previously the Bronze 5100 plan required members to meet their deductible for office visits (outside of preventive care). The Bronze Full PPO Savings 4500 & Bronze Full PPO Savings 5500 plans can be integrated with H.S.A. Administration services provided by Health Equity.
  • Sorela Health:  Lifestyle coaching  geared toward reducing the risk of type 2 diabetes. Blue Shield members can be referred by a physician and can also enroll in any program after completing a risk assessment at Solera4me.com.
  • New Palliative Care Program:  In January, Blue Shield of California began offering their fully insured Sacramento-area plan members a new, home-based palliative care program as a benefit.   For more information,  read the press release announcing the new program, available on Blue Shield’s Media Center.
  • Updated Broker Portal:   Producer Connection will now be Broker Connection and is being updated and upgraded. 
  • Post Enrollment Materials: Once your clients’ post-enrollment materials for any respective month are ready, they will be posted on Shield Renewals in our Renewal Center,
  • Updated Forms for Q2:  The Master Group Agreement (MGA), Employee Enrollment Form, Request for Contract Change and Subscriber Change Request forms have been revised for Q2 2017.  Submissions using outdated underwriting forms will pend until the updated forms are submitted. You can find all of the up-to-date materials at Producer Connection - Forms.
  • Teladoc Member Email Outreach: New and renewing groups members can save time and money by using the embedded Teladoc benefit.   View the Teladoc flyer for more information.   Members in groups with January and February 2017 renewal or effective dates will receive emails from Teladoc on how they can begin using this service.
  • BSC Vision Plans:  BSC offers one of the largest vision provider networks.  Click here, to access rates and plan information.
  • ID Monitoring: Blue Shield medical plan members can now get identity protection services such as identity repair assistance, identity theft insurance, and credit monitoring, offered at no charge. 

COVERED CA

     
Partner Alert

  • Delinquency Policy:  Employees will no longer receive a CCSB delinquency notice when an employer has missed their initial payment deadline.   


View Document
CaliforniaChoice Retro 1/1-6/1 Benefit Changes
by Rosa Tessandori » Wednesday, March 08, 2017 10:04 AM


CALIFORNIACHOICE

Benefit Changes Retroactive 1/1/17 - 6/1/17

To comply with California Department of Managed Health Care requirements, various plan benefits were retroactively revised. CaliforniaChoice emailed employers a list comparing the incorrect quoted benefits vs the final corrected benefits,
 click here to view the list.  Rates for these plans did not change.

Plans quoted through EBIX/HealthConnect prior to February 24, 2017 and plans quoted through the CaliforniaC The 1/1/17 – 3/1/17 SBCs, EOCs, Employee Enrollment Guides and Benefit Summary Guides previously available on the CaliforniaChoice website  may contain incorrect plan information. Corrected documents will be posted once received.  The 4/1/17 – 6/1/17 documents are not yet available, but will contain the correct plan information once posted on the CaliforniaChoice website. hoice quote system prior to 12:00 pm on Tuesday February 24, 2017, contain the incorrect benefit information.  


CaliforniaChoice and the applicable carriers, are not sending members a notification of the change.  Employers are responsible for notifying affected members.   Employees enrolling or renewing who are affected by the benefit changes and may have received a CaliforniaChoice quote, Enrollment Worksheet, SBC, EOC, Employee Enrollment Guide or Benefit Summary Guide containing the incorrect benefit information, should be provided the following two documents:

Members remaining enrolled in a plan affected by a benefit change, will automatically have their claims reprocessed and a revised Explanation of Benefits (EOB) will be mailed out to the member as applicable.

Members affected by a retro benefit change can request a plan change.  However, all requests are subject to review.  Requests should be submitted as soon as possible.  

For instructions on how to submit a plan change request, for a side by side comparison quote of the affected plans, or if you have any other questions or concerns regarding this matter, please contact your Rogers Benefit Group Sales Representative or email/call our main office. 

View Document
Carrier Updates 2.27.17
by Rosa Tessandori » Wednesday, March 01, 2017 9:49 AM


BLUE SHIELD OF CA
  

COVERED CALIFORNIA
   
  • Health Net Off Cycle Rate Change:  Effective May 1, 2017, Health Net has issued off cycle second quarter rate changes that will impact Covered California for Small Business renewals and new business with effective dates of May 1, 2017 and June 1, 2017. April rates will not be affected.

UNITEDHEALTHCARE
   
  • Specialty Medications:  Effective Jan. 1, UHC requires prior authorization for the new specialty medications: Probuphine (buprenorphine) subdermal implants, Cinqair® (reslizumab) and Nucala® (mepolizumab), Ocrevus™ (ocrelizumab), and Gonadotropin-releasing hormone analogs.  For more information, visit UHC's Specialty Pharmacy Information Center or contact your UHC representative.
  • 2017 Specialty Product Bonus Program:  Earn bonuses on new and renewing sales of dental, vision, basic life, supplemental life, short-term and long-term disability, critical illness protection, accident protection, and hospital indemnity protection.  View the bonus brochure.
  • Broker Webinar Training: Learn more about UHC's quoting tools and other broker resources on United eServices®  Date:  Tuesday, Feb. 28.   Time:  11 am to Noon  ET.  Register here. 
  • Employer Webinar Training:   Your clients can better administer their benefit programs on Employer eServices® by attending a UHC informational webinars.  Groups 2-99 Thursday, March 9, 2017 at 11 a.m. ET.  Register here .  Groups 100+ Tuesday, March 14, 2017 at 11 a.m. ET.  Register here.  Note:  Dial-in information will be sent via email three to five days prior to the webcast.
  • Telemental Health:  To improve access to care, Optum Behavioral Health has expanded its telemental health network to over 3,000 behavioral providers including AmWell and Doctor on Demand psychologists and psychiatrists. For more information, click here.
   Webcast Invite
  • Webcast Wednesday, March 8th at 2:00 p.m. (Pacific):  UHC's Northern California 1-100 Sales Team will be hosting a 2017 Webcast for their GA and Broker partners.  Registration is not required but space is limited, so please join the webcast early. Please refer to the attached flyer for details. The following topics will be discussed during the Webcast:   2017 Portfolio Refresh, How to Submit a Renewal, How to Use United eServices, and Upcoming SBC Changes. 


    View Document
    Carrier Updates 2.21.17
    by Rosa Tessandori » Friday, February 24, 2017 1:48 PM


    AETNA

    • Updated CA SB Toolkit: The attached Benefit Grid Toolkit includes slight updates to the HMO plans approved by the Department of Insurance and the Department of Managed Care.


    ANTHEM BLUE CROSS

    Producer Online News

    • Oroville Dam Emergency: To assist members impacted by the Oroville Dam emergency, Anthem has relaxed some of their guidelines for; filling an Rx, time limits on prior authorizations/pre-certification/referral requirements, replacement of DME that is damaged or lost, and has extended claims filing deadlines. Refer to the announcement for applicable dates and a list of plans/coverages excluded from the relaxed guidelines. For additional information or support, members can call the Member Services number on their ID card or select Customer Support on the Anthem website.


    BLUE SHIELD OF CA

    Producer Alert

    • 1099-INT Forms: In January 2017, Blue Shield of CA sent some members a 1099-INT form in error. The forms were meant for providers. Members will receive a letter next week, with a corrected 1099-INT form. Blue Shield did not send or report any information on the erroneous 1099-INT to the IRS, so members do not need to take any action.


    CALIFORNIACHOICE

    • New 4/1/17 Network Availability Grid: This new comparison provides a snapshot view of the CaliforniaChoice carriers with a listing of plans by tier and their network assignments. It’s a quick, easy way to see how the dozens of plan options under CaliforniaChoice break down by PPO, EPO, HSP, HMO, and carrier. View the announcement and access a link to the comparison.


    KAISER

    • 2017 DME List: All Kaiser Small Business plans cover “base” durable medical equipment items that are essential health benefits. View the attached flyer, for a list of plans that cover “supplemental” durable medical equipment.




    View Document
    Carrier & Compliance Updates 2.13.17
    by Rosa Tessandori » Monday, February 20, 2017 2:35 PM


    ANTHEM BLUE CROSS

    Producer News Online
    • Metallic Dental Complete PPO Plans: Sold only through California general agents effective April 1, 2017. For details, view the metallic dental plan details flier. Your RBG Quote team is ready to assist with requests for a Metallic Dental Complete PPO quote. Don't forget about Anthem's 5% bundling discount.
    • 2017 Commission Payment Schedule: The schedule shows the key dates in 2017 when your commission statements will be posted on your producer website, when electronic fund transfers (EFT) will take place (for those on direct deposit), and when commission checks will be mailed (for those not on direct deposit). View the schedule.
    • Blue View Vision: Reminder, quote using enrolled lives, not eligible lives. 
    • Dual PPO Network Option Promotion Ending Soon: Effective March 15, 2017, the Dual PPO Network Option Promotion* for new Small Groups will end. Submit forms for renewing or already renewed groups before the deadline. 

    BLUE SHIELD OF CA

    Producer Alert
    • Employer Connection Plus (EC+): Tips, in case an employer is having trouble logging into the site.
    • 1095-B Forms: Members should have begun to receive their form as of February 6.

    CALIFORNIACHOICE


    Broker Notification
    • Network Availability by Carrier & Plan Summary: Download a copy and easily compare 4/1/17 plans, networks and metal tiers.


    METLIFE
     
    Tailored Benefit Bundles 
    • Simply Smart: Bundles dental and vision for groups 10-99. View the pre-built MetLife simply Smart Bundles.
    • MetLaw: Simply Smart Bundles also gives you the exclusive option to offer a voluntary legal services plan for groups 10-99.
    • 2-year Rate Guarantees: Lock in pricing for your clients for 24 months across bundled products.
    • Multi-Product Bonus:  Sell a dental plan and at least two new coverages and earn an additional one-time payment of 1.5%.  View the details. 
    TASC

    Compliance Notice
    • It's The Law: TASC can help you stay protected all year, every year with their wide selection of compliance services to handle the work and worry for you. Let TASC be the compliance expert so you don’t have to. View info on the eight different pre-packaged compliance bundles.

    WAGEWORKS


    Compliance Alert
    • FMLA and Benefits Plans: This article examines the rules for participants going on an unpaid Family and Medical Leave Act (FMLA) leave. Regulation 1.125-3 summarizes employees’ rights to continue or revoke coverage and cease payment for Healthcare flexible spending accounts (FSAs) when taking an unpaid FMLA leave and specifications for participants returning from leave.  


    View Document
    Carrier Updates 2.6.17
    by Rosa Tessandori » Tuesday, February 07, 2017 11:11 AM



    BLUE SHIELD OF CA
     
    January Broker Update
    • Note of Thanks: Jim Elliott (VP & GM Core Accounts, Small Business Market, Producer & Channel Partner Relations) extends his thanks to the broker community.
    • Employer Connection Plus (EC+): The Blue Shield of CA online employer portal, is removing from the website the ability to submit enrollments that are due to loss of coverage or due to court orders. Instead, administrators will be required to submit these enrollments via paper. Blue Shield of CA will provide a notification when this change is implemented and reflected on EC+. 
    • SGOR Tool Online: The Small Group Online Renewal Tool is up and available for use to submit contract changes online.
    • 1095 Forms: BSC will mail members their copies of the 1095-B form by January 31, 2017. Employers may request a copy of the 1095-B forms to assist with filling out the employer 1095-C forms by calling Employer Services at (800) 325-5166.
    • Q2 - What’s New 4/1/17: View the guide for details. 
    • April Renewals: Visit the Renewal Page on Producer Connection to download your clients’ renewal kits.
    • Trio Network: Visit blueshieldca.com/aco for a complete listing of Trio covered zip codes and ACO providers. Areas with recent network expansion include San Diego, Riverside, San Bernardino, San Mateo and Nevada Counties.
    • 2016 Medical Loss Ratio Rebate (MLR) - Employer Survey: In December 2016, Blue Shield emailed the 2016 Medical Loss Ratio (MLR) employer survey to fully insured client groups (small and large). On February 6, 2017, Blue Shield will resend a copy of the 2016 Medical Loss Ratio (MLR) employer survey letter to fully insured client groups that did not respond to the original survey request. Employers can provide the requested information by going to blueshieldca.com/groupsize or by faxing the form back to (855) 895-3497. Survey information is required by February 24, 2017.
    • Teladoc: Is now included in all new 2017 plans and upon renewal for existing groups. Teladoc is a cost-saving service with $5 copays for most plans (except HSA's). Find out more about Teladoc.
    • Wellvolution: Is now included for groups effective and renewing as of November 1, 2016. This service is available for members 18 years of age and older. Wellvolution assists members with measuring their well being and in addressing specific health concerns such as preventing diabetes. Visit mywellvolution.com for more information (login required).
    • Diabetes Prevention Program (DPP): The DPP can help members lose weight, adopt healthier habits and reduce the risk of developing type-2 diabetes. This benefit is available at no cost to members and is included in all medical plans upon renewal, beginning November 2016. Visit solera4me.com/shield for more information.
    • Quitnet: Effective January 1, 2017 for all groups, regardless of the renewal date, will include nicotine replacement therapy (NRT) at no additional charge.

    EBIX
     
    Quoting Updates
    • Two New Enhancements: You can now create a "New Hire" Worksheet and run table rates with contributions.


    View Document
    Carrier & HR Compliance Updates 1.30.17
    by Rosa Tessandori » Monday, January 30, 2017 2:53 PM


    BLUE SHIELD OF CA
     
    Health Equity Employer Portal Webinars
    • Webinar Dates: Join Health Equity, Blue Shield of CA's HSA partner, for an introduction to their employer portal. Health Equity will demonstrate the key functions of the Employer Portal including the various options for making contributions. Please register for the date that best suits your schedule.

    CALIFORNIA CHOICE
     
    4/1/17 New Plan Options
    • 5 New Plan Options: Effective April 1, 2017, the following new plans have been added to the California Choice portfolio: UnitedHealthcare (UHC) HMO C: Bronze Metal Tier, Alliance Network; in southern California Sharp Health Plans: HMO D: Bronze Metal Tier, Premier Network; Sharp Health Plan: HMO C: Silver Metal Tier, Premier Network; Sharp Health Plan: HMO C: Gold Metal Tier, Premier Network; Sharp Health Plan: HMO C: Platinum Metal Tier, Premier Network. View the Private Exchange Guide and Fast Facts Flyer.

    CHOICE BUILDER
     
    Program Highlights and Guidelines
    • Highlights: Choice Builder® offers employers with 2-199 employees the nation’s premier dental, vision, chiropractic, and life carriers: Ameritas, Anthem Assurity, Delta Dental, Eye Med, Landmark, MetLife and VSP. In addition, groups receive access to two value add services, the Cal Perks entertainment discounts and the HR AsnwerLink HR Support Center Library.
    • Guidelines: Employer eligibility at initial enrollment requirements, plan availability, new hire waiting rule options, orthodontia availability and plan comparison of plans.

    HR ANSWERLINK
     
    From the News Desk
    • Executive Order: President Trump signed an Executive over for minimizing the ACA’s fiscal burdens. For employers, the effects of the Executive Order will not be immediate. Employer obligations under the ACA, such as the employer mandate and reporting, cannot be undone without revising regulations. For now, the employer mandate and employer reporting requirements remain in effect and employers should continue to comply with all provisions of the ACA.

    Federal Law Alert
    • OSHA 300A Forms Must Be Posted by February 1: The Occupational Safety and Health Administration (OSHA) mandates that all employers who are required to maintain the OSHA 300 Log of Work-Related Injuries and Illnesses post a summary of the previous year’s log between February 1st and April 30th each year, even if no incidents occurred in the preceding calendar year.


    View Document
    Carrier & HR Compliance Updates 1.23.17
    by Rosa Tessandori » Monday, January 30, 2017 2:41 PM


    ANTHEM BLUE CROSS

    Agent Newsletters
    • Identity Protection Services Due to Expire Soon: Individuals impacted by the 2015 cyber attack against Anthem were offered two years of AllClear ID Credit and Identity Theft Monitoring Services (called PRO). That two-year time frame is coming to a close.
    • January MyAnthem News: The January issue of our employer newsletter is now ready for your Small Group clients.
    • California Medi-Cal,  What You Need to Know: California’s Medicaid program is called Medi-Cal. Medi-Cal is free or low-cost health benefits for children and adults with limited income resources. Find out more about how this program works and how it may help your Individual clients.


    BLUE SHIELD OF CA


    Producer Alert - 2nd Quarter Product Cycle
    • Rate Action: PPO 0.8% increase and HMO 4.3% rate increase. 
    • Continued Easier New Group Installation: Through April 1, 2017, groups can choose either no forms for employees enrolling in an other carrier's HMO or no DE9C - for groups with 10 enrolling employees that complete an Eligibility/Participation Attestation form. 
    • Relaxed Participation Guidelines: Available through June effective dates. Requires only 25% employee participation (minimum of five enrolled employees for medical plans).
    • Renewals Online: April Renewal Kits are available online on the BSC Renewal Site. Submit member level changes through Employer Connection Plus. Kits will be mailed to clients January 20th. The Small Group Online Renewal (SGOR) tool will be available in mid-February for Q2 renewal changes.
    • Benefit Summaries: Benefit Summaries are being updated on Producer Connection to reflect some benefit changes pending regulatory approval. When approved, details of these endorsements will be sent to you soon in a separate communication. The Spanish versions of the 2017 Benefit Summaries have not yet been updated to reflect these changes, but we expect to have them also posted on Producer Connection by the end of January.
    • Trio ACO HMO: The Trio ACO HMO network continues to be expanded with new providers and in new regions. www.blueshieldca.com/trio to see if your clients are in a Trio coverage area. The Trio ACO plans can be offered alongside the full Access+ HMO® network for greater member options.
    • Dental Network Expansion: BSC continues to expand their PPO provider network and has the second largest dental HMO network in California. Specialty rates remain steady making it the perfect time for employers to offer specialty benefits alongside Blue Shield medical plans or on a standalone basis.
    • Value Adds: Remember that clients have access to Teladoc, Wellvolution, ID protection, HealthEquity, and Blue Shield’s updated mobile app. Your clients can learn more about these programs and take advantage of them by visiting blueshieldca.com.

    UNITEDHEALTHCARE
    • Retro Changes - Extended Deadline: For new and renewing 12/1/16 and 1/1/17 groups, to ensure that all of their customers are set up correctly, UHC is extending the deadline for eligibility changes from 30 days to 60 days. The deadline for December 1, 2016 eligibility changes is January 31, 2017 and the deadline for January 1, 2017 eligibility changes is February 28, 2017. This opportunity is time sensitive and no further eligibility corrections will be made once the extended deadlines have passed. Outside of these two effective dates the normal 30 day limit will apply.

    HR ANSWERLINK - HR Support Center

    Federal Law Alert
    • New Form I-9: The new Form I-9, released November 14, must be used as of Sunday, January 22, 2017.


    View Document
    Carrier Updates 1.17.17
    by Rosa Tessandori » Friday, January 20, 2017 10:19 AM


    ANTHEM BLUE CROSS
    • Second Quarter Rates Available for Quoting: Rate pass for both PPO and HMO. For renewing groups, the average net rate effect for all regions combined will be 1.1% increase for PPO and on average a decrease of -3.0% for HMO.
     
    BLUE SHIELD OF CA

    Producer Alert
    • Merger - New Comprehensive Health Info Exchange: The California Integrated Data Exchange (Cal INDEX, founded by Blue Shield of California and Anthem Blue Cross) and Inland Empire Health Information Exchange (IEHIE) today announced a planned merger that will create one of the nation’s most comprehensive nonprofit health information exchanges (HIEs). HIEs help improve the quality of the patient experience, support collaboration and coordination and improve efficiencies. HEIs will also make it easier for doctors, hospitals and other care providers to securely review, analyze and share medical information across the health care system.
    Producer Alert
    • Second Quarter Rates Available for Quoting: Rates for Q2 effective dates are available for quoting and downloading. PPO will experience a 0.8% across all regions. HMO will experience 4.3% increase across all regions. 
    • April Renewals: Kits are available for downloading on 1/13/17. Member level changes can be submitted through Employer Connection Plus starting 1/18/17. Printed renewal kits will be mailed out on 1/20/17.

     
    CHOICE BUILDER

    New Carrier
    • MetLife: If your new and renewing groups are considering Dental for 4/1/17 (or later), they now have a new option, Choice Builder. MetLife is joining Choice Builder with three Employer-sponsored Dental PPO plans and one Voluntary Dental PPO plan. View the Delta Dental and MetLife comparison.
     
     
     UNITED HEALTHCARE
    • Second Quarter Rates Available for Quoting: Great news, UHC CA Small Group 1-100 will be having a Rate Pass Q2 2017.
     


    View Document
    Carrier Updates 1.9.17
    by Rosa Tessandori » Wednesday, January 11, 2017 10:10 AM


    BLUE SHIELD OF CA
    Producer Alert
    • Sutter Health Contract: New 3-year agreement signed effective January 1, 2017!

    COVERED CALIFORNIA (CCSB)
    Partner News 
    • Enhanced Agent Portal: Website improvements are expected for release in the first quarter of 2017. Expected enhancements will include processing client renewals, submitting eligibility changes, access commission information and other time saving capabilities.
    • .Enhanced Employer Portal: Later in the year, employers will be able to pay premiums online, update employee information, download side-by-side comparison worksheets of their benefit plan options and much more.
    • Nonpayment of Premiums - Policy Change: Effective January 1, 2017, the statement of consequences will be enclosed with the employer's invoice and serves as the first notice of delinquency.
    • Carrier ID Cards: Carrier partners of Covered California for Small Business are now given the option to either continue printing ID cards with the Covered CA logo or remove the logo altogether. Thus far, Blue Shield of California (PPO plans only) and Health Net have confirmed that they will remove the Covered CA logo from their ID cards in early 2017.
    • No Out-of-State Participation Requirements: Covered California for Small Business has eliminated membership participation requirements across states, so long as the business’s headquarters are registered in California.
    • General Agent Partners: GA's are here to help, readily available services include: prospecting, pre-screening, underwriting, quoting, pre and post-sales support, enrollment, customer service, renewal support and other resource materials.
    • PEO's: CCSB is a great place for placing your Professional Employer Organizations, read the alert and see why.
    • Updated Eligibility Guidelines: The Covered California for Small Business Enrollment & Eligibility Guidelines were recently updated and are now available for download under the Agent Sales Tool Kit.
    • 2017 Health Plan Change Summary Now Online: View a side-by-side comparison of the 2017 plan benefits, 2017 Health Plan Change Summary.
    • Customized New Hire Employee Worksheets: Receive a customized new hire worksheet within 48 hours of your request.


    View Document
    Carrier Deadlines for January 1, 2017 SG Contracts
    by Rosa Tessandori » Wednesday, January 04, 2017 9:36 AM


    If you have not yet submitted your 1/1/17 small group cases, please submit your case(s) as soon as possible. This will allow the RBG underwriting department the opportunity to scrub the group and request missing information prior to submission to the carrier.

    Several carriers now require us to submit groups via their carrier portal, which extends the amount of time needed for our office to meet the carriers' deadlines for submission of new groups.

    RBG must submit your January 1, 2017 Small Group Case(s) to the applicable carrier by the following due date and time*:

    Due January 9th by 12:00 p.m.
    o Blue Shield of California

    Due January 9th by 5:00 p.m.
    o Anthem Blue Cross of CA
    o California Choice
    o Kaiser Permanente
    o United HealthCare

    Due January 11th by 5:00 p.m.
    o Covered CA**

    Due January 13th by 5:00 p.m.
    o Choice Builder**

    *Aetna submission cut-off date was December 30, 2016
    ** Special Extension

    At the time of submission to the carrier, the group must be "complete". A "complete" submission must include all required documents such as: the employer application, reconciled DE-9C (when required), employee applications, ownership documents and a binder check (if required).

    Carriers are also expecting that the group will be "clean" and not require needing to obtain a long list of missing information. Any grace period for missing information will be determined by the carrier upon recipient and review of the case.

    We greatly appreciate your business during this busy time of year and your assistance in meeting the carrier deadlines.

    View Document
    Carrier Updates 1.3.17
    by Rosa Tessandori » Tuesday, January 03, 2017 8:37 PM


    BLUE SHIELD OF CA

    Bulletin
    • Annual Notifications: Insured subscribers (excludes Shared Advantage, ASO, Medicare, and FEP) will receive the annual notification notice (attached) by December 31, 2016. The annual notice helps Blue Shield to satisfy federal, state, and NCQA/HEDIS requirements for notification to subscribers. The communication covers the following topics: standards for timely access to care, personal benefits information, preventive health guidelines, member rights & responsibilities. It also includes information on programs to help manage chronic conditions, quality improvement and patient safety, utilization management, and case management as well as information on language assistance, privacy practices, filing grievances, becoming an organ donor and coverage for mastectomy-related services for breast cancer. 

    Producer Alert
    • Sutter Health Contract: Negotiations continue, but the existing contract has expired and Sutter Health is no longer a Blue Shield in-network provider as of January 1, 2017. In the interim, Blue Shield and Sutter Health have agreed to a six-month transition period (through June 30, 2017) to help ensure uninterrupted care for members. For members with questions about Sutter Health and their access to care, Blue Shield has set up a dedicated phone line (888) 852-5345 from 8:00 a.m. to 5:00 p.m. Monday through Friday to address their concerns. View the notice for additional transition details.   


    View Document
    Carrier & Compliance Updates 12.27.16
    by Rosa Tessandori » Friday, December 30, 2016 12:55 PM


    ANTHEM BLUE CROSS

    Online News
    • Limited Promotion - Dual PPO Network Option Effective 1/1/17 through 3/15/17: New, renewing and groups requesting an early renewal, can offer both the Prudent Buyer and Select PPO network plans for a limited time.

    CALIFORNIA CHOICE

    From the President's Desk
    • Message to Brokers and Employers: Emails were sent to brokers and employers with a message reassuring them that despite any changes the Trump administration may bring to healthcare reform, that small group health insurance benefits through CaliforniaChoice are safe. In addition, the notice to brokers also included a notification that effective 4/1/17, Aetna will no longer be a contracted provider.
    NON-MEDICAL RESOURCES


    E - IS FOR ERISA

    Compliance Update
    • CA State Automatic-IRA Effective 1/1/17: The Automatic IRA has been proposed as a way for the roughly half of U.S. workers that are not offered a 401(k) or any other type of employer-sponsored plan to save for retirement. However, in California, enrollment is postponed until regulations governing the program are adopted. The California program, titled the California Secure Choice Retirement Savings Program, phases in participation based on employer size. In addition, the DOL safe harbor prohibits employer contributions to auto-IRAs and requires that employers fulfill only “ministerial” (clerical) tasks. Note, employers always have the option of maintaining their own plan. Noncompliance may result in penalties and voluntary participation in Auto-IRA Program may create an ERISA plan.
     
     WAGEWORKS/CONEXIS

    Compliance Alert
    • New Type of HRA for Employers with less than 50 FT Employees: On November 13, 2016, President Obama signed the 21st Century Cures Act. Among a variety of healthcare provisions, this legislation establishes a new type of health reimbursement arrangement (HRA) called the Qualified Small Employer Health Reimbursement Arrangement (QSEHRA). The provisions for QSEHRAs are effective for plan years beginning on or after January 1, 2017. 


    View Document
    Carrier Updates 12.19.16
    by Rosa Tessandori » Thursday, December 22, 2016 10:15 AM


     
    ANTHEM BLUE CROSS

    Producer News Online
    • Small Group Q4 2016 Update - From the desk of Joe Greenberg:  Read a short synopsis on Anthem's success in Q4-2016 and 2016 overall, as well continued expansion of services and tools in 2017. Via the Anthem Educational Blog, you can keep up to date with Anthem's new communication outreach program for new group administrators and continued political updates and other news 
    • 2017 H.S.A. Plan Changes: The 2017 Silver H.S.A. plan will have a three tier deductible and three tier out-of-pocket maximum (OOP). In addition, the deductible and OOP will now be embedded. RBG side note: The current version of the benefit summary contains an error in the footnote section which is expected to be corrected in the coming weeks. The footnote erroneously indicates that for a family "one member must satisfy their individual deductible and one member, (either same or other family member) must satisfy the individual out of pocket amount. Click here to view the summary.
    • December Webinars: No RSVP required, just click to join the meeting at the scheduled time. Small Group updates 12/22 9:30 a.m. PST, click here and LiveHealth Online 12/28 9:30 a.m. PST, click here. Test the links before joining.
    • Online Small Group Renewals: Renewals are now available online, but groups must first register on EmployerAccess. View the flier.
    • Online Tool Enhancements: View reports to identify who is turning 26 or 65 up to one year in advance; Dental and vision quote updates; Enhancement to the Small Group Details screens; Bill History screen enhancements and more.
     
    BLUE SHIELD OF CA

    Broker Update
    • Client News: Responding to ACA questions following the presidential election.
    • Broker Tools: ABC's and 123's of HMO's and PPO's - Health care basics for your clients and the 2017 updated MGA.
    • Reminders: Broker of Record changes; CVS flyer - the sequel; Renew all of your Q1 clients now. 
    • Member Benefits: Find a doctor and holiday gifts with the Blue Shield mobile app; Viva la Wellvolution!; and Teleport to a physician with Teladoc.
     
     
    KAISER PERMANENTE

    Broker News
    • 2017 Santa Cruz County - Small Group Bonus Program: Eligible groups need a physical headquarter address in Santa Cruz County. Note: Some groups headquartered in Monterey County that have employees living in Santa Cruz County also are eligible. The bonus program runs from January 1, 2017, to June 1, 2017. The bonus amount is $50 per Kaiser Permanente member (based on the member count as of the effective date for the new group). The bonus applies to all channels (including Covered California Small Business and California Choice).
     
    UNITED HEALTHCARE

    Broker Connection
    • Various Updates: View the Prescription Drug List (PCL) changes for 1/1/17-6/30/17; IRS Extends Deadline for form 1095, the new deadline is March 2, 2017, however the deadline for 10945 reporting has not changed; Learn about the UHC weight loss program for groups 51+; New Musculoskeletal value-based care payment program; Value-based Care report results; The Member Disclosure Notice was mailed the week of November 28; and read about the origination and prevention of opioid abuse.
    Important Billing Update 
    • Remittance Mailing Addresses Change for Non-Medical: Per the notification included in the July 2016 Invoice mailing, the mailing address for UnitedHealthcare Life, Disability, Critical Illness and/or Accident Coverage has been changed. View the update for the new mailing addresses for regular and overnight mail and handling of checks mailed to the old address.
     
    NON MEDICAL SERVICE PROVIDERS

    WAGEWORKS/CONEXIS

    Newsletter
    • Compliance Corner: COBRA Q&A; 2016 IRS instructions for reporting COBRA coverage on 1094 forms; 2017 FSA plan limits; and PCOR fees rise.
    • News & Trends: OCR pays closer attention to small HIPAA breaches; and Better informed employees make better benefit choices.
    • Behind the Scenes: WageWorks holiday supply drives for local charities
     
     


    View Document
    2016 Holiday Schedule
    by Rosa Tessandori » Thursday, December 22, 2016 9:57 AM




    View Document
    HR On-Demand by HRAnswerLink & RBG Discounts
    by Rosa Tessandori » Thursday, December 22, 2016 9:43 AM