Category Archives: Broker Updates

Horizon BCBSNJ Brief Notes V. 22, No. 912: Launches New Fitness Reimbursement Program

Horizon BCBSNJ Brief Notes V. 22, No. 912:
Applies to: Public Sector and Mid-size (100 to 499 employees) groups

Horizon Blue Cross Blue Shield of New Jersey Launches- New Fitness Reimbursement Program

Horizon Blue Cross Blue Shield of New Jersey is pleased to offer HorizonbFit to eligible members ages 18 years and older enrolled in public sector and fully insured mid-size groups. The program launches April 1, 2013 and offers reimbursements of $20 per month to members who enroll and visit a participating fitness facility at least 12 times or more a month. Members can earn up to $240 a year in rewards. The program makes it easier and more affordable for members to exercise regularly.

HorizonbFit is the only fitness reimbursement program that offers:

  • All-electronic utilization tracking and reimbursement processing. Members do not have to track their visits or submit any paperwork to claim their reimbursements.
  • Secure, online personal account management. Members establish an online account. Once established, members can view their attendance and reimbursements, change their primary fitness facilities and update their personal profiles and account information.
  • The ability for Horizon BCBSNJ members who are currently members at a fitness facility to participate in HorizonbFit. All eligible Horizon BCBSNJ members can participate in HorizonbFit without having to cancel their existing fitness facility memberships. If a member belongs to a fitness facility that is not included in the network, the member can nominate it for inclusion pending agreement with the fitness facility.
  • Access to medically integrated fitness centers. HorizonbFit includes hospital-affiliated fitness centers that offer exercise programs that can be integrated with chronic care management, rehabilitation and other physician-directed health maintenance, measurement and testing.
  • Utilization review. Through its all-electronic utilization tracking, data can be analyzed by Horizon BCBSNJ to better manage member care.
  • Full membership privileges, preferred rates, flexible, month-to-month membership terms and “away-from-home” access to any participating facility. (Only for Horizon BCBSNJ members who join a fitness facility when they enroll in HorizonbFit.)

HorizonbFit is administered by Advanta Health Solutions, an innovative health and fitness provider that develops and manages physical activity programs to help people live healthier. It is initially being offered to members ages 18 years and older in the public sector and mid-size (100 to 499) employer group markets. Eligible members can enroll online now at HorizonbFit.com for an April 1, 2013 effective date.

Horizon BCBSNJ is dedicated to working with our valued brokers to provide your clients and their employees with competitive offerings that support member satisfaction and retention. HorizonbFit’s approach to corporate fitness rewards healthy behavior and fosters personal accountability. It is cost-effective for the employer group and motivational for employees.

View the HorizonbFit enrollment site at HorizonbFit.com.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

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Amerihealth IHC: AmeriHealth New Jersey EPO

As always, AmeriHealth New Jersey strives to provide comprehensive health care that’s as affordable as possible throughout the state. The AmeriHealth New Jersey IHC Exclusive Provider Organization (EPO) does exactly that. The IHC EPO allows members to choose their own doctors and hospitals from our participating provider network without selecting a primary care physician (PCP) and receive services without referrals. Members must use network providers in order to access their benefits. IHC EPO does not have out-of-network benefits. AmeriHealth New Jersey IHC EPO plans are only available with the Value Network.

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Horizon BCBSNJ Brief Notes V. 22, No. 899, Horizon BCBSNJ Leads the Way in Innovative

Horizon BCBSNJ Brief Notes V. 22, No. 899, Horizon BCBSNJ Leads the Way in Innovative Payment Models in New Jersey
January 15, 2013

Applies to: All Markets

Horizon Blue Cross Blue Shield of New Jersey Leads the Way in Innovative Payment Models in New Jersey

As health care costs continue to rise, it is clear the current system is unsustainable. To keep health insurance affordable, we need to focus our efforts on slowing the growth of medical costs. One solution that is showing some success in reducing costs while improving quality is the migration away from the current fee-for-service reimbursement model.

Horizon Blue Cross Blue Shield of New Jersey has taken a leading role in collaborating with doctors and hospitals to develop accountable care programs to transform how health care is delivered and paid for in our state. Since early 2011, Horizon BCBSNJ, through Horizon Healthcare Innovations, has been pioneering new health care programs that change incentives to better reward doctors and other health care professionals for improving the coordination and quality of care. We’re working with practices to help them achieve specific quality targets, then changing the reimbursement models to better reward doctors who meet these standards.

Read what Jim Albano, Vice President of Network Management and Horizon Healthcare Innovations for Horizon BCBSNJ, recently shared with local media outlets here.

Please see attached Broker Brief PDF Horizon BCBSNJ Brief Notes V. 22, No. 899

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BB2013InnovativePayment (Size: 245 Kb )

Horizon BCBSNJ Brief Notes V. 22, No. 908: Affordable Care Act requires Reinsurance Assessment fee

Applies to: Most markets (with exceptions listed on page 2)

Affordable Care Act requires Reinsurance Assessment fee
New fee raises premiums

The Affordable Care Act (ACA), also known as federal health care reform, establishes reinsurance and risk adjustment programs and a federal risk corridors program.

The overall goal of these programs is to provide certainty and protect against adverse selection in the market while stabilizing premiums in the individual and small group markets as market reforms and health insurance exchanges begin operations in 2014. Under the ACA, states may establish a reinsurance program by January 1, 2014. Establishing a reinsurance program is optional for each state.

The money to fund these programs will come from a Reinsurance Assessment fee that must be paid by insured and self-insured group health plans.

Effective date
The Reinsurance Assessment is a temporary program that begins in 2014, and ends in 2016.

How the assessment may impact some market segments
The ACA may or may not require the business segments listed on page 2 to pay the assessment.

Expected 2014 assessment fees

The fee applies to all enrollees, including employees, under age 65 retirees, spouses and dependents.

The final Per Member Per Month (PMPM) and Per Member Per Year (PMPY) fees will be announced by the U.S. Department of Health and Human Services (HHS) in its final Notice of Benefit and Payment Parameters in the coming weeks. HHS will determine the total amount owed
by Horizon BCBSNJ, based on our reporting of the number of contributing enrollees to HHS by November 15, 2014.

Each year, a health plan’s fee will be calculated by multiplying the average number of covered lives in the plan by the contribution rate for the applicable year.

Unlike the tax on premiums, known as the Insurer Fee, the reinsurance assessment is tax deductible for federal and state income tax purposes.

How payments are made
The ACA requires health insurers and third-party administrators on behalf of self-insured group plans to collect and make reinsurance payments from 2014 to 2016.

A self-insured, self-administered group health plan must make its reinsurance payments directly to HHS.

What this means is that Horizon BCBSNJ is responsible for collecting fees from your clients and paying them on their behalf. Your clients are responsible for the accuracy of the amount Horizon BCBSNJ collects.

How payments are collected

  • We will not pay interest on the amounts we collect and will not charge for collecting amounts.
  • Your clients cannot opt out of their fees.

For insured clients:

  • We are including the reinsurance fee within the monthly rate starting with March 2013 renewals. The reinsurance fee will be spread over a 12-month period, rather than one big payment.

For self-insured clients:

  • The following statement is included with bills and states that the ultimate liability for payment (and accuracy of member counts) rests with your¬†clients.

In 2014, the Affordable Care Act requires that the Plan Sponsor for self-funded accounts is required to pay a reinsurance assessment and that the third-party administrator of the self-funded plan will pay the fee on behalf of the self-funded sponsor. Horizon Blue Cross Blue Shield of New Jersey will pay this fee on your behalf. Your January 2014 bill will include an estimated monthly charge for this fee. By September 30, 2014, we will request that you provide the appropriate enrollee count that we should report to the U.S. Department of Health and Human Services (HHS). Should we not receive your response in a timely manner, the enrollment will be determined by Horizon BCBSNJ.

  • For insured two to 50 groups and Individual:
  • Currently, we cannot build the reinsurance assessment into pricing due to New Jersey minimum loss ratio requirements. Horizon BCBSNJ is working with the New Jersey Department of Banking and Insurance (DOBI) to address this issue so future pricing can cover these fees.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

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BB2013Reinsurance (Size: 632 Kb )

Amerihealth – PPACA retroactive termination policies

Patient Protection and Affordable Care Act (PPACA) retroactive termination policies are in effect

We are writing with an important notice about the retroactive termination policy that applies to all fully-insured customers. AmeriHealth New Jersey wants to ensure that you, your staff, and your customers understand the importance of compliance with this policy as part of health care reform. If you have not discussed this with your staff and customers already, now is the time to take action to help avoid potential financial penalties to your customers.

The retroactive termination policies

Per the PPACA retroactive termination guidelines, the period of time in which AmeriHealth New Jersey will retroactively terminate members for fully-insured groups has changed from 60 days plus the current month to 30 days plus the current month in which the request was made. The PPACA prohibits health insurers and group administrators from rescinding coverage except in the case of fraud, intentional misrepresentation of material facts, or failure to pay required premiums. A rescission is defined as a cancellation of coverage that has a retroactive (occurring in the past) termination date.

Please note that when requests for retroactive terminations are submitted, AmeriHealth New Jersey will regard the submission as certification that the termination is in the normal course of business and certification that no premium/contribution was paid by the member/dependent for that period. If a member paid premium or contributed to the cost of the plan, coverage may not be terminated with a past effective date except in the case of fraud or a misrepresentation of a material fact. The group health plan or health insurance issuer must provide a 30 day written notice of coverage termination to each individual affected by the termination before coverage may be rescinded. The member has the right to appeal the rescission of coverage.

To comply with the PPACA, the AmeriHealth New Jersey retroactive termination policy for fully-insured customers is as follows:

  • For fully-insured groups, retroactive terminations may be made for up to 30 days plus the current month (30-60 days). This means that a termination cannot be made for more than 60 days before the date that AmeriHealth New Jersey is notified.

The policy for self-funded groups remains unchanged:

  • For self-funded groups, retroactive terminations may be made for up to 60 days plus the current month (60-90 days). This means that a termination cannot be made for more than 90 days before the date that AmeriHealth New Jersey is notified. Self-funded groups can decide how to implement retroactive terminations within this timeframe.

Help your customers avoid potential penalties for non-compliance

If you have not discussed the impact of the PPACA retroactive termination guidelines with your staff and customers we urge you to do so now. By doing this you will help to ensure that retroactive termination requests are processed in accordance with PPACA specifications.

To help your groups to avoid potential penalties, when a termination date is requested that is outside the guidelines above, a letter will be sent to the group administrator that will advise that the termination date has been adjusted to fall within the policy guidelines.

Please be assured that AmeriHealth New Jersey complies with the applicable provisions of the PPACA. Our goal is the same as yours; to provide our customers with quality benefits at the best possible price. We greatly appreciate your efforts to support these initiatives. If you have any questions, please contact your AmeriHealth New Jersey broker representative.

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Horizon BCBSNJ Brief Notes V. 22, No. 906: Affordable Care Act imposes Insurer Fee on premiums

Horizon BCBSNJ Brief Notes V. 22, No. 906: Affordable Care Act imposes Insurer Fee on premiums
February 20, 2013

Applies to: All insured markets, Federal Employee Program, Medicare, Medicaid, dental and vision

Affordable Care Act imposes Insurer Fee on premiums
Insurer Fee will increase premiums

Many important changes in federal law will affect and are affecting your clients.

The Affordable Care Act, also known as federal health care reform, imposes a fee on health insurance premiums that will increase the cost of buying health care coverage, beginning in 2014. The Insurer Fee is commonly called a premium tax.

The amount of the Insurer Fee on the industry nationwide will be $8 billion in 2014, increasing to $14.3 billion in 2018, and increase based on premium trend thereafter.

Effective date
The requirement is scheduled to begin in 2014, with the first estimated Insurer Fee paid to the Internal Revenue Service by September 2014, based on 2013 data.

Purpose of the Insurer Fee
The Insurer Fee will fund subsidies for individuals and families with household incomes between 100 percent and 400 percent of the federal poverty level. These individuals and families will buy their health insurance through health insurance exchanges, which launch in 2014, and have Open Enrollment in October 2013.

Market segments subject to the Insurer Fee
Please note: The law is not clear on market segments subject to the fee, so this list can change.

How the Insurer Fee works
The Insurer Fee is a permanent premium tax on most insurance companies starting in 2014. The requirement imposes an annual tax on the health insurance industry nationwide, according to the following schedule:

  • $8 billion in 2014.
  • $11.3 billion in 2015.
  • $11.3 billion in 2016.
  • $13.9 billion in 2017.
  • $14.3 billion in 2018.
  • For years after 2018, the fee will be the amount from the previous year increased by the rate of premium growth.

Fees will be prorated for each insurer based on its share of the nationwide premiums that are
subject to the fee for the preceding calendar year.

Impact to your clients
Horizon Blue Cross Blue Shield of New Jersey pays claims and other expenses, including taxes such as the Insurer Fee, from the premiums collected from your clients. To pay increased costs, Horizon BCBSNJ must increase premiums accordingly. The ACA does not permit Horizon BCBSNJ to deduct the Insurer Fee from its federal and state taxes. As a result, if Horizon BCBSNJ’s tax rate is 20 percent requiring a payment of $80 in taxes, Horizon BCBSNJ must collect $100 from its clients to pay the $80.

The total amount that Horizon BCBSNJ will collect from its clients is an estimated $162 million for 2014.

  • For insured 51+ groups:
  • We have begun to charge the Insurer Fee in renewals.
  • For insured two to 50 groups and Individual:
  • Currently, we cannot build in the Insurer Fee due to New Jersey’s minimum loss ratio requirements. Horizon BCBSNJ is working with the New Jersey
  • Department of Banking and Insurance to address this issue, so future pricing can cover these fees.

Impact to premium bills
Horizon BCBSNJ will not bill your clients all at once. Instead, Horizon BCBSNJ will spread the billing over a 12-month period, starting with March 2013 renewals.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.
The information included in this document may be subject to change at any time as laws and regulations and related guidance are issued by state and federal agencies. This document is for educational purposes only.

UHC Dental/Vision Rate Cards for 2nd Quarter

Please see attached for 2nd Quarter Dental & Vision rate cards pertaining to NJ groups.

  • Voluntary & Contributory plans are listed on these rate cards. Products can be sold standalone.
  • UHC quotes on eligible, not enrolled.

Remember:

  • Voluntary Dental: Only 2 needed to enroll
  • Voluntary Vision: Only 1 needed to enroll (Significant price reduction in Vision plans for 2nd quarter)
  • Voluntary OBM: Only 2 needed to enroll. (Quote at www.oxfordbenefitmanagement.com)

Top Vol Dental Plans: PIN53, P3366
Top Vol Vision Plans: V1043, V1008

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UHCDental (Size: 341 Kb )