Category Archives: Broker Updates

Aetna – Save up to 10-22% with New Jersey Aetna Savings Plus plans NEW PRODUCTS – Please Read

New Jersey/New York brokers:

New, lower-priced Aetna Savings Plus plans come to New Jersey February 1, 2013

We’re joining with certain providers in New Jersey to bring you a new, innovative product: Aetna Savings Plus. Effective February 1, 2013, you can offer a variety of competitive plans to New Jersey businesses with 2-50 and 51-100 eligible employees.

The Savings Plus plans help businesses provide health benefits that fit their needs and budgets. The plans give members access to an affordable network of health providers right in their own community.

These quality-based, lower-cost network plans offer your clients anywhere from 10%-22% savings (on average), compared to similar Aetna plans. Members have lower out-of-pocket costs when using the New Jersey Savings Plus network. Review the 2-50 Savings Plus plan guide and the 51-100 Savings Plus plan guide for more benefits details.

Savings Plus service area

The Savings Plus plans are ideal for New Jersey-based employers whose employees use doctors and facilities in New Jersey and in the following New York boroughs and counties for those individuals covered under New Jersey plans who prefer to visit providers in New York:

  • Manhattan
  • Queens
  • Brooklyn
  • Staten Island
  • The Bronx
  • Long Island
  • Westchester County
  • Rockland County
  • Putnam County Orange County
  • Dutchess County
  • Ulster County
  • Sullivan County

Aetna – Health Care Reform updates for the week of January 14

Stay up to date with Health Reform Weekly.

We want you to have access to the latest health care reform news from Washington, D.C., and states across the country. This weekly e-mail links you to updates on health reform legislation that could significantly impact you.

This week’s health care reform news:

43 State Legislatures Convene in January

Forty-three states have convened or are scheduled to convene in January, with many dealing with the launch of health insurance exchanges later this year. Other issues facing many states include Medicaid expansion, benefit mandates and provider contracting.

Other highlights include:

  • California’s governor is seeking $350 million in the state budget for Medicaid expansion.
  • Delaware is expected to wrestle with specialty pharmacy drug tier and biosimilars legislation in the new session.
  • New Mexico will accept federal dollars to expand Medicaid.

To view the full articles, visit Health Reform Weekly.

Amerihealth – Health Care Reform – Impact on Renewals

Health Care Reform: Impact on Renewals

The Affordable Care Act (ACA) has mandated funding from all health insurers to build a pool of funds for several initiatives. The funds will be used to help stabilize premiums for the newly insured, develop best practices to improve the quality of medical outcomes, and prevent undue profits as more Americans purchase health insurance.

Several taxes and fees to support these programs began appearing on the AmeriHealth New Jersey medical rate paperwork in November 2012. Because we anticipate that groups will be confused by several new lines of charges on the Rate Renewal Worksheets, and will pose a number of questions concerning these fees and taxes, it is important that we can explain them. This piece will help you to understand and explain the fees and taxes to group decision makers who call with questions.

Plese click on the link below for details.

Amerihealth – Meadowlands Hospital Termination

Over the past year AmeriHealth New Jersey has attempted to renegotiate the terms of the agreement with Meadowlands Hospital Medical Center. Unfortunately, we have not been able to reach an agreement. As a result, AmeriHealth New Jersey provided ninety (90) days advanced written notice of our intent to terminate the contract between Meadowlands Hospital Medical Center and AmeriHealth New Jersey. The termination date will be February 1, 2013. Upon completion of the state mandated four month cooling off period, Meadowlands Hospital Medical Center will be a non-participating provider in the AmeriHealth New Jersey network effective June 1, 2013.

We regret the need to end our long standing business partnership, but our main priority is to assure that our members receive quality health care services at an affordable cost.

The following participating acute care hospitals are within a five mile radius of Meadowlands Hospital Medical Center:

  • Hoboken Hospital Center
  • Christ Hospital
  • Palisades Medical Center
  • Jersey City Medical Center

If you have additional questions, please contact your AmeriHealth New Jersey broker representative.

Horizon BCBSNJ Brief Notes V. 22, No. 897, ValueOptions Award 2014

Horizon BCBSNJ Brief Notes V. 22, No. 897, ValueOptions Awarded Behavioral Health Services Management Contract Effective 2014

Applies to: All Customers with Behavioral Health and Substance Abuse Benefits through Magellan Behavioral Health, Inc.

ValueOptions Inc. Awarded Behavioral Health Services Management Contract Effective 2014

As part of Horizon Blue Cross Blue Shield of New Jersey’s strategy to provide our customers with access to effective and safe care, we recently concluded a rigorous five-month Request for Proposal (RFP) and evaluation process to determine the future direction of our behavioral health services program. As a result of the evaluation, Horizon BCBSNJ has decided to transition its behavioral health services management contract from our current vendor, Magellan Behavioral Health, Inc., to ValueOptions Inc.

On December 28, 2012, we informed Magellan of our decision to move forward with ValueOptions. As a result and as a publicly-held company, Magellan has reported this information to its shareholders and other members of the financial community. Our contract with Magellan will remain in place through the first half of 2014 as we transition to ValueOptions.

ValueOptions, the nation’s largest independent behavioral health care and wellness company, specializes in management for all behavioral health issues, and mental health and chemical dependency diagnoses. Our agreement with ValueOptions supports our commitment to the continued health and well-being of our 3.6 million members.

Please read the following questions and answers to help you respond to your client’s questions.

Q1. When will the transition occur?
A1. Horizon BCBSNJ plans to transition our behavioral health management contract to ValueOptions sometime during the first half of 2014. As preparation work begins in early 2013 with ValueOptions and Magellan, Horizon BCBSNJ will give our customers more detailed transition information.

Q2. Why is this transition occurring?
A2. Horizon BCBSNJ is transitioning our behavioral health management function to ValueOptions because we believe the change will:

  • Improve outcomes through better integration of medical and behavioral health¬†services.
  • Improve health care affordability.
  • Continue to improve the customer experience.

Also see:
Horizon897MagellanValue (Size: 108 Kb )

Aetna- New 2013 FlexBen pricing guide now available

New for 2013

Your FlexBen pricing guide here

We want to share with you the 2013 FlexBen pricing guide for our HRA administration. In the coming year, we will continue to work with Flexible Benefit Service Corporation (FlexBen) to handle your clients’ employee benefits administration.

The 2013 pricing guide includes the various administrative fees for the following:

  • Premium-Only Plan (POP)
  • Health Reimbursement Arrangement (HRA)
  • Flexible Spending Account (FSA)
  • COBRA Services
  • Transit Reimbursement Account

Also see:
2013FlexBenPricing (Size: 130 Kb )

Healthcare Reform – United Updates

Dear Brokers:

The Patient Protection and Affordable Care Act is built around dozens of provisions. Some changes are already in place. But the provisions will continue to be enacted over the next several years. To find out what these changes are and when they’re scheduled to take effect, you can refer to United’s Reform website. The link is below. Also, attached is a printable version PDF of the timeline.

We hope you find this useful! There are still many unanswered questions and we will share new information as it becomes available.

Wishing everyone a very Happy Holiday!

Your Friends At
Coastal Financial Group

Also see:

Reform Timeline PDF (113 KB)