Employers Paying Premium for Individual Policy Coverage

Capital BlueCross cannot knowingly accept payments that violate the various statutes which prohibit a group/employer from paying us the premium for an individual policy for active employees.

Drug Formulary and Utilization Management Program Updates

Decisions from November 2014 and February Pharmacy & Therapeutics Committee meetings has resulted in open/closed and selectively closed formulary including:

• Newly Marketed Drugs
• Products Change Tier Status
• Pharmacy Utilization Management Programs

Formulary updates are communicated via BenefitFOCUS, Simply-Well, and the Provider Administrative Bulletin. Quarterly Formulary Update Decision Summaries for the open/closed formulary and the selectively closed formulary can also be found on the pharmacy page of our website.

UPDATE 2015 PPACA Large Group Benefit Impacts

Based on clarification received in March 2015, in order to be compliant with PPACA INN OOP max requirements, the benefit period accumulation requirement that was in place on the first day of the benefit period must be followed. This clarification impacts calendar year groups that renew on a plan year basis (other than January).

Click here to download the Communication.