AGENCY ACTION ALERT FOR JULY 29, 2015

This week's Agency Action Alert covers the following topics:

SEP enrollment changes to a paper process Aug. 1
New House Call Program for individual and small group members with ACA plans

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INDIVIDUAL MARKET UPDATE

SEP enrollment changes to a paper process Aug. 1

Starting Aug. 1, 2015, SEP enrollments must be submitted using a paper process, because these enrollments now require additional documentation be submitted with the application. A new paper SEP form has been developed that explains the documentation required. This form will display when viewing plans online, and will also be available in the Resources section of the producer portal.

Please note the following:

Applications submitted prior to Aug. 1, 2015, do not require additional documentation
Once open enrollment begins, regular enrollments will be accepted through the online process
A reference guide on the paper SEP process is available on the producer portal

Additionally, beginning with Nov. 1, 2015, effective dates, all off-exchange enrollments must be submitted using the online process, through the producer portal, in order to receive producer credit. Paper applications from producers will no longer provide producers with credit for the sale, and no commissions will be paid.

If you have questions, please contact your Highmark individual sales channel consultant.

HIGHMARK UPDATE

New House Call Program for individual and small group members with ACA plans

Highmark is launching the 2015 House Call Program for a select group of individual and small group members with ACA plans. This free program asks members to invite representatives of a trusted Highmark partner into their homes to conduct a general health assessment. It is aimed at helping members (selected adults and children), who have one or more health conditions and are at-risk of further health complications, to better understand their situations and how they can access the resources they need.

How it works

Highmark identifies members with certain conditions and those who may be disengaged from their normal care routines. Members are contacted by ESMI, a partner of Highmark that specializes in in-home health assessments. Members are asked if they would take an hour to help get their health care organized by inviting a licensed health professional into their homes to perform a free health assessment.

The visit focuses on four primary areas:

Reviewing the member's current health status
Answering any health-related questions the member may have
Confirming the member's current medications
Ensuring the member's medical history is accurate and up to date with complete documentation

Since the assessments are conducted in members' homes, they may feel more comfortable discussing additional health issues or concerns than they would in another setting. A follow-up list of personal health recommendations is mailed to the member and the member's PCP. There is no charge for the visit.

Questions

If you have any questions, please contact your Highmark client manager.