AGENCY ACTION ALERT FOR JULY 29, 2015

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

PHARMACY UPDATE

New specialty drugs option for members

Effective Jan. 1, 2016, members in western Pennsylvania will have a second option for certain specialty drugs - Giant Eagle pharmacies. Giant Eagle will be able to provide approximately 100 specialty drugs.

Currently, Highmark members must get specialty drugs via mail from Walgreens Specialty Pharmacy. With this new option, they will pay the same price whether they choose Walgreens Specialty Pharmacy or Giant Eagle. 

Please note, this option is NOT available for self-funded clients or members in any Highmark Medicare Advantage, Medicare supplement and Medicaid products.

Members currently receiving specialty drugs from Walgreens will receive a letter in November from Highmark explaining this option. There is no requirement for members to change and, if they have questions, they can talk with their doctor or call the Member Service number on the back of their Highmark insurance card.

Please review these talking points for more information.

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.