ALERT FOR THE WEEK OF JANUARY 9, 2017

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

• Large Group Update
• 2017 Quote Request Form Now Available
• Small Group Update
• 2017 $3 Generic Rx Collateral Available Now
• 2017 Business Application Fillable PDFs Now Available
• Individual Market Update
• Highmark Individual Invoices 
• On-Marketplace Cancellations or Enrollment Questions
• Marketplace Special Enrollment Period Pilot

Please share this information with your sub-agents by forwarding this email, posting this content to your internal website, or copying and pasting the text into another format.

LARGE GROUP UPDATE - 2017 QUOTE REQUEST FORM NOW AVAILABLE

The 2017 Quote Request Form (QRF) is now available on the Producer Portal under the Resources section. Please note the following updates to the QRF:

• Lehigh Valley Flex Blue is a collaborative product with Lehigh Valley Health Network (LVHN) that offers two levels of network benefit coverage for most services: 
• Enhanced Value Benefits - Members have lower out-of-pocket costs when they receive care from providers affiliated with LVHN and other aligned hospitals because of LVHN's expertise in coordinating and streamlining care, delivering care in the most efficient manner and ensuring each patient's needs are met with the best possible health outcomes in mind.  
• Standard Value Benefits - Members have higher out-of-pocket costs when they receive care from other network providers; members in PPO plans can also choose out-of-network coverage at the highest level of out-of-pocket costs.

       2. Added Flex 8W Dental Plan           

• In order to enhance our standard portfolio, the Flex 8W Dental Plan has been added as a standard option. It provides 100 percent coverage for Class 1 and 2, and 50 percent coverage for Class 3. It is also priced at both 20-69.99 percent participation, and 70 and above.

 

If you have any questions, please contact your Highmark Sales Executive.

SMALL GROUP UPDATE 

2017 $3 GENERIC RX COLLATERAL AVAILABLE NOW

The 2017 Small Group $3 Generic Drug Lists and Member Fliers for all applicable health plans are now available on the Highmark "Shop" website.

Members are encouraged to share the Drug Lists and Flier with their doctor to see if a generic drug option is right for them. Also, members should check the $3 Drug Lists periodically, as the list of eligible drugs may change throughout the year.

2017 BUSINESS APPLICATION FILLABLE PDFS NOW AVAILABLE

A fillable PDF version of the 2017 Small Group Business Application is now available on the Producer Portal under the Resources section. 

If you have any questions, please contact your Highmark Client Manager or Sales Executive. 

INDIVIDUAL MARKET UPDATE

HIGHMARK INDIVIDUAL INVOICES

Highmark invoices for individual customers reflect their plan enrollment at the time of the bill generation. Customers that are in transition at the time the invoice generates may believe they were billed for incorrect amounts. Please follow these steps to ensure customers are properly enrolled and pay the correct amounts:

• Confirm the customer enrollment has been received and processed by calling or emailing Producer Hotline
• 866-602-1248
• ProdEm@highmark.com
• Advise the customer that their next invoice will reconcile the charges to the correct premium amounts. Adjusted invoices cannot be generated.  
• If the customer is billed an incorrect amount, they should pay the amount they owe based on their correct plan selection, not the amount of the invoice.
• They can pay by phone to ensure they are paying the correct amount by calling:
• Off-exchange business: 877-986-4571
• Highmark On-exchange business: 888-510-1084
• HHIC On-exchange business: 888-510-1064

Initial invoices for 2017 were mailed to the customers' permanent home address and not the billing address indicated on the application. There is no need to contact Highmark regarding this as all future invoices will be mailed to the mailing address requested.

ON-MARKETPLACE CANCELLATIONS OR ENROLLMENT QUESTIONS
 

On-Marketplace customers that wish to cancel their enrollment or question changes or corrections to enrollment must do so through the Marketplace by calling 1-800-318-2596. Highmark is unable to process On-Marketplace cancels or plan changes/corrections and will refer customers back to their agent or to contact the Marketplace directly. 

MARKETPLACE SPECIAL ENROLLMENT PERIOD (SEP) PILOT
 

CMS is launching a new pilot program in 2017 to test a process that requires pre-enrollment verification of consumers' special enrollment period (SEP) eligibility for Individual Marketplace coverage. 

This pilot program on HealthCare.gov is intended to test how pre-enrollment verification affects compliance, enrollment, continuity of coverage, the risk pool and other outcomes. It impacts all states served by the HealthCare.gov Individual Marketplace platform. 

Your clients' applications may be among those randomly flagged to have their plan selections held by the Marketplace until they submit documentation to prove their SEP eligibility. Review the fact sheet below for more information and be ready to answer your clients' questions.
 

If you have any questions, please contact your Highmark Individual Sales Channel Consultant.