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| Health Plan Options |
Don't Miss Connect with Capital, July 2018, vol. 1
For Deb
What's Inside:
Online Billing and Payment History Coming Soon | Medical Underwriting Required for All Small Business ASO and Mid-Market Fully Insured Prospect Quotes | You Can Now Make Multiple eGEMS® Updates in One Transaction | HSA Member Cost Share Now Waived for Certain Services Provided Through Oncology Program | New Template Streamlines Waiver Requests | Virtual Care Frequently Asked Questions | Stay Protected with Capital BlueCross’ Cyber Liability Insurance | Order Limits on the Shingrix Vaccine | 360° for Our Members | 360° for Business |
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| Online Billing and Payment History Coming Soon |
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In August, online billing will be available to our small and large commercial groups! They will continue to receive paper invoices unless, at a later date, they decide to go paperless.
We'll email more detailed information to group administrators in July. |
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| Medical Underwriting Required for All Small Business ASO and Mid-Market Fully Insured Prospect Quotes |
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Heads up! All small business ASO and mid-market fully insured prospect quotes with effective dates starting October 1 must undergo medical underwriting. (This requirement previously applied to groups with fewer than 50 enrolling employees.)
Please continue to quote using a valid member-level census. The following information must be complete and accurate for rates to process correctly:
- First and last name
- Gender
- Date of birth
- Contract type
- Employment status
- Zip code
- Medicare eligibility status
Incomplete and inaccurate data may lead to delays, denials, and could even impact rates.
Use the new census template we introduced in the last issue of Connect with Capital. For additional help, check out the updated Small Business ASO Fact Sheet.
Please note that requests for medically underwritten rates should be submitted to the account executive. Underwriting will provide a risk assessment utilizing the Milliman Curv tool. |
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| You Can Now Make Multiple eGEMS® Updates in One Transaction |
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Ready for things to be a little simpler? eGEMS has been upgraded to allow employer groups to make multiple member updates in a single transaction.
All current eGEMS accounts will have access to the new capabilities on July 9.
Enhanced capabilities include: |
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- Mass Add—Add a product plan to multiple existing members
- Mass Change—Change a product plan for multiple existing members
- Mass Termination—Terminate a product plan from multiple existing members
- Mass Update Status—Check the completion status of your mass update transactions
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For additional support, you can reach out to the eGEMS specialists and their online Help feature.
Still need producer eGEMS access for your group? Encourage them to complete and submit the current version of the Producer of Record letter to get the process started. |
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| HSA Member Cost Share Now Waived for Certain Services Provided Through Oncology Program |
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Members who have an HSA plan will no longer pay a cost share on care coordination and management codes for care they receive through the QualityFirst Patient-Centered Oncology Program. We made the change in light of an IRS guideline on disease management where no direct patient care is involved. The change applies to services received on or after July 1.
Care Coordination codes may be billed by practices participating in the program to cover the costs associated with enhanced care coordination and management services.
For more information about the QualityFirst Patient-Centered Oncology Program, contact your account executive. |
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| New Template Streamlines Waiver Requests |
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One form is better than two! The Waiver of Group Health Insurance Coverage template has been updated and no longer requires spousal and dependent information.
Use this file template to report employees who are waiving group coverage. (Please do not alter the format of the spreadsheet.) |
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| Virtual Care Frequently Asked Questions |
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Since the June 15 launch of the Virtual Care* app, we've compiled answers to some questions.
What is Virtual Care?
Virtual Care allows members to see a physician, counselor, or psychiatrist anytime, anywhere, using their smartphone, tablet, or PC. Members can get the app from the Apple Store, Google Play, virtualcarecbc.com, or from the Virtual Care page on capbluecross.com. |
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When would someone use Virtual Care services?
Capital BlueCross covers Virtual Care services for these common symptoms and conditions: | | Medical | |
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Abdominal pain
Acute bronchitis
Acute conjunctivitis (pink eye)
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Acute cystitis
Acute pharyngitis
Acute sinusitis
Diarrhea
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Fever
Headache
Influenza
Painful urination |
Respiratory infection
Strep throat
Urinary tract infection |
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Anxiety
Bereavement
Depression |
Grief
Insomnia
LGBTQ counseling |
Life transitions
Obsessive-compulsive disorder |
PTSD
Panic attacks
Trauma |
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Anorexia
Anxiety disorders
Bulimia |
Bipolar disorder
Cognitive disorder
Depression |
Insomnia
Obsessive-compulsive disorder |
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Does all the information from a member’s Amwell account transfer to Virtual Care? To protect privacy, only some information is transferred, not all. Pharmacy history, previous visit history, and the original medical questionnaire will not transfer to the new account.
When are doctors available? For medical visits, doctors are available 24/7, every day of the year. For counseling and psychiatry visits, members can make an appointment online or through the app. However, these appointments are generally available from 8 a.m. to 10 p.m., ET. Times may vary by time zone and location.
Are the doctors rated? After every virtual visit, members are asked to rate their experience and their provider. The website will show the star ratings as providers acquire them.
What’s the difference between a counselor and psychiatrist? A psychiatrist can prescribe medication and a counselor (or psychologist) provides talk therapy.
What’s the wait time for seeing a counselor or psychiatrist? Counseling and psychiatry visits must be scheduled. Most counseling appointments are available in four days or less; however, there are times when
counseling appointments are available the same day. Most psychiatry appointments should be available in two to four weeks or less. |
Are members charged more if they see a counselor or psychiatrist on weekends, nights, or holidays? No. The cost is the same no matter when the member has a virtual visit with a counselor or psychiatrist.
Is a member charged if they miss a scheduled appointment? There is a $40 reservation/booking fee charged to the member's credit card on file if they do not cancel their appointment with at least 24 hours' notice.
What if a member's Primary Care Physician (PCP) offers virtual visits? Members can see their PCP for virtual visits if the doctor is listed on capbluecross.com as an approved provider for virtual visits. To be sure the physician is approved to conduct virtual visits, look for the small video icon in the search results at capbluecross.com. | |
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*Virtual Care is not available to all members. Members should check with their employers or review their benefit plan booklets to verify that Virtual Care is included in their program.
On behalf of Capital BlueCross, American Well® Corp. provides this online health care tool. American Well is an independent company |
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| Stay Protected with Capital BlueCross’ Cyber Liability Insurance |
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| BCS Insurance Company is an independent company whose products and services are not BlueCross products and services. BCS Insurance Company is solely responsible for this stop loss coverage |
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| Order Limits on the Shingrix Vaccine |
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According to the Centers for Disease Control and Prevention, due to high levels of demand for GSK’s Shingrix vaccine, GSK has implemented order limits and providers have experienced shipping delays. It is anticipated these order limits and shipping delays will continue throughout 2018. In response, GSK has increased the US supply available for 2018 and plans to release doses to all customer types on a consistent and predictable schedule for the rest of 2018. Overall, the supply of Shingrix during 2018 is sufficient to support the vaccination of more patients during 2018 than were vaccinated against shingles in 2017.
This order limit may affect members' ability to get the vaccine through their pharmacists. |
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| Members received the summer edition of our quarterly 360° for Our Members on June 22, just in time for fun in the sun! Check out everything we covered, from Virtual Care to international travel. |
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| 360° for Business | | Have you seen June's issue of 360° for Business? Employer groups are covered in our monthly newsletter. See what's inside! |
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| | If you have any questions, please contact your account executive. |
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All Rights Reserved
Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies serving 21 counties in Central Pennsylvania and the Lehigh Valley.
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