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| Health Plan Options |
Connect with Capital, November 2018, vol. 2
For Deb
What's Inside:
Small Group (1–50) Employers Can Offer EAP Starting January 1 | 2019 Opioid Formulary Updates | 2019 Open/Closed Formulary Updates | Encourage Employers to Participate in a Blue365 Demo With a Chance to Win a Gift Card | Catasys OnTrak Behavioral Health Program | Update: Expanded Lab Network and ID Cards | Please Remember: Use A Group’s Full Legal Name on All Documents | A Better 360° for Business Experience |
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| Small Group (1–50) Employers Can Offer EAP Starting January 1 |
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Effective January 1, PPACA-compliant fully insured Small Groups (1-50) can offer eligible employees* access to an Employee Assistance Program (EAP) through Mazzitti & Sullivan EAP at no cost to them.
Through an EAP, employees can receive support and services for personal or work-related issues, such as marital and family counseling, drug and alcohol use, guidance through grief and loss, parenting, and teen counseling. Each member can receive up to four free sessions per incident. For example, a couple seeking marital help is eligible for four sessions each, totaling eight sessions. |
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Signing up for the EAP is easy. Employers call the provider, Mazzitti & Sullivan EAP, at 800.543.5080 any time after January 1 for a short set-up call. The program will be available to employees the same day they call. The EAP will be available starting January 1, regardless of when their Capital BlueCross coverage renews.
Mazzitti & Sullivan EAP also offer employer assistance, including support for Human Resources and supervisor orientations.
Have questions? Mazzitti & Sullivan EAP are ready to answer them. Employers can call 800.543.5080, or visit their website at mazzittiandsullivan.com. Producers will have access to collateral in a future issue of Connect with Capital.
*An eligible employee has full medical coverage with Capital BlueCross and is covered under a PPACA-compliant fully insured Small Group (1–50) product. Those members with Senior medical are not eligible; however, any dependents with full medical coverage can use the EAP. |
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| 2019 Opioid Formulary Updates |
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As previously reported, we are making the following changes to the 2019 opioid formularies in order to help reduce opioid abuse and misuse. These changes reflect guidelines from the Centers for Disease Control and Prevention, per the recommendation of the Commonwealth of Pennsylvania.
- Morphine milligram equivalents (MME) will be reduced to less than or equal to 50 MME on all extended-release and immediate-release opioids (previously 90 MME)
- Sickle cell crisis and terminal illness will be added as acceptable exceptions to the quantity and MME restrictions
- Quantities of immediate-release products will be limited to five days for adults (18 years of age or older) and three days for children (under 18 years of age)
- As a reminder, in 2017/2018 we implemented utilization management for opioids; these changes for 2019 supersede the changes made in 2017/2018
- Quantities beyond initial limits will only be covered for chronic pain in the event of tapering the opioid dose; Capital BlueCross will allow longer time for dose reductions with a medical necessity prior authorization, which must be requested by the prescribing provider
- Additional quantities for acute pain will not be covered
- Medication-Assisted Treatment (MAT) Therapy will be a covered benefit
These changes will take effect on January 1 for our individual and CHIP members, and February 1 for most commercial groups. Self-insured groups do not have the option of excluding them from their coverage. |
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| 2019 Open/Closed Formulary Updates |
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In addition to the opioid changes for 2019, formulary updates will also include:
- Drugs changing tier status
- Newly marketed drugs
- Pharmacy utilization management programs [Prior Authorization (PAR), Enhanced Prior Authorization (EPA)/Step Therapy, and Quantity Level Limits (QLL)]
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Please take special note of these changes:
- Topical Steroids/Agents—Adding new PAR and QLL
- Muscle Relaxants/Agents—Adding new PAR
- This change was initiated because utilization data identified that, despite being indicated for short-term use, they are being prescribed for long-term use. Exceptions: Baclofen, dantrolene, and tizanidine, which are indicated for the treatment of spasticity and may require longer therapy durations.
- Anti-Diabetic Agents—Jentadueto, Jentadueto XR, and Tradjenta will be moved from preferred to nonpreferred with PAR required.
We communicated changes to the Open/Closed formulary regarding insomnia agents in July. For now, those changes are put on hold. No changes will be made to the PAR or QLL for those drugs, and we will provide ample notice before making any changes in the future.
This is just a sample of some of the formulary changes that will take effect on January 1. For more information and to find the most current formulary, visit capbluecross.com.
Members who are currently taking these medications will be notified by mail. |
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| Encourage Employers to Participate in a Blue365 Demo With a Chance to Win a Gift Card |
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To help employers amplify their wellness strategy, invite them to one of our new Blue365 demo offerings. As a bonus, when they register, they’ll be entered for a chance to win a $50 Amazon gift card.
Blue365 offers access to unmatched savings on gym memberships, wearables, weight loss programs, and more. |
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| They can visit the employer solutions page to register for either a one-hour demo on December 6 at 12:00 p.m., or January 8 at 3:00 p.m., ET. |
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| The Blue365® program is brought to you by the BlueCross BlueShield Association. The BlueCross BlueShield Association is an association of independent, locally operated BlueCross and/or BlueShield Companies. Blue365 offers access to savings on health and wellness products and services and other interesting items that members may purchase from independent vendors, which are different from covered benefits under your policies with Capital BlueCross and its family of companies, its contracts with Medicare, or any other applicable federal healthcare program. |
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| Catasys OnTrak Behavioral Health Program |
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Beginning January 2019, Catasys will bring its OnTrak™ program to our fully insured groups and individual members.
OnTrak is a 52-week intensive outpatient program that integrates medical assessments, skills-based therapy, and care coaching. It focuses on treating an overlooked population, helping those with undiagnosed behavioral health issues. These members may be suffering from undiagnosed chronic disorders, such as substance use disorder, anxiety, and depression. They may rarely seek care or may not realize they have a disorder.
Using predictive modeling and analytics, health plan members with coexisting behavioral and physical conditions are identified for the program. OnTrak Care Coaches (nurses with extensive behavioral health experience) reach out to these difficult-to-engage members to motivate them to make positive changes in their lives.
To participate, members will need to opt in to the program. Once enrolled, they will be connected with local providers in Magellan Healthcare, Inc., our behavioral health network. If members have questions about the program, or any communications they receive, they can contact OnTrak at 866.517.1417.
OnTrak does not charge Capital BlueCross for this service until a member opts in. There are no fees for members who choose to participate in this program. |
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| On behalf of Capital BlueCross, Catasys, Inc., an independent company, provides the OnTrak integrated health program. |
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| Update: Expanded Lab Network and ID Cards |
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You may recall that beginning January 1, members in our 21-county service area will have more in-network options for routine lab work. This change mostly affects in-area HMO members who currently have a lab designation of Quest or HNL. Starting in the New Year, they will be eligible to go to other in-network labs. That means they will receive new ID cards with the standard HMO lab indicator of Lab TP (third party).
Note: In-area HMO members who already have Lab TP on their ID card will not receive a new ID card. |
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| Please Remember: Use A Group’s Full Legal Name on All Documents |
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Group name accuracy in our internal systems is important. So please be sure to use the group’s full legal name on all group documents.
- The full legal name of a group includes any designations such as LLC, Inc., Co., etc.
- All group paperwork includes, but is not limited to, Application for Group Benefits, Business Associate Agreements, Census Templates, and contracts.
This will streamline the processing of received requests and invoicing, the implementation of new enrollments and changes for group members, the issuance of ID cards, and more. |
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| A Better 360° for Business Experience | | For a better reading experience, you will now get 360° for Business delivered to your inbox! Direct access will help you stay on top of the information-packed monthly newsletter we send to employer groups. Enjoy! |
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