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What's Inside:
Pennsylvania Act 106 Substance Abuse Management Reminder | 2019 BlueCross Dental Portfolio for Groups | Checklists for New Groups and Existing Group Plan Changes | Coding Advisor Program to Help Curb Costs | The Fitness Your Way Promo Is Almost Over | Last Call for Submissions for the Faces of Fearless Award | Riddle Me This |
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| Pennsylvania Act 106 Substance Abuse Management Reminder |
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The Pennsylvania Act 106 of 1989 established minimum coverage for alcohol and substance abuse treatment for fully insured plans. It also limited the plan’s ability to medically manage that care during the initial period of treatment in a PA-licensed facility (up to 45 days annually), when prescribed in writing by a physician or psychologist.
The act applies to all fully insured groups. ASO groups are not required to follow state mandates.
However, for ASO groups that are not subject to ERISA (such as counties, towns, school districts, and certain charities), we offer them the option to apply this provision to their plans. The election form must be provided to all large non-ERISA ASO groups so they have the opportunity to make the election. By signing this form, they understand that:
- They are electing to remove our ability to manage these services during the first 45 days of prescribed inpatient treatment in a PA-licensed facility.
- Medical management will resume if the member remains in the facility after that time or returns during the same year and receives more than 45 days of treatment.
If we do not receive a signed form, no change will be made to the group’s current substance abuse medical management.
All large non-ERISA ASO groups (upon renewal or initial effective date) must be provided the Act 106 election opportunity. The account executive will coordinate with the group’s producer to provide this form to qualifying groups. |
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| 2019 BlueCross Dental Portfolio for Groups |
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The 2019 BlueCross Dental Group Product Grid has been revised to correct an error message that was received when attempting to access the Dental PPO Basic plan highlight sheet.
Remind groups that when they combine dental and medical coverage from the Capital BlueCross family of companies, they offer a more coordinated approach to member care. This helps groups lower healthcare costs and improve member health outcomes. From preventive care to orthodontics, BlueCross Dental includes benefits to help members live healthy. |
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| Checklists for New Groups and Existing Group Plan Changes |
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| What documents are needed when you sell a new group or are renewing an existing group with plan changes? Our revised interactive checklists include links to the forms you need for 2019 activity. |
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| New Fully Insured, Mid-Market, or Small Sales |
| New ASO Small Business Sales |
| New Fully Insured Large Group |
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| RENEWING GROUP CHECKLISTS |
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| Renewing Fully-Insured Mid-Market or Small Sales |
| Renewing ASO Small Business Sales |
| Renewing Fully Insured Large Group |
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| Coding Advisor Program to Help Curb Costs |
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| To help employers further lower their health plan spend, Capital BlueCross has introduced Coding Advisor. Through this program, we identify providers who submit claims for
services at a higher rate than their peers. After finding these provider outliers, we offer them education and tips on how to more accurately code claims, helping to improve claims processing while lowering claims costs for groups. |
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| When the program avoids costs, we pass along the majority of the projected savings to employers whose members seek care from the providers we identified. Renewal contracts will include more details on Coding Advisor. |
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| The Fitness Your Way Promo Is Almost Over | | Time is running out. February 28 is the last day members can take advantage of a gym membership with no enrollment fee. All they have to do is use the Blue365® promo code FEBSAVE when they sign up for the Fitness Your Way gym membership program. Tivity Health will then waive the enrollment fee. Share this flyer with your employer groups. (It’s also available in Spanish). That way, they can make one last pitch to their employees. |
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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 policies with Capital BlueCross and its family of companies, its contracts with Medicare, or any other applicable federal healthcare program. | | On behalf of Capital BlueCross, Tivity Health assists in the administration of fitness programs and is an independent company. |
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| Last Call for Submissions for the Faces of Fearless Award℠ |
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| *The Faces of Fearless℠ award program is open only to legal residents of the 50 United States (and the District of Columbia), Panama, Uruguay, or Puerto Rico who are at least 21 at the time of entry and are insured by a licensed BCBS company continuously during 1/17/19 through 5/31/19, and who submit a Faces of Fearless story and photos or video that meet the Submission Guidelines described in the Official Rules and pertain to true events that happened to that individual on or after 1/1/14 and also occurred at a time when that individual was insured by a BCBS company. NO OTHER PURCHASE OR PAYMENT IS NECESSARY TO ENTER OR WIN. Entry period begins on 1/17/19 and ends 2/28/19 at 5pm CST. Winner will
be selected based on criteria specified in the Official Rules. Award winner must 1) be able to attend the 2019 National Summit in Grapevine, TX on 4/29/19–5/2/19 and 2) agree to receive the Faces of Fearless Award on stage on 4/30/19 during a keynote session for the Summit. Subject to Official Rules available at bcbs.com/facesoffearless. Void where prohibited. Federal employees excluded. Approximate
Retail Value of each Award, per Winner: $24,000 (based on Winner plus three [3] guests; transportation costs will vary, depending on Winner’s residence); maximum Total Approximate Retail Value of all Awards (aggregate, for all Winners combined) not to exceed $72,000 (based on a maximum of three [3] Awards). Sponsor: Blue Cross and Blue Shield Association, 225 N. Michigan Avenue, Chicago, IL 60601. |
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| Riddle Me This | | What four-letter word can be written forward, backward, or upside down, and can still be read from left to right? |
Wait for the next issue of Connect with Capital
for the answer! |
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Answer to last issue’s riddle
Why are 1988 pennies worth more than 1983 pennies? Answer: For the same reason 20 pennies are worth more than 15 pennies! 1983 and 1988 are numbers of pennies, not the years they were made. |
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| | If you have any questions about content in this email, please contact your account executive. |
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