What's Inside: Join us: Get deeper insights into our pharmacy management program | Colorectal screening age is changing to 45 | Onsite flu clinics are available | Not your typical dental plan | Health plan solutions webinar is online | More groups told about opting in to Further
Join us: Get deeper insights into our pharmacy management program
You are invited to Power of One, a Capital Blue Cross and Prime Therapeutics virtual forum, happening Tuesday, July 20. This one-hour webinar will begin at 1:00 PM.
Join us as we tackle different topics, including:
Reporting — See how we mine critical data that can help employers make informed decisions about their plan management.
Utilization management — Learn how our effective programs are helping to drive savings and improve member health.
Strategies — Get insights into how we monitor the drug pipeline and focus on disease state management strategies.
Effective August 1, Capital Blue Cross is updating our Patient Protection and Affordable Care Act (PPACA) preventive coverage guidance for colorectal cancer screening in accordance with the newest U.S. Preventive Services Task Force (USPSTF) recommendation.
The USPSTF has lowered the age for screenings from age 50 to 45, adding that screenings should continue through age 75. Colorectal cancer screenings include procedures such as colonoscopies, flexible sigmoidoscopies, computed tomography, colonography, fecal occult blood tests, and fecal immunochemical DNA tests (called FIT). These preventive screenings are free for members.*
The new guideline increases members' success in treating colorectal cancer if found in a screening. Studies have proven that early detection and resulting treatment makes for better, more successful outcomes.
Capital's preventive care services suggested schedule — and all other documents addressing these screenings — will be updated to reflect the new beginning age of 45 years old.
*Fully insured and self-insured nongrandfathered group customers who have PPACA preventive services coverage under their Capital medical benefits are impacted by this update.
Onsite flu clinics are available
Some Capital Blue Cross participating pharmacies offer onsite flu clinics to our group customers. Fully insured and self-insured groups who have coverage for preventive seasonal vaccines as part of their Capital pharmacy benefits can offer onsite flu clinics to their employees.
A group customer requesting an onsite flu clinic will need to:
Determine if the group will need or want an online scheduling tool. (Rite Aid and CVS currently have this capability available. The group customer would work directly with the pharmacy to set up the online tool.)
Provide the pharmacy with the date and time to hold the clinic.
Identify the expected number of participants or employees (a minimum of 30 employees is required but the pharmacy may be negotiable for fewer).
At the clinic, employees will need to present their member ID card to the onsite pharmacy.
Note that claims will process under the pharmacy preventive benefit at $0 cost share to the member for those groups that have the preventive pharmacy benefit coverage.
If the group’s employees do have other pharmacy coverage and the pharmacy administering the onsite clinic is a participating pharmacy with that coverage, the same process may apply. Their claims may be submitted to their current pharmacy benefit coverage.
If the group’s employees do not have this coverage or the employees are covered by another plan that excludes flu vaccines on the pharmacy benefit, they could provide the flu vaccine to their employees at a fee-for-service rate.
CVS Employer groups may register online. If a group needs specific information or details regarding CVS flu clinics, they may send an email with their questions to flushotclinicsquest@cvscaremark.com.
Capital will not coordinate onsite flu clinics for our group customers.
Not your typical dental plan
Available to employer groups in Small Group (50 and fewer), Mid-Market (51 – 99), and Large Group (100+) Premier Choice markets, the Capital Blue Cross Dental Select 705x plan offers a different kind of coverage.
All dental treatment begins with the member’s primary care dentist (PCD). To coordinate care, the Dental Select 705x plan requires that a member selects a primary dental office from the Capital Blue Cross Dental Select participating network, which has over 6,000 dental providers regionally.
PCDs can make referrals for specialty dental care. They can also preauthorize services obtained outside of the PCD office, in which case services outside of the PCD would be covered. And, of course, out-of-area emergency dental services are also covered under this plan.
Employers can offer both the PPO and Select options and let members choose the plan that best meets their needs. They get more choices while groups gain additional savings when compared to offering a PPO-only option.
To find out more about Dental Select 705x, or to see if it’s right for a group, contact your account executive. Rate sheets are also available for Small Group as well as Mid-Market and Small Business ASO.
Health plan solutions webinar is online
In case you missed it or want to refer back to what you learned, a recording of the Solutions Tailored for Employers' Needs webinar is available on our YouTube channel.
This week, we sent an email to more groups about the transition to Further and what they'll need to do if they want to offer their members the new and improved full Capital Blue Cross solution for health savings accounts.
The email gives step-by-step instructions, and offers several resources we have for them to make a smooth transition to Further, including a link to the Employer FAQ.