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Health Plan Options |
Producer Newsletter November 2021, Volume 2
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What's Inside: Capital Blue Cross Virtual Care member cost share waivers are expiring | Open enrollment dates to remember | Consolidated Appropriations Act (CAA) resource page | Healthy Blue Rewards 2022 program information | 2022 Underwriting Compliance Guidelines | New York Health Care Reform Act (NYHCRA) Compliance | Use YES to track the status of your new group submissions | November and December invoices may not reflect correct premiums
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Capital Blue Cross Virtual Care member cost share waivers are expiring |
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The member cost share waivers for Capital Blue Cross Virtual Care, which were put in place for standard plans and Fully Insured Groups during the onset of the pandemic in 2020, will expire on December 31, 2021.
Our website, the Virtual Care app, and Amwell’s digital resources will be updated on the deadline to remove any references about the cost share waivers.
We’ll continue to remind employers and members that the waivers will expire later this year in their respective newsletters in November and December. |
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Open enrollment dates to remember |
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Medicare Open Enrollment runs through December 7, 2021.
The Individual Market open enrollment period will continue through January 15, 2022. During this time, an individual may shop for a plan on Pennie, or they can shop directly with Capital Blue Cross.
Individuals who purchase a plan from November 1 through December 15, 2021, will have a January 1, 2022 effective date. |
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Individuals who purchase a plan from December 16 through January 15, 2022, will have a February 1, 2022 effective date.
To be sure group members with January 1 effective dates receive ID cards timely, our adjusted renewal paperwork submissions are:
- Non-Large groups — November 29, 2021
- Groups using electronic enrollment (including eGEMS) — December 9, 2021
When submitting enrollments, please confirm that all forms are completed and all necessary documents are included. |
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Consolidated Appropriations Act (CAA) resource page |
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In 2020, Congress passed a $2.3 trillion year-end spending package known as the Consolidated Appropriations Act (CAA), which included several requirements that affect commercial health insurance products. We’ve published a guide to give leaders an overview of the law and what Capital Blue Cross is doing to comply with the CAA’s requirements. We will update it as new information becomes available. |
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Healthy Blue Rewards 2022 program information |
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Capital Blue Cross is rolling out an enhanced Healthy Blue Rewards platform experience for 2022.
Healthy Blue Rewards is a wellness journey strategically designed to provide personalized guidance on the next right thing to do for one’s health and well-being. |
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The Healthy Blue Rewards program is automatically included in all plans for our standard commercial group and Individual PPO and HMO products. Subscribers (and spouses for group only), who are enrolled in a qualifying Capital Blue Cross plan, will automatically have access to the Healthy Blue Rewards portal on our website, and the mobile app. Members must agree to the terms of service of the program to receive rewards.
The standard Healthy Blue Rewards program runs on a calendar year basis regardless of renewal date. For example, if a Small Group renews December 1, 2021, the 2021 Healthy Blue Rewards program design will continue through December 31, 2021. The 2022 program design will not take effect until January 1, 2022.
The Healthy Blue Rewards program for Custom Large Groups is available in tiers. Healthy Blue Rewards Lite (formerly Health Assessment Only) is automatically available at no cost to the group, while Healthy Blue Rewards Premier will be available as a buy-up option for groups wanting to customize their own program. The level of enhancements will vary based on tier level.
A comparison guide is available. |
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2022 Underwriting Compliance Guidelines |
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The 2022 Underwriting Compliance Guidelines for commercial group health, dental, vision, and prescription drug coverages offered by Capital Blue Cross, as well as our wholly-owned subsidiaries, have been released.
Changes of note for 2022 included that the Capital Advantage EPO and Performance PPO can now be sold as fully insured in the Small Group market.
The guidelines are considered proprietary and intended for underwriting Capital Blue Cross business only. |
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New York Health Care Reform Act (NYHCRA) Compliance |
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The New York State Office of Pool Administration requires all ASO groups to be compliant with NYHCRA legislation. This applies to all groups, whether they have employees in the state of New York or not. NYHCRA paperwork needs filed in these situations:
- A new ASO Group contracts with Capital Blue Cross.
- An existing Fully Insured Group changes to ASO.
- A group cancels medical coverage and needs to release Capital Blue Cross from reporting responsibilities.
- A group changes its name due to acquisition or merger.
To determine which forms are required, and to view additional resources, visit the NYHCRA.
Forms are available in our Salesforce Producer Partner Community Content Library. Need Salesforce Partner Community access? Reach out to your preferred to get your request started. |
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Use YES to track the status of your new group submissions |
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Your Enrollment Solution (YES) offers convenience when checking the status of your new group submissions. In the Salesforce Partner Community, query for the group and navigate to the YES Employer Status Field.
Review the status stages and what they mean. Check back regularly to assure your group is not delayed in a stage and is being processed.
Visit the YES Resource Center for more. |
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YES EMPLOYER STATUS |
DESCRIPTION |
Accepted Order |
Employer Onboarding link has appeared for the producer |
Paperwork Started |
YES entry from Partner Community (PC) – producer clicked 'Employer Onboarding' link |
Paperwork Submitted to Employer |
Producer in YES sends paperwork to Employer |
Employer Rejected Paperwork |
Employer selects a 'rejected' reason and sends response to producer |
Producer Fixing Rejection |
YES entry from PC– producer clicked 'Employer Onboarding' link after status shows "Employer Rejected Paperwork" |
Paperwork Being Updated by Producer |
Producer clicked "Reopen Onboarding Paperwork" on the complete step |
Paperwork Received by Capital |
Documents passed successfully from YES to Salesforce |
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November and December invoices may not reflect correct premiums |
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Due to the volume received this time of year, some invoices may not reflect the correct invoice amounts.
We are aware of the issue and have included inserts to the December invoice mailings so employer groups are aware of the discrepancy. If groups only view their bills online, however, they may not be aware.
Please share the news with your clients to help limit the influx of calls.
If a group received a drastic decrease in their invoices due to benefit changes and a discrepancy has occurred because of a Capital Blue Cross error, groups will be rebilled appropriately. |
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