What's Inside: Details coming soon about coverage for at-home COVID-19 tests | Support contacts for new home delivery and specialty Rx services | About member ID cards, delivery, and benefit access | Broker and consultant compensation disclosure for Individual health plans | 2022 Healthy Blue Rewards | PPO Choice providers | The No Surprises Act | Congratulations and Farewell
Details coming soon about coverage for at-home COVID-19 tests
Since the start of the pandemic, Capital Blue Cross has worked diligently to educate and engage our members and the general public on ways to slow the spread of COVID-19. As part of our commitment to protect the health, safety, and well-being of our members and their communities, we recognize that access to COVID-19 testing is one tool in this fight.
Under short notice, we are working quickly with health officials and providers to comply with the federal directive that requires health plans to cover the cost of over-the-counter, at-home testing. We will share more details as they become available. We appreciate your patience and understanding.
Support contacts for new home delivery and specialty Rx services
We recently sent you and your clients support information for the new 2022 home delivery and specialty drug services provided by Express Scripts and Accredo, respectively.
As a reminder, we already mailed letters to members who currently use specialty and home delivery services about setting up accounts with the new vendors.
Reach out to your account executive if you have further questions.
About member ID cards, delivery, and benefit access
In 2022, we’re issuing new ID cards to members for both new and renewing groups to comply with the Consolidated Appropriations Act (CAA). Cards are being processed upon renewal, where applicable.
Some members may have already received their new cards while we continue to process them as quickly as possible. Employer groups should know that if their employees have not yet received their card, they can still access their benefits and should not postpone necessary medical treatment.
Existing members who are renewing with no benefit changes can continue to use their current ID card to access services. If there are benefit changes, members can use their current ID card, but the cost share information may be incorrect for 2022. They can refer to the 2022 highlight sheet for Medical and Pharmacy benefit cost sharing amounts.
Existing members also can download an electronic ID card through their secure account or on the mobile app. If the member is new or can’t access the online version, the member or provider should call Member Services to obtain the enrollment information.
New Groups New members cannot create a secure account or register for the app until they have their group number and member ID number. As long as their information is in our system, all members can call Member Services for information they need to present to providers and pharmacies in order to get care or prescriptions until their ID card arrives.
Broker and consultant compensation disclosure for Individual health plans
As we previously announced, the Consolidated Appropriations Act of 2020 (CAA) requires the disclosure of direct and indirect broker and consultant compensation to individual health insurance policyholders and plan fiduciaries beginning December 27, 2021.
The CAA Producer Payment Notification flyer, 2022 Broker and Consultant Compensation Disclosure, is available in the producer tools section of our website for individual products (producer login required) and at the end of the individual’s application process.
2022 Healthy Blue Rewards
Healthy Blue Rewards is a wellness journey platform strategically designed to provide personalized guidance on the path to better health. Customers across Capital’s commercial group and Individual books of business can look forward to an enhanced platform experience for 2022.
There are three tiers available: Healthy Blue Rewards, Healthy Blue Rewards Lite, and Healthy Blue Rewards Premier.
Healthy Blue Rewards is automatically included in all plans for our standard Commercial group and Individual product portfolios. The standard Healthy Blue Rewards program runs on a calendar-year basis regardless of renewal date. Subscribers (and spouses for standard group only), who are enrolled in a qualifying Capital Blue Cross health plan, will automatically have access to the Healthy Blue Rewards portal through our website and the mobile app.
Healthy Blue Rewards Lite (formerly Health Assessment Only) is automatically available at no cost to custom Large groups.
Healthy Blue Rewards Premier is available as a buy-up option for custom Large groups wanting to customize their own program. Additionally, the level of enhancements will vary based on tier level. Standard and Individual plans will have an incentivized Healthy Blue Rewards program as they do today.
Web access and navigation A secure account is required to access Healthy Blue Rewards.
Health assessment The questionnaire is individualized to the participant and takes approximately 10–15 minutes to complete. The health assessment is included in all three Healthy Blue Rewards tiers.
Biometric screenings Access to the biometric screening form is available through the member’s Healthy Blue Rewards online dashboard. Screenings can be performed by doctors (MD or DO), nurse practitioners, physician assistants, health coaches at any of the Capital Blue Cross Connect health and wellness centers, and any screening vendors contracted by groups to perform the screening. Regardless of who performs the screening, members MUST comply with all terms and conditions of the program to receive any rewards.
Rewards For standard Commercial group and Individual plans, members who earn rewards can receive an e-gift card (i.e., digital code) from a retailer of their choice from available options in the platform. For Healthy Blue Rewards Premier groups, reward cards (physical or digital) are an available buy-up option.
Employer Premium Credit Incentive Eligible groups may receive a premium credit based on employee engagement in the Healthy Blue Rewards program.
PPO Choice providers
PPO Choice is a three-tier PPO plan available to groups physically located in Adams, Berks, Lancaster, and York counties: Choice 1, Choice 2, or Nonparticipating (NonPAR).
Each choice tier has a separate deductible. This means that if members satisfy the Choice 1 deductible, they will still have one to meet if they visit Choice 2 or NonPAR providers.
Out-of-pocket maximums are combined for Choice 1 and Choice 2. NonPAR has a separate OOP maximum.
Members have the lowest out-of-pocket costs when using Choice 1 providers.
Choice 1
Select in-network providers, as well as out-of-area BlueCard providers
Member cost sharing is at its lowest level when they use these select providers; emergency and urgent care will always pay at the Choice 1 level
Includes Geisinger, Lancaster General Hospital, Lehigh Valley Health Network (LVHN), Penn State Health, St. Luke’s University Health Network, and UPMC
Choice 2
The remaining providers that participate in our PPO network, with the exception of Reading Hospital and their associates as they are nonPAR for the PPO Choice plan
Includes Tower Health (Reading Hospital) and WellSpan Health
Nonparticipating (nonPAR)
Providers that do not participate in the Capital Blue Cross network
The No Surprises Act
As part of the Consolidated Appropriations Act (CAA), beginning January 1, 2022, the No Surprises Act protects individuals from surprise medical bills for emergency services, out-of-network air ambulance services, and certain nonemergency services provided by out-of-network providers at in-network facilities.
Capital is required to comply with this act and make information available to members and providers. As a federal mandate, groups likewise cannot opt out of No Surprises Act requirements.
Plans are required to cover the following for in-network or out-of-network providers at in-network deductibles and cost sharing:
Emergency department services or emergency services administered in a free-standing emergency department without prior authorization including items or services furnished after the patient is stabilized or as part of outpatient or inpatient services following the emergency admittance, for which benefits are provided by the plan or issuer.
Nonemergency services performed by an out-of-network provider at an in-network facility (except if specific notice and consent requirements are fulfilled).
Out-of-network air ambulance services for any services that would have been covered if the air ambulance provider was in-network.
This mandate is important so members are aware of their rights due to these protections.
In some cases, out-of-network providers may request and obtain consent from members to give up their protections under the law and be responsible to pay for items and services received. If the member grants consent, the amount they pay may not count toward their deductible and out-of-pocket limit.
Members will be or have been alerted about this act through several channels.
The All in One newsletter was mailed the week of November 29 to all commercial members.
We will mail an insert with EOBs that includes claims that may be subject to surprise billing.
The No Surprises Act also provides access to an independent dispute resolution (IDR) process for providers and plans who cannot reach an agreement on payment. If the IDR process is triggered, an external IDR entity (arbiter) will be assigned to determine the amount the provider must accept as final payment.
Congratulations and Farewell
Please extend a congratulations to Anne Baum. Anne has been named the first President of Lehigh Valley Reilly Children’s Hospital, part of the Lehigh Valley Health Network (LVHN). She assumed her new role on January 3.
We thank Anne for her years of dedication to Capital Blue Cross and bid her a warm farewell as she moves to give to Lehigh Valley Reilly Children's Hospital the same dedication, service, and care.
The producer relations and sales teams will build upon her endeavors, continuing to forge relationships and offer the best support for our producers, groups, and communities.