What's Inside: Avalon Stop Loss Incentive+ Producer Program runs through January 2024 | Still time to earn rewards with Capital Blue Cross Producer Incentive+ Program | 2023 Medicare Advantage Star Ratings | 2024 plans for individual and families | 2024 Underwriting Compliance Guidelines | Initial deposit submissions | Important reminders to help us help you | DigiBite teledentistry access for Capital Blue Cross Dental members | Timeline for rate requests | CAA Gag Clause Prohibition Compliance Attestation | The health benefits of simply talking — and listening
Avalon Stop Loss Incentive+ Producer Program runs through January 2024
Avalon Insurance Company rewards you for large group Avalon Stop Loss sales and renewals. The Avalon Stop Loss Incentive+ Producer Program runs from February 1, 2023 through January 31, 2024.
To help you on your way, here are some things to get started:
Share this flyer with your prospective large employer groups to start the conversation about the Avalon Stop Loss advantage.
And as always, the Avalon Producer of Record recognizes you as your client’s authorized producer/consultant and qualifies you for incentive programs.
Still time to earn rewards with Capital Blue Cross Producer Incentive+ Program
Capital’s Producer Incentive+ programrecognizes your block management, new business sales, and renewals for employer groups from February 1, 2023 through January 31, 2024. Additional rewards can be earned for specialty networks, Rx, Capital Blue Cross Dental, and Capital Blue Cross Vision offerings.
Highlights of the program include:
Each component of the program will be for the incentive program year February 1, 2023 through January 31, 2024.
An incentive was added for Capital Blue Cross Vision.
Block management section rewards renewing your groups and adding new business.
2024 Medicare Advantage Star Ratings
CMS recently released star ratings for plan year 2024. For any 2024 enrollment kits that you have in inventory, please replace the star rating sheets. Be sure to include both HMO and PPO versions. You should begin using the 2024 star ratings in 2024 enrollment kits effective immediately.
If you need us to send you a supply of star rating sheets, email us.
2024 plans for individuals and families
Both the 2024 rate guide and product brochure are now available, including rates and benefits for on and off Pennie plans. As a reminder, we have two new plans for 2024: PPO Choice Select will be available in Cumberland, Dauphin, and Perry counties; and Performance PPO will be offered in Adams, Franklin, Lebanon, and York counties.
2024 Underwriting Compliance Guidelines
The 2024 Underwriting Compliance Guidelinesare now available. These guidelines apply to all commercial group health, dental, vision, and prescription drug coverages offered by Capital.
Updates have been made throughout to reflect the plan offerings for effective dates beginning January 1, 2024. Other changes include:
Addition of information about offering benefits to highly compensated individuals can be found in Section II. Group Eligibility D. Employee class.
Addition of a religious waivers FAQ in Section XII. Frequently Asked Questions 13. How does Capital handle religious waivers?
The guidelines are considered proprietary. Disclosure, use, or reproduction for purposes other than the intended use of underwriting Capital business is prohibited.
Initial deposit submissions
New small and mid-market group applications must be accompanied by an initial deposit payment. This includes new medical groups with prior ancillary-only coverage with Capital.
There are several group payment options. The electronic submission of funds is the preferred method for making any payments to Capital Blue Cross. it helps to promote our electronic options as they provide a timely and secure alternative to sending paper checks. The Automated Payment Options form allows new groups to elect a one-time only eCheck, recurring auto withdrawals via Check It Out, or both eCheck and Check It Out.
eCheck payments are typically processed so they are withdrawn within seven business days of the contract effective date. The payment will be processed upon receipt if the request is received within that time period, or after the effective date. High volumes may skew the processing timeframe.
Some tips:
Paper checks must be made payable to Capital Blue Cross and will be deposited within seven business days of contract effective date or when received if past the effective date.
Checks should be mailed by the group for receipt prior to effective date at time of contract acceptance.
Courier service that allows tracking is highly recommended if the group is sending a hardcopy check for their initial deposit.
The address for group initial deposit check submission is:
Capital Blue Cross 2500 Elmerton Ave. Harrisburg, PA 17177
Important reminders to help us help you
Capital appreciates our producer partners and strive to provide efficient and accurate service. Here are some tips to facilitate a positive experience:
Always include the group name, group number, effective date, and the nature of your inquiry in the subject line of any email correspondence.
If it is a general inquiry, please include that in the subject line.
The more details you can provide, the better. Include the who, what, when, where, and why in the body of your email.
When calling Capital, listen thoroughly to the prompts so that your call is directed accordingly.
Please limit duplicate requests and if you do need to follow up, let us know when, how, and to whom the original inquiry was directed.
Always use the most current forms and collaterals available in the Salesforce Partner Community for producers. Outdated forms and incomplete fields will result in processing delays.
DigiBite teledentistry access for Capital Blue Cross Dental members
Digibite is a teledentistry app that provides on-demand access to dentists without leaving home.
Digibite does not replace oral health maintenance but a person can get help determining if an in-person dental visit is needed. Digibite offers access to consultations, second opinions, and personalized treatment plans using live video and offline options.
DigiBite may not be available in all 50 states or available on all plans. DigiBite is an independent company whose products and services are not Capital Blue Cross products and services.
Timeline for rate requests
High volumes may impact processing times of medically underwritten (MUW) rates for small business ASO and mid-market groups. Ensure the census information is accurate, includes the required information, and allow ample lead times for processing. At a minimum, requests for MUW rates must be submitted by the twelfth of the month before the effective date.
CAA Gag Clause Prohibition Compliance Attestation
Capital Blue Cross is preparing to submit the CAA Gag Clause Prohibition Compliance Attestation (GCPCA) on behalf of fully-insured and small business ASO (5-99) group customers. Those groups do not have to take any action for this submission.
Self-funded ASO groups are also required to submit the GCPCA. However, Capital is offering an option for self-funded ASO group customers to elect to have Capital submit a GCPCA on their behalf. Self-funded ASO group customers will receive communications in the coming days with details about the opt-in process and deadline should they choose to have Capital submit an attestation on their behalf.
Self-funded ASO group customers electing to have Capital submit an attestation on their behalf will need to complete an online form to opt in and agree to certain terms and conditions by November 22, 2023 . This deadline allows our teams time to prepare files and complete our submission to CMS prior to the December 31, 2023 deadline. There is no charge for this service, and we will issue an update on our CAA page when the submission is complete.
Thank you for your collaboration as we work through the complexities of this CAA requirement. We appreciate your business and working with you to help our respective clients and customers. Please direct any questions to your legal counsel or Account Executive.
Important notes: This form must be completed by an authorized employee of the group and cannot be completed by a producer. Capital’s reporting on behalf of our self-funded ASO group customers does not transfer those groups’ compliance obligations to Capital.
The health benefits of simply talking — and listening
Talking about our thoughts and feelings have well-documented health benefits, and talk therapy has emerged as a key strategy to combat mental health issues like anxiety and depression. Learn more at THINK, our online source of education, resources, and news on the latest health and insurance issues.
Your producer relations team
Capital Blue Cross has adopted a team approach to support you, as we collaborate to enhance business relationships, foster your growth through education and incentives, and actively support the communities we serve. The Producer Relations team thanks you for your commitment and hard work. Reach out whenever you need them.
If you have any questions about content in this email, please contact your account executive.
