What's Inside: Coming in 2025: Change to PPO Choice provider tiers | When is ownership tax documentation required with new group enrollments? | Strive Health Renal Care Services program | January is National Cervical Health Awareness Month | Share the benefits of Healthy Blue Rewards in 2024 | 1095-B forms for fully insured and small group ASO members
Coming in 2025: Change to PPO Choice provider tiers
There will be a change in provider tiers in our PPO Choiceplan in 2025. PPO Choice is available to groups physically located in Adams, Berks, and Lancaster counties and is also available as an Individual Account plan option for individuals residing in Lancaster county. PPO Choice offers two levels of provider options: Choice 1 and Choice 2. The lowest possible out-of-pocket costs for members comes with Choice 1 providers, but members may opt to use Choice 2 providers, subject to higher cost-share. Members also have an out-of-network benefit, subject to the highest member cost-share.
Choice 1 providers for the PPO Choice currently include:
Ephrata Hospital, Geisinger, Lancaster General Hospital, Lehigh Valley Health Network, Penn State Health, St. Luke’s University Health Network, and UPMC Central Pennsylvania.
Out-of-area BlueCard providers, as well as select independent providers.
Effective January 1, 2025, Ephrata Hospital will be moving to Choice 2.
Choice 2 providers currently include:
Tower Health (Reading Hospital) and WellSpan Health.
The remaining providers that participate in our PPO network.
When is ownership tax documentation required with new group enrollments?
Ownership tax documentation is the schedule from the most recent filed federal tax return showing the owner names and percentage of ownership for a business.
Include this documentation when:
The owner(s) is enrolling but does not appear on the UC-2.
Groups with fewer than four applicants are enrolling.
The YES tool will ask “Are you enrolling three or fewer subscribers?” and if true, include instruction to attach ownership tax documentation under Other Documentation.
Strive Health Renal Care Services program
Capital Blue Cross is contracting with Strive Health to help our members with chronic kidney disease (stages three, four, and five) and end-stage renal disease manage their condition by providing one-on-one support from a team that includes nurse practitioners, dieticians, social workers, and care managers. Strive Health — and their affiliated providers — have a national reach and physical presence in some areas with virtual services in others.
Eligible members with chronic kidney disease or end-stage renal disease, and members who may be at risk for chronic kidney disease and could benefit from their services, will receive a postcard in the mail introducing Strive Health and their services. The postcard will be mailed in February, and will inform the member to expect a phone call from Strive Health.
Renal care management through Strive will apply to most medical lines of business. CHIP, Medicare supplement, SAS, and TPA account members are excluded. ASO groups will automatically be opted in. If a large group ASO would like to opt out, contact the Capital account manager. Contact your Capital Blue Cross account executive for more information.
On behalf of Capital Blue Cross, Strive Health LLC, an independent company, works with members to help improve their kidney health.
January is National Cervical Health Awareness Month
While vaccinations and appropriate screenings such as Pap and human papillomavirus (HPV) tests have dramatically dropped new cervical cancer cases in the United States over the past century, the disease remains the fourth-most-common cancer among women worldwide, according to the World Health Organization.
Up-to-date, preventive screenings are the single most important thing women can do to successfully battle cervical cancer. Women are encouraged to talk to their regular healthcare provider about risks and how often they should get screened.
Share the benefits of Healthy Blue Rewards in 2024
One of the most beneficial ways to prioritize health is to stay up to date on preventive health screenings in order to catch potential health issues early on. Beyond health screenings, lifestyle modifications can play a big role too. This includes engaging in regular physical activity, eating a balanced diet, or managing stress.
Capital Blue Cross members can learn more about the importance of preventive health by completing the Preventive Health: Reducing Your Risks self-guided program through our standard Healthy Blue Rewards program. Members will learn how to take an active role in staying healthy by understanding how to prevent chronic diseases with regular screenings, immunizations, and lifestyle changes.
Healthy Blue Rewards program has many additional features and tools to help members manage their health, including an interactive health assessment, personal challenges, and healthy behavior tracking tools. Members can access the Healthy Blue Rewards platform online or with the AlwaysOn® mobile app.
If you are interested in learning more about Healthy Blue Rewards, including custom program designs for ASO groups, and how best to promote the program to your employer groups and their employees, please call or email a Senior Health Education Consultant for more information.
AlwaysOn® is a registered trademark of Onlife Health, Inc., an independent company. On behalf of Capital Blue Cross, Onlife Health provides health information content and wellness tools.
1095-B forms for fully insured and small group ASO members
The 1095-B is specific to fully insured coverage. Capital will mail the required 1095-B tax document no later than January 31 to the following:
All fully insured group subscribers.
Off-exchange Individual subscribers.
On-exchange catastrophic subscribers.
PersonalBlue subscribers.
Small group ASO subscribers (groups with 49 or fewer employees).
1095-B forms are only issued to subscribers. Neither the forms nor a spreadsheet are provided to groups. Should a subscriber require a duplicate or replacement, they should go log into their secure account. They can then go to "Manage My Information" and "Tax Forms" to view and print their 1095-B. Subscribers can also request a copy by calling Member Services at the phone number on the back of their ID card.
If the member identifies a need for an update or correction to the information found on the 1095-B, they should contact their employer to follow established processes that provides Capital with updated information. If enrolled in an individual account product that was not purchased on the Pennsylvania State Exchange (Pennie), an updated enrollment application should be submitted to Capital. All required updates or corrections must be supplied to Capital Blue Cross, and received by Capital no later than March 4, 2024.
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.
This is a marketing email for producer use only. Replies to this mailbox are unmonitored. Contact us.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. Communications issued by Capital Blue Cross in its capacity as administrator of programs.
