What's Inside: Coming soon! New way to price out-of-network (OON) provider claims | 2024 standard benefit updates | Keep mental wellness top of mind in October | New gym membership promotion available through the end of October | Three important vaccines for fall
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Coming soon! New way to price out-of-network (OON) provider claims
By the end of the year, Capital Blue Cross will launch a new process for pricing certain OON claims using a vendor with 40+ years of experience contracting with healthcare providers.
Employer groups with ASO plans may realize additional savings on claims priced using this new process; that savings will be shared as part of our Shared Savings program. Talk to your account executive to learn more.
2024 standard benefit updates
We’re making several standard benefit updates to employer group plans in 2024:
Expanding autism spectrum disorder (ASD) benefits — Starting upon renewal on or after January 1, 2024, we will expand our ASD benefit coverage to our PPACA Small Group market. Capital currently offers ASD benefits for fully insured and ASO plans for groups of 51 or more employees.
Revising durable medical equipment (DME) coverage for wheelchairs outside the home — Starting upon renewal on or after January 1, 2024, the member Benefits Booklet (Certificate of Coverage) and medical policy were updated to include additional coverage to support activities of daily living and primary use outside the home when preauthorized and medically necessary.
Updating out-of-network (OON) facility claims processing — Effective upon renewal on or after January 1, 2024, OON facility claims will process with coinsurance after the deductible is applied. Currently, OON facility claims process with coinsurance before the deductible. This change will ensure that OON facility claims and our OON professional claims are processed the same way (coinsurance after deductible). All employer group plans, except for HMO and EPO plans, are included.
Removing meal expense reimbursement for transplant travel benefit — Effective January 1, 2024, we will no longer reimburse for meal expenses as part of our standard Blue Distinction Centers for Transplant (BDCT) travel benefit. We’re making this change to meet Internal Revenue Service (IRS) guidelines. All employer group plans are included.
If you have questions, please reach out to your account executive for assistance.
Keep mental wellness top of mind in October
This month marks National Depression Month World Mental Health Day. Good mental health is crucial to overall health and well-being, but one in five U.S. adults experiences mental illness every year.
The Capital Blue Cross Health Promotion and Wellness team offers Balance — a multi-session program that teaches employees to develop a plan and process to work through life’s stressful situations. Sessions include how to stress less, clear the mind, create positive self-talk, and build resilience. This program is offered as a self-paced digital program or instructor-led, which can be scheduled virtually or at your client’s worksite.
Capital Blue Cross members can also access mental health resources, including the new self-guided Mental Health Awareness program, by logging into their Healthy Blue Rewards account or logging in to the AlwaysOn® Wellness app, available in the App Store (iOS) or Google Play (Android).
If your clients are interested in learning more about these opportunities, 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.
New gym membership promotion available through the end of October
Capital Blue Cross members have a great way to get on track with their fitness goals before the holidays.
With Fitness Your Way by Tivity Health, members can save $19 when they enroll in October. All they have to do is use promo code FYWOCTOBERPROMO at checkout.
Fitness Your Way offers more than gym memberships, which allows access to over 10,000 gyms nationwide. They also offer digital-only packages starting at $10 per month, as well as access to health- and well-being specialists. Feel free to print or email this flyer to share with employees.
On behalf of Capital Blue Cross, Tivity Health, Inc. assists in the administration of fitness programs. Tivity Health is an independent company.
Three important vaccines for fall
Most Capital Blue Cross plans cover preventive vaccines with no cost share when vaccinations come from an in-network provider. We want your employees to stay healthy by protecting themselves and their covered dependents.
Three vaccines to keep in mind are influenza (flu), COVID-19, and respiratory syncytial virus (RSV). All three vaccines provide extra protection against infection and can be administered at a doctor's office or participating pharmacy.
