Benefit FOCUS TOOLS TO HELP. Compare Costs and Save Money. Your Employees. Staying Ahead of Health Care Reform

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1 Benefit FOCUS SPRING/SUMMER 14 Staying Ahead of Health Care Reform Earn up to $50,000 for Worksite Wellness TOOLS TO HELP Your Employees Compare Costs and Save Money Capital BlueCross is an Independent Licensee of the BlueCross BlueShield Association

2 Table of Contents Health Care Reform 3 Health Care Reform 3 Reinsurance Fees Now in Effect 4 Out-of-Pocket Maximums 5 FSA Funds 6 Accountable Care Arrangements 101 Products and Services 7 Earn Premium Credits Through the 2014 Worksite Wellness Awards 8 A Fresh Approach to Wellness 8 Reward Your Employees for Living Healthy Notices and Advisories 11 Rx Coverage and Services 12 Member Privacy Notice 13 Change to Preauthorization Requirements 9 Free Glucose Meters for Members with Diabetes 10 Ways to Save Alerts 10 Search & Save Center 11 Solutions for Individual Coverage capbluecross.com

3 Health Care Reform Can you believe it has been four years since the Affordable Care Act was signed into law? While the legislation has taken many twists and turns since 2010, and several provisions were postponed or changed, one constant remains: Capital BlueCross continues to serve as the region s leading trusted advisor to help consumers and employers navigate the complexities of the law. Reinsurance Fees Now in Effect The Affordable Care Act requires health insurers and third party administrators to make contributions (referred to as reinsurance fees ) to help stabilize individual market premiums between 2014 and This year the fee is $5.25 per member per month. Capital BlueCross will submit payments on behalf of fully insured groups. Employers with an Administrative Services Only or ASO plan must make this payment directly to the federal government. Check out the next edition of BenefitFOCUS for more information. Stay Reform Ready Visit the Health Care Reform section of our website to stay current on the Affordable Care Act. 3

4 Out-of-Pocket Maximums Beginning in 2014, the Affordable Care Act places limits on in-network out-of-pocket maximums for ACA-compliant group health plans. These limits are: 2014 $6,350 for individual coverage $12,700 for family coverage 2015 $6,600 for individual coverage $13,200 for family coverage Large groups must also factor member prescription cost shares into these maximums. That can be accomplished by: Combining medical and prescription cost shares so they are applied to a single limit; or Setting a medical and prescription out-of-pocket limit so that, when combined, they do not exceed the law s limits. BenefitFOCUS 4

5 FSA Funds Following recent modifications to the use-or-lose rule for medical flexible spending accounts (FSAs), groups can choose to apply their unused funds to the following plan year in one of two ways: 1. Through a grace period in which an unlimited amount of unused FSA funds can be spent up to two and a half months into the new plan year; or 2. A rollover option in which up to $500 of unused FSA funds can be used at any time during the new plan year. If your group uses an FSA arrangement and does not elect either of these options, your funds will be forfeited after the run-out period. This modification does not apply to dependent care FSAs. 5

6 Accountable Care Arrangements 101 Improved care. More affordable costs. When it comes to health care, you don t have to choose one or the other. In fact, the combination of better care and affordability provide the foundation of Capital BlueCross Accountable Care Arrangements. Through an Accountable Care Arrangement, Capital BlueCross rewards providers for value quality care and better managed costs associated with the treatment of their Capital BlueCross member patients. In other words: the better the patient outcome, the more compensation a provider earns. This innovative way of rewarding providers for value differs from the traditional fee-for-service model, in which providers are reimbursed based upon the volume of services they provide. So why is this important to you? Simply put, these arrangements can help lead to happier and healthier employees who are more engaged with their health and well-being. And healthier employees can make for a healthier bottom line. While Capital BlueCross is an Accountable Care Arrangement leader within our service area, Blue plans nationwide have established similar programs in 48 states, the District of Columbia, and Puerto Rico. Currently, more than 24 million Blue plan members and $65 billion in claims are linked to a value-based care program. The BlueCross BlueShield Association is working to develop a national program focused on giving Capital BlueCross members access to other Blue plan value-based care programs. [Capital BlueCross ACA Program] has taken us light years beyond where we were in being able to manage our patient population [Capital BlueCross efforts] have surpassed all other payer efforts in similar initiatives. Anonymous, provider satisfaction survey BenefitFOCUS 6

7 Earn Premium Credits Through the 2014 Worksite Wellness Awards What could $5,000 $50,000 mean for your company s wellness efforts? That s what you stand to win through Capital BlueCross 2014 Worksite Wellness Awards. The Worksite Wellness Awards recognize employers for their innovation, dedication, and accomplishments in promoting health and wellness in the workplace. Among other criteria, employer worksite wellness plans are evaluated on engagement methods, management support, planning and measurement, and success stories. This year, four winners will earn the following wellness credits awards: Major Group (500+) $50,000 Major Group (runner up) $25,000 Large Group ( ) $15,000 Small Group (1-99) $5,000 Find applications online at capbluecross.com/wellnessawards. Please contact your account executive or producer if you have questions. The greatest gift any company can give to its employees is one of good health and wellness. -- Capital BlueCross Chief Medical Officer Jennifer Chambers, M.D WORKSITE WELLNESS AWARDS Congratulations to the 2013 Capital BlueCross Worksite Wellness Award Winners! First place, Major Group Market Hershey Entertainment & Resorts Runner-up, Major Group Market Good Samaritan Health System Large Group Market Adams Electric Cooperative, Inc. Small Group Market ArtsQuest 7

8 A Fresh Approach to Wellness Live Healthy Capital BlueCross has kicked off a fresh platform for our health and wellness offerings. Live Healthy, formerly known as Better Health Works, consists of programs and tools that encourage your employees to do just that live healthy! Available health and wellness programs and tools include: Personal profiles Disease management Case management Digital health coaching Live Healthy mobile app Live Healthy newsletter Employees can explore these programs by clicking on the Wellness tab after logging into their secure member page at capbluecross.com. Reward Your Employees for Living Healthy Your Capital BlueCross plan becomes even better with Healthy Rewards, a program that rewards your employees for living well. Healthy Rewards not only empowers you to promote good health and lower the risk of chronic disease within your workforce through health management programs and campaigns, but also helps to reduce health care costs, lower absenteeism, and increase productivity. With Healthy Rewards, employees complete activities to improve their health or maintain wellness. Examples include choosing a personal (or primary care) doctor, getting a preventive exam, and completing an online health coaching program. Upon completion of each activity, employees can earn rewards. To learn more, contact your Capital BlueCross account executive or producer. BenefitFOCUS 8

9 Free Glucose Meters for Members with Diabetes To help control health care costs for your business, prescriptions for nonformulary diabetic test strips began to require prior authorization on January 1, Members who use preferred brand test strips from Bayer or OneTouch can receive a free blood glucose meter by contacting one of the following companies. OneTouch: Visit OneTouch.orderpoints.com or call and provide brochure code 524CAP001 Bayer: Visit BDCFreeMeter.com or call and provide order code BDC-CBC Members can receive one of the following free meters from OneTouch or Bayer: OneTouch Ultra 2 OneTouch UltraMini OneTouch Verio IQ Bayer Breeze 2 Bayer Contour NEXT Bayer Contour NEXT EZ Bayer Contour NEXT USB Test strips used with OneTouch meters include OneTouch Ultra and OneTouch Verio. Test strips used with Bayer meters include Breeze 2, Contour, and Contour NEXT. 9

10 Ways to Save Alerts Help your employees take control of their health care costs with Ways to Save Alerts. Employees simply need to register at capbluecross.com to sign up to receive a monthly text message or about savings opportunities and tips to reduce out-of-pocket expenses on their most common health care services. Find Ways to Save Register or log in at capbluecross.com then click on My Account and update your settings to receive and text messages about Ways to Save Alerts. Receive a cost-savings tip each month via text or . Save by following the links within each message. Ways to Save Alerts is a trademark of Change Healthcare Corporation. On behalf of Capital BlueCross, Change Healthcare Corporation provides health information content and member health platform tools. Change Healthcare Corporation is an independent company. Ways to Save Alerts are available to commercial pre-65 members with individual coverage and to members of many group-sponsored plans from Capital BlueCross family of companies. If you have employersponsored coverage, please check with your employer about availability. Search & Save Center Quality, cost, and convenience are three factors you likely consider before making any important purchase. That s why we created the Search & Save Center, a go-to resource to help customers make informed health care decisions. Using the Search & Save Center, your employees can find a provider, compare treatment costs, estimate out-of-pocket costs, and provide reviews on doctors and hospitals. To access the Search & Save Center, visit our Consumer Tools page or download the Capital BlueCross mobile app available on the Apple App Store or Google Play. 10

11 Solutions for Individual Coverage There are considerable advantages to continuing to provide health coverage for your employees, including: Increased employee morale and productivity. Talent recruitment and retention with a more competitive benefits package. Tax advantages. However, if you are considering transitioning your employees to individual coverage, Capital BlueCross has solutions you can trust. At choosecapitalblue.com, employees can learn about health care reform and shop for an insurance plan that meets their needs and budget. Features of the site include: Smart Start, where individuals can learn about health insurance in easy terms, especially useful for those who are purchasing individual coverage for the first time. Premium Tax Credit Estimator Tool, found in the Tool Kit of the Smart Start section, helps individuals find out if they qualify for a lower-cost subsidized health plan. Explore Online, for basic health plan design, benefit coverage, and price comparisons. Register & Shop, an online shopping portal for the individual consumer. Rx Coverage and Services To view prescription drug information, please visit the pharmacy page of capbluecross.com. Here your employees can view the formulary and Guide to Prescription Drug Benefits booklet, download forms, view their specific prescription benefit information, and much more. Click here for the most recent Capital BlueCross formulary updates. 11

12 Member Privacy Notice Capital BlueCross Protects Members Privacy The Gramm-Leach-Bliley Act protects the privacy of an individual s nonpublic financial information. This protection includes nondisclosure of certain personal financial information, such as income or premium amounts. To demonstrate our compliance, Capital BlueCross provides the following privacy notice to our group and individual customers: Member Privacy Is Important to Us At Capital BlueCross, we are committed to providing our members with the highest quality health care products and services. An important part of this commitment is our pledge to protect our members nonpublic personal financial information. Our Privacy Pledge Capital BlueCross does not sell member information. We do not disclose nonpublic personal financial information, except as permitted by law. We do not disclose this information, even when our customer relationships end, except as permitted by law. Information We Collect We collect nonpublic personal financial information from the following sources: Applications and other forms provided to us. Transactions (such as claims submissions and payments) with us, our affiliates, or others. Outside sources, such as health care providers, other insurance companies, and federal and state agencies. How We Protect Member Information Our policies restrict access of member information only to employees who need this information to provide our products and services, and as permitted by law. We maintain physical, electronic, and procedural safeguards that comply with legal requirements to protect nonpublic personal financial information. BenefitFOCUS 12

13 Change to Preauthorization Requirements On April 1, 2014, Capital BlueCross added the following preauthorization requirements to many plans to help us continue to balance providing access to high quality care with managing rising costs. High-Tech Nonemergency Imaging Procedures All high-tech, nonemergency imaging procedures will require preauthorization including:* MRI (Magnetic Resonance Imaging) MRA (Magnetic Resonance Angiography) CT (Computerized Tomography) scans CTA (Computerized Tomography Angiography) scans PET (Positron Emission Tomography) scans SPECT (Single Proton Emission Computerized Tomography) scans Observation Care All observation cases will require preauthorization for continued observation status that exceeds or is expected to exceed 48 hours. * Preauthorization for these services is not being added for Traditional members. The preauthorization requirement on high tech nonemergent imaging procedures already exists for our Keystone Health Plan Central, SeniorBlue HMO, and SeniorBlue PPO members. his preauthorization requirement and review process already exists for our SeniorBlue HMO T and SeniorBlue PPO members. The requirement became effective for SeniorBlue HMO and SeniorBlue PPO members on January 1,

14 Change to Preauthorization Requirements (continued) Radiofrequency Ablation for Pain Management/Denervation of Facet Joint Pain Management Radiofrequency ablation for pain management (Facet Joint Denervation) will require preauthorization. Participating providers are responsible for administering the preauthorization requirements for our members. As long as a member uses a participating provider, administration of the preauthorization requirements are the responsibility of the provider. If a member uses a nonparticipating provider or a BlueCard participating provider, it is the responsibility of the member to make sure that the provider obtains preauthorization on the member s behalf. Regardless of the provider s participation status, it is always a good idea for members to be aware of the preauthorization requirements associated with their health plan and to discuss these requirements with their providers. We understand that managing health care costs is often a priority. As a medical value leader, we pride ourselves on helping our customers become smarter health care consumers. Our Search & Save Center is designed to help customers find doctors, compare costs, and start saving. This tool can also help you to determine if a provider is a participating or BlueCard provider. You can access the Search & Save Center by logging in to the personal member page at capbluecross.com. Please reference your certificate of coverage for more details about preauthorization requirements related to your coverage. Your Capital BlueCross Account Executive or Producer can help you if you have any questions or concerns about these requirements. You can also send a secure at capbluecross.com/contactus. The preauthorization requirement became effective for SeniorBlue HMO and SeniorBlue PPO members on January 1, BenefitFOCUS 14

15 YOUR OFFICIAL NOTIFICATION OF BENEFIT AND POLICY CHANGES BenefitFOCUS is designed to inform and educate our customers about recent benefit and policy changes that may affect your coverage. If you have any questions about your group s benefits, contact Group Services at Please share this information with your employees/members. You can add other benefit administrators to our mailing list by contacting your Capital BlueCross account representative. Since this information may affect your contract, as well as any labor contracts you may have, please file this update for future reference, or visit capbluecross.com/employers for the current and archived issues of BenefitFOCUS. capbluecross.com capitalbluestore.com/blog Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company, Capital Advantage Assurance Company and Keystone Health Plan Central. Independent licensees of the BlueCross BlueShield Association. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies.

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