Category Archives: Broker Updates

Horizon BCBSNJ Brief Notes V. 22, No. 920: Update to reinsurance assessment fee

Applies to: Self-insured groups

Update to reinsurance assessment fee

How payments are made

 In March, Brief Notes, Vol. 22 No. 907, “Affordable Care Act requires Reinsurance Assessment Fee,” was released, stating that the Affordable Care Act (ACA) requires third-party administrators to collect and make reinsurance payments from 2014 to 2016 on behalf of self-insured group plans.

We would like to inform you of an update to the transitional reinsurance program from the U.S. Department of Health and Human Services (HHS).

 HHS has clarified that for a self-insured group health plan, it is the plan itself that is responsible for making the reinsurance contributions and reporting counts to HHS. Horizon Blue Cross Blue Shield of New Jersey will not collect a reinsurance fee, nor make any reports to HHS on behalf of the self-insured plan, effective with the January 2014 bills.

 If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

 The information included in this document may be subject to change at any time as laws and regulations and related guidance

are issued by state and federal agencies. This document is for educational purposes only.

Click  the link below for PDF

BB V.22 No. 920 Update to Reinsurance Assesment

 

Amerihealth – Updates on SBC’s & Off-Anniversary Changes

Updates on the Summary of Benefits and Coverage

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We would like to share some important updates and reminders about the Summary of Benefits and Coverage (SBC), under the Affordable Care Act (ACA), including information about off-anniversary benefit changes, and SBC postcards that are sent to members. Under the ACA both group health plans (customers) and health insurance issuers (health insurers) are required to provide the SBC to participants under certain circumstances.

ACA 60-day notification requirement for off-anniversary benefit changes

For customers who make off-anniversary material modifications (e.g., benefit changes) that affect the content of the SBC, participants in the customer’s group health plan must receive notification of the change (including a new SBC) at least 60 days prior to the effective date. As a result, off-anniversary changes must be submitted to AmeriHealth New Jersey a minimum of 75 days in advance of the effective date to ensure that we can generate the SBC within the required timeframe. All groups are required to adhere to this 60-day notification.

A material modification is a coverage change that would be considered by the average plan participant (member) to be an important change in covered benefits or other terms of coverage, for example, changes to copays, coinsurance, or coverage levels and includes an enhancement as well as a reduction in benefits.

Any customer or health insurer who does not comply with this requirement may be penalized with fines of up to $1,000 for each failure to deliver the SBC to a participant. Note: Each participant would be a separate offense. The penalty may apply to the customer, the health insurer, or both depending on the funding methodology of the customer:

  • Fully-insured customers: The penalty applies to the health insurer and to the group customer.
  • Self-funded customers: The penalty applies only to the group customer.

To ensure compliance of the provisions of the ACA, AmeriHealth New Jersey will implement a new policy which prevents us from releasing a rate quote for a material benefit change within a 60-day period prior to the effective date. ROAM will also be updated in the coming months so that you may only submit a material benefit change 75 days or more prior to the requested off-anniversary effective date.

SBC Postcards

If a customer is not making changes to their benefits from the previous year, AmeriHealth New Jersey will mail a postcard to subscribers (members and any dependents who do not live in the same household as the policy-holder) 30 days prior to their anniversary date. For example, postcards will be mailed on 6/1 for groups with a 7/1 anniversary date. AmeriHealth New Jersey will also mail postcards to all direct bill (individual) members 30 days prior to their anniversary date.

View a sample postcard that we will send to members when their group plan is not making any changes to their benefits. The federal government has suggested certain language to include on the postcard.

If you have any questions about this information, please contact your AmeriHealth New Jersey broker representative.
 

Horizon BCBSNJ Brief Notes V. 22, No. 914:New Horizon Blue App provides quick access to health plan information

Horizon BCBSNJ Brief Notes V. 22, No. 914: New Horizon Blue App provides quick access to health plan information

Applies to: All markets

New Horizon Blue App provides quick access to health plan information anywhere, anytime

Horizon Blue Cross Blue Shield of New Jersey is pleased to announce the release of our new Horizon Blue App. With our new Horizon Blue App, our members can use their hand-held device to find everything from health plan options and information to our Online Provider Directory, which offers quick and easy access to contact information for our 72 network hospitals and over 28,000 physicians and health care professionals located across New Jersey.

Staying connected is easier than ever for members, with all of their essential information right at their fingertips. By downloading the new Horizon Blue App to their iPhones™ or Androids™*, members will have quick access to:

Online Provider Directory

  • Search for a provider based on specialty or ZIP code.
  • View detailed information for a provider through the search results.
  • Access map navigation to a provider’s address.

Claims Information

  • View most recent claims and their details.
  • Search for claims within a date range.
  • View benefit information such as copayment, coinsurance and deductibles for a specific claim.

Authorizations and Referrals

  • View authorization and referral details.
  • Check the status of authorizations.

Identification (ID) Cards

  • View the front and back of ID cards.
  • Request a duplicate ID card.

Benefits

  • View product and coverage information.
  • View benefits information such as copayment, coinsurance and deductibles.

Update Additional Insurance

  • Add or update coordination of benefits.

Manage An Account/Profile

  • Register for Member Online Services
  • Retrieve a User ID.
  • Retrieve a password.
  • Modify a profile (password, e-mail address or phone number).
  • Opt-in or opt-out for paperless explanations of benefits (EOBs), e-mails or text alerts.
  • Change a Primary Care Physician

Contact Us

  • Access our telephone directory.
  • E-mail questions via an online form.

Providing our members with easy access to their health plan information is the latest example of how Horizon BCBSNJ is Making Healthcare Work.

* There is no charge from Horizon BCBSNJ to download the Horizon Blue App, but rates from members’ wireless providers may apply.

Also see:
BBNewHorizonBlue (Size: 583 Kb )

AmeriHealth New Jersey and Cooper University Health Care form new venture

AmeriHealth New Jersey and Cooper University Health Care form new venture

In a highly innovative move, unprecedented in New Jersey, a health insurer and a hospital system AmeriHealth New Jersey and Cooper University Health Care announce today that Cooper will acquire a 20 percent interest in AmeriHealth New Jersey. This venture intends to transform health care in the state by increasing quality and lowering costs through a more highly coordinated care model.

For more information, please read the press kit or contact your AmeriHealth New Jersey broker representative.

http://www.amerihealth.com/htdocs/custom/nj/cooper.html

 

Horizon BCBSNJ Brief Notes V. 22, No. 913: Debit Card Regulation

Horizon BCBSNJ Brief Notes V. 22, No. 913: Debit Card Regulation
April 5, 2013 V ol. 22 No. 913

Applies to: HRA and FSA Debit Card Holders

A new regulation went into effect as part of the Dodd-Frank Wall Street Reform and Consumer Protection Act

Effective April 1, 2013, a new regulation went into effect as part of the Dodd-Frank Wall Street Reform and Consumer Protection Act. This new regulation requires consumers to be provided with the option to pay for eligible expenses using a Personal Identification Number (PIN) at the time of purchase, in addition to the current signature process.

This does not change how members currently use their Horizon MyWay or Benny Prepaid Benefits cards. Members may continue to use their card as they always have by swiping their card and providing a signature. However, now they have the option of entering a PIN when using their card.

To use the PIN option, members must first call 1-866-898-9795 to set up their self-selected PIN. The automated system will walk members through the prompts to create a PIN for their card.

Members making a purchase using the Horizon MyWay or Benny Prepaid Benefits Card can:

Swipe their card, then choose:

  • Credit to require their signature; or
  • Debit to enter their PIN.
  • Cash-back and ATM transactions are not allowed under either payment option.

Horizon Blue Cross Blue Shield of New Jersey representatives are available to answer members’ questions about this new payment option, or any other questions about their health care coverage.

Members who have a:

  • Health Reimbursement Arrangement (HRA) should call 1-800-355-BLUE (2583).
  • Flexible Spending Account (FSA) should call 1-800-224-4426.

Member Services representatives are available Monday through Wednesday and Friday between 8 a.m. and 6 p.m., Eastern Time (ET), or Thursday between 9 a.m. and 6 p.m., ET

Also see:
BB2013DebitCard (Size: 614 Kb )