• Jim Grazko
    President, Blue Cross Blue Shield of Alaska

    The more you sell, the bigger your reward

    With the 2014 Sprint Rewards Program when you sell new group medical and dental plans, you‘ll earn incentives per new enrolled member while growing your book of business.* There are no minimum sales requirements and no payout maximum.

    For more information on this exciting program, check out this flyer.

    * Qualification and payments for the program are calculated and paid only on groups of two or more enrolled employees who are active at the time the payment is generated. Renewal business is excluded. Policy effective dates from 8/7/2014 through and ending 1/31/2015.

    Saving your clients money

    24-Hour NurseLine awareness campaign targets those with avoidable ER visits

    You know Emergency Room visits are costly to your clients. But did you know when our members call the 24-Hour NurseLine with the intention of going to the ER, or calling 911, they are de-escalated to a lower cost option nearly 75 percent1 of the time?

    To help your clients understand how much the 24-Hour NurseLine can help their health and their wallet, we’ve embarked on a new, highly targeted direct mail campaign. It began the first week in August and targets members from the individual, small and mid-size markets that have avoidable ER visit diagnosis codes. The headlines on the mailers read, ‘I Need Help! Should I go to the ER? Maybe – Maybe Not. Call the free 24-Hour NurseLine to find out.’

    On a monthly basis we will send this mailing to members who:

    • Visited the ER with avoidable ER diagnosis codes
    • Did not call the 24-Hour NurseLine
    • Were not admitted
    • Received their provider bill

    We will track the 24-Hour NurseLine utilization along with inappropriate ER use as this campaign continues throughout 2014. Please continue to strongly promote the benefits of the 24-Hour NurseLine to your clients. It is one of the best tools we have to reduce health care costs.

    1 CareWise Health Performance Summaries

    Primary Care Doctors and Prevention

    The two go hand in hand

    The best defense is a good offense. It’s why we encourage your clients to be proactive about their health and use their preventive-care benefits to protect it. If their primary care doctors can detect health issues early, things like lifestyle changes and treatments can be most effective.

    Because it’s so important, most preventive care is covered at 100 percent when provided by an in-network primary care doctor, meaning your clients pay nothing–no deductible, copays or coinsurance. And preventing or detecting health problems early will likely save them even more money down the road.

    So if you want to discuss the benefits of having primary care doctors and using preventive benefits with your clients, here are some helpful talking points.

    Primary Care Physician = Medical Manager

    “With copays as low as $10, finding a primary care physician should be the first money saving thing your clients do,” says Dr. Chelle Moat, Premera Medical Director and former Primary Care Physician. “This kind of doctor is trained to encourage good health, prevent disease and monitor a person’s overall well-being. They also serve as a medical manager so if your clients need specialized care, other clinicians know where to go for their medical history. Your clients don’t need to do a thing.”

    Find a primary care doctor

    The best first step to great preventive care is to start a relationship with a primary care doctor and get regular checkups. Checkups -- also called wellness exams, physicals, or preventive-care exams -- are recommended every year for children under 19 and every two years for adults, and are covered at 100 percent. This doctor is their first resource in making sure they get the preventive care that’s right for them.

    Preventive care covers many things

    Common examples are blood pressure screenings; immunizations for flu, tetanus, whooping cough, measles and mumps; cholesterol tests; mammograms and PAP smears for women; and prostate cancer screening for men. Some medications, including prescription drugs to help people quit smoking, are also considered preventive care.

    Preventive benefit basics

    • Find a primary care doctor on Premera.com and get regular preventive-care exams
    • Print out and take the preventive benefits list to the doctor because it can serve as guide to determine if any recommended tests are preventive or not
    • Understand the difference between preventive vs. diagnostic - some tests are considered preventive before a condition is suspected, but “diagnostic” if a condition is suspected or has already been diagnosed
    • Know that after being diagnosed with a medical condition, tests to monitor that same condition are no longer considered preventive benefits.

    Testing begins for Part D’s credible coverage

    Every year we audit our prescription drug plans to ensure they meet the annually updated actuarial testing standards determined by the Centers for Medicare and Medicaid Services (CMS). In testing, prescription plans are identified as creditable prescription drug coverage, or not, when compared to Medicare Part D.

    Testing and notification timelines

    Testing will begin this summer so credible coverage notification letters can be sent to Medicare eligible Individual, and Group members and their dependents before Medicare’s election period (October 15 through December 7). This is when eligible individuals may enroll in Medicare Part D.

    Meet our team

    Pamela Melin, Team Lead, Large Group Sales Support


    Pamela Melin, a life-long Alaskan, brings more than 15 years of experience in the insurance industry to Premera. Her role is to respond to the needs of the large group support team and provide daily oversight of service, operations, and program implementation.

    Pamela is an avid hunting and fishing enthusiast and has many great stories to tell. She also enjoys outdoor events that support local charities, such as Casting for Recovery—fly fishing retreats that promote healing among women dealing with and recovering from cancer.

    Pamela is happy to help you and can be contacted by email at pamela.melin@premera.com or phone at 907.677.2468.

  • John Mychalishyn
    Director, Individual Market Segment

    Directly to You

    The story behind Washington National’s critical illness coverage

    “I’m going to send you a check for 10,000 dollars,” said the agent. “Don’t you mean to the hospital? Not directly to me,” said Joyce. “Yes, directly to you,” said Joyce’s agent.

    This is the conversation policyholder Joyce and Washington National’s Pam Dabner had after Joyce’s cancer diagnosis and treatment. Directly paying the policyholder or someone she or he designates, giving them control over which bill gets paid when, is a hallmark of this product.

    We recently entered a relationship with highly regarded Washington National Insurance Company so we could offer members additional financial protection when they need it most. Washington National Critical Solutions® caught our eye for several reasons.

    The Washington National Critical Solutions® policies can focus on cancer only, heart, stroke, kidney failure or a combination of these issues. There are two benefit options for the applicant to choose between, A and B. They have benefit levels of $10,000 to $70,000. There are seven total questions to answer on the application with no family history.

    Option A

    This option offers lump sum benefits ranging from $10,000 to $70,000. There is coverage for children set at a $10,000 lump sum payment. The benefit can be paid once per insured after the first diagnosis of cancer, heart attack, stroke or kidney failure.

    This option offers a 50 or 100% optional return of premium rider.

    Option B

    Option B has two benefit levels for a hospital confinement benefit. One is $200 per day for 1–30 days. The other is $400 per day for 31+ days. There is also a consultation benefit of $250 after diagnosis. These are all one-time benefits.

    There is also a wellness benefit under option B; $50 per year critical illness with or without cancer only or $100 per year combined critical illness.

    We're here to help

    If you have further questions about our relationship with Washington National or these products contact Nancy Valdez at 907-677-2406.

    For agent information only. This material should not be distributed to the public or used in any solicitation.

    Individual producer administrative guides created

    We understand keeping up with all of the changes in the Individual market for your clients can be a challenge. Premera Blue Cross Blue Shield of Alaska has created a new online resource for you to use to find answers to your questions about how we administer the new Individual metallic plans at Premera.

    Today we’re launching the new Individual Administrative Guide for Producers. The guide will include the following content and much more:

    • Premium due dates, grace periods and third-party payer rules
    • Eligibility requirements
    • Special enrollment periods and qualifying events
    • How to select a PCP

    The guide is designed to be concise and easy to read, so you can find what you need quickly. Look for it on the producer section of our website under the Resources tab.

    Take a few minutes this week to read the new guide.  Contact Producer Support at 877-205-9725, Option 3 if you have questions about our administrative practices.

    Individual exchange rule issued

    You’ll receive a letter from PBCBSAK soon that explains new requirements for producers doing business on the Federally Faciliated Marketplace, or FFM. Starting this fall, you need to confirm for us that you have a current producer license and you completed and passed the agent and broker course for selling health plans on the FFM. Watch for our upcoming letter that will explain the steps you need to take. You can register on the federal exchange now, and we ask that you send us your documents before October 16, 2014.

  • Lynn Rust Henderson
    Vice President of Sales

    New Small Group metallic wellness program reminder

    Unlocking the door to controlling medical costs just got easier for your clients. It all starts by encouraging employees to complete their Premera health plan’s embedded wellness program. The end goal? To help your clients gain control over healthcare costs by building a culture of wellness that engages and motivates employees. When employees participate, everyone wins!

    Communicating to employers

    It’s easy for employers to take advantage of savings and inspire good health with our new monthly email reminder. Within the first month of their plan effective date or renewal date, employers with a Small Group metallic plan will receive an email reminder about the embedded wellness program. The message alerts them of their engagement period end date and includes an email template they can easily click and share with employees to help them get started on their path to wellness. Check out the employer message here and feel free to share the information with your clients.

  • Lynn Rust Henderson
    Vice President of Sales

    Health plan identifier deadline approaching

    Large self-funded health plans, defined as those with annual receipts greater than $5 million, are required to obtain a Health Plan Identifier (HPID) by November 5, 2014. Small self-funded health plans are defined as those with paid claims of $5 million or less and they are not required to obtain the identifier until November 5, 2015. Insured plans are not required to obtain an HPID because they will be identified by the health insurer’s unique identifier. 

    What is an HPID and why is it required?

    An HPID serves as a unique identifier for health plans when they are identified in HIPAA standard transactions. It’s intended to provide consistency and a standard format for insurers and health plans to identify themselves and to simplify the routing, review and payment of electronic transactions and reduce errors and manual intervention. HIPAA standard transactions include: medical and dental claims and encounters, payment and remittance advice, claims status request and response, eligibility and benefit inquiry and response, benefit enrollment and disenrollment, referrals and authorizations, and premium payment.

    Applying for an HPID

    The Department of Health and Human Services (HHS) has established a website where health plans can register and obtain their HPID. Check out this helpful video that walks an employer through each step of the application process to obtain it. For more information you can also visit the Health Plan Identifier page on CMS.gov.

    Next Steps

    The only action required by employers at this time is to obtain the HPID number according to the guidelines and timeline identified. While self-funded employers are still required to obtain their HPID by the deadline, Premera is in the process of evaluating whether we will conduct HIPPA standard transactions on behalf of our self-funded clients. Additional information will be provided as it becomes available. Actual use of HPIDs will not be required until November 7, 2016.