• John Casper
    Director, Western WA Mid-Market Sales
    Trevor Moore
    Director, Eastern Washington Sales and Marketing

    Producer Bulletin - July 2014

    The summer issue of Premera For Your Health is here!

    Premera For Your Health includes timely articles, such as how to receive care while traveling and summer cost-savings available through Premera member discounts. We designed these newsletters to engage consumers, so they get the most out of their coverage.

    Group summer edition

    Employers are receiving the new summer edition of the group member newsletter now. We recently sent this email to employers that have an email address on file with us. We provided them with an Outlook template so that they can easily share the newsletter with their employees.

    Individual summer edition

    Your clients enrolled in Individual plans are also receiving the new summer edition of the Individual member newsletter now. We sent digital copies recently to our members who have an email on file with us.  We’ll send print copies to members who do not have an email on record with us later this month.

    If you have questions about his publication, contact your Premera Account Manager or Individual Producer Support at 877-205-9725, Option 1.

    Updated member dashboard and mobile app

    Check out the new member dashboard on the website

    Snazzy new layout makes it easier to find and use website tools, such as:

    • Order prescriptions
    • Connect with preventive services such as health risk assessments, weight and activity tracking, and care guides for common conditions
    • Use the secure inbox (to communicate private information)
    • Use the online EOB

    New tools help members:

    • Track dental as well as medical deductibles
    • Estimate treatment costs
    • Make payments (members on individual plans only)

    The mobile app has some new tricks and improved experience

    Use new features for the mobile app to:

    • Track where you stand on your deductible
    • Check coverage for a referral instantly
    • Check the status of claims

    The improved design makes it even handier to:

    • Find a doctor or hospital
    • Email your proof of coverage to the doctor
    • Connect with the 24-Hour NurseLine
    • Discover and use Extra! Discounts

    You can find out more about the many mobile apps available to Premera members by visiting Premera.com. Please recommend these improved tools to your clients so they can start enjoying the upgraded member experience today. 

    Impact of Premera’s settlement of lawsuits concerning neurodevelopmental therapy and Applied Behavior Analysis (ABA)

    What you need to know

    In recent years more than a dozen class action lawsuits have been filed in Washington over exclusions and limitations of neurodevelopmental and behavioral therapies in individual, employer group and Medicaid health plans. Premera are among the health plans that have been involved in these lawsuits.

    In May, Premera reached a settlement agreement with the plaintiffs in the three class action lawsuits involving our coverage of neurodevelopmental therapies (speech, occupational and physical therapies) to treat members’ mental health conditions and applied behavior analysis (ABA) therapy to treat members with autism in Washington.  The impact of the settlement will be as follows:

    Neurodevelopmental therapy

    As previously reported back in September 2013, as a result of these lawsuits Premera ceased application in their individual and insured (small and large) group plans issued in Washington State of any blanket exclusions and age exclusions for medically necessary treatments of developmental delay or neurodevelopmental disabilities for members with a qualified mental health condition. A qualified mental health condition is a condition listed in the Diagnostic and Statistical Manual of Mental Disorders (“DSM”), other than substance related disorders and life transition problems (“V” codes) and diagnostic codes 302 through 302.9. Application of these exclusions ceased for applicable medical claims received on or after September 10, 2013.

    The May 2014 Settlement does not have any further impact on how Premera processes neurodevelopmental therapy claims in its insured plan in Washington State. What the settlement will do, once finalized, is establish a Settlement Fund of $3,500,000. This fund will reimburse class members for uncovered out-of-pocket expenses for neurodevelopmental therapy services which they have already incurred.The disbursement of the settlement funds will be handled by the plaintiffs’ lawyers – Premera will not responsible for paying out these funds.

    ABA therapy

    In terms of ABA therapy, as a result of the settlement, Premera will provide members and providers with guidance on how to access coverage in their medical plans for medically necessary ABA therapy to treat members diagnosed with autism. Premera will provide ABA coverage pursuant to specific coverage criteria, including therapy provided by therapy assistants working under the supervision of state licensed providers.

    Impact on individual and insured group plans only - Washington state members only

    We will be sending a letter out in early July to fully insured employers to provide them with an update on the settlement. Please note this does not impact any of our self-funded groups in Washington State.

    Current status of the settlement

    While the parties have agreed in principle to settle these lawsuits, before the settlement becomes effective and the terms of the settlement are put into place by the parties, including payment of claims out of the Settlement Fund and implementation of the ABA coverage terms discussed above, the settlement agreement requires preliminary and final approval by both state and federal courts. This process will take some time and will likely not be completed until the fall of 2014, at the earliest.

    Member communication

    The parties are currently waiting for the three courts involved to grant preliminary approval of the Settlement. Once that has happened, notice of the settlement will be mailed to potential class members. This class notice will provide members with all the information they need regarding the settlement, including the process by which members can submit claims related to uncovered out-of-pocket expenses for neurodevelopmental therapy services. 

    If you have any questions please contact your Premera sales team. 

  • John Mychalishyn
    Director, Individual Market Segment

    Premera + Washington National

    Offering your clients more choices in financial protection

    Imagine a runner, or a hiker. Pretty common sports in our active part of the world right? What’s also easy to envision are potential falls resulting from these activities. In fact, falls are the number one cause of accidental injuries in the U.S.1 Can you picture a client getting a cancer diagnosis? It’s not something anyone wants to think about, but beyond the realities of treating the illness, even with a health plan in hand, nearly 61% of all cancer costs will be nonmedical.2

    These are just two examples of why we recently entered a relationship with highly regarded Washington National Insurance Company. It was so we could offer our members additional financial protection when they need it most through supplemental health and life insurance products.

    Since 1911, Washington National has helped Americans protect themselves and their families from the financial hardship that often comes with critical illness, accidents or loss of life. Washington National insures nearly 1 million policyholders and 25,000 employer groups offering important benefits at a competitive price. You and your clients can count on Washington National for dependable, high-quality service and support.

    Specific product information

    Accident, critical care and life insurance are the three offerings you will see through us from Washington National. There is no specific open enrollment period for these products so anytime is a good time to discuss them with your clients.

    • Washington National Accident Assure® – supplemental protection against accidental injuries
    • Washington National Critical Solutions® – critical illness coverage that’s simple to understand and use
    • Washington National Life AssureSM – straightforward, assured life insurance that keeps pace with your clients’ lives

    More detailed information is available on Premera.com.

    Washington National is an independent provider of accident, critical care and life insurance products that does not provide Blue Cross Blue Shield products or services. Washington National is solely responsible for its products and services. Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association.

    Get appointed today

    It’s important to get appointed today so we can send you e-leads that come directly to us for these products. You can request a producer appointment using Washington National’s ezAppoint:

    • Open a browser and paste in “washingtonnational.com/ezappoint”
    • Click “instruction manual”, which walks you through the appointment process
    • Create a Premera logon and password
    • Enter a package code. If you are:
    • An agency principal (paid agent) enter “CFX5301”
    • An affiliated producer within your agency (licensed-only agent) enter “CFX5302”
    • An independently contracted producer enter “CFX5301”

    We’re here to help

    If you have further questions about our relationship with Washington National or these products contact Producer Support at 877-205-9725, Option 1 or your Sales Executive:

    1 National Safety Council, Injury Facts, 2010 Edition

    2 American Cancer Society, Cancer Facts & Figures 2010, p1

    The dental clock is ticking

    Special dental open enrollment runs through July 31, 2014

    You have a few weeks left to submit applications for your clients for an Individual dental plan with Premera Blue Cross.

    Now is the time to talk to your Premera clients about enrolling in our Select Dental Plan for Adults during a special open enrollment period that runs through July 31 for an effective date of August 1. This plan is available to your clients age 19 and older who are enrolled on a Premera Individual metallic plan.

    This special enrollment period is a good opportunity to encourage your clients to consider a Premera dental plan to round out their medical coverage. Common enrollment is required.

    For more information about our dental plans, please contact your sales executive or Producer Support at 877-205-9725, Option 1.

    Individual reinstatement policy announced

    With the launch of the new Individual metallic plans, some of you have asked us if Premera will allow reinstatements if your clients’ plans are terminated due to late payment. Here’s how we’re approaching requests for reinstatement for plans purchased directly from Premera.

    For Individual metallic plans direct from Premera

    If your client’s Individual metallic plan is cancelled due to non-payment of premium, reinstatement is not available. In this situation, your client’s next opportunity to enroll in an Individual metallic plan is the upcoming open enrollment period, which will be November 15, 2014 – February 15, 2015.

    For Individual grandfathered plans

    Your clients enrolled on Individual grandfathered plans have continued access to reinstatement once every 12 months if their plan is terminated for lack of payment.

    If your client with an Individual grandfathered plan receives a notification from us saying their plan has been terminated they must pay the full amount due by the stated date in the letter. They will be granted only one reinstatement every 12 consecutive months.

    On the exchange

    Your clients who obtain a policy on the exchange and not direct from us will need to contact the exchange to see if reinstatement is possible.

    For more information

    Should you need to request an exception on behalf of your client please email it to Producer Support. If you have further questions, please contact Producer Support at 877-205-9725, Option 1.

  • Trevor Moore
    Director, Eastern WA Sales and Marketing

    Helping members take healthy steps

    We’re committed to starting members on a journey to wellness that leads to better health – and real rewards!

    When members of Small Group plans complete their wellness activities within 90 days of their plan effective date or plan renewal date, they receive a $100 gift card. And for each employee that completes the wellness steps within this timeframe, the group wins, too – they save 7.5% on their premium back to their effective date for the plan year!

    To help members and groups get their rewards, we’re sending wellness reminder emails to members who we have email addresses on file for. Messages are sent at 30 and 60 days into the plan year, based on which of the two wellness activities members have achieved and which still need to be completed:

    The wellness program is built into every Premera small group metallic health plan. Please contact your general agency partner for more information on how the wellness program benefits your small group clients.

  • John Casper
    Director, Western WA Mid-Market Sales
      Trevor Moore
      Director, Eastern WA Sales and Marketing

    Final Mental Health Parity Rules – Effective July 1

    With so much attention focused on the Affordable Care Act, it’s easy to lose sight of other important changes, including final regulations issued under the Mental Health Parity and Addiction Equity Act of 2008. We’ve had interim rules in place since 2010, and now final rules provide guidance and rules on how parity requirements relate to the ACA, and other issues that were not addressed in the interim rule.

    These new rules go into effect for Large Groups (fully-insured and self-funded) with 51 or more employees that are new or renewing on and after July 1, 2014. Medical necessity criteria must still be met when applicable:

    • Contract exclusion for  residential treatment and quantitative (e.g., number of hours) limits on neurodevelopmental testing no longer apply
    • Detoxification now covered in any medically necessary setting when coverage requirements are met
    • Physical, occupational and speech therapies for mental conditions, including autism, are now covered under the mental health care benefit (not under the rehabilitation, neurodevelopmental, or habilitative care benefits), and automatic visit limits no longer apply.

    Your group’s contract will be updated when issued in 2015, and Premera will issue a contract endorsement upon renewal in 2014.

    If you have any questions, please contact your sales team.