Effective January 1, 2016, we have revised our Prior Authorization List requirements for commercial products (Direct Network HMO (including CommunityCare), EPO, HSP, POS, PPO, and Flex Net). Significant changes to the list are indicated below. A complete copy of the new January 1, 2016, PAL requirements is attached for your reference.
Foster Youth, Pregnancy, Medi-Cal updates to Covered California online enrollment
Covered California has updated their online application for 2016 open enrollment to automatically determine the eligibility of former foster youth and pregnancy coverage for Medi-Cal programs. In previous online versions the applicant was directed to the respective program for more information and final eligibility determination. In many situations the new Covered California enrollment website will help place the individual directly into the program they are eligible for.
Online mental health counseling coming to Anthem Blue Cross plans
Starting January 1, 2016, Anthem members will be able to use LiveHealth Online to have private video visits with a psychologist or therapist for behavioral health counseling. LiveHealth Online makes it easy and convenient for members to get the care they need from the comfort of their own home with:
2016 changes to Covered California small group plans
Small employer group plans acquired through Covered California Small Business program will see benefit and coverage changes consistent with changes implemented for individual and family plans in 2016. Covered California has released a spread sheet comparing the 2015 benefit level to the new 2016 benefits by coverage type. The most significant changes will occur on Bronze level plans where coinsurance is rising from 30% to 100% after the deductible for many covered benefits. In addition, Kaiser and Health Net will be discontinuing their Silver 70 H.S.A. plans.
Maps of subsidy eligible neighborhoods created by Covered California
These maps identify targeted areas of remaining uninsured or privately insured consumers, representing Covered California subsidy-eligible target populations. In addition, the maps identify locations of Covered California Agents and Community Partner Storefronts, Navigator Grant Program Entities, Certified Application Entities, Certified Insurance Agents, and Community Outreach Network Partners.
Evidence of Billing delayed for Blue Shield Medicare plans
We are writing to advise you that some Blue Shield Medicare Advantage HMO members have not received their Explanation of Benefits (EOB) for medical or hospital services (Part C) for June, July, August, or September of this year, which includes their total out-of-pocket expenses to date.
Cal INDEX enrollment for Blue Shield Medicare plans
We will be notifying all Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Choice Plan (HMO) and Blue Shield Medicare Prescription Drug Plan members by mail of their automatic enrollment in Cal INDEX. The notification letter explains the purpose and value of Cal INDEX, its privacy practices, and the opt-out process.
$2.4 billion ACA medical loss ratio consumer rebates
The Centers for Medicare & Medicaid Services (CMS) released a new report today showing that consumers have received more than $2.4 billion premium rebates since 2011 because the Affordable Care Act requires that health insurance companies spend at least 80 percent of premium dollars on health care. For 2014 alone, over 5.5 million consumers received nearly $470 million in rebates, for an average of $129 per family.
Obamacare Premium Assistance Repayment Limitation
If the advance credit payments are more than the amount of the premium tax credit you are allowed, you will add all or a portion of the excess advance credit payments made on your behalf to your tax liability by entering it in the ‘Tax and Credits’ section of your tax return. This will result in either a smaller refund or a larger balance due.
Blue Shield to offer employer deductions for individual and family plan enrollment
List Billing: A New Option
If your client can’t afford coverage or wants to cancel their Small Business health plan in 2016, you can offer another option for their employees to have access to quality Blue Shield coverage. Called List Billing, it begins with you helping their employees choose on-exchange or off-exchange Individual and Family Plans (IFP).
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