New Product Portfolio
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The following features will be included in all benefit designs for groups with an effective date on or after September 23, 2010.
- No annual or lifetime dollar limits on essential health benefits
* We have removed the annual limit on durable medical
equipment
* We have removed the lifetime maximum on out-of-
network transplant benefits
- Dependent coverage up to age 26 - Dependents who were previously terminated due to age may re-enroll during the next open enrollment period.
- No pre-existing condition exclusions for members up to age 19
- 100% coverage for in-network preventive care - Coventry Health Care encourages all members to take advantage of this opportunity to update the Health Risk Assessment with current biometric information.
- Emergency benefits that are the same in- and out-of-network - All benefit plans were already in compliance with this feature.
- Direct Access to OB/GYN services - All benefit plans were already in compliance with this feature.
- Selection of a pediatrician as a Primary Care Physician - All benefit plans were already in compliance with this feature.
- BenefitExpress Product Portfolio effective October 1, 2010 - Note that the benefit summaries in benefitexpress will not reflect updated benefits until December, 2010.
- Schedules of Benefits that reflect health reform-compliant benefit designs
During the re-design of the benefitexpress Product Portfolio, several plan designs were retired. They will be removed from benefitexpress in December. In the meantime, please do not sell the following designs to your clients in benefitexpress.
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Value HMO $15/$30/20% - consider Value POS $15/$30/20% as an alternative
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CDHP Rx 1500 (both in- and out-of-area plans are retired)
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CDHP Rx 3000 (both in- and out-of-area plans are retired)
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QHDHP 0%/3000 non-embedded and QHDHP 20%/3000 non-embedded - consider the QHDHP 0%/3000 with the embedded deductible as an alternative (both in- and out-of-area plans are retired)
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QHDHP 20%/1500 - consider the QHDHP 0%/1500 as an alternative (both in- and out-of-area plans are retired)
As always, groups with over 50 enrollees may select from an expanded portfolio of products, including the plans that have been retired in benefitexpress. Please contact your Account Manager to discuss additional reform-compliant benefit options.
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"Classing Out" Employees
| | Though employers retain ultimate responsibility for decisions related to eligibility, after September 23, 2010, most employers will not be able to class out employees who generally have larger salaries - provide shorter waiting periods, set up more lenient criteria for eligibility based on hours worked, contribute more for premiums, or provide richer benefits. Upon the first renewal on or after September 23, 2010, Coventry Health Care will no longer maintain separate subgroups with different eligibility rules (salaried and hourly, management and non-management) for non-Grandfathered employers. |
Expanded Pharmacy Vaccine Program
| | Coventry Health Care is committed to the prevention of illness through appropriate vaccination. For several years, we have offered members the opportunity to receive flu shots at participating pharmacies for a Tier One copayment. This year, we have expanded the program to include a longer list of vaccines, including the flu vaccine, shingles vaccine, and others. Moreover, we are pleased to be able to announce that the vaccines on this list are available to all members for no copayment when they receive them at participating pharmacies, regardless of the pharmacy rider purchased by their employers. |
Personal Health Account Changes - OTC
| | Effective January 1, 2011, the Patient Protection and Affordable Care Act changes the list of items eligible to be paid for using funds from personal health accounts like Flexible Spending Accounts, Health Savings Accounts, and Health Reimbursement Arrangements. Certain over-the-counter items (i.e., cough syrup and pain relievers) will no longer be eligible for reimbursement. Those clients who currently have Flexible Spending Accounts administered by Coventry Consumer Choice will be receiving notification of these changes in the coming weeks. Click here to see the flyer outlining the changes. |
| Broker Tool Kit | We encourage you to familiarize yourself with the Broker Tool Kit section of our website. In it, you will find among other things:
- Schedules of Benefits for products in the standard benefitexpress Product Portfolio
- The list of retiring benefitexpress plans effective October 1, 2010
- The most up-to-date version of the Group Application - make sure you are using the most recent version so we have the correct eligibility rules on file for your clients.
- The Request for Medically Underwritten Proposal form - don't forget to submit this with your small group quote requests or your rates may be delayed.
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Never Miss an Issue!
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Remember seeing something in a past newsletter, but didn't keep the email? Not a problem anymore!
Past issues of the Broker News Flash beginning with January 2008 are now archived for easy access. Click on the link below and be directed to our past issues.
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Safe Senders
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If you are not receiving emails notifying you that a new commission statement is available, please check to make sure that the following address is in your "safe senders" list. You may also use this address to send questions about your commissions.
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| Coventry Health Care and Southern Health are registered trade names of Southern Health Services, Inc., a Virginia HMO. PPO products are underwritten by Coventry Health and Life Insurance Company and administered by Southern Health Services, Inc. in Virginia. | |
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Charlottesville Office:
434.951.2500
Richmond Office:
804.747.3700
Roanoke Office:
540.265.6720
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