| Small Group Pre-Enrollment Materials | |
We appreciate the feedback on the policy of providing documents electronically for our mutual clients. Coventry Health Care is pleased to announce that we will begin providing a Small Group Enrollment Guide and accompanying pre-enrollment documents in print for your clients with effective dates on and after July 1, 2011. Contact your Account Executive or Account Manager to request printed enrollment materials.
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| Reminder: Telephonic Enrollment | |
Through our partnership with healthEdata, Coventry Health Care is able to offer prospective clients with 15 or more enrolled subscribers the opportunity to participate in telephone interviews take the place of paper statements of health. Please contact your Account Executive to take advantage of this offer.
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| Managing the Enrollment Process | |
As a reminder, the most efficient way for your clients to process their enrollments and terminations is to use Online Account Management (OAM). Our secure, self-service employer portal gives benefit administrators 24/7 access to manage their accounts with Coventry Health Care. On the Enrollment tab of OAM, your clients can view their roster, add and terminate employees and their dependents at any time that is convenient for them. There is no need to submit a paper application to Coventry Health Care for any changes made through OAM; however, we recommend that your clients retain the enrollment form for their records.
If, for any reason, your clients prefer not to use OAM for enrollments and terminations, they may fax the Enrollment/Change Form to 877-554-9145 and we will process them. Incomplete Enrollment/Change Forms will be returned via mail with a letter identifying the missing information. If you would like additional training on OAM, or if your clients would like to learn more, please contact your Account Manager to discuss a personal training session.
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Allegra Over-the-Counter
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As many of you may know, the popular allergy medication Allegra is now available over-the-counter (OTC). We have sent letters to notify members who have filled prescriptions for Allegra of the availability of Allegra OTC for a Tier One copayment and advised them that they will continue to have coverage as long as they have a prescription for Allegra OTC. Although prescription Allegra is no longer in production by the manufacturer, many pharmacies still have a supply of Allegra.
Please be aware that Coventry Health Care will only cover Allegra OTC and members will need to have a prescription for Allegra OTC to ensure coverage at the pharmacy. Coventry Health Care will continue to evaluate changes in the market that bring safe, effective drugs to consumers without a prescription and will modify our list of covered OTC medications as opportunities arise. For a list of OTC medications covered in our pharmacy riders, click here.
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| Broker Customer Service Unit | | Since it was first established, the Broker Customer Service Unit has dedicated itself to becoming a valuable resource for our partners. If you have questions about claims, enrollment, member ID cards, billing, prescription coverage, or a general customer service question, do not hesitate to call the Broker Customer Service Unit. You can reach them Monday through Friday, 8:30 - 5:00 ET, at 866-855-1128. Please continue to contact your Account Manager for information about renewals, alternate benefits and escalated service issues. We are always interested in your feedback; feel free to share your thoughts with your Coventry Health Care representative. |
Mandatory Generic and QHDHPs
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Question: What happens when a member on a Qualified High Deductible Health Plan (QHDHP) requests a brand name medication when the generic equivalent is available?
Answer: The allowable amount of the generic equivalent will apply to the QHDHP deductible. However, the remaining member share (the Ancillary Charge) is an administrative fee and therefore does not apply to the QHDHP deductible or the maximum out-of-pocket in accordance with IRS regulations.
We encourage all members to discuss utilization of generic medication with their physician in an effort to reduce the overall cost of health care. |
Pre-Existing Conditions
| The following Guidelines apply to the Pre-Existing Conditions Exclusion:
2-14 Enrolled Subscribers
At initial group enrollment and for newly eligible employees, after the original effective date, the Pre-Existing Conditions Exclusion will apply if prior creditable coverage cannot be confirmed and documented.
Documents required to waive the Pre-Existing Conditions Exclusion at initial enrollment or for newly eligible enrollees:
- A copy of the most recent carrier invoice. Enrollees listed on the prior carrier invoice will have the exclusionary period waived.
- Enrolling employees or dependents not listed on the most recent carrier invoice or newly eligible enrollees during the contract year, will need to provide a certificate of creditable coverage or documentation from the previous carrier which states the dates of the individual's coverage with the prior carrier.
15 - 99 Enrolled Subscribers
Groups enrolling with 15-99 enrolled employees will have the Pre-Existing Conditions Exclusion waived at the initial Group enrollment. Newly eligible employees after the original effective date will need to provide a Certificate of Creditable Coverage for prior coverage to reduce or eliminate the Pre-Existing Conditions Exclusion period.
Documents required to waive the Pre-Existing Conditions Exclusion for newly eligible enrollees:
- Newly eligible enrollees during the contract year will need to provide a certificate of creditable coverage or documentation from the previous carrier that states the dates of the individual's coverage with the prior carrier.
100+ Enrolled Subscribers
Groups with 100 or more enrolled will have the option of having a Pre-Existing Conditions Exclusion.
In compliance with federal law, the Pre-Existing Conditions Exclusion does not apply to pregnancy or individuals under age 19. The exclusion also does not apply for members who have had breast cancer and are receiving routine follow-up visits if they have been breast cancer-free for 5 years. Please call your Coventry Health Care representative with any questions you may have.
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| Important Notice from CMS | The Centers for Medicare and Medicaid Services (CMS) has asked us to pass along the following information. In accordance with the request, we will be posting this in the Announcements section of www.southernhealth.com for our clients, but wanted to share it with you first. CMS believes that there may be some confusion regarding the applicability of the Part D- Income Related Monthly Adjustment Amount (IRMAA) to members enrolled in employer group health plans that offer drug coverage. Some employer groups are under the mistaken impression that members enrolled in employer group health plans do not have to pay the Part D - IRMAA and may be discouraging members from paying any assessed amounts.
The Part D - IRMAA is an amount added to the monthly Part D premium for members whose modified adjusted gross income exceeds certain threshold amounts. An employer group may make arrangements to cover its members' Part D-IRMAA, but CMS is not able to facilitate such arrangements. In all cases, affected members will either have the income-related adjustment deducted from their Social Security (or Railroad Retirement) check or be billed directly by CMS. Thus, even if an employer group chooses to cover the Part D - IRMAA, for example, by reimbursing members for any amounts paid, the member continues to be legally responsible for ensuring that premiums are paid each month.
Read Social Security Publication 10536, "Medicare Premiums: Rules for Higher-Income Beneficiaries." |
Dental Network Expansion
| Click here to read about Coventry Dental's new, expanded network in Virginia. Current Coventry Dental members will receive new co-branded ID cards in mid-July.
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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.
Broker Newsletter Archive |
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
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