Applied Behavior Analysis Notice
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In our November 3 broker newsletter, we addressed the expanded coverage for Autism Spectrum Disorder that will go into effect as of January 1, 2012 as the result of a new Virginia mandate. As you may be aware, the mandate requires coverage for applied behavior analysis (ABA) provided or supervised by a board certified behavior analyst who is licensed by the Virginia Board of Medicine. At this time, the Attorney General has issued an opinion that the Board of Medicine does not have the authority to create licensure criteria for behavior analysts. Until the General Assembly grants the authority to the Board of Medicine and the Board of Medicine institutes a licensure process for behavior analysts, we are unable to develop a network of ABA providers who are able, under the terms of the mandate, to provide ABA services. Until network development is made possible, these ABA benefits will not be available under our plans.
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Change in Claims Processing for Medicare Eligible Members
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In the past, our policy has been to process claims as if a member has elected Medicare Part B regardless of whether a member has actually enrolled in Part B. Effective with January 1, 2012 dates of service, we will discontinue this policy for all clients and members - even those in the middle of their contract year. We will continue to coordinate benefits with Medicare when a member is actually enrolled in Part B.
Should you have questions regarding this policy change, please contact your Coventry account representative.
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Gap Plans and Personal Health Accounts
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When determining pricing for any plan design, underwriters evaluate specific features of the plan, including deductibles, and assign a utilization credit based on the assumed impact of the deductible on utilization patterns. In recent years, employers have had access to a variety of mechanisms by which they can take advantage of the premium savings inherent in a higher deductible while exposing employees to minimal levels of the additional cost-sharing.
Please remember the following when considering a Coventry Consumer Choice product and HRA:
- Members must maintain a minimum responsibility of 50% of the deductible.
- Coventry Consumer Choice has modified product selection worksheets to eliminate any Health Reimbursement Arrangement (HRA) options that do not conform to this structure.
- If Coventry Consumer Choice will not be the administrator of your client's HRA, it is necessary that you alert us to the existence of an HRA and inform us about its design.
Aside from using an HRA or Health Savings Account to offset deductibles, some clients explore the use of "Gap" plans that reimburse employees for expenses subject to deductibles, coinsurance, and copayments under employees' comprehensive medical plan. Coventry Health Care Underwriting policy prohibits the pairing of any of our benefit plans with "Gap" policies. If you have questions about this policy, please contact Chris Fanning, Scot Chancy, or Freddie Oliver directly.
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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 address below 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. |
