Here is the latest edition of Model Consulting's Week in Review Newsletter. We
hope you find the Newsletter informative and helpful.
Your feedback is
extremely important to us. Please contact Tracy Duffield at 215.947.7167 or tduffield@modelconsultinginc.com to share your ideas, comments
and/or suggestions. We look forward to hearing from you!
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Aetna: Medicare Credibility Coverage
Status
Plans sponsors who provide prescription drug
coverage to their Medicare-eligible populations are responsible for notifying
their plan members annually about Medicare creditable coverage status.
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Aetna:
Implementation of Federal Mental Health Parity Act
The Mental Health Parity and Addiction Equity
Act of 2008, passed by Congress in October 2008, promotes equitable care for
mental health illnesses by requiring parity between medical and mental health
benefits. The law applies to group health plans, including both fully insured
and self-funded plans. However, small employers with 2-50 employees and
individual coverage are exempt.
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AmeriHealth NJ: Medicare Secondary Payer
Requirements
To comply with the Centers for Medicare &
Medicaid Services' (CMS) Medicare Secondary Payer requirements, additional
information is required from your customers to determine who should be the
primary payer for claims: AmeriHealth or Medicare. To help you understand these
new requirements, we've put together a list of frequently asked questions to use in talking with your customers.
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AmeriHealth NJ: October Newsletter
This
month's newsletter includes information on network updates, Healthy Lifestyles
Rewards, Medicare Annual Notification and Evidence of Coverage, plan upgrades,
Prevacid 24HR availability, and national access information.
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HealthAmerica: Albert Einstein Healthcare Network Contract
Terminated
Effective
November 30, 2009, Albert
Einstein Medical
Center and Moss
Rehabilitation
Hospital
will no longer be participating facilities for HealthAmerica members.
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Horizon BCBSNJ: Medicare Credibility Notification
Health
plan sponsors (employer groups) that offer prescription drug coverage to
Medicare-eligible beneficiaries and dependents are required to notify those
beneficiaries and dependents whether their coverage is "Creditable" or
"non-Creditable." Notification must be sent before the 2010 Medicare Open
Enrollment, which begins on November 15, 2009.
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