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! |
Aetna: Health Coverage for Dependents
Up to Age 30 in PA
We want you to be aware of a new Pennsylvania state law that affects your clients and their
employees. They may contact you for assistance with this coverage.
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Anthem: First Wave of Participants Eligible for COBRA
and State Continuation Subsidies are Reaching the End of their Nine-Month
Subsidy Period
The American Recovery and Reinvestment Act
provided eligible COBRA and state continuation participants with nine months of
subsidized premiums. Participants who became eligible in this first wave on
March 1, 2009, received a 65 percent premium subsidy through November 30, 2009.
They will be responsible for paying 100% of the premiums beginning in December
2009. For example, if a participant's subsidized premium was $105 in November
2009, that premium will increase to $300 for December 2009. This is a
significant increase and may be unexpected for some participants who may have
lost track of the nine-month end date.
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Capital BlueCross: Hanover
Hospital Provider
Contract
Hanover Hospital's CEO publicly distributed a letter
regarding their provider contract with Capital BlueCross. Capital BlueCross issued a response. Please read the attached alert and provided attachments
for details.
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HealthAmerica: Adult Dependent Coverage, 2010 Pharmacy
Benefits & Network Updates
Health Insurance Coverage for Adult Dependents
Employers offering group policies have the option to provide health insurance
coverage to adult dependents of employees through age 29. Under certain
conditions, this allows dependents who reach the limiting age to remain covered
by their parent's health insurance up to age 30.
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Highmark
Blue Shield: 2010 Prevention Schedule
Highmark
Blue Shield has issued their 2010 Preventive Schedule. It is attached for your review.
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Horizon BCBS of NJ:
New Advantage Formulary Introduced in 2010
Beginning January 1, 2010, Horizon Blue Cross Blue Shield of New
Jersey will implement a new formulary for fully insured groups whose
prescription benefit includes prior authorization. The new Advantage Formulary
incorporates utilization management (UM) programs and prior authorization
processes that require members to try a first tier medication. Select brand
name drugs will be covered after first-tier medication has been tried.
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Independence Blue Cross: Security 65 and 65 Special Notice of Change
We are writing to alert you to
important information that will be mailed to Security 65 and 65 Special members
in the next week.
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Oxford: Specialty Pharmacy Program Implementation
On January 10, 2010 Oxford
will begin implementing the UnitedHealth Pharmaceutical Solutions Specialty
Pharmacy Program. The program takes a comprehensive approach to patient care
and cost management, through clinical programs and a network of specialty
pharmacies. The goal is to help make specialty medications accessible and
affordable for our groups and members. The program is being implemented for
Oxford groups in NY and NJ, and will become effective on the group's renewal
date.
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UnitedHealthcare/Oxford: Hospital Negotiations Continue with Continuum
Health Partners
Negotiations continue toward a new contract with the Continuum Health
Partners which include several key hospitals in NYC. If they do not come to an
agreement the hospitals will become non-participating after December 31, 2009.
Please see the attached letters of notification going to both employers and
members.
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