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! |
 Regulations
Released on Grandfathered Health Plans
The U.S. Departments of Health
and Human Services, Labor and Treasury have issued new regulations, a fact sheet and FAQs outlining how a health plan may
retain its grandfathered status under the Patient Protection and Affordable
Care Act (PPACA).
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Aetna NY/NJ: Preauthorization Required for Out-of-Network
Ambulatory Surgical Facilities
Members often
think that if they choose a doctor in our network, any care that doctor
provides is covered at our in-network rate. However, sometimes these doctors
perform outpatient procedures at facilities that are not in our network. This
can mean members owe more money because of facility charges.
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Capital BlueCross: Dependents to Age 26 Provision Updates
The purpose
of this Bulletin is to provide producers additional information on specific
topics related to the Health Care Reform-Dependents to Age 26 Provision.
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Horizon BCBSNJ: Walgreens
No Longer Participating in CVS Caremark Pharmacy Networks
Walgreens
recently announced its decision not to participate on a go-forward basis in CVS
Caremark's PBM pharmacy networks for new and renewing clients. Today, CVS Caremark
announced that Walgreens will be removed from its commercial pharmacy network
in 30 days, effective July 9, 2010, and from its Medicare Part D pharmacy
network, effective January 1, 2011. This
announcement was unexpected, and Horizon Blue Cross Blue Shield of New Jersey
is working closely with CVS Caremark to ensure a smooth transition for our
members.
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UnitedHealthcare: Client Notification for Federal Mental Health
Parity Addiction and Equity Act
The Federal
Mental Health Parity Addiction and Equity Act (Act) becomes effective
with plan renewals on and after July 1, 2010.
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UnitedHealthcare/Oxford: Update on NY COBRA &
State Continuation Coverage Extension
A gap has been identified in the Oxford notifications that were sent regarding
the law that amended New York COBRA/State Continuation coverage. Certain
members with COBRA/State Continuation coverage scheduled to expire were not
notified that they may be entitled to an extension. Options for reinstatement
or re-enrollment are now available. Click on more for details.
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UnitedHealthcare: Settlement Information
On November 17, 2009, the Court entered a
Memorandum and Order preliminarily approving a $350,000,000 class action
settlement with UnitedHealth Group, resolving a nearly decades-long challenge
to its practices involving reimbursement for health care services by
out-of-network providers. On January 4, 2010, the Court entered an Order
setting down certain dates important to potential class members. Those dates
were changed by Order dated February 25, 2010.
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