Employer Obligations Under Medicare Part D
| Each year during an annual enrollment period ("AEP"), Medicare beneficiaries are allowed to enroll or change their enrollment in a Medicare outpatient prescription drug benefit program ("Medicare Part D"). The law that authorized this Medicare benefit - the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ("MMA") - also imposes an obligation on employer groups that provide prescription drug coverage to Medicare beneficiaries to disclose whether the employer group coverage is "creditable prescription drug coverage."
While the obligation to actuarially test the plan and send the notices is solely the employer group's responsibility, as a courtesy to our customers, we have provided the results of our actuarial testing. We have performed testing on the riders/benefit plans using general utilization assumptions. The testing did not take into account group specific characteristics.
To view the results and the letter we sent to employer groups regarding this notification, please read: Employer Obligations Under Medicare Part D.
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Deadline Approaching for December Early Renewals
| The deadline for signing up existing small-group clients for a new December 2013 contract is October 15, 2013.
We are unable to offer a December 1, 2013 contract for existing Coventry clients after the deadline.
Contact your local Coventry account manager or account executive today with any questions.
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Commercial Formulary Update
| Each quarter the Coventry Pharmacy and Therapeutics (P&T) Committee meets to review drug classes in order to assess the value of new drugs that come to market and new clinical information about currently available drugs.
As a result of these meetings, Coventry may implement new utilization management requirements (i.e., prior authorization, step therapy or quantity limits). Communications to providers and members impacted are sent 60 days prior to any changes that might occur. In addition, formulary documents on the website, including the searchable formulary, will be updated to reflect any changes including those for January 1, 2014.
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| 24/7 Access to a Physician | We are happy to announce CareClix™ telemedicine is now in-network.
CareClix is an on-demand telemedicine solution offering various options for the delivery of healthcare depending on a members' needs. Coventry Health Care of Virginia, Inc. members can now consult with board certified physicians via streaming video or phone*, and even receive a prescription if necessary - anytime, anywhere!
Why CareClix telemedicine?
- Members and their family members (covered on a Coventry Health Care of Virginia, Inc. health plan) can see a doctor 24 hours a day/7 days a week
- Access to a CareClix physician can reduce visits to the ER, Urgent Care, and associated costs
- Sick but can't miss work? Schedule a doctor's appointment online or via telephone without leaving the workplace
- If a member has an HSA, services qualify for reimbursement
- Primary Care Physician (PCP) visit copay
CareClix™ is not intended to replace a member's relationship with their primary care physician (PCP). Other PCPs in our network may offer telemedicine services. Members are encouraged to have all recommended preventive care and screenings with their established PCP.
*Compatible with iPhone®, iPad®, iPod touch® and Android devices. The CareClix app is free to members and available for download at Google Play and the App Store. Android and Google Play are trademarks of Google Inc. iPhone, iPad and iPod touch are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc.
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OAM and Small Groups: Website Changes Upon Renewal for 2014
| Select features of Coventry's Online Account ManagementSM (OAM) website will function differently for a period of time due to changes* that have been made to accommodate health care reform requirements for small groups.
Upon renewal for 2014, small groups with two to 50 employees will notice the following:
- Enrollment Rosters - Instead of running one roster for all subscribers in a group, your clients will only be able to run a roster for one subscriber at a time. A "Select All" feature will be made available in the near future.
- Statements - Since each subscriber will have their own Subgroup, the "Invoice Summary" page could display up to 50 Subgroups. This also means your clients will be able to view only one subscriber at a time on the "Invoice Detail" page.
- User Management - Authorized Employer Users (who can be setup by the Employer Administrator to assist in managing the group's account) will not automatically have access to Subgroups created for new hires added to their group for 2014 with the "Add Employee" feature. The Employer Administrator will need to grant any Employer Users access to subscriber-level Subgroups by updating privilege settings under "User Management."
If you're a broker who administers your clients' group accounts using OAM, you, too, will notice the changes impacting Enrollment Rosters and Statements. If you don't have access to your clients' accounts in OAM, log in to OAM at https://oam.cvty.com and refer to the Broker use guide on the Resource Library to learn how to request access.
A website update is planned for early 2014 to update these features and enhance functionality. If you have any questions, please contact your Coventry representative.
*Large Groups are not affected. Small Groups making 2013 changes as well as those that have not yet renewed for 2014 are also not affected.  |
Safe Senders
| If you are not receiving emails notifying you that a new commission statement is available, please check to make sure that the email address coventrycommissions@cvty.com is in your "safe senders" list. Do not send an email to this address. Instead, call 800.438.4029 for any questions regarding commissions.
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PPO products are underwritten by Coventry Health and Life Insurance Company and administered by Coventry Health Care of Virginia, Inc. |
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Charlottesville Office:
434.951.2500
Richmond Office:
804.747.3700
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