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Regence BlueShield Specialty and Mail Order Vendor Changes


Question of the Week

How are Seasonal Workers Treated When Determining Employer Size Under the Employer Shared Responsibility Rules?
 

 

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INSURANCE SPOTLIGHT

February 17, 2016

Carrier News

Regence BlueShield - Specialty and Mail Order Vendor Changes
Pill Rx As pharmacy costs continue to rise, Regence is working hard to make sure their members receive access to high-quality, cost-effective care based on nationally recognized standards and evidence-based guidelines. As a result there will be two major Rx  vendor changes that will impact most members. 

Specialty Medications
On March 1, BriovaRx becomes Regence's preferred specialty pharmacy.  Many members have already received letters preparing them for this change and BriovaRx care coordinators have begun phone calls to assist in the transition. Sample letter

Mail Order
On April 1, OptumRx becomes Regence's preferred mail order pharmacy.  Letters to members affected by the mail order change will be sent the week of Feb. 15.  Walgreens will no longer be an option for mail order medications. Sample letter and new mail order form.

Delta Dental Has Launched Their Interactive Voice Response (IVR) System 
The new IVR gives members and dentists 24/7 access to important benefit information. By saying or keying their member ID number, members can learn about their:
  • Plan
  • Deductibles
  • Remaining maximums
  • Coverage levels for general benefits
  • Claim status
  • Predetermination status
If their questions can't be answered by Delta Dental's IVR system, they may talk to a customer service specialist or sign in to MySmileŽ at DeltaDentalWA.com. A Delta Dental customer service specialists is available Monday-Friday during regular business hours. MySmile is available 24/7.  Click here to download a flyer to share with your employees.
  
Seattle Cancer Care Alliance Joins Premera's Value-Based Networks
Premera and Seattle Cancer Care Alliance (SCCA) negotiations have finalized and SCCA has joined the Heritage Signature network (used for small group and individual medical plans) as well as the Heritage Prime network (used for some 51+ employee groups) effective January 1, 2016. SCCA is one of the top five cancer care facilities in the United States, and the last key holdout in the King County area for Premera's value networks. Read more

Federal & State News

IRS Extends Due Dates For ACA Information Reporting
Employers subject to the Affordable Care Act's 2015 information reporting requirements now have extra time to give forms to employees and to file them with the government. On December 28th, the Internal Revenue Service (IRS) made an announcement regarding compliance to new Affordable Care Act (ACA) mandated coverage reports (6055 and 6056) for 2015. The IRS announced that it is giving employers additional time to file certain reports. In Notice 2016-4, the IRS stated that it is delaying filing deadlines after determining that "additional time to adapt and implement systems to gather, analyze, and report this information" was needed by employers, insurers, and other providers.
The deadline for providing employees with 1095 forms for 2015 was extended from February 1, 2016, to March 31, 2016. Additionally, the deadline for employers to electronically file 1094 forms to the IRS for 2015 was also extended by 3 months.  The new deadlines are listed below:
 
Previous IRS Due Date
New IRS Due Date
Forms 1095-B and 1095-C were due to employees by Feb. 1, 2016
March 31, 2016
Forms 1094-B, 1095-B, 1094-C and 1095-C were required to be filed with the IRS if filing on paper by Feb. 29, 2016
May 31, 2016
Forms 1094-B, 1095-B, 1094-C and 1095-C were required to be filed with the IRS if filing electronically by March 31, 2016
June 30, 2016
1095 Forms and Personal Tax Filing
For 2015 only, individuals who file their federal income tax returns before receiving their 1095-B and 1095-C forms will not be required to amend their income tax returns once they receive their forms. They should keep their forms, once received, with their tax records.
Health & Wellness

Zika Virus

Prevention The Zika virus is part of the same family as yellow fever, West Nile, chikungunya and dengue. But there is no vaccine to prevent Zika or medicine to treat the infection.  Even though symptoms are most often mild, Zika is commanding attention because of an alarming connection between the virus and microcephaly, a neurological disorder that results in babies being born with abnormally small heads. It causes severe developmental issues and, in some cases, can result in death. United HealthCare Global has put together a summary of facts about the virus and how it could affect you.

If you have any questions about the articles contained in this newsletter, please give us a call or e-mail us: