We are not publishing News from the Blues on Wednesday, Dec. 23,
and
will be closed for Christmas on Dec. 25.
We wish you a happy and healthy holiday season.
News from the Blues
COVID-19 Update
News from the Blues
*Update on COVID-19 Vaccines and Coverage
Two companies – Pfizer and Moderna – have reported positive preliminary results from large trial testing of COVID-19 vaccines. Pfizer received Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA) to begin vaccinating the public. Moderna has applied to the FDA for EUA to begin vaccinating the public.
Hot Topics from Blue Cross and Blue Shield of Texas (BCBSTX) are here to support you during the enrollment season.
News from the Blues
Options for Paying First’s Month Premium
Avoid call center wait times. The first premium payment is required to effectuate coverage for individual retail qualified health plans. There are many ways that applicants and members can pay. To avoid call center wait times, here are the best options for your clients.
Pay online: Go to our Pay My Bill page and select “I Enrolled in a New BCBSTX Health Plan.” Applicants can pay with the last four digits of their Social Security number, birthdate and ZIP code.
Pay by phone: Use our automated interactive voice response (IVR) system to pay by phone. Bypass hold times that occur when waiting to speak with a Customer Advocate. Call 888-697-0683 and press “1” at the first payment prompt.
Payment deadlines:Get the details on payment rules and deadlines.
News from the Blues
2021 SEP Training Available; Mandatory for Commissions
Requirement for compensation: Producers selling our individual qualified health plans due to qualifying life events must complete our annual special enrollment period (SEP) training and affirm training completion to qualify for off-exchange SEP compensation.
Training “grace period:” You have a grace period to complete and affirm SEP training through Feb. 15, 2021. After reviewing the training, be sure to affirm you completed it. See the last section of the training for affirmation details. Save the training as a guide when working with clients to ensure a smooth enrollment experience.
News from the Blues
All Markets
News from the Blues
*Update on the 2021 Pharmacy Network Changes
What’s changed: As previously communicated, it was shared that Sam’s Club would be excluded from all pharmacy networks effective Jan. 1, 2021. This is no longer the case.
Sam’s Club will remain an in-network pharmacy option for members with prescription drug benefits administered by Prime Therapeutics®.
For our Preferred pharmacy network(s), Sam’s Club will also continue to be considered a “preferred,”or lower payment tier, pharmacy.
Why the change: In December 2019, our pharmacy benefit manager (PBM) Prime Therapeutics (Prime) entered into a three-year collaboration with Express Scripts® (ESI), a PBM owned by Cigna®. Effective April 1, 2020, this collaboration uses ESI’s pharmacy networks to negotiate lower costs and provide the best pricing possible.
Sam’s Club had not yet agreed to participate in ESI’s 2021 networks when letters were sent to impacted members in late October 2020. Sam’s Club has now agreed to participate in the networks effective Jan. 1, 2021.
Why it matters: Members who received the notification letters can choose to remain a Sam’s Club customer in 2021. If members have questions about a pharmacy’s network status, they can ask their pharmacist or call the number on their ID card. If you have any questions, contact your BCBSTX representative.
News from the Blues
CommonSpirit Health Negotiation Ends Today
We’ve told you about our negotiation with CommonSpirit Health. Today is the deadline for CommonSpirit to rescind its termination. If it does not, CommonSpirit facilities will be out-of-network for all networks but MyBlue HealthSM starting tomorrow, Dec. 17, 2020.
The final outcome: We will update our microsite at bcbstx.com/CHI when we know CommonSpirit’s decision.
News from the Blues
Group
News from the Blues
*Fitness Program Members Now Have Access to New Digital Fitness Benefit
What you should know: Well onTarget® Fitness Program membership includes BurnAlong. Fitness program members can access thousands of digital fitness videos, live classes and fitness programs at no extra cost with BurnAlong. Digital classes include cardio, bootcamps, barre, yoga and more.
Live solo or group classes: Live classes – led by wellness professionals – are available indozens of categories. Members can get inspired by others in the community and take live classes with friends, regardless of where they are in the world.
Free fitness programs and class recommendations are based on behavior and preferences. Members can also connect to other members and instructors online for added motivation and exchange healthy recipes, tips or words of encouragement to achieve goals.
It’s easy to join:
Your clients can let their employees know to sign in to their Well OnTarget Fitness Program account and click "Explore Burnalong" to create their complimentary BurnAlong account.
They’ll get access directly through the website or mobile app. Their account will remain active as long as their Well onTarget Fitness program membership is active.
Why it matters: The BurnAlong digital benefit allows members to stay active from the comfort and safety of their own homes. It is just another option to help keep employees healthy and fit.
News from the Blues
Reminder: Blue EssentialsSM Is Transitioning to PCP Capitation in 2022
Effective Jan. 2, 2021, we will stop offering Health Savings Account (HSA) plans on our Blue Essentials network.
What else is changing?
While our Blue Essentials network will still be available to Large Groups, the capitated model will go live Jan. 1, 2022, and select office visit services will shift to copay only.
This will allow these services to shift from a fee-for-service to a fee-for-value model.
In order to allow for this change, we will move all membership from fee-for-service plan designs, effective Jan. 1, 2022.
2021 Certification resources to sell ACA Marketplace individual and family health plans
2021 Certification resources to sell Medicare plans
Help for employees losing coverage: If you have group clients with employees losing their employer-sponsored health coverage, we have resources to help them. The Individual Coverage Toolkit on Blue Access for EmployersSM can help your clients communicate the individual coverage options to those employees. And you can help transition them to individual coverage.
An email template that employers can use to communicate the resources available to their employees
NEW: 2021 brochures to help employees evaluate their coverage options
News from the Blues
Medicare
News from the Blues
Medicare Supplement Sizzle Sheet Is Now Available for 2021 Sales
The updated Sizzle Sheet for the BCBSTX 2021 Medicare Supplement sales cycle is now available.
What you need to know: The sheet includes new CMS values for 2021 (e.g., deductible). You also can access it on the Producer Supply Portal.
News from the Blues
Preview BlueVISION Monthly Employer Newsletter
News from the Blues
You can read the featured article below in the December employer newsletter for national accounts that is being sent Friday morning. The newsletter also includes other news recently shared small, mid-market and large groups.
News from the Blues
Resources Can Help Employees Manage Holiday Stress
While holidays can be a time for joy and celebration, they can also create stress and be a time to ponder one’s worries.
Many of us push ourselves and others during the holidays with the overwhelming pressure to cook the perfect dinner or buy the perfect gift. And this year, there’s the added strain and disruption from the ongoing pandemic. To help minimize stress, we can rein in our expectations and set a budget so as not to get overextended. We might also need a reminder to ask for help from loved ones and be sure to take the time to treat ourselves.
Your employees can take simple steps to better handle the range of holiday blues that can affect their health and productivity. Here are a few places to begin.
Employees can go to our Connect community to find articles about how to handle holiday stress. They can use the search function to hone in on other areas of concern. Pass along these articles:
24/7 Nurseline*: When health concerns arise – whether at noon or midnight – registered nurses are available to most members to answer general health questions and guide members to the appropriate level of care. When they call the Nurseline (using the number on the back of their Blue Cross and Blue Shield of Texas ID card), they can also access an audio library with more than 1,000 health topics.
Employees needing more help and support should talk to their health care providers. They can also call the number on their ID card to learn more about the behavioral health resources and benefits that your health plans offer.
*The 24/7 Bilingual Nurseline may not be available with all plans.
*This article, or a similar version, is being shared with employer groups in the biweekly BlueVISION newsletter.
Prime Therapeutics LLC (Prime) is a separate pharmacy benefit management company contracted by BCBSTX to provide pharmacy benefit management and other related services. BCBSTX, as well as several Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.
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