Hot Topics from Blue Cross and Blue Shield of Texas (BCBSTX) are here to support you during the enrollment season.
News from the Blues
New Special Enrollment Period from Feb. 15 through May 15
In response to the COVID-19 Public Health Emergency, on Jan. 28 the Biden-Harris Administration announced a special enrollment period (SEP) from Feb. 15 through May 15. This new enrollment window allows individuals and families to apply for Marketplace (on-exchange) coverage.
Main features:
Anyone who is eligible for a Marketplace plan can apply for this SEP, including those who have existing ACA coverage.
The effective date of coverage for this SEP will be the first day of the month following plan selection.
Our BCBSTX on-exchange plans will be available on HealthCare.gov for this SEP.
We’re evaluating options to make this SEP available off exchange and will provide additional information as it’s available.
Additional details: We know you have questions and we’re working to get them answered. Click here to see the first round of producer FAQs. We’ll have more answers and updated training soon.
Resources: For more on this new SEP, see the following documents:
Why All Pages of the Application Are Needed: Consumer Choice Disclosures
Bottom line: Page 14 of the BCBSTX off-exchange paper application has a Consumer Choice Plan disclosure form that the Texas Department of Insurance (TDI) requires.
Requirement: TDI requires carriers to retain signed disclosure statements from applicants who applied for BCBSTX Consumer Choice plans.
When you send us paper applications for Consumer Choice plans, the disclosure must be completed and included.
Note that online applications via the Retail Shopping Cart and Retail Producer Portal already collected e-signatures.
Reminder: Send the full application to applicants and members requesting a copy of the disclosure statement.
*1095 Reports: How to Request Reports for Former Employees with COBRA Benefits
Why it matters: As tax season approaches, you may have employer groups that administer their COBRA benefits through BCBSTX looking for directions to request 1095 reports.
*Pharmacy Program Quarterly Update: Changes Take Effect April 1, 2021
Pharmacy network changes: The 2021 pharmacy network was updated since previously communicated. Sam’s Club and some other pharmacies will continue to participate in the networks. Members should check their pharmacy's network status by going to MyPrime.com or calling customer service before switching a prescription.
Member notices: Per our usual process of notifying members prior to the effective date, targeted mailings were sent to members affected by:
Drug list revisions and/or exclusions
Prior authorization program
Dispensing limit changes
News from the Blues
*Another Statin Drug to Be Covered Without Cost Sharing
What’s changing: Beginning April 1, 2021, generic Atorvastatin (10 mg and 20 mg) will be added to the list of statins covered without cost sharing. This applies to members who:
Are between 40-75 years of age
Have one or more cardiovascular disease (CVD) risk factors such as hypertension, diabetes or smoking
Have a calculated 10-year risk of 10% or higher for experiencing a cardiovascular event
Note: Onlygeneric Atorvastatin 10 mg and 20 mg will be covered without cost sharing. Brand Atorvastatin (Lipitor) will continue to have member cost sharing.
When is the change happening? This change takes effect April 1, 2021, regardless of renewal date.
Which groups are impacted? The change will apply to all non-grandfathered groups, both insured and ASO.
Background: The United States Preventive Services Task Force (USPSTF) recommends statin use for the primary prevention of CVD in adults without a history of the disease.
News from the Blues
*Help Your Groups Enroll Employees and Manage Benefits
Lighten their workload with benefits administration software. Clients with 51+ employees can handle enrollment and manage ongoing benefits with Blue DirectionsSM.
Help employees make benefit decisions or update their benefits.
Help clients take care of enrollment, reporting and ongoing management.
Share the News: New Members Can Join the Fitness Program and Have Enrollment Fee Waived for February
Help us spread the word: Let your National Accounts know about the promotion. Due to timing issues, we were not able to include the Fitness Program promotion article in their monthly employer newsletter, BlueVISION.
What it is: New eligible members can take advantage of a waived enrollment opportunity through the Fitness Program. The enrollment fee of $19 is being waived for eligible new members who sign up from Feb. 1 to Feb. 28, 2021. To qualify for the waived fee, members will be asked to enter the coupon code STARTINFEB at the time of checkout. Review the promotion details.
News from the Blues
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News from the Blues
*Texas Legislative Digest #4: Read the Latest Update
What’s happened: The Texas House and Senate released their respective budgets for the 2022-2023 state biennium during a recent session. These include funding riders that could impact Medicaid procurements. The budgets outlined funding for education, Medicaid, group health insurance and more.
Download and review the training today. See Pages 52-54 for the SEP business rules. Review Pages 55-58 for detailed screen-by-screen affirmation steps.
Log in to Blue Access for ProducersSMusing your own account, not your agency's. The affirmation must be made by the writing producer.
Select “Producer Services” at the top of the page and click on the “SEP Training Affirmation” link.
Read the affirmation language and click on the green “Submit” button. Be sure to keep the “Service Request” ticket confirmation number for your records.
The deadline is nearing – take the time to get this done today.
News from the Blues
*This article, or a similar version, is being shared with employer groups in the BlueVISION newsletter or news alert.
Blue Cross and Blue Shield of Texas (BCBSTX) contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. In addition, contracting pharmacies are contracted through Prime Therapeutics. The relationship between BCBSTX and contracting pharmacies is that of independent contractors. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. MyPrime.com is an online resource offered by Prime Therapeutics.
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