Anthem Rx Reporting for Select Clients
Beginning in late December, Anthem sent a series of communications to Large and Small Group employer clients. The emails had information regarding the Prescription Drug Data Collection (RxDC) related to the Consolidated Appropriations Act (CAA) of 2020 and the Transparency in Coverage (TIC) rule. They also requested various actions be completed for the required reporting.
- On December 18th, an email was sent to Large and Small Groups whose required Employer Identification Number (EIN) was missing in Anthem's system.
- On January 1st, an email was sent to ALL groups notifying them that Anthem completed the December 27th required filing of prescription drug data on their behalf, in compliance with federal regulations.
- On January 8th, Anthem sent an email to a list of ASO clients informing them that due to recent changes in the federal regulatory guidelines, Anthem is changing the submission process for 2022 data. Due June 1, 2023, ASO groups or their delegates will be responsible for filing the D1 Premium and Life Years report.
- On January 8th, an email was sent to fully insured commercial groups, Large and Small Groups (including Small Group Anthem Balanced Funding). The email included a link to an
online form for clients to complete and return with the required information so Anthem
can complete the filings on their behalf in compliance with the federal provisions.
You can click here for a full list of the emails and what information was provided or requested in each one.
HealthKeepers Expanding Out-of-State Coverage
Effective with the plan’s renewal date in 2023 and for all new groups, Anthem HealthKeepers will use their national BlueCard PPO network (including more than 1.7 million doctors and hospitals in all 50 states) for care received outside of Virginia. By doing so, the plan:
- Expands healthcare access outside of the Virginia service area through participating BlueCard PPO providers
- Extends in-network benefits to all healthcare services covered by the plan, not just urgent or emergency care
- Adds flexibility to use participating BlueCard PPO laboratory providers outside of the Virginia service area
- No longer requires individuals to register with Guest Membership to use in-network benefits when outside of the service area
UHC Level-Funded Now Available for 2-4 Groups
Effective January 1, 2023, UHC can now offer Level-Funded plan options to groups with 2-4 eligible employees.
- Previously, the minimum eligible was 5 lives
- These new groups will require IMQ - Individual Medical Questionnaires - for each employee and must go through underwriting
Please email email@example.com to get started.
Cigna Individual Payment Deadline Extended
Cigna has extended the binder payment due date for January 1, 2023 individual and family policies to January 31, 2023.
- Applications will not be fully processed until the payment is submitted.
- A "Pending Enrollment" report can be found in your CignaforBrokers.com portal.
- Binder payments can be made by phone, mail or online.
- Phone at 877-900-1237
- Online at cignaindividual.com/payments
- Send a payment to the address on the member's bill
Update from Optima Health
Sentara Healthcare has acquired AvMed, Inc., a not-for-profit health plan in Florida. AvMed, headquartered in Miami, provides commercial group, individual, and Medicare Advantage coverage to more than 200,000 members.
Anthem & Optima Q2 Rates are Live in TFA Edge!
The information herein should not be construed as legal or tax advice in any way. This content is provided for informational purposes only. You should seek the advice of your attorney or tax consultant for additional or specific information.