Attached you will find two important documents.  The first is Advisory Bulletin 10-SEH-04.  This bulletin provides detailed insight into the new SHE guidelines.  The second document provides the carrier specific guidelines for all carriers who offer SEH coverage in New Jersey.  I would strongly suggest reviewing this document carefully as there are variations among the carriers’ underwriting guidelines.

Please let us know if you have any questions about this important topic.

Additional payment options

Our Small Group customers can now pay their monthly bills by:

·         Calling our automated phone number: 1.866.350.7644. Customers will need to provide their bank account and Aetna account information.

·         Visiting www.AetnaMemberResources.com. Customers should click on “billing” and then look for the section labeled “Small Group Employers” where employers can provide their Aetna account and bank account information.

·         An employer print stuffer will be included with the June/July billing statements (attached for your reference, feel free to share with your clients)

·         We’ll be adding the web address and pay by phone number to the Small Group billing statements starting in June.

·         The 25/50/500 Small Group plan option is primarily designated as a new business option.  As a result, AmeriHealth only makes quoting available for this product on the HealthConnect system.  AmeriHealth has reminded KTB that they have designated HealthConnect as a new business quoting tool and that they will only accept renewal change requests with rates that have been run on ROAM.  Due to the fact that the 25/50/500 plan is not available to be quoted on ROAM (and a renewal change cannot be requested with a HealthConnect quote), any renewal submission with this option must be submitted to KTB at least 8 business days in advance of the renewal submission deadline to allow for Underwriting to develop the quote for this product.  AmeriHealth has informed KTB that if the submission is not received at least 8 days prior to the deadline, they will not guarantee the requested change date.

·         Renewals and options for SEH groups that are subject to Federal Mental Health Parity must have renewal options run by Underwriting.  As a result, you will need to request options with sufficient lead time to allow for the release of the options/presentation to the group/submission of the paperwork by the submission deadline.  Please allow for at least a one week turnaround for all requested options.

·         Renewals for SEH groups with ARRA participation are not being distributed via ROAM.  These renewals are being manually developed and distributed by AmeriHealth to KTB.  All renewal options must also be developed by Underwriting so please allow for at least a one week turnaround for all requested options.

Please let us know if you have any questions regarding these issues or if we can be of any assistance.

The change will be implemented as a way of standardizing Stop-Loss reporting within Highmark, Inc.   Attached with this email is the standardized format that will be used.  If your vendor needs any additional information, such as prognosis information or any additional claim information, a fee for any additional reports will be charged.

The standard monthly report will be provided at no cost to the vendor or group; however, a fee will be charged for any more complex ad hoc reports that are requested.

Before making these changes, we did consult with other markets to understand what is "standard procedure" and "best practice" when sharing information between the health care carrier and stop-loss carriers.  We feel our standard report will be compliant with what the industry would consider to be "standard."

If you have any questions, please feel free to contact your group's Highmark Blue Shield client manager for details.

The U.S. government today declared the swine flu outbreak a public health emergency. We have developed the following information for you to share with your employees/members. Attached you will find an 8x11-inch flier or 11x17-inch tabloid poster with information about Swine Flu to help keep your workforce and their families healthy.

(See attached file: Swine Flu Flier-HBS.pdf)(See attached file: Swine Flu

Poster-HBS.pdf)

(See attached file: Swine Flu Flier-UB.pdf)(See attached file: Swine Flu

Poster-UB.pdf)

For more information on Swine Influenza A/H1N1, contact the Pennsylvania Department of Health at 1-877-PA-HEALTH or visit www.health.state.pa.us.

More Swine Flu information is available at:

   www.dsf.health.state.pa.us/health/site/default.asp

   www.cdc.gov/swineflu/key_facts.htm

You can download PSA’s, podcasts, videos and other promotional materials

at:

   http://www.cdc.gov/flu/professionals/flugallery/index.htm#nivwflupsa

Independence Blue Cross (IBC) is committed to finding real solutions to complex health care issues facing our customers today so that we can continue to build the good health of our members; provide convenient access to affordable, quality care; and strengthen the health of our community. Our latest initiative addresses the challenges associated with self-injectable medications.