Broker Bulletin

Broker Blasts

6/4/2019 - Mid-Year Check-In for New 2019 QHP Members, Individual and Medicare Advantage Agent of Record Forms Submission

Retention Campaign for Individual Market and Mid-Year Check-In for New 2019 QHP Members

Blue Cross of Idaho aims to be on our members' side, and not in their way during their health journey. We are excited to announce another way we are investing in being by our members' side. Each month from June through December, we will be reaching out to QHP and/or Grand-mothered-Grandfathered members. These engagements will either be a phone call, an email or a mailing, and the purpose is to promote the value in their health plan and empower members to take an active role in their healthcare. Each month we will communicate to you what we will be sharing with your clients. The retention campaign kicks off in June, with our customer advocates conducting a mid-year check-in, by making outbound calls to new 2019 QHP members, with effective dates as of January 1, 2019. The purpose of this outreach is to supplement your efforts to ensure your clients are getting the most of their plan benefits. Here are example topics of what the conversation our customer advocates will have with new 2019 QHP members regarding their health plan journey.

  • Highlight the value of the member portal and confirm the member is registered or help them register for a member portal account; an email will be sent out later this month regarding this self-serve tool
  • Verify if the member has selected a primary care provider or help them select one
  • Showcase access to provider search, formulary search, wellness tools, cost advisor tool, etc.
  • Inform members of programs for wellness and case management for diabetes and other chronic conditions

Individual and Medicare Advantage Agent of Record Forms Submission

We have previously informed you of updated guidelines for the submission of off-exchange Individual and Medicare Advantage (MA) Agent of Record (AOR) requests. These guidelines are now effective as of June 1, 2019. As a result, there are updated AOR request forms on the broker portal. Please use the updated forms found on the broker portal home page under the Just for Brokers section.

As a reminder, here is a summary of the new guidelines: Off-exchange Individual and MA AOR requests received on or before the 10th of the month will be effective on the first of the following month. Requests received after the 10th will be effective on the first of the second month that follows. These changes will ensure timely and accurate disbursement of commissions for your off-exchange Individual and MA business.

To simplify the process of updating, moving or transferring any on-exchange business, changes must be made through Your Health Idaho (YHI). YHI it is the system of truth for all on-exchange business. YHI will share the change with Blue Cross of Idaho and the record will be updated. This ensures the account is updated accurately and timely within Blue Cross of Idaho’s systems.


Change in Quality Improvement Organization (QIO) for Medicare Health Plan Enrollees

CMS announced a new Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO). On June 8, 2019, KEPRO will be responsible for case review work for beneficiary appeals and quality-of-care reviews in Region 10. Idaho is part of Region 10.

Region Address Contact
10
(AK, ID, OR, WA)
KEPRO
5700 Lombardo Center Dr.
Suite 100
Seven Hills, OH 44131
888-305-6759
833-868-4064 (fax)

Blue Cross of Idaho is currently updating our materials that provide members with access to QIO information. We will also notify enrollees who requested hard copy (or alternate format) material about this change as well.

5/21/2019 - SilverScript Appointment and Commissions, AOR Form Submission Updates

SilverScript Commissions and Bundle Bonus

Adding our SilverScript prescription drug plan (PDP) to your Blue Cross of Idaho portfolio gives you more options to offer your clients. It also provides you an opportunity to earn an annual lump sum commission and a bundle bonus when you sell SilverScript through your Blue Cross of Idaho SilverScript login.

Enrollment Type 2019 Rate
SilverScript Initial $74 Annual
SilverScript Renewal $37 Annual
Bundle Bonus* $2 Per Member, Per Month (PMPM)

*When you enroll your clients in an Idaho MedPlus Medicare Supplement plan and bundle it with either (or both) a Healthy Smiles dental plan or a SilverScript policy, you are eligible for a $2 PMPM bundle bonus, paid quarterly.

SilverScript Appointment

To sell SilverScript PDP, brokers and their agencies must be contracted and appointed with SilverScript. If you are interested in selling SilverScript and did not receive a broker and/or an agency contract, please contact us and we will email your contract right away.

If you have returned a signed contract and are not appointed to sell through SilverScript here are your next steps:

  1. After we verify your signed and completed contract, we will provide you login access to the SilverScript portal
  2. Log in to the SilverScript portal and complete the required training, testing and certification
  3. Complete the required appointment paperwork through SilverScript 4. Once complete, the appointment process takes a couple weeks and you may begin selling

Individual and Medicare Advantage Agent of Record Forms Submission

As a reminder, we are implementing guidelines for the submission of off-exchange Individual and Medicare Advantage (MA) Agent of Record (AOR) requests. Off-exchange Individual and MA AOR requests received on or before the 10th of the month will be effective on the first of the following month. Requests received after the 10th will be effective on the first of the second month that follows. These changes will ensure timely and accurate disbursement of commissions for your off-exchange Individual and MA business.

To simplify the process of updating, moving or transferring any on-exchange business, changes must be made with Your Health Idaho (YHI) since it is the system of truth for all on-exchange business. YHI will share the changes with Blue Cross of Idaho and the record will be updated. This ensures the account is updated accurately and timely within Blue Cross of Idaho's systems.

5/9/2019 - Age Calculation Change for Age-Rated Small Groups, GeoBlue, 2019 MA Materials

Individual and Medicare Advantage (MA) Agent of Record Forms

To help us better serve you, we are implementing guidelines for the submission of Individual and MA Agent of Record (AOR) requests. Individual and MA AOR requests received on or before the 10th of the month will be effective on the first of the following month. Requests received after the 10th will be effective on the first of the second month from the month of receipt. These changes will ensure timely and accurate disbursement of commissions for your Individual and MA business.

Age Calculation Change for Age-Rated Small Groups

Blue Cross of Idaho is implementing an easier method to calculate and understand age calculations for members of age-rated small groups who are added off-renewal. Age is now calculated from the member's age at the time of effectuation rather than their age at the time of renewal. This impacts only members who were added off-renewal and had a birthday after the group's last renewal date, but before their coverage start date. All products that have age-rated premium calculations are impacted by this change (medical, dental and life). We believe this adjustment makes it easier to understand how age is calculated, and will help you and small group employers during the process of quoting premiums to new employees.

Here is an example of how this change affects impacted member premiums for an age-rated group that renews on June 1, 2019. If an employee's date of birth is July 22, 1978 and a coverage effective date of September 1, 2019, we now calculate their age as of September 1, 2019, which is 41 years of age in this example.

GeoBlue: Travel Health Insurance

When your clients travel internationally, help them feel more comfortable by knowing an elite level of medical care is available on a moment's notice, no matter what country or time zone they are in. GeoBlue provides peace of mind to world travelers and expats living abroad anywhere in the world via a strong network of providers, innovative mobile and online tools, and exceptional customer service. From a two-day leisure trip to a two-year work assignment, GeoBlue has cost effective plans for that. GeoBlue health plans are offered in cooperation with Blue Cross of Idaho. Find more information about offering GeoBlue to your clients here. This link will also let you sign up to be an appointed GeoBlue broker through Blue Cross of Idaho.

If you have questions, contact Rachelle Taylor-Feith at 986-224-3894, or rachelle.taylor-feith@bcidaho.com.

Updated 2019 MA Sales Material Now Available

Updated 2019 MA materials are now available on the broker portal. You can also order via the Order 2019 MA Material button on the 2019 Medicare Advantage Resources page of the broker portal. You can access that page by selecting the link above or going to the Broker Portal, hovering over Selling Medicare Advantage, then selecting 2019 Resources. Select the Order 2019 MA Material button near the top of the page to complete and submit an order form.

4/23/2019 - Group Census Template, MA and Individual QHP Plan Benefits in Action

Group Markets

Simplified Group Census Template

Our new consolidated Group Census Template is commonly used to quote and enroll mid-size and large groups. Do you know it can also be used to enroll small groups in lieu of the paper Idaho Universal Group Application and Cover Sheet? The template is an Excel workbook that includes three tabs with instructions on how to use the template, formatting guidelines and the census sheet. The information is then used by Blue Cross of Idaho to upload member level data and complete the enrollment process.

For groups wanting to enroll directly in the Online Enrollment Center, fill out the blue columns marked Enrollment. To enroll through a one-time electronic file feed, groups should fill out the brown columns marked Benefit Elections.

Return the completed Group Census template to salesopsimplementation@bcidaho.com or to your Blue Cross of Idaho sales representative via secure email only. To access the Group Census Template, go to brokers.bcidaho.com, hover over the Forms & Documents, then select Group Documentation. You'll find the Group Census Template near the top in the yellow shaded box under Mid-size and Large Group Quoting Documents.


Senior & Individual Market

MA & Individual QHP Plan Benefits In Action

Home Risk Assessment and Wellness Programs
We are excited to share our Home Risk Assessment and Wellness Programs for Medicare Advantage (MA) and Qualified Health Plan (QHP) members. Each initiative centers around your clients’ wellbeing and is designed to meet them where they are in their healthcare journey. These programs are services included with their plans. There is no cost to the member.

In-Home Health Assessment
Blue Cross of Idaho has partnered with Episource to help with our in-home health assessment program. Some MA members will receive a call from Episource on behalf of Blue Cross of Idaho to schedule an in-home visit with a medical professional. This is a convenient way for a member to receive a medical visit in the comfort of their own home.

This service is meant to be an additional medical visit and not a replacement for a member's annual wellness exam with their primary care provider (PCP). The information gathered during the in-home visit will be shared with the member’s PCP. Based on the results of the in-home visit, the provider may refer the member to other important healthcare services offered by Blue Cross of Idaho such as preventive services, care and disease management and chronic condition management services. This will allow members to take charge of their healthcare and access all of the services offered by Blue Cross of Idaho. The visit will also assess other risks that might exist within the home.

Your client may receive a letter or a phone call about scheduling an annual in-home visit. Please reassure them that the letter or phone call is a Blue Cross of Idaho member outreach.

Three-Way Calling Campaign
Our three-way calling initiative aims to engage MA members who have not utilized their benefits in the past 12-18 months. The three-way phone call will be with the member, a Blue Cross of Idaho representative and the member's PCP.

The objectives of the call are to educate the member on the importance of annual exams, encourage proper use of their health plan benefits and assist with scheduling a primary care and/or specialist appointment. The annual wellness exam and annual wellness visit are the health plan benefits focused on in the phone call.

The discussion may also include preventive screenings for breast cancer, diabetes, colorectal cancer, osteoporosis, rheumatoid arthritis and care for older adults as needed.

Primary Care Provider (PCP) Outreach
The PCP outreach program is available for our MA and QHP members. Blue Cross of Idaho works with members’ PCPs to urge them to proactively call their members to schedule annual wellness exams. Studies show that patient health improves with a PCP relationship. Increased annual wellness participation between members with their PCPs will lead to overall improved health. This could impact risk adjustment and help stabilize the cost of healthcare.

Benefits to Members

  • These services are part of the member’s current coverage and is covered by their health plan at no cost for them
  • Supports regular evaluation and monitoring of risk adjustment activities and metrics
  • Assists with comprehensive pre-visit planning
  • The data from the member’s visit will be shared with their PCP, giving them a better picture of the member’s overall health and healthcare needs
  • Utilizes important healthcare services offered by Blue Cross of Idaho such as:
    • Preventive Services
    • Care and Disease Management
    • Chronic Condition Management Services

Benefits to Brokers

  • Improves members’ plan satisfaction and renewal rates
  • Increases wellness benefits utilization, which boosts Medicare Star Ratings - Higher Star Ratings can lower premiums, increase benefits and allow for additional ancillary services
  • Provides an opportunity to educate members on wellness services included in their plan
  • Promotes early detection and ongoing monitoring of chronic conditions
  • Helps your clients receive timely preventive care services such as their annual wellness visit, preventive screenings and other disease management services
  • Assists networks and providers to identify and risk stratify individuals within defined populations
  • Healthier clients

4/9/2019 - AOR Forms on Broker Portal Homepage, ACH/E-Check for Groups

Just for Brokers - Broker Portal Home Page

Do you need to submit a broker of record or letter of record form? Wondering where you can locate the Medicare Advantage Agent of Record form? You can now find the necessary forms via the broker portal home page under the section titled Just for Brokers. Login is not required to access these maintenance forms.


Group Markets

ACH/E-Check Withdrawal for Monthly Premiums Form

All groups have the option to make their first month premium payment using monthly bank draft. Your groups can use the ACH/E-Check Withdrawal for Monthly Premiums Form, and elect to:

  1. Pay only the initial premium payment electronically
  2. Pay the initial premium payment, then enroll in monthly bank draft
  3. Use the form to set up monthly bank draft

Access the form at brokers.bcidaho.com and select Forms & Documents, then select Group Documentation, then expand the group type and select ACH/E-Check Withdrawal for Monthly Premiums.

3/26/19 - Updates

Combating Idaho's Biggest Healthcare Costs

Musculoskeletal services are one of the biggest healthcare costs in Idaho. To help Idahoans control costs related to musculoskeletal conditions, beginning April 1, 2019, changes will be made to the Prior Authorization List on the Blue Cross of Idaho website. Prior authorization is just one of the ways we're working to save your clients money and address rising healthcare costs. This process also helps determine the appropriateness of services and prevents overutiliza

These changes will affect all individual members, fully insured groups and balanced funded groups. Below is a summary of the changes:

Shoulder Surgery – shoulder surgeries require prior authorization (hip and knee surgeries already require prior authorization)

Pain Management Procedures – all pain management procedures require prior authorization

Arthroscopy Surgery – hip, knee, shoulder and other joint arthroscopy surgeries require prior authorization

These services are added to the other services that require prior authorization as described on the prior authorization list. Individual members and group administrators are receiving letters explaining these changes. Your clients can also call Customer Service at the number listed on the back of their member ID cards to determine if a service requires prior authorization.

Timely Tip - Errors and Omissions (E&O) Insurance

Having valid E&O coverage is a good way to safeguard your ability to retain and grow your Blue Cross of Idaho book of business. As soon as you change or renew your E&O coverage, please send us a copy for our records. Be sure that all covered brokers are listed on the E&O contract or addendum. You can send it to brokerrelations@bcidaho.com or fax it to 208-286-3594.

2/26/2019 - What's New for 2019 Medicare Supplement

Blue Cross of Idaho Care Plus, MedPlus plans can be a great option for your clients. Below is information to remind you of the new Medicare supplement Plan G as well as the updated Medicare supplement underwriting guidelines that went into effect for members on January 1, 2019.

NEW FOR 2019

  • Plan G
  • Guarantee issue changes
  • Applicants can pay their monthly premiums in one of two ways:
    1. Monthly Automatic Bank Withdrawal – Elect to have monthly premium payments withdrawn from an account
    2. One-Time Annual Payment – Applicants can pay a one-time payment for the full amount of their premium at the time they submit their Idaho MedPlus application
  • SilverScript - Medicare Part D
  • 2019 Sales Literature and Medicare Supplement Application
    • 2019 Benefit Guide Idaho MedPlus Medicare
    • 2019 Outline of Coverage Idaho MedPlus Medicare
    • Medicare Supplement Application

MEDICARE SUPPLEMENT GUARANTEE ISSUE RULES

Plan G may be the best option for some of your Medicare-eligible clients this year. In 2019, Blue Cross of Idaho implemented a few changes to the Medicare supplement guarantee issue requirements, which you can review below:

Applicants are Guarantee Issued into Plan G if:

  • The applicant is requesting an effective date that is less than or equal to six months from their Medicare Part B enrollment effective date, regardless of the applicant's age (Original Open Enrollment Period).
  • The applicant joined a Medicare Advantage (MA) plan when first eligible for Medicare Part A, is enrolled in Part B and within the first year of joining decided to switch to Original Medicare (Trial Right #1).

    If the applicant does not meet one of the scenarios above and wishes to enroll in Plan G, they must complete the health statement on the application and be approved by underwriting.

If an applicant wishes to enroll in Plan A, F, K or N, they may do so without health underwriting in the following circumstances (Enrollment into Plan G requires underwriting for these scenarios):

  • The applicant is transferring from existing Blue Cross of Idaho group, individual, or MA* coverage.

    *If transferring from a Blue Cross of Idaho MA plan to a Medicare Supplement plan, the applicant must have had 12-months of continuous medical enrollment with Blue Cross of Idaho. Continuous enrollment can be a combination of any medical line of business in combination with MA.
  • The applicant is transferring from other carrier coverage and has concurrent group and Medicare enrollment.
  • The applicant dropped a Medicare Supplement policy to join an MA policy for the first time, kept the MA plan for less than 12 months and wants to switch back to Medicare Supplement (Trial Right #2).
  • The applicant is enrolled in an MA plan and the plan is leaving Medicare or stops serving the area, or the applicant moves out of the plan's service area.

IF YOUR CLIENT CURRENTLY HAS A MEDICARE ADVANTAGE OR MEDICARE SUPPLEMENT POLICY, HERE ARE SOME DETAILS TO KNOW

If your client intends to cancel their existing Medicare supplement insurance and replace it with a Blue Cross of Idaho Care Plus policy, they have a 30-day window to decide, without cost, whether they want to keep either their old or new policy. Help them review any new coverage carefully. Compare it with any health insurance they have now. Cancel their present policy only if, after due consideration, they find the purchase of Idaho MedPlus Medicare supplement coverage is the choice they wish to make.

Keep in mind, if a client moves from a Medicare supplement policy to an MA policy, it is their responsibility to cancel their Medicare supplement policy as this does not occur automatically. Additionally, if your client is moving from an MA plan to a Medicare supplement plan, you do not want to enroll them in a stand-alone Prescription Drug Plan (PDP), until after your client has received confirmation of enrollment on the supplemental plan. Enrolling in a PDP will automatically terminate an existing MA plan because CMS considers an MA no Rx, PDP and MA-PD plans as an MA plan and your client can only be enrolled in one MA plan at a time.

2/12/2019 - Healthy Rewards and Small Group Eligibility

Senior Markets

Healthy Rewards Program

Healthy Rewards is a Blue Cross of Idaho program where Medicare Advantage members can earn rewards for taking care of their health and completing simple healthcare activities, like going in for an annual wellness visit or getting a flu shot.

The 2019 program includes 11 healthcare activities where members can earn $10 and $25 gift cards, depending on activity. Activities must be completed and gift cards redeemed by December 31, 2019.

Check out the Healthy Rewards Program flyer on the broker portal at brokers.bcidaho.com, select Selling Medicare Advantage, and then Other Plan & Benefit Information.

Group Markets

Small Group Eligibility

The plans and networks offered through Blue Cross of Idaho coupled with the growth of small groups throughout the state provide a massive opportunity for you to retain and grow your small group book of business. We are eager to assist you in any way we can. As a reminder, below are the small group eligibility* requirements:

  • A physical location in Idaho that has decision-making authority for employees of that location and at least 50 percent of employees work in Idaho
  • Employs an average of at least two but no more than 50 eligible employees at any time during the preceding calendar year
  • Employs an average of at least two but no more than 50 eligible employees on the first day of the plan year, the majority of whom were and are employed within Idaho

*Blue Cross of Idaho audits groups that are at risk for meeting eligibility requirements. Audit packets will be sent to group administrators and copies sent to their broker. The audit packet must be returned no later than 30 days before their renewal date. Failure to return the audit information will result in termination of coverage.

1/29/2019 - Updates

All Market Segments

2019 Commission Flyer and Calendar

Check out the 2019 broker commission structure flyer to see what you could be earning as you continue retaining and growing business with Blue Cross of Idaho. You can also view the Group Bonus Program flyer, commissions cut-off and payday calendar and other broker commission forms at the broker portal. After you log in to your broker portal account, select REPORTS & COMMISSIONS then BROKER COMMISSION INFORMATION.

Senior Markets

Medicare Advantage (MA) Book of Business

To make sure you get the right commissions, we strongly encourage you to review your MA book of business report to verify all your clients are listed. If you have clients who are not shown on this report, please contact us immediately at iss@bcidaho.com.

You may also notice a client listed on your MA book of business report, but you didn’t receive January commissions for that client. MA members can ask for premiums to draft any day of the month and MA commissions pay based on that date. If the bill date was after January 11, 2019, the January commissions cut-off, your January commissions for that member will be paid in February.

Member ID Cards

Earlier this month, there was a delay in members receiving their ID cards due to a coding error. As of mid-January, all member ID cards have been mailed. If a client asks about his or her ID card, feel free to offer these options to them:

  1. They can log into their online Member account on the Blue Cross of Idaho member site at bcidaho.com to request new cards and get a digital ID card right away. If they have not registered for a member site account, here are instructions. Please be aware that they will need their member ID number to register.
  2. They can call the Blue Cross of Idaho Customer Service Department at 1-800-494-2583.

Individual Market

Managing On-Exchange Accounts

To simplify the process of updating, moving or transferring any on-exchange business, changes must be made with Your Health Idaho (YHI) since it is the system of truth for all on-exchange business. YHI will share the change with Blue Cross of Idaho and the record will be updated. This ensures the account is updated accurately and timely within Blue Cross of Idaho's systems.

1/3/2019 - Updates

All Markets

Reminder: Change in Acceptable Payment Methods

Making monthly premium payments online or with a monthly bank draft provides the best, most streamlined experience for your clients. As a reminder, Blue Cross of Idaho will no longer accept cash payments starting on January 15, 2019. A flyer with additional details about payment methods can be found under the What's New section of the broker portal homepage.

Meridian District Office Temporarily Relocating

The Meridian district office will undergo renovations starting January 11, 2019. You can visit our district office staff in the enrollment center, where they will be temporarily relocated.

Group Markets

Open Enrollment Period (OEP) Dates

The Open Enrollment Period for your groups on the Online Enrollment Center (OEC) is always the 1st - 15th of the month prior to the renewal effective month. For example, if a group has a renewal date of March 1, 2019, their OEP is February 1-15, 2019. To ensure the best experience for your group clients, we ask that you help your groups understand their OEP dates.

If a group needs accommodation or exception, email onlineenrollment@bcidaho.com prior to their OEP so the group's renewal information is accurately reflected in the OEC. A second but shorter OEP can be provided to allow elections to be completed if benefit changes received after their initial OEP. Any extension may delay in group members receiving their ID cards.

Individual Market

Updating On-Exchange Accounts

To simplify the process of updating, moving or transferring any on-exchange business, changes must be made with Your Health Idaho (YHI) as they are the system of truth for all on-exchange business. YHI will share the change with Blue Cross of Idaho and the record will be updated. This ensures that the account is updated accurately and timely within the Blue Cross of Idaho system.

If you have any questions, please reach out to sales support at iss@bcidaho.com or call 800-365-2345.

Sincerely,

Sales Support
Blue Cross of Idaho

12/18/2018 - All Markets, End of the Year Updates

Group Markets

January 1, 2019 Effective Dates

You have worked hard with your groups through the quoting and sales process with Blue Cross of Idaho, and now you want their enrollment experience to be the best possible. January 1, 2019 is a few days away and there are still many groups on hold, waiting for additional information.

If you have a new group that does not have complete and accurate paperwork submitted to Blue Cross of Idaho, the employees may be at risk of not gaining access to their medical or pharmacy benefits on January 1, 2019. Please submit the required information quickly so there is no disruption of service for your group.  If you have a group at risk, we ask that you begin having the appropriate conversations, so employees do not experience a disruption in needed services.

Important information:

  • Complete and accurate paperwork received:
    • After December 18, members may not receive their member ID cards by their effective date of coverage
      • New group members will still have access to their member ID numbers through their plan administrator prior to their effective date
    • After December 21, members are at risk of not having access to their medical or prescription benefits on January 1, 2019
    • After December 26, members will not have access to medical or prescription benefits on January 1, 2019
  • Widespread inclement weather may cause delays in members receiving their ID cards
  • If your group is at risk of a late enrollment, encourage their members to fill all prescriptions prior to January 1, 2018 so there is no disruption to their medication needs
  • If a member does not have their member ID number and needs a prescription filled on January 1, 2019, the member can:
    1. Pay for the prescription
    2. Submit a claim for reimbursement to Blue Cross of Idaho
      • Please remind your groups that Walgreens is non-contracting in most cases.

    Sold Group Implementation Checklist

    To provide an exceptional customer experience and avoid processing delays, please utilize the Small Group, and Mid-Size and Large Group Checklists. These checklists are not mandatory, but they highlight areas often missed during the implementation process and are available via the broker portal:

    1. bcidaho.com
    2. Hover over FORMS & DOCUMENTS
    3. Select GROUP DOCUMENTATION
    4. Select Small Group Checklist or Mid-Size & Large Group Checklist

    EZ Quote Scheduled Downtime

    The small group quoting tool, EZ Quote, is scheduled to be offline on December 31, 2018 after 6 p.m. MST for a system upgrade. Please insure all your quoting is complete or saved prior to the scheduled downtime.  

    2019 Group Bonus Plan Highlights

    Check out the highlights and a link to more details about Blue Cross of Idaho's enhanced group medical bonus program:

    • Increased per-contract bonus for group retention
    • Increased maximum payout per group for group retention
    • Increased maximum payout per group for new groups
    • Lowered minimum number of contracts to qualify for the bonus for group retention

    Full details about the 2019 Group Bonus Plan are available here.

    Senior Markets

    Introducing SilverScript – Medicare Part D

    Providing value, security and peace of mind is important when recommending a health plan to your clients. Selling a prescription drug plan (PDP) with a Medicare Supplement plan creates the financial security your clients look for when seeking your advice.

    Blue Cross of Idaho is excited to announce our partnership with SilverScript, a Medicare PDP administered by CVS. Adding our SilverScript PDP to your Blue Cross of Idaho portfolio gives you more options to offer your clients.

    SilverScript contracts for independent brokers need to be signed in order to offer SilverScript. Agency principals and agency brokers need to sign SilverScript contracts to offer SilverScript as well. Contracts were sent to many brokers last week. If you are interested in selling SilverScript and did not receive a contract, please contact us and we will email your contract right away.

    Using Public Employee Retirement System of Idaho (PERSI) Funds

    With an upgraded payment system, PERSI is now able to track retirees’ prior coverage. If members did not have coverage with Blue Cross of Idaho through their school districts, they are not able to use PERSI to pay their Blue Cross of Idaho Medicare Advantage or Idaho MedPlus plan premium.

    Individual Markets

    Portneuf Quality Alliance (PQA)

    With Mountain View Network (MVN) merging with PQA network, some MVN network providers are currently contracted with the new PQA network. There are several providers in the process of applying, which can take up to six to eight weeks. We are continually adding to and updating the provider directory, so we encourage you to regularly check to see if your clients’ providers were recently added to the PQA network.

    If a MVN provider decides not to join the PQA network, they will automatically be contracted with the Hometown East (HTE) network. If your client prefers, they can change to HTE within 90 days of the effective date of their plan.

    Things to Remember After Open Enrollment

    As the busiest time of your year ends, here are a few things to remember:

    • Assist your new clients in selecting a primary care provider (PCP). Selecting a PCP that your client can trust is key to starting their health journey off right.
      • You can assist your client in selecting their PCP and add the PCP through your broker portal
      • Your client can call customer service at 855-230-6862 and we can assist them with PCP selection
    • Although open enrollment ended on December 15, 2018, clients who started an application through Your Health Idaho (YHI) have until December 22, 2018 to complete their plan selection.
    • To help your clients avoid losing coverage, encourage them to pay their January premium.

    If you have questions, please reach out to sales support at iss@bcidaho.com or call 800-365-2345.

     

    Sincerely,

    Sales Support
    Blue Cross of Idaho

12/04/2018 - Idaho MedPlus Guarantee Issue & other updates

All Market Segments

Plan Ahead: How Members Can Pay Their Bill

In an effort to give your clients the best experience at affordable prices, Blue Cross of Idaho encourages members to make their payments online or with a monthly bank draft. For security reasons, Blue Cross of Idaho will no longer accept cash payments starting on January 15, 2019. A flyer with additional details about payment methods can be found under the What's New section of the broker portal homepage.

Senior Market

Strong Network Relationships

You may be aware of recent communication in regarding ongoing negotiations between Saint Alphonsus Regional Medical Center/Saint Alphonsus Medical Center – Nampa and another competing Medicare Advantage Organization. These negotiations may place members enrolled in those plans at risk of losing their in-network doctor during 2019.

We want to insure you that Blue Cross of Idaho’s relationship with Saint Alphonsus remains strong and the clients you enroll in our products are not affected by any of those outstanding negotiations. Our Medicare Advantage products include a robust network of providers that includes Saint Alphonsus Regional Medical Center and Saint Alphonsus Medical Center – Nampa.  You can be assured that we stand ready to service the healthcare needs of your members.

Over the Counter (OTC) Benefit

Blue Cross of Idaho Care Plus Medicare Advantage (MA) members have a quarterly over-the-counter (OTC) benefit, administered by Convey Health Solutions, allowing them to purchase necessary OTC products.

Beginning in January 2019, they will have access to a catalog with dozens of products to choose from. It will include instructions on how to place their order – online, phone, and mail order. Encourage your clients to take advantage of this valuable benefit each quarter.

A flyer with additional details is available to you and your clients here. Please note: Members can place one order per quarter and their allowance resets January, April, July and October.

2019 Idaho MedPlus Applications

The 2019 Idaho MedPlus application is approved and available on the broker website at brokers.bcidaho.com. To locate the form:

  1. Hover over FORMS & DOCUMENTS, then select INDIVIDUAL DOCUMENTATION.
  2. Select Medicare Supplement.
  3. Select 2019 Idaho MedPlus Application.

Medicare Supplement Guaranteed Issue

Plan G may be the best option for some of your Medicare-eligible clients in 2019. In some situations, we require health underwriting to be eligible for new enrollment into Plan G. Please review the Blue Cross of Idaho outline of guaranteed issue scenarios below:

Applicants are Guarantee Issued into Plan G if:

  • The applicant is requesting an effective date that is less than or equal to 6 months from their Medicare Part B enrollment effective date, regardless of the applicant's age (Original Open Enrollment Period).
  • The applicant joined a Medicare Advantage plan when first eligible for Medicare Part A, and within the first year of joining decided to switch to Original Medicare (Trial Right #1).

If the applicant does not meet one of the scenarios above and wishes to enroll in Plan G, they must complete the health statement on the application and be approved by underwriting.

If an applicant wishes to enroll in Plan A, F, K or N, they may do so without health underwriting in the following circumstances (Enrollment into Plan G requires underwriting for these scenarios):

  • The applicant is transferring from existing Blue Cross of Idaho group, individual, or Medicare Advantage (MA)* coverage.
    • *Note: If transferring from a Blue Cross of Idaho MA plan to a Medicare Supplement plan, the applicant must have 12-months of continuous medical enrollment with Blue Cross of Idaho. Continuous enrollment can be a combination of any medical line of business in combination with MA.
  • The applicant is transferring from other carrier coverage and has concurrent group and Medicare group enrollment.
  • The applicant dropped a Medicare Supplement policy to join a MA policy for the first time, kept the MA plan for less than 12 months and wants to switch back to Medicare Supplement (Trial Right #2).
  • The applicant is enrolled in a MA plan and the plan is leaving Medicare or stops serving the area, or the applicant moves out of the plan's service area.
  • Other guaranteed issue situations as defined by the Centers for Medicare and Medicaid Services (CMS).

Group Market

Discounts for First-time Dental Purchasers

If your group doesn't have dental with us today, we will reduce their medical rate for the first year by 1% to add a PPO dental or Dental Blue Connect (Willamette Dental-managed) to their medical plan. This also applies to new medical business with dental. As a reminder, our broker bonus program pays $5 per contract for every new eligible dental sale above a combined 50 (i.e., can be a combination of groups).

Group Type* Discount Offered (for First Year)
  • Fully Insured: Mid-size or Large
  • Balance Funded
1% off medical rates
  • ASC
Medical/pharmacy administrative cost reduction of $1 PEPM

Our dental network is the largest in Idaho (including 90 percent of providers), and our members have access to Blue dental networks across all 50 states. Given our competitive prices, this is a great opportunity to pair your clients with a dental plan that will work for them.

*Voluntary products, association plans, small group, and any mid-size eligible groups with less than 51 enrolled employees are ineligible for discounted rates.

Electronic Premium Payments

Small groups now have the option to make their first month premium payment using monthly bank draft. You and your small groups can access a new ACH Withdrawal Form, and choose to:

  1. Pay only the initial premium payment electronically
  2. Pay the initial premium payment then enroll in monthly bank draft
  3. Use the form to only set up monthly bank draft

Access the form at brokers.bcidaho.com then select FORMS & DOCUMENTS, select GROUP DOCUMENTATION, then expand the group type and select ACH Withdrawal for Monthly Premiums

If you have questions, please reach out to the Sales Support team at iss@bcidaho.com or call (800) 365-2345.

 

Sincerely,

Sales Support
Blue Cross of Idaho

11/27/2018 - 2019 Medicare Supplement Plans

Dear Broker,

The 2019 Idaho Care Plus, Med Plus plans and rates are approved and ready to sell. Below is information you will need to effectively assist your clients through the process.

The 2019 Idaho Med Plus application is still pending approval so please use the 2018 Medicare Supplement Application located in the Benefit Guide. If selling a Plan G, write the plan name on the application. We will update you when the 2019 application is available.

New for 2019:

  • Plan G
  • Premium payments for all new enrollments
    • Applicants can pay their monthly premiums in one of two ways:
      • Annual payment – Pay for the entire year at the time of application
      • Automatic Withdrawal – Elect to have monthly premium payments withdrawn from an account

2019 Commission New Business

Medicare Supplement Age-In or Underwritten Member Guarantee Issue Member
(Excluding Age-Ins)
Idaho MedPlus plans
A, F, G, K, N
Age 65 & older
$20
Per member, per month
&7.50
Per member, per month
Under age 65 $0 $0

Commissions for Med Sup policies written prior to 2019 will grandfather with the current commission rates as outlined in the 2018 commission brochure. Please see outline below.

Commissions - Business written prior to 2019

Medicare Supplement Per Member Per Month
Idaho MedPlus plans A, F, K, N $7.50
Medicare Supplement Prime 65
Plans A, K, M, N
$10
Medicare Suppplement Prime 65 plan F $15

2019 Monthly Premium Rates for Idaho MedPlus Medicare Supplement Plans

Download a pdf of the 2019 Monthly Premium Rates for Idaho MedPlus Medicare Supplement Plans.

if you have any questions, please reach out to the Sales Support team at iss@bcidaho.com or call 800-365-2345.

Sincerely,

Sales Support
Blue Cross of Idaho

11/21/2018 - Updates

All Market Segments

HSA Preventive Drug List

Your group and individual clients who are enrolled in health savings account (HSA) plans or high-deductible health plans (HDHPs) can get some preventive drugs at little or no cost to them. The HSA Preventive Drug List was updated in June and is available on the broker portal under Just for Brokers or by selecting SALES ASSISTANCE --> ADDITIONAL FORMS/RESOURCES --> HSA Preventive Drug List. The list of covered drugs has not changed.

Blue Cross of Idaho Thanksgiving Holiday Office Hours

Date Business Hours
Wednesday, November 21 8 a.m.-3 p.m.
Thursday, November 22 Closed
Friday, November 23 Closed

Blue Cross of Idaho district offices will be open for normal business hours on Monday, November 26.

Blue Cross of Idaho December Holiday Office Hours

Date Business Hours
Friday, December 21 8 a.m.-3 p.m.
Monday, December 24 Closed
Tuesday, December 25 Closed

Blue Cross of Idaho district offices will be open for normal business hours on Wednesday, December 26.

Group

Open Enrollment and Renewal Timelines

Your groups that are enrolled on the Online Enrollment Center (OEC) platform will see a change in their open enrollment (OE) period this year. To make sure your clients receive their ID cards on time, groups renewing January 1, 2019 have an OE period of December 1-December 15, 2018. If they need more time, please contact onlineenrollment@bcidaho.com and we may be able to extend the deadline.

OE period will be extended for groups with changes received by December 10. Groups with changes received after December 11 will have a first OE period from December 1-December 15 to let them to add members with current benefits. They will then have a second OE period for changes to the new benefits. Refer to the table below for dates.

There could be a delay in having 2019 plans loaded to the OEC if groups submit late changes. As a result, the OE period for these groups and the arrival of their ID cards may be delayed as well. Extending OE timeframes may also delay enrollment and ID card arrival.

Changes Received By: Open Enrollment Dates: *
Signed changes received by 11/19
Standard enrollment period
Open Enrollment 12/1 - 12/15
Signed changes received by 11/26
Extended enrollment period
Open Enrollment Extended to 12/20
Signed changes received by 12/03
Extended enrollment period
Open Enrollment 12/14 – 12/28
Signed changes received by 12/10
Extended enrollment period
Open Enrollment 12/21-12/31
Signed changes received by 12/17
Extended enrollment period
Open Enrollment 12/28-1/10/19

*Approximate timeframe of 10 business days for completion of changes within BCI

 

Individual

2019 Individual Plan Guides

The 2019 Individual Plan Guides are available to order. After logging in at brokers.bcidaho.com, select FORMS AND DOCUMENTS then ORDER BROKER SUPPLIES  and complete the order form.

Member Outreach During Open Enrollment

To both help you and give our members the best possible customer experience, the Blue Cross of Idaho Member Services team is calling and/or sending emails to individual members who have one of the following situations  impacting their premiums or coverage:

  1. A member who loses his or her Advance Premium Tax Credit (APTC) and may need to redetermine with the Idaho Department of Health and Welfare
  2. A member whose 2019 premiums will increase by $50 or more and pays his or her monthly premium using autopay
  3. A member whose network is not in their county of residence

Bronze 7900 Benefit Clarification

There may be some confusion about out-of-pocket costs for ER visits, as well as prescription drug benefits for tiers 3-6, because of Individual Bronze 7900 plan benefit details on Your Health Idaho, at shoppers.bcidaho.com, and in our sales literature.

The in-network deductible and out-of-pocket maximum are both $7,900. Once a member meets his or her deducible, the out-of-pocket maximum is also met and there will NOT be any additional in-network cost sharing.

If you have any questions, please reach out to the Sales Support team at iss@bcidaho.com or call 800-365-2345.

Sincerely,

Sales Support
Blue Cross of Idaho

11/02/2018 - Updates

All Market Segments

Portneuf Medical Center ER Providers

Blue Cross of Idaho and Rocky Mountain Physician Group (RMPG) have agreed to an in-network contract. The contract includes a value-based care arrangement that rewards high-quality care at lower costs. Here are a few important things to be aware of with this new contract:

  • The contract is retroactive to April 14, 2018. All claims on or after this date will be processed as in network.
  • Deductibles and coinsurance responsibilities will follow normal guidelines.
  • Members who received emergency care with RMPG can contact us with any questions about their bill by calling the number on the back of their member ID card.

MA Creditable Coverage

The Centers for Medicare and Medicaid Services-required notice of creditable coverage to Medicare Part D is now available. This information must be disclosed to members on an employer group plan and to their dependents.

These notices are posted on the broker portal at brokers.bcidaho.com and were mailed to your affected clients:

Group administrators and individual members received a cover letter.

Group administrators received sample creditable coverage and non-creditable coverage notices.

Individuals received either a creditable coverage or non-creditable coverage notice depending on their coverage.

Group

New Highlight Sheets Available on the Broker Portal

Summaries of plan benefits can be found on the broker portal at brokers.bcidaho.com by navigating from the home page to Sales Assistance, then to Sales Literature and then to Group Medical or Group Dental. These sheets are helpful to compare plans but are not a complete description of benefits.

Small Group Sales Literature

The 2019 Small Group Sales Literature is available on the broker portal. We will send notification when printed booklets are available.

Group Cut-Off Date

New and renewing groups can confirm rates and benefits up until the last business day of the month that comes before their effective date.

For example, if a group desires an effective date of November 1, 2018, the deadline for submitting complete and accurate paperwork is 5 p.m. October 31, 2018.

The sooner you submit complete and accurate paperwork, the quicker your clients will have access to their ID cards and benefits. Submitting paperwork on the last day before the deadline will delay your group's ability to access care beginning on the effective date.

No Health Statements for Mid-Sized Group

As of September 1, 2018, you and your mid-sized groups are no longer required to provide health statements for groups with 51-99 enrollees. If your mid-size group has fewer than 50 enrollees, the health statement is still required.

Individual

Bronze 7900

Healthcare needs to be more affordable and your clients should always get what they pay for. Our new Bronze 7900 product was created for this purpose. We encourage you to advise your clients about the benefits of this product while they search for a low-cost plan option.

Provider Directory

As open enrollment period approaches, we want to highlight the disclaimer language on Your Health Idaho (YHI) for provider searches. YHI's provider search offers an estimate of doctors and clinics based on the search terms and scope. This means the results displayed may not represent all offices of a provider. We strongly encourage shoppers to use the full provider directory. While browsing plans on shoppers.bcidaho.com, they can select the Plan Details section of the plan tile to find a link to a full provider directory.

 

If you have any questions, please reach out to Sales Support at SalesSupport@bcidaho.com or call (800) 365-2345.

Sincerely,

Sales Support
Blue Cross of Idaho

10/23/2018 - Group Cut-off Changes: Effective Immediately

Group Cutoff Date Changes

To facilitate the ease of onboarding your new groups and to allow greater flexibility in doing business with Blue Cross of Idaho, we have changed the cutoff date for group business.

You and your new and renewing groups can confirm rates and benefits up until the last business day of the month preceding their effective date.

For example, if a group desires an effective date of November 1, 2018, the cutoff for submitting complete and accurate paperwork is 5pm on October 31, 2018.

Please remember the sooner you submit complete and accurate paperwork, the quicker your clients will have access to their I.D. cards and benefits. Submitting complete paperwork on the last day will delay your group's ability to access care on their initial effective date.

We believe this change will help you drive your business to Blue Cross of Idaho and provide value during this busy time.

3/15/2018 - Reminder - Group Cutoff Change

Dear Broker,

The cutoff dates for group business is now 15 days prior to the effective date. This change will allow us to provide exceptional customer service to all members starting on the first day of coverage.

This change takes effect for May 1, 2018 for both new and renewing groups. We will send an email communication to each of your renewing group administrators so they are aware of this change. 

Completed paperwork…

  • Must be submitted by 5 p.m., complete and accurate
  • If the 15th day falls on a weekend or holiday, cut-off is the following business day
  • Applies to all small, medium and large groups (both fully insured and self-funded)

Note: This change does not impact new hires.

More Information

For your convenience, we've listed the due dates for the next year.

EFFECTIVE DATE

MATERIALS DUE BY 5 P.M. ON:

May 1, 2018

April 16, 2018

June 1, 2018

May 17, 2018

July 1, 2018

June 15, 2018

August 1, 2018

July 17, 2018

September 1, 2018

August 17, 2018

October 1, 2018

September 17, 2018

November 1, 2018

October 17, 2018

December 1, 2018

November 16, 2018

January 1, 2019

December 17, 2018

February 1, 2019

January 17, 2019

March 1, 2019

February 14, 2019

April 1, 2019

March 17, 2019

May 1, 2019

April 16, 2019

Contact

If you have any questions, please reach out to us at Broker Relations & Support.

855-365-2345
brokerrelations@bcidaho.com

2/14/2018 - Blue Cross of Idaho Expands Choices, Serving More Idahoans

Blue Cross of Idaho is proud to support Governor Otter’s executive order and the Department of Insurance’s guidelines allowing the introduction of state-based health insurance plans to the people of Idaho. Blue Cross of Idaho is releasing 5 new state-based products, in addition to current plans offered under the Affordable Care Act. The plans will be available in early March for coverage effective April 1, 2018.

Blue Cross of Idaho’s new state-based plans will give Idahoans:

  • Additional choices in healthcare coverage
  • Lower cost options
  • Peace of mind for those concerned about the uncertainty of their health insurance today

Freedom Blue plans are tailored for consumers looking for a health insurance plan that fits their individual health needs with significant cost-savings. Together, we are creating a way for middle-class Idahoans who are not covered by an employer-sponsored plan to choose an affordable health plan for themselves and their families.

In the next few days, you will receive an email invitation to attend a webinar where you will hear the details of these new plans.

The Blue Cross of Idaho team is looking forward to working collaboratively with you as we provide the people of Idaho the choices in health insurance coverage they have been asking for … and we are now providing. We take great pride in providing your clients the best choices for healthcare coverage.

1/15/2018 - Change to Group Application Cut-Off

Dear Broker,

Blue Cross of Idaho shares the same objective that you do – to provide our mutual customers an exceptional customer experience from the first day they are enrolled in coverage.

Our current application cut-off date, coupled with last minute and incomplete application submissions, is resulting in members not having a good experience or access to their coverage on time.

To promote a better customer experience, we are adjusting our application cut-off date.

Change to Group Application Cut-Off

Starting with May 1, 2018 effective dates, all group paperwork must be:

  • Received 15 days in advance of the effective date
    • Submitted by 5p.m.
    • If the 15 is a weekend or holiday, cut-off is the first preceding business day
  • Complete and accurate
  • This change applies to all small, medium, and large groups both fully insured and self-funded

EXAMPLE: Assumes all paperwork is complete and accurate

  • May 1, 2018 effective date: Cut-off April 16, 2018
  • October 1, 2018 effective date: Cut-off September 17, 2018 (September 15 is a Saturday)

We realize improvements are needed for the application submission process for you, our broker partners. Blue Cross of Idaho is working on an improved process and will communicate the improvements in the near future.

Sincerely,

Broker Relations
Blue Cross of Idaho

1/8/2018 - January Binder Payment Extension & APTC Changes

Dear Broker,

January Premium Due Date Extension

Online Payment Portal Issues

We experienced issues with the Blue Cross of Idaho online payment portals and unfortunately, this caused problems for some of your individual QHP clients.

Blue Cross of Idaho Correction

The payment portal issues are resolved, and we’ve extended the deadline for individual QHP binder payments through January 15, 2018.

Broker/Member Options

January binder payments can be made by:

  1. Customer Service – Select the payment option in the Interactive Voice Recognition (IVR)
  2. Call 855-230-6862
  3. No hold times
  4. Member ID or Social Security Number required
  5. Payment accepted by e-check, credit/debit card
  • YourHealthIdaho (YHI) payment redirect to Blue Cross of Idaho
    1. Have your client login to their Idalink account at yourhealthidaho.org and select the payment option
    2. Payment accepted by e-check, credit/debit card
  • Blue Cross of Idaho Member PortalCurrent renewing members can log in to the member portal and pay online at members.bcidaho.com
    1. Payment accepted by e-check, credit/debit card
  • Walk in to any sales office
    1. Payment accepted by e-check, credit/debit card or cash

We sincerely apologize for the inconvenience and appreciate your continued partnership.

RE: Individual change in APTC & Individual Payments

DHW Recalculation of APTC

Some of your clients saw recent APTC changes that increased their monthly premiums. Blue Cross of Idaho will not automatically cancel coverage due to an APTC change. Below outlines how we consider premium increases.

Blue Cross of Idaho Billing Methodology

Below lists each scenario and how additional premiums are considered.

New Individual QHP Enrollment

Pre-effectuated members:

  • A new letter will generate
  • We allow additional 15 days from date on the letter to pay the first month’s premium

Effectuated members:

  • Members billed by monthly statement – February bills generated on January 4 and included the additional amount
    • If the change is processed after, February statements will be rebilled
  • ACH – February draft will include any outstanding January balance due

Renewing Individual QHP Members

ACH members:

  • If APTC changes are made prior to the ACH draw date, the adjusted amount will draft
  • If the APTC changes are made after the ACH draft bills, the additional premium will be included with February draft

Members billed by monthly statement:

  • When APTC is processed, a new bill will generate
    • If the member had APTC in December, they have a grace period and can pay the balance in February
    • If they did not have an APTC in December, they need to pay by January 15

Please contact customer service or your local sales representative with any questions.

Sincerely,

Broker Relations
Blue Cross of Idaho