Highmark Blue Cross Blue Shield Latest Updates

 

 

October 2024 Updates:

 

Gag Clause Prohibition Compliance Attestation as Mandated by the Consolidated Appropriations Act

  • As we approach the December deadline for the Consolidated Appropriations Act’s Gag Clause Prohibition Compliance Attestation (GCPCA) , carriers are beginning to provide related guidance.
  • Highmark has announced below, similar to last year, it will…
    • File the GCPCA on behalf of fully insured clients, by the December 31st deadline.
    • Provide guidance to ASO (self-funded) clients via letter.  A link to the communication that will be issued November 1st can be found below for ASO clients who hold their own responsibility to file by December 31st.
      • Letter offers validation that Highmark is in compliance with the CAA rules regarding gag clause prohibitions.
      • A link is provided to refer ASO (self-funded) clients to the CMS site for their required next steps.

View Highmark Update 

September 2024 Updates:

 

Highmark and US Digestive Health Reach Multi-Year Agreement

Please see below regarding recent Highmark re-contracting of US Digestive Health (USDH) for a multi-year agreement.

View Highmark Update 

 

Highmark Small Group Portfolio of Plan Options Moving to Highmark Senior Health Company in Southeastern Pennsylvania

  • A filing change is occurring for the company under which Highmark SouthEastern PA (SEPA) clients will be written.
  • The Highmark SEPA region includes the counties of Bucks, Chester, Delaware, Montgomery & Philadelphia.
  • This modification, although behind the scenes, triggers necessity for Highmark to make system changes and issue notifications to impacted clients.
  • Explanation of the process and sample communications can be found within links below.

View Highmark Update 

 

Highmark Announces Changes to Standard Benefits for Weight Loss Management Medications

As most NFP BNGA Partner business is within the Highmark Pennsylvania Regions, below callouts focuses on this geography.  Highmark resources included in their update below expand upon how this change relates to non-Pennsylvania regions as well.

  • This GLP-1 Receptor Agonist for weight loss exclusion already existed for Pennsylvania ACA Small Group & Individual and Small Group Grand-mothered in North Eastern PA
  • Weight loss medications, including GLP-1s FDA approved for weight loss, will automatically be excluded from coverage as a standard benefit beginning with December 1, 2024 plan renewal dates and upon renewals occurring thereafter for the following newly impacted PA segments:
    • PA Fully Insured Large Group (unless specifically meeting grandfathered status requirements)
    • PA Fully Insured Small Group Grand-mothered in Western PA and Central PA
  • Coverage of GLP-1’s FDA approved for diabetes will not be impacted, although some Authorizations or Medical Management may apply.
  • ASO clients will continue to have choice of coverage.

For additional guidance, details on non-Pennsylvania regions or to watch Highmark’s recorded webinar on the change, please refer to the links below.

View Highmark Update 

 

Highmark 2023 MLR Rebates – Notice of Client Letters

  • Highmark has released details surrounding Medical Loss Ration (MLR) rebate issuance for Pennsylvania Regions (WPA, CPA & NEPA), including corresponding timelines for communications and related rebate checks.
  • Per below & follow-up guidance from Highmark Pennsylvania Account Management – There are NO rebates within the Small Group entities for 2023 MLR rebate year
  • Communications surrounding Individual & Large Group issuances will begin next week (see chart of delivery timelines below)
  • If carrier notification is received related to specific Large Market Clients qualifying to be issued an MLR rebate, we will share with you and your teams.
  • Issuance to Clients will include accompanying Membership Roster details to aid in their distribution responsibilities.
  • Sample Client & Subscriber communications can be found within links below.

View Highmark Update 

August 2024 Updates:

 

Highmark Changes to Producer of Record Process Effective September 16, 2024

  • As Highmark is seeking to clarify the Producer of Record takeover process, they have issued updated POR templates and instructional guidance.
  • The Channel Compensation Team will adhere to stringent guidelines on how these submissions are handled and processed now and onward.
  • There are important nuances on how the Producer (an appointed Highmark Agent) and the General Agency (our organization as your distribution channel) are listed in print.
  • If you are interested in a prepopulated version of the POR Letter, specific to your agency and agents, please reach out to nfpbnga@nfp.com for assistance. In your request, please let us know which regions you are interested in obtaining pre-populated templates for:
    • Western PA (WPA)
    • Central PA (CPA)
    • Northeastern PA (NEPA)
    • Southeastern PA (SEPA)
    • West Virginia (WV)

View Highmark Update 

 

July 2024 Updates:

 

Penn State Health Chief Executive Officer Steve Massini to Retire

Sharing Highmark announcement below regarding upcoming leadership changes for a key partner, Penn State Health. As any news surfaces regarding a new CEO announced for the Health System, we will share as well.

View Highmark Update 

June 2024 Updates:

 

Announcing Vice President of Eastern Pennsylvania Sales and Client Management

  • As Highmark continues to strengthen the foundation of their expansion into Eastern PA, leadership changes have been announced.
  • Jim Mackrell has been introduced as Regional Vice President of Sales and Client Management.
  • Jim’s reach for Sales and Service will encompass Northeastern as well as Central Pennsylvania Highmark Clients & Prospects.

We encourage you to utilize your NFP BNGA Team for Sales opportunities or to navigate the Support Channels within the carrier. We are happy to assist or make the appropriate connections to management when necessary.

View Highmark Update 

 

Expansion of Highmark’s Specialty Drug Management Arrangement Powered by Free Market Health

  • Highmark is bringing their Free Market Health Pharmacy downstream as a small market solution.
  • Copies of Client Communications are provided via links below, as well as a deeper dive into the advantages the program offers.
  • This program will become available to ACA and non-ACA small group clients for an August 1st, 2024 effective date.
  • ASO Clients have the option to adopt the Free Market Health Solution or to continue with their existing specialty arrangement. This decision must be submitted by 8/31/2024 for a January 2025 effective date of change.

View Highmark Update 

 

May 2024 Updates:

 

Important Updates for Prescription Drug Coverage Effective July 1, 2024 – Formulary Deletions and Utilization Management Updates

  • Highmark regularly assesses their Prescription Formulary to ensure it provides safe & cost-effective treatments options for its members.
  • As of July 1, 2024, there are a number of medications removed from Highmark Formularies & some remaining, that now have Step Therapy requirements.
  • An appeal/exception process is available for members of plans with Closed Formularies, that seek consideration to stay on their medication. Providers can complete a non-formulary drug form on the members behalf if they believe there is medical reason for continuance of the removed drug.
  • Any Highmark members known to be taking a medication impacted by the formulary deletions or utilization management changes, and their Prescribing Providers, will be informed of these changes in writing by Highmark.

View Highmark Update 

 

New to Highmark Discount for Selling Highmark Medical Insurance with Existing United Concordia Dental Clients in Southeastern Pennsylvania

  • Highmark Southeastern PA Region is offering enhanced Medical Discounts to New to Blue Mid-Market clients that carry existing United Concordia Dental Coverage.
  • Offer is valid for clients enrolling in the New Highmark Medical Coverage for 8/1/2024 through 1/1/2026 effective dates.
  • For questions regarding the offering or assistance in quoting Medical for the Highmark Southeastern PA regions, please reach out to your NFP BNGA Team via nfpbnga@nfp.com.

View Highmark Update 

 

New Highmark Billing Late Pay & Termination Process

Highmark has informed us of some changes on how they notify us and employers when a group is either delinquent or set to be terminated due to non-payment of premium.

Employer Notification:

  • 15 days behind on premium – Highmark will send a (digital) reminder that payment is due
  • 30 days behind on premium – receive a hard copy warning letter in the mail
  • 60 days behind on premium – receive a hard copy termination letter in the mail stating the group will be termed on date X unless paid

Broker Notification:

  • NFP BNGA will no longer receive copies of letters that were mailed to employers.
  • We will receive a list from Highmark of groups who are delinquent once the 30-day warning letters have been mailed.
  • Highmark will follow up with us regularly with a list of groups that have paid OR continue to be delinquent.
  • Highmark will advise us on final termination date if applicable. This status will be shared with your teams from the NFP BNGA Team.
  • For any of the above steps, your NFP BNGA Team will share notification(s) via email with our impacted Producer Partners.

Any groups that terminate and need to reinstate must pay all outstanding premiums as well as current premiums owed.

 

Spring 2024 Producer Training Series Webinar Recordings & Slide Decks Now Available

For those that may have missed any live sessions of Highmark’s 2024 Producer Training Series, please see the recordings and accompanying slide decks available.

These highly informative sessions offer helpful details surrounding the following topics:

  • MyHighmark App and Website (all regions, all sizes, all funding arrangements)
  • Mental Well-Being powered by Spring Health (all regions, all sizes, all funding arrangements)
  • Specialty Drug Management – Free Market Health (all regions, all sizes, all funding arrangements)
  • Highmark Performance Networks (all Pennsylvania regions)
  • Large Group Quoting Requirement – applicable to 51-99 and 100+ (all regions)*
  • Christiana Virtual Primary Care (specific to Delaware only)
  • Dental Updates – separate sessions available for each Highmark Region

*For quoting assistance, please reach out to your NFP BNGA Team. If you are an organization that is hands-on for your own large market quoting submissions, please note that Highmark will be looking to see the General Agency (Benefits Network Inc / NFP) listed as ‘Agency’ on the Quote Request Form, with ‘Name of Producer’ reflecting your agent’s name. Please be sure to include nfpbnga@nfp.com on your submission.

View Highmark Update 

 

Important Update Regarding Multi-factor Authentication (MFA) for Producer Portal Access

  • • Earlier this month Highmark enhanced the security of their Producer portal with prompts for new password & the addition of Multi-Factor Authentication.
    • For those with established portal access, please see below on what to expect throughout upcoming log-in attempts
    • If you are an organization that has shared log-in details through the past, independent access should be established for members of your team that plan to utilize the Highmark system.
    • As your General Agency for Highmark Group Commercial coverage, we can help in this process – Please reach out to your NFP BNGA Team for assistance.

View Highmark Update 

 

April 2024 Updates:

 

Highmark PA Update – 2024 MSP/MLR Survey Collection – Action Required

  • Communications from Highmark had been distributed earlier this month regarding a survey requirement for groups size. This is directly related to Medicare Secondary Payer (MSP) determinations and Medical Loss Ratio (MLR) calculations.
  • As there are multiple regulations that overlap in timing, it may be differentiate this request from the CAA RxDC Survey requests clients are similarly be presented with
  • Please see below from Highmark to indicate when/what communication was circulated to clients, along with some further explanations of purpose.
  • Helpful Resources included
    • link to the client letter copy
    • link to Highmark’s MSP/MLR survey instructions that includes path to online survey

View Highmark Update 

 

Highmark Update – CAA Rx Data Reporting Mandate – Action Required by Clients

  • Please see the reminder from Highmark regarding upcoming deadline for Consolidated Appropriations Act (CAA) RxDC Reporting.
  • Clients that have not completed Highmark online survey(s), in its entirety, by the required deadline will be responsible for their own filing. It has been clarified by Highmark Account Management that the official deadline is 11:59pm on April 30, 2024.

Your NFP BNGA Team is working with Highmark to obtain status reporting, for a snapshot of what clients may not have taken sufficient action. We will share those results with your teams.

View Highmark Update 

 

Spring 2024 Producer Training Series Webinars

Highmark announces a number of informative webinar opportunities within their Spring 2024 Producer Training Series – your participation is highly encouraged!

  • Trainings will take place throughout April 2024. If you are interested but unable to attend live, registration will typically yield a recorded follow-up.
  • Please note that trainings are categorized below to specify any Region, Group Size, or Funding specific eligibility criteria. States/Regions where Highmark branded products and services are offered are as follows:
    • Highmark Pennsylvania (NFP BNGA serves as a General Agency Distribution Channel for all PA regions)
      • Western PA
      • Central PA
      • Northeastern PA
      • Southeastern PA
    • Highmark West Virginia (NFP BNGA serves as a General Agency Distribution Channel for the WV Region)
    • Highmark New York (outside of the NFP BNGA General Agency Channel – a referral to partnering GA organization can be provided)
    • Highmark Delaware (outside of the NFP BNGA General Agency Channel – a referral to partnering GA organization can be provided)

If you have questions related to Highmark products or opportunities or wish to receive more information on a Highmark related topic not reflected below, please contact Kara Bernhart of your NFP BNGA Team.

The Highmark Region applicable for your Producer Appointment is specific to the situs location of your client. If you are unsure what Regions you are contracted within, or have interest in expanding your Producer Appointments, please reach out to Cheranne Jurena.

View Highmark Update 

 

March 2024 Updates:

 

CAA Rx Data Reporting Mandate – Action Required by Clients

  • Section 204 of the Consolidated Appropriations Act, 2021 (CAA) requires health insurance issuers and self-insured group health plans to submit information regarding prescription drug spending, health care spending, and enrollment each year to the Centers for Medicare and Medicaid Services (CMS) on an annual basis. This information must be submitted in specific file formats to CMS for the 2023 calendar year by June 1, 2024.
  • Similar to last year, Highmark is again offering to complete the Employer Plan Sponsor portion of this CAA RxDC Reporting requirement.
  • Slight changes to the Highmark process this round are the following:
    • Fully insured and ASO clients that would like Highmark to submit data to CMS on their behalf must submit all required information via the Prescription Drug Data Collection (RxDC) Survey below by no later than May 1, 2024. Otherwise, clients will have to submit independently to the federal governing agencies.
    • Highmark is requesting information to complete this reporting directly from our mutual clients via email this week (sample below). Highmark Client Managers may seek broker action to assist with contacting some clients where delivery issues arise – we will inform you of any requests pertaining to your clients.
  • To support the completion of the survey, a detailed worksheet and process overview document are being provided by Highmark below. It is strongly recommended to complete the worksheet prior to completing the survey to expedite the submission process.
  • Support of this initiative is important to encourage client completion. It is much smoother if clients take advantage of the carrier offer to complete CAA RxDC reporting requirement on their behalf, rather than going through the process independently.
    • A sample Outlook template (example of verbiage some Producers are using in client communication to support Highmark outreach) is available and can be easily modified to suit your messaging preferences. *Please email nfpbnga@nfp.com if you would like to request this Outlook template.
    • If clients choose to ignore this request or not comply by the specified deadline, please note that the carrier & NPF BNGA cannot intercede on their or your behalf.
  • We have requested additional details from the carrier to help determine where their CAA RxDC links were specifically routed per client and will work towards helping to track progress of this initiative. More resources will be provided as they are obtained.

View Highmark Update 

Prescription Drug Data Collection (RxDC) Overview 

Prescription Drug Data Collection (RxDC) Survey Worksheet 

 

How Highmark is Helping Participating Providers After Change Healthcare Cyber Event

Please see below statement and press release regarding Highmark’s commitment and assistance to their Participating Provider community.

View Highmark Update 

 

Reminder: Highmark’s Well360 Virtual Health Accessibility in 2024

Highmark relies on Producer Partners to help educate members on what benefits are at their fingertips and how to access them best. As Highmark makes a final push to redirect members to the new My Highmark App, the availability of these resources on that platform can help to keep Virtual Health accessibility front of mind to members. The standalone Well360 Virtual Health app and website can no longer be used to schedule virtual visits – it will only be accessible via the My Highmark App.

View Highmark Update 

 

2024 Highmark Brochures and Forms

2024 Blue Plans – Network Listing and Maps  

2024 Enrollment Form  

2024 Member Change Form  

2024 Preventive Schedule – WPA  

BCBS My Highmark Member Activation – Find In-Network Providers 

Blue365 Flyer, BCBS  

BlueCard International Travel Flyer  

Copay Armor Member Flyer, BCBS  

Mental Well-Being Post-Enrollment Flyer, MyHighmark, BCBS 

Onduo Diabetes Management Post Enrollment Flyer, BCBS 

Sword Virtual Physical Care Member OE Brochure, BCBS 

Well360 Virtual Health Enhanced Flyer, BCBS 

 

February 2024 Updates:

 

Highmark Producer Portal’s New Password Requirements for Enhanced Security

As an advanced warning, you may be prompted to create new password when entering the Highmark Product Portal. Password parameters are now stricter and will need to adhere to the guidelines shown below. If you have questions or difficulties, contact the respective technology teams with the contact details provided.

View Highmark Update 

 

UPDATE: $0 in HSA Fees for New and Existing Clients that Add HSA w Eff. Dates Prior to 6/30/2025

Highmark is currently offering options for $0 HSA administration to self-insured clients. They are extending the promotion further to include effective dates through 6/30/2025. If stepping into a Producer relationship with a current Highmark ASO client, or looking to shop an ASO client with Highmark in the near future, this offer can be beneficial.

View Highmark Update 

 

Changes & Upgrades to Highmark’s Employer Portal

Highmark is seeking Producer assistance to spread the word regarding Highmark Employer Portal changes.

  • The former client portal experience is being replaced by the new experience enhancement.
  • An email template is provided for ease of communication to your Highmark clients & to introduce the advantageous features of the upgrade.
  • This change similarly affects Producers that utilize the portal, through Highmark Producer Portal Single Sign on, for the ‘Log-in As Employer’ capabilities.
  • If you are not currently utilizing this functionality but have interest in doing so, please reach out to your NFP BNGA Support Team.

View Highmark Update 

 

UPDATE: GLP-1 Receptor Agonist Metformin Autostep Removal

  • Changes are occurring for prescription drug management of GLP-1 (Gluacagon-Like Peptide-1 Receptor Agonist) that now require prior authorization.
  • This change occurred 1/1/2024 for new starts, but is now applicable to existing users effective 4/1/2024.
  • Impacted members are being issued notification from Highmark
    • Members with a diagnosis of diabetes were grandfathered through 9/30/2024 and will not receive a letter at this time.
    • Current mailing (early February) includes applicable members whose employer group renewals May through July 2024.
    • Further impacted members will receive notification on a quarterly basis.
  • Examples of Member & Provider Letter verbiage are included below.
  • The communication rollout plan outlined is applicable to fully insured groups.

Please reach out to your Highmark Service Manager or NFP BNGA Team for any specifics on an ASO client.

View Highmark Update 

 

January 2024 Updates:

 

Highmark Update – CAA Gag Clause Attestation Filing Update

  • Highmark’s follow-up guidance surrounding the Gag Clause Prohibition Attestation Requirements
  • Most Highmark clients through our General Agency channel fall under the category of Fully-Insured, for which Highmark attested on behalf of the client.
  • If a client is seeking confirmation of the attestation, it can be requested from their Highmark Client Service Manager. For assistance with any client specific request, please reach out to nfpbnga@nfp.com. We ask that you provide the name of the group and Client ID in your email.

View Highmark Update 

 

 

December 2023 Updates:

 

SEPA: 2024 Large Group Quote Request Form Now Available

  • For those prospecting in the Large Market space, the new Request forms included will be required during the RFP process for the applicable Highmark Region of South Eastern PA (SEPA)
  • Enhanced capability of an eSignature has been added, for ease of completion.

View Highmark Update 

 

WPA-CPA-NEPA: 2024 Large Group Quote Request Form Now Available

  • For those prospecting in the Large Market space, the new Request forms included will be required during the RFP process for the applicable Highmark Regions of
    • Western PA (WPA)
    • Central PA (CPA)
    • North Eastern PA (NEPA)
  • Enhanced capability of an eSignature has been added, for ease of completion.
  • Key plan design updates for the 2024 plan year are noted.

View Highmark Update 

 

 

 

October 2023 Updates:

 

Credible Coverage for Small Group Prescription Drug Design Notices in Western & Northeastern PA

Please see below applicable to Highmark Western PA and Northeastern PA Regions (file as both Blue Cross & Blue Shield).

View Highmark Update 

 

Credible Coverage for Small Group Prescription Drug Design Notices in Eastern PA – Central PA

Please see below applicable to Highmark’s Central PA Region (files as Highmark Blue Shield only).

View Highmark Update 

 

Well360 Clinical Programs with Size Requirements Lifted eff. Jan 1st 2024

  • Beginning 1/1/2024, ASO clients will no longer be prohibited by size restrictions for participation in four WellCare360 clinical programs.
  • See below for description of the effected programs that no longer carrier minimum size requirements.

View Highmark Update 

 

WealthCare Saver (Alegeus) New HSA High-Yield Interest option available

  • Highmark spending account vendor, Alegeus, introduces an additional interest earning option.
  • WealthCare Saver (Alegeus) Members will be alerted via their member website & mobile app, to make them aware and provide details for their account options.
  • Advantages surrounding interest earning ability & HSA management capabilities are listed below.
  • Members will remain in the traditional interest option for HSA cash balances until they opt into the High-Yield interest option on the member website.

View Highmark Update 

 

Re: Summer 2023 Producer Training Series Webinars

For those who may have missed Highmark’s Summer 2023 Producer Training Series or attended and are seeking follow-up resources, see below.

Recordings and Slide Decks are made available for each of the August sessions. In each course description, you will find any related market segmentation or region specification of importance highlighted for easy identification.

View Highmark Update 

 

Strategy and Opportunities Across PA – Webinar Discussion
October 12 at 9:00am

We welcome you to join Highmark Small Group Leadership, to learn more about strategy and opportunities throughout the state of Pennsylvania. This includes the following Highmark regions:

  • Western PA (WPA)
  • Northeastern PA (NEPA)
  • Central PA (CPA)
  • Southeastern PA (SEPA) *newly formed for 2024

Register via the link below. Please note that Highmark will provide the meeting link via email (to those that have registered in advance) on the morning of the webinar.

Register Here 

 

ASO Client File Feed Fee Structure is Changing for 1/1/2024

  • For Highmark ASO clients that are structured for electronic file feeds, the fee schedule for feed charges is changing effective 1/1/2024.
  • This change is only related to ASO – Administrative Services Only (self-funded) relationships.

View Highmark Update 

 

Mental Well-Being Program & Targeted Outreach Notice

  • Highmark has provided details on a recent partnership with SpringHealth, for Mental Well-Being, to take effect in client 2024 plan years.
  • For Producers with Highmark ASO (self-funded) clients – Groups will have the ability to opt out of these programs, but must do so within the allotted 10/19/2023 deadline.
  • Highmark will be issuing client emails for awareness of this program and the alternative to opt-out. Your ASO client may contact you with questions.
  • More details to follow for what this partnership will mean for Highmark fully-insured clients – please keep on the lookout.

View Highmark Update 

 

Large Group Quoting Requirements and Collateral

  • The included map of Highmark’s Service area is a useful resource in identifying varying Highmark Regions. This is key to determining the proper portfolio available, process, contacts and Producer Appointment status.
  • The refreshers outlined are all important reminders for 51+ business opportunities as we head into peak season
  • Although these resources/reminders are available to you, please remember that our NFPBNGA team is here to assist in the quoting process for this segment as well. We will assist to ensure there is proper appointment with the carrier & to help along the way in submissions and negotiations with the Highmark New to Blue Sales Representatives.

View Highmark Update 

 

September 2023 Updates:

 

Highmark and AHN to host virtual discussion on Cancer Care
October 4 from 9:00-9:30am

Highmark welcomes you to join in on the virtual discussion to learn about Allegheny Health Network’s transformative approach to Cancer Care. This session will benefit Producers with clients or prospects in the Western Pennsylvania Region.

Register Here 

 

Highmark released updated Grandmothered Small Group Policy Renewal Options for 2023-2024

View Grandmothered-Portfolio Brochure 2023 WPA – 2024 Update 

 

Highmark released an update regarding CAA Gag Clause Prohibition Attestation.

  • For this particular Consolidated Appropriations Act, 2021 (CAA) Gag Clause Prohibition provision, there are filing requirements to multiple enforcement agencies due December 31, 2023.
  • Highmark is taking steps on behalf of its fully insured clients.
  • Highmark clients with ASO coverage will be responsible for their own preparation & filings.

View Highmark Update 

 

Highmark released a notice regarding 2022 MLR Rebates.

  • Medical Loss Ratio (MLR) Rebates have been calculated for the 2022 plan year & are scheduled to be distributed to applicable Employer groups at this time.
  • As Insurers are required to notify impacted Employer Groups, Highmark has provided a sample of their communication strategy below.
  • In the upcoming week, your NFPBNGA team will provide a listing of Highmark group clients know to be receiving 2022 MLR rebates and communications from the carrier for small group (SG) and large group (LG).
  • Within our follow-up communication, we will provide a copy of the previously released NFP MLR Rebate White Paper for additional support surrounding employer obligations & considerations.

View Highmark Update 

 

Highmark announced a new policy regarding diabetes GLP-1 drug coverage.

  • Eff. September 15th, new users/new starts to these drug therapies are reviewed for a diagnosis of type-2 diabetes or a history of a different diabetes medication in pharmacy claims. Otherwise, they will be subject to prior authorization.
  • Highmark has issued communications to existing users & prescribers of impacted medications.
    • Those with a diagnosis of Type-2 diabetes, or a history of different diabetes medications in their claims history, will not be subject to prior authorization.
    • Members not meeting the above criteria will be subject to prior authorization as of November 1st.

View Highmark Update 

 

 

July 2023 Updates:

Highmark distributed an invitation to an in-person 2 Credit Continuing Education class.

  • Class will be held on Thursday, August 17th – Register here.
  • RSVP by Wednesday, August 9th.
  • Those attending should bring license number/national producer number.

 

 

 

 

May 2023 Updates:

Highmark to host an educational webinar about My Highmark, the digital experience for members:

  • Webinar to cover how clients can leverage rewards via My Highmark.
    • Scheduled for tomorrow, Wednesday, May 31 @ 10 AM.
  • Register here.

My Highmark – ACA & Small Group Member Activation:

  • New member web and app experience, as a replacement to their current member portal & Highmark Plan App.
  • Beginning June 1, all ACA & Small Group members will have access to My Highmark.
  • Members will be receiving texts / emails & may reach out for clarification.

2023 Incentive Reminder from Highmark:

  • Applies to Small Group & Large Group clients in PA, with effective dates 2/1/23 – 1/1/24.
  • Amounts as follows:
    • New to Highmark Group Medical
      Fully Insured – $100 per contract
      ASO w Rx – $50 per contract
    • Medical Underwriting Incentive
      Completed with FormFire – $7.00 per application
      Completed Paper Application – $1.00 per application
      Sold Medically Underwritten – $3.00 per application
    • Bundled Incentives
      High Performing Networks* – $3.00 per contract
      Stop Loss with HMIG – $2.00 per contract
      Spending Accounts – $2.00 per contract
      Dental (UCD or BED) – $1.50 per contract
    • Well360 Clinical Incentives**
      Well360 Clarity – $5.00 per contract
      Well360 Connect – $4.00 per contract
      Well360 Focus – $2.50 per contract
      Well360 Lifestyle – $2.00 per contract
      Well360 Concierge – $1.00 per contract
      SmartShopper – $0.50 per contract*Blue HPN, Choice Blue, Lehigh Valley Flex Blue, Performance (Flex) Blue and Together Blue
      **These clinical programs have group size requirements; please work with your Sales Executive for a quote!
    • This Incentive applies to Small Group (2-50) and Large Group (51+) clients in Pennsylvania.
    • Applies to effective dates February 1, 2023 – January 1, 2024.
    • All agencies qualify for the New to Highmark Incentive.
    • New to Highmark Incentive is a one-time payout, paid on sold contracts 60 days after the effective date.
    • Medical Underwriting incentive is only paid when Highmark Medical Applications are completed. If more than one producer submits medical applications for the same client, incentive is paid to the first producer to provide a complete submission.
    • Incentive is capped at $500,000 per agency, not to exceed $100,000 per client.
    • Incentive is contingent upon received and applied payment from the client.
    • Highmark reserves the right to recoup the incentive if the group cancels before their next renewal date, or if the business does not remain in place for one full year.

Highmark issues letters to members, correcting erroneous communication:

  • Letters were sent to enrolled members in error stating that providers and/or facilities were no longer considered in network.
  • Highmark is now manually inspecting files to avoid this mistake from happening in the future.

Highmark offers $0 HSA Admin Fees for one year:

  • Applies only to Self-Funded clients, with effective dates 3/1/23 – 1/1/24.
  • Only available to new HSA clients or existing clients with no spending account.

June 2023 Plan for Health Newsletter

 

 

April 2023 Updates:

Highmark Spring 2023 Producer Webinar Training Series has officially ended, and the carrier has released slide decks & recordings for each webinar.

  • Please see below “February 2023 Updates” section to view each deck & recording.

Highmark distributed the April & May 2023 Plan for Health Newsletters:

 

 

March 2023 Updates:

Highmark distributes CAA RxDC Reporting Survey:

  • Tri-state agency mandate requires reporting of prescription data for 2022 calendar year
  • Highmark’s deadline is Friday, April 21, 2023
  • Downline producers with Small Group Highmark business will be contacted by NFP BNGA for next steps

Highmark extends cost-share waiver plans through May 31, 2023

  • Public Health Emergency ends May 11, 2023

Highmark announces new 2023 New to Highmark Incentive:

  • Applies to Small & Large Group in PA
  • Effective dates February 1, 2023 – January 1, 2024
  • Amounts as follows:
    • New to Highmark Group Medical:
      • Fully Insured – $100 per contract
      • ASO w Rx – $50 per contract
    • Medical Underwriting Incentive:
      • Completed with FormFire – $7.00 per application
      • Completed Paper Application – $1.00 per application
      • Sold Medically Underwritten – $3.00 per application
    • Bundled Incentives:
      • High Performing Networks* – $3.00 per contract
      • Stop Loss with HMIG – $2.00 per contract
      • Spending Accounts – $2.00 per contract
      • Dental (UCD or BED) – $1.50 per contract
    • Well360 Clinical Incentives:
      • Well360 Clarity – $5.00 per contract
      • Well360 Connect – $4.00 per contract
      • Well360 Focus – $2.50 per contract
      • Well360 Lifestyle – $2.00 per contract
      • Well360 Concierge – $1.00 per contract
      • SmartShopper – $0.50 per contract
  • Incentive details:
    • This Incentive applies to Small Group (2-50) and Large Group (51+) clients in Pennsylvania.
    • Applies to effective dates February 1, 2023 – January 1, 2024.
    • All agencies qualify for the New to Highmark Incentive.
    • New to Highmark Incentive is a one-time payout, paid on sold contracts 60 days after the effective date.
    • Medical Underwriting incentive is only paid when Highmark Medical Applications are completed. If more than one producer submits medical applications for the same client, incentive is paid to the first producer to provide a complete submission.
    • Incentive is capped at $500,000 per agency, not to exceed $100,000 per client.
    • Incentive is contingent upon received and applied payment from the client.
    • Highmark reserves the right to recoup the incentive if the group cancels before their next renewal date, or if the business does not remain in place for one full year.

Highmark releases March 2023 Plan for Health Newsletter:

 

February 2023 Updates:

Corrected Highmark WPA Brochures – Digital Files:

Updated WPA Small Group Sold Checklists:

Highmark Spring 2023 Broker Webinar Training Series:

 

January 2023 Updates:

Highmark released a Mental Health Parity (MHP) 2023 Compliance Update:

  • Effects business in DE, PA & WV
  • Impacts urgent care, out-patient diagnostic services & therapy services (physical medicine, occupational therapy, speech therapy)
  • Updates are effective upon renewal January 1, 2023 forward, for all fully-insured clients

Highmark released their February 2023 Plan for Health Newsletter.

December 2022 Updates:

November 2022 Updates:

  • November 2022 “Plan for Health” Newsletter
  • December 2022 “Plan for Health” Newsletter
  • Pharmacy network update:
    • Kroger intends to terminate their agreement for network participation with Express Scripts effective 1/1/2023
      • Not many Krogers in our area but applies to business in DE, NY, PA & WV
    • Highmark is proceeding as if the contract is terminated but will update if that changes
    • Change will impact members within Highmark’s Commercial, ACA, & CHIP business
      • Members will receive a mailing

  • Highmark 2023 Experianfor Small Groups:

    • No-cost identity protection services to all eligible plan members
    • Employers who opted in to identity protection services in 2022 will be automatically renewed through Experian for 2023
    • Employers opting in for the first time in 2023 should do so through the portal at highmarkbcbs.com
      • Open enrollment period is now – December 31
      • Groups should enroll & notify their employees to enroll by December 31

October 2022 Updates:

September 2022 Updates:

August 2022 Updates:

Investment account changes:

  • 3 different investment options – Managed, Self-Directed, & Brokerage
  • Effective 8/1/2022 – all HSA members who do not have an investment account are being directed to new investment solution
  • Effective 9/21/2022 – HSA members who do have a current investment account will have funds liquidated & moved to their HSA cash balance account
  • Effective 10/3/2022 – liquidation of all member investment funds will be completed
  • FAQ for Blue Cross Blue Shield (PA)

Back by popular demand: Producer Training Series – Summer 2022 Edition

  • 30-60 minute training sessions to provide up-to-date information
  • Fully Insured Clinical Management – Monday, August 29, 2022 @ 11:00 AM
    Description: Join our clinical management team to learn about the Well360 Core clinical solutions available to all fully insured members including Proactive Specialty Case Management, the Integrated Care Team, and our Type 2 Diabetes Management. Information will apply to fully insured all market segments for clients in PA, DE, WV, and NY.
    Registration Link: Click for Fully Insured Clinical Management
  • Producer Portal – Enrollment & eBill Demo – Monday, August 29, 2022 @ 1:00 PM
    Description: The enGen team will be providing a demo of the enrollment and billing functions accessed through the producer portal. This information will apply to fully insured clients in all market segments in PA, DE, WV, and NY.
    Registration Link: Click for Producer Portal – Enrollment & eBill Demo
  • ASO Clinical Management Solutions – Part I – Tuesday, August 30, 2022 @ 9:00 AM
    Description: Join our clinical management team to learn about Well360 Core for ASO, Well360 Lifestyle and Well360 Focus. New for 2023 – these programs will be available to ASO clients with 250+ contracts. Learn how these clinical solutions enhance engagement opportunities for members with emerging risk and prevalent conditions. Information will apply to ASO clients in PA, DE, WV, and NY.
    Registration Link: Click for ASO Clinical Management Solutions – Part I
  • ASO Clinical Management Solutions – Part II – Tuesday, August 30, 2022 @ 10:00 AM
    Description: An opportunity to continue the Clinical Management conversation with a deep dive into Well360 Connect and Well360 Clarity. These programs integrate member advocates with our multidisciplinary clinical team and even member engagement guides to deliver proactive member engagement and guided care navigation that drive optimal health outcomes and near-term cost savings. Information will apply to ASO clients in PA, DE, WV, and NY.
    Registration Link: Click for ASO Clinical Management Solutions – Part II
  • Beneficity – Thursday, September 1, 2022 @ 11:30 AM
    Description: Join our client advising team to learn about Beneficity. Beneficity will be available to large national and strategic clients beginning January 1, 2023, and available for clients with Well360 Concierge, Well360 Connect and Well360 Clarity. Beneficity is a single place to access benefits, personalized tools and even links to programs and offerings provided by the employer. It is an easy place to go for total health. The app makes it easy to stay on top of benefits and coverage right from a phone.  Check claims, view ID card or find a provider, connect to a virtual visit or a health coach. It allows members to easily access many employer-sponsored benefits for physical health, financial health, and wellness.
    Registration Link: Click for Beneficity
  • Individual ACA & Medicare – 2023 Product Overview – Tuesday, September 6, 2022 @ 12:00 PM
    Description: Join our federal markets team to learn about 2023 products and enhancements for Individual ACA and Medicare members. Information will apply to federal market members in the PA, DE, WV, and NY markets.
    Registration Link: Click for Individual ACA & Medicare – 2023 Product Overview
  • Specialty Pharmacy Transition – Wednesday, September 7, 2022 @ 10:00 AM
    Description: Join our pharmacy team to learn about the specialty pharmacy transition to Accredo coming January 2023. Information will apply to ASO clients, individual and SG ACA, as well as SG grandmothered clients in PA, DE, and NY.
    Registration Link: Click for Specialty Pharmacy Transition
  • Renewal Timelines & Expectations – Tuesday, September 7, 2022 @ 12:00 PM
    Description: Join members of our client management team to learn about renewal timelines and expectations to help prepare you for the upcoming business session! This webinar will be geared toward 51+ business in PA.
    Registration Link: Click for Renewal Timelines & Expectations

July 2022 Updates:

Highmark to provide guidance & support to customers in light of Roe v Wade legislature – updates to come.

UnitedConcordia & Blue Edge Producer Incentive Program:

June 2022 Updates:

Click the links below to access Highmark WPA commonly used forms:

Click here to access a Highmark Portal Training Guide.

Behavioral Health with AHN & Highmark Webinar Recording available here.

Spring 2022 Updates Webinar Info

Marketing Materials

Free Market Health – February 2022 Webinar

Highmark to Expand Pharmacy Program CoPay Armor, Effective July 1, 2022 – for select eligible self-funded clients

Highmark to adhere to Transparency Mandates in 2022 – more info here.

 

May 2022 Updates:

View region-specific marketing landing pages or microsites:

If you see a region above that you are not appointed for, please contact Cheranne Jurena with interest.

 

Highmark Behavioral Health Client Brochure

 

Recently Archived Updates:

Highmark to Offer New Specialty Pharmacy Program – Sempre Health, Effective July 1, 2021

Highmark Press Release:  Highmark Medical and Pharmacy Benefits Integration Lowers Costs, Improves Health Outcomes

Highmark Extends Coverage of COVID-19 treatment and Telemedicine – Press Release

Visit Highmark’s FAQs page

Notice of Risk Corridor Medical Loss Rebate to Small Group clients and Individual Market members

Important Update regarding OOA/OON Radiology and Cardiac Imaging

Highmark Value Added Benefit Announcement – College Tuition Benefit
This college savings program is now available to Medical (Mid/Large fully-insured & ASO in PA, DE & WV) and BlueEdge Dental (Small/Mid/Large clients in PA & DE).

Highmark and HealthNow New York receive Affiliation Approval

Living Health Dynamic Platform update: Verily collaboration announced

No Action Required: Clients being notified of PLHIGA

Highmark HPN: Performance (Flex) Blue Webinar – session focused on the Southern Alleghenies Region (Recorded Webinar)

Highmark Member Brainshark: The Highmark Plan App

Highmark Member FAQs related to COVID-19 Vaccine & COVID-19 Vaccine Flyer