Highmark Blue Cross Blue Shield Latest Updates

 

 

September 2023 Updates:

 

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.

For more information, see the 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.

For more information, see the 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.

For more information, see the 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.

June 2023 Updates:

Highmark distributed the July 2023 Plan for Health Newsletter:

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