We are excited to usher in the new year! Pretty soon, we will be sending out information on a new level funded carrier relationship as well as new stop-loss partnerships we are excited about. As a reminder, we can quote the following carriers and products:

  • Blue Cross
  • EMI
  • Allstate
  • Trustmark
  • Allied National
  • Nova
  • Gap (large group or with major medical)
  • MEC (large group or with major medical)
  • Limited medical

We can also do unbundled quotes for you as well.
January 2023 begins the launch of a new carrier with a different approach to health insurance
and engagement in AZ.

MotivHealth is changing healthcare by focusing on HSA-based insurance plans that produce lower premiums, better benefits, and the ability for employees to build significant health savings. Informed, engaged, and empowered clients are key to solving the high-cost issues of healthcare. Don’t worry, there are PPO Plan designs available too! MotivHealth has successfully done it for hundreds of employers with an average premium increase of less than 2%. MotivHealth will use Arizona Benefit Plans as the General Agent partner in Arizona and the Blue Cross Blue Shield of Arizona statewide network for connectivity to providers.

Look for more details from us in the coming weeks. Here are some teasers about cool stuff Motivhealt offers – embedded HSA administration that Motivhealth provides, a safety net advance program if an employee does not have enough money in their HSA account, and MotivU – a series of training programs online that pays employees and dependents when they participate. Here is a link to the MotivHealth website https://www.motivhealth.com/. Take a look, it has some cool stuff!
Our number one priority at Blue Cross® Blue Shield® of Arizona is ensuring our members have access to quality care and that it’s as affordable as possible. We are currently in negotiations with the following three groups, all of which have notified us they intend the leave the Blue Cross Blue Shield of Arizona network if an agreement is not reached. This impacts all lines of business, excluding Medicaid. Please note the out of network dates below.

  • American Vision Partners
  • Barnet Dulaney Perkins: 12/01/22
  • Retinal Consultants of AZ: 12/01/22
  • Southwestern Eye Center: 1/15/23
  • Genesis OBGYN (Pima county): 12/15/22
  • Yavapai Regional Medical Center: 12/31/22

As is the case with all provider negotiations, Blue Cross Blue Shield of Arizona is interested in reaching a fair and reasonable solution for all parties. We will continue to work with these groups in good faith to keep them in-network.
 
Members may be receiving notification letters if they have received care from the groups mentioned above in recent months. We will be sharing a similar message with employer groups and will share updates with you and impacted members if and when new developments arise.
 
Your broker support team is available to address any of your questions, and as always, customer service teams are here for members.
Hot of the presses – 2023 underwriting guidelines.


Pharmacy Announcement:
We have an IMPORTANT ANNOUNCEMENT regarding an upcoming change with Express Scripts that we encourage you to share with your groups! Express Scripts is reaching out directly with this information to members who have utilized Kroger facilities in the last year, but this would be a great opportunity to let your groups know for those who may be filling prescriptions in the coming months.
 
What is changing?
Starting January 1, 2023 prescriptions will not be covered by the group plan if filled at a Kroger pharmacy. This includes Smiths in Utah, Fry’s in Arizona and Fred Meyer in Idaho. If your members continue to fill prescriptions at a Kroger pharmacy, they may pay a higher cost for their medication as it will not be processed through their health benefit.
 
What Your Members Need to Do
To avoid any interruption in your member’s treatment, encourage them to transfer their prescription before January 1, 2023. Members can visit express-scripts.com/findapharmacy for a full list of in-network pharmacies. Please note that Kroger pharmacies will continue
to show as in-network pharmacies until 1/1/2023.

It’s easy for your members to move their prescriptions. Here are 3 ways to make the switch:
1.      Take your prescription bottle to your new pharmacy and they’ll contact your current pharmacy to transfer your prescription.
2.      Call your new pharmacy and ask them to transfer your prescription.
3.      Ask your doctor to contact your new pharmacy with your prescription information.
 
This is also a good opportunity to encourage your members to switch to Express Scripts mail order (home delivery), especially for their maintenance medications (diabetes, asthma, cholesterol, blood pressure, birth control, etc.).
 
I have also attached a sample of the letter being sent out to members who have utilized a Kroger pharmacy recently.
This past year has brought significant changes to our healthcare policies stemming from the Transparency in Coverage (TinC) Final Rule in 2020 and Consolidated Appropriations Act, 2021 (CAA). Allied has remained steadfast in its commitment to supporting our clients and prioritizing the needs of our members above all. We have made it our mission to ensure that each of our clients has the resources needed to comply with the law by delivering turnkey products and solutions.

To meet the Transparency in Coverage Rule requirements for an internet-based self-service tool, Allied will be launching a compliant transparency platform – Provider Finder, as part of our core product offering to all clients on January 1, 2023.

About the Transparency in Coverage Rule Requirement for a Self-Service Price Comparison Tool

The Transparency in Coverage Rule (finalized in November 2020) requires insurers and group health plans to create an online consumer tool that includes personalized information regarding members’ cost-sharing responsibilities for covered items and services. The tool must be an internet-based cost estimator tool to estimate personal cost-share liability and must:

  • Permit members to search based on billing code or description.
  • Allow members to compare costs across both in-network and out-of-network providers.
  • Inform members of any accumulated deductible or other out-of-pocket expenditures to date.
  • List any factors that impact the cost, such as service location.
  • Provide cost estimates in paper format at the member’s request.

Beginning with plan years on or after January 1, 2023, the cost estimator tool must disclose information on 500 items and services identified in the final rule. Starting with plan years on and after January 1, 2024, the tool must list all covered items and services.

Provider Finder: TinC Compliant Online Member Tool
Provider Finder will be an integrated and easy-to-use care and cost search tool for plan members that will meet all applicable TinC requirements. With the tool, members will be able to get real-time estimates of their cost-sharing liability for covered healthcare items and services from different in-network providers so they can shop and compare prices before receiving care. To access the tool, plan members will need to log into or register their Allied Member Portal account on alliedbenefit.com.

The compliant Provider Finder platform brings together:
  • Provider Search – Plan members can easily find the right care with multiple ways to search for network physicians or facilities.
  • Cost Calculator - Plan members can view personalized out-of-pocket cost estimates
and personalized cost information on their deductible status.
  • Patient Ratings & Reviews - Plan members can create, share, or read reviews and ratings on their personal experiences with physicians and facilities
The Provider Search feature is supported by PPO Network data. Members enrolled in a network-based plan will be able to search for providers in their plan’s network based on the directory data supplied by the PPO Network. As such, this feature is only available to plan members enrolled in a network-based plan. Members enrolled in a no-network plan, such as the ACP, MEC, or Health Choice, will not be able to search for providers as there is no directory data to support it at this time. Members in a no-network plan will still have full capability to conduct a cost search based on the billing code or billing code short description and obtain personalized estimates based on their benefits as required by The Rule.
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