Author Archives: jtdickerson

New Bluechoice Pharmacy network!

31 Aug , 2016,
jtdickerson
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Earlier this week, we learned that the Bluechoice Pharmacy network for all marketplace plans would change to the Advanced Choice Pharmacy Network, effective October 1st 2016.

Bluechoice Pharmacy network

Bluechoice Pharmacy network is changing!

What does this mean for you? The BIGGEST change we expect most members to notice, effective October 1st 2016 is that Rite-Aid and Walgreens pharmacies will NO LONGER be IN NETWORK.

From the press release:

Effective October 1, 2016, all Blue Option individual and family plans under the Affordable Care Act (ACA) will be covered by the Advanced Choice Pharmacy Network. This is an exclusive pharmacy network impacting current members, as well as members with new plans sold with effective dates October 1 and beyond. Exclusive pharmacy networks are a necessary step toward controlling prescription drug cost increases that continue to trend upward.

We want to make sure our members understand their health plans and get the most out of their pharmacy benefits. The new network of pharmacies includes CVS, Costco, Kmart, Long’s Drugs, Target, Walmart — as well as grocer pharmacies such as Bi-Lo, Food Lion, Harris Teeter, Ingles, Kroger, Winn-Dixie and Publix — and many others.

It is important to note, however, that Walgreens and Rite-Aid are not in the Advanced Choice Pharmacy Network. We will not cover prescription drugs purchased out of network.

If a member is currently using a pharmacy that will be out of network effective October 1, our customer service team is ready to help them transition to a network pharmacy. Beginning this week, Caremark will send letters to members who have filled a prescription at one of the non-network pharmacies in the past six months. View a sample letter.

View the list of pharmacies in the Advanced Choice Network.

The list of network pharmacies will be updated on www.BlueOptionSC.com on the day the change goes into effect.

Have questions? Feel free to call, comment, email or tweet us!

 

New Bluecross South Carolina pharmacy network!

Aug , 2016,
jtdickerson
one comments

Earlier this week, we learned that the Bluecross South Carolina Pharmacy network for all marketplace plans would change to the Advanced Choice Pharmacy Network, effective October 1st 2016.

Bluecross South Carolina Pharmacy network

Bluecross Pharmacy network is changing!

What does this mean for you? The BIGGEST change we expect most members to notice, effective October 1st 2016 is that Rite-Aid and Walgreens pharmacies will NO LONGER be IN NETWORK for the Bluecross South Carolina pharmacy network.

From the Bluecross Blueshield South Carolina pharmacy network press release:

Effective Oct. 1, 2016, all BlueEssentialsSM individual and family Affordable Care Act (ACA) plan members must fill prescriptions at a pharmacy in the Advanced ChoicePharmacy Network. This will impact current members, as well as members with new plans sold with effective dates of Oct. 1 and beyond. Exclusive pharmacy networks are a necessary step toward controlling prescription drug costs that continue to trend upward.

We want to make sure our members understand their health plans and get the most out of their pharmacy benefits. The new network of pharmacies includes access to CVS, Walmart, Sam’s Club, Costco, Kroger, Publix, K-Mart, Long’s Drugs, Bi-Lo and Winn-Dixie pharmacies plus various other grocers and independent pharmacies.

It is important to note, however, that Walgreens and Rite-Aid are not in the Advanced Choice Pharmacy Network. We will not cover prescription drugs purchased out of network. If a member is currently using a pharmacy that will be out of network effectiveOct. 1, our customer service team is ready to help them transition to a networkpharmacy. Beginning this week, Caremark will send letters to members who have filled a prescription at one of the non-network pharmacies in the past six months. Caremark is an independent company that provides pharmacy benefits management on behalf ofBlueCross. View a sample letter.

View the list of pharmacies in the Advanced Choice Network.

The list of network pharmacies will be updated on www.SouthCarolinaBlues.com prior to the change going into effect. As always, we encourage members to log in to My Health Toolkit® for the most up-to-date list of in-network pharmacies.

Aetna/Coventry to stop selling Obamacare plans in South Carolina

17 Aug , 2016,
jtdickerson
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Per a recent press release, Aetna will discontinue offering health insurance plans on the Federal marketplace (healthcare.gov) in South Carolina for 2017. As reported by the Charleston Post and Courier, this is expected to impact approximately 8,000 South Carolina residents.

Currently, Aetna offers coverage in 14 counties – including the Charleston Tri-county area, a handful of counties in the midlands, Greenville county in the upstate, as well as York and Lancaster counties on the SC/NC border. For the current 2016 plan year, Aetna/Coventry discontinued offering plans in Lexington and Spartanburg counties.

If you are currently enrolled in a marketplace plan with Aetna/Coventry, DON’T WORRY, WE CAN HELP! Current enrollees will be covered until December 31, 2016, and will have the opportunity to select a new plan during open enrollment, beginning November 1st 2016. We can help you select a new plan – please call 843-882-7062 to setup an appointment. You can also view all marketplace plan 24/7 on our website by CLICKING HERE. Be sure to make your new plan selection by December 15th to ensure new coverage effective January 1, 2017. However, we do anticipate an Special Enrollment Period for current Aetna enrollees to make a plan selection up until December 31, 2016 for a January 1st 2017 effective date. Contact us to learn more!

Stay tuned to www.SChealthconnector.org for more late breaking health plan information!

 

 

Breaking News: South Carolina 2017 Health Insurance Rate Increases

10 Aug , 2016,
jtdickerson
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Breaking News!

Based on information posted at https://ratereview.healthcare.gov we now have information available on requested rate increases for South Carolina marketplace health insurance plans. Please note, that at this time, rate requests are NOT approved and final rate change requests have NOT yet been approved. Therefore, it is important to point out that these numbers are subject to change pending review by the SCDOI (South Carolina Department of Insurance), the HHS (Department of Health and Human Services) and/or CMS(Centers for Medicare & Medicaid Services).

Stay tuned for our in depth analysis of these requested rate increases!

www.SChealthconnector.org is your #1 source for South Carolina health insurance news & FREE open enrollment assistance!

Current submitted individual rate requests:

 

Company NameSorted ascending, select to sort descending Issuer IDNot Sorted. Select to sort ascending Product NameNot Sorted. Select to sort ascending Date SubmittedNot Sorted. Select to sort ascending Requested Rate IncreaseNot Sorted. Select to sort ascending Effective DateNot Sorted. Select to sort ascending Final Rate IncreaseNot Sorted. Select to sort ascending StatusNot Sorted. Select to sort ascending
Aetna Health Inc. (a PA corp.) 38408 HMO On-Exchange – CB – Individual – 38408SC001 05/06/2016 27.17% 01/01/2017 Not Available Submission Filed
Blue Cross and Blue Shield of South Carolina 26065 Blue Cross Blue Shield, a Multi-State Plan – Individual – 26065SC040 05/11/2016 13.98% 01/01/2017 Not Available Submission Filed
Blue Cross and Blue Shield of South Carolina 26065 BlueEssentials – Individual – 26065SC038 05/11/2016 14.74% 01/01/2017 Not Available Submission Filed
Blue Cross and Blue Shield of South Carolina 26065 BlueEssentials Catastrophic – Individual – 26065SC039 05/11/2016 3.09% 01/01/2017 Not Available Submission Filed
BlueChoice HealthPlan of South Carolina, Inc. 49532 MyChoice Advantage – Individual – 49532SC038 05/11/2016 14.36% 01/01/2017 Not Available Submission Filed
Cigna Health and Life Insurance Company 54362 SC_IND_Open Access Plus – Individual – 54362SC001 05/27/2016 14.68% 01/01/2017 Not Available Submission Filed
Freedom Life Insurance 80431 SC EHB FLIC – Individual – 80431SC020 06/06/2016 17.37% 01/01/2017 Not Available Submission Filed
Freedom Life Insurance 80431 SC EHBC FLIC – Individual – 80431SC021 06/06/2016 17.37% 01/01/2017 Not Available Submission Filed
National Foundation Life Insurance 94608 SC EHB NFL – Individual – 94608SC030 06/06/2016 17.37% 01/01/2017 Not Available Submission Filed

Bluechoice SC Implements a Musculoskeletal Care Management Program

9 May , 2016,
jtdickerson
one comments

The following is a late breaking announcement from Bluechoice Healthplan of South Carolina:

Effective immediately, BlueChoice HealthPlan is implementing a Musculoskeletal Care Management (MSK) program. This program requires prior authorization for two components of non-emergent MSK:
Outpatient interventional spine pain management services
Inpatient and outpatient lumbar and cervical spine surgeries.
Why are we offering this service?

The estimated financial costs related to musculoskeletal pain is currently $874 billion, exceeding the cost of heart disease, cancer, or diabetes. BlueChoice® decided to implement this program to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.

What do members have to do?
Members who receive any of these services on or after May 1 will need to make sure their providers get prior authorization. BlueChoice has proactively reached out to our providers to educate them about the process. Please note that only outpatient procedures require prior authorization. All interventional pain management procedures performed in the emergency room or as part of inpatient care do not require prior authorization.

National Imaging Associates (NIA) Magellan Healthcare Inc. will manage the advanced imaging program. The interventional pain procedures are part of that program. NIA Magellan Healthcare Inc. is an independent company that provides utilization management services on behalf of BlueChoice. BlueChoice currently use NIA to manage pre-certifications for imaging services like positron emission tomography (PET) scans and magnetic resonance imaging (MRI). This program will be an extension of those services.

 

Blue Cross South Carolina Tobacco Cessation Information!

2 Mar , 2016,
jtdickerson
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March is here, which means we’re two months in to our New Year’s resolutions and goals! We suspect that you have goals to live healthier lifestyles! In many cases, the first step toward a healthy lifestyle is to give up bad habits like smoking.

As you know, smoking can lead to numerous complications and preventable deaths. Are you ready to help stick to your New Year’s resolutions? We’re ready and we’re here to help!

Who it Covers:
The Affordable Care Act (ACA) mandates coverage of tobacco cessation products for members participating in non-grandfathered plans purchased after March 23, 2010. This coverage is already in effect for members with grandfathered plans purchased before March 23, 2010 and ACA plans.

Please note: Product coverage applies to BCBS-SC Individual and Group plan holders.

How it Works:
BlueCross Blueshield of South Carolina will cover certain tobacco cessation products at zero ($0) member cost share . BCBS-SC developed the program based on accepted national smoking cessation treatment guidelines. Members participating in non-Marketplace plans will need to request prior authorization for coverage of these drugs in order to promote the safe and cost-effective use of the available therapies.

The tobacco cessation drugs covered at zero member cost share ($0) are:
Prescription-only bupropion 150mg (generic Zyban)
Prescription-only Chantix
Prescription-only nicotine nasal spray or inhalers (ex: Nicotrol NS and Nictorol inhaler)
Over-the-counter (OTC) nicotine patches/transdermal systems (ex.: Habitrol OTC and Nicoderm CQ OTC)
OTC nicotine gum (ex.: Nicorette gum OTC)
OTC nicotine lozenges (ex.: Nicorette lozenge OTC and Nicorette mini lozenge OTC)
Requirements for Coverage
Member must be 18 years old
Coverage for Chantix, prescription-only nicotine nasal spray or nicotine inhaler require members complete unsuccessful trial or experience an adverse reaction during the trial of both of the following products:
Bupropion 150mg
One of the available OTC nicotine replacement products (note: OTC nicotine trial must be documented in prescription history)

Length of Treatment:
BCBS-SC will limit prescription fills for any of these products to a 30-day/one-month supply at a time. The maximum is 90 days/three months per approval. When appropriate, members can request reauthorization to continue treatment for an additional 90 days/three months of therapy. This cannot exceed two 90-day/three-month periods of smoking cessation therapy per 365 days/12 months.

Tobacco Cessation Counseling:
Quit rates are highest when you pair tobacco cessation counseling and nicotine replacement therapies together. BlueCross Blueshield of South Carolina health coaches use motivational interviewing to help members decide when and how to quit. They will provide ongoing support to help members become tobacco free. Members with non-grandfathered plans can enroll by calling 855-838-5897, option 2. Members with ACA plans can enroll by calling 800-327-3183, ext. 25805.

Member Tools:
BlueCross Blueshield of SC members can find information about their pharmacy coverage for all drugs, including tobacco cessation, by logging into My Health Toolkit®. Under Benefits, they can select Prescription Drugs to see benefit coverage for a specific drug.

First premium payment deadline for February 1 coverage extended to February 12 for Aetna and CoventryOne on- and off-exchange SC members!

9 Feb , 2016,
jtdickerson
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South Carolina Aetna and CoventryOne on- and off-exchange members must take action to pay their first premium by February 12, 2016 to ensure their coverage is effective February 1, 2016.

The quickest, most efficient payment methods:
Members have several ways to make a payment, or to set-up recurring payments with electronic funds transfer (EFT) or credit / debit cards.

Over the phone Aetna plans 1-877-302-3862
Aetna Leap plans 1-844-289-4505
CoventryOne plans: To set up EFT payments 1-877-849-9690

To utilize the automated payment system 1-877-906-1282

Innovation Health 1-866-772-3862

OnlineAetna plans – Log onto Aetna Navigator®

CoventryOne plans – The online EFT authorization form is at My Online Service (online member portal).  The EFT authorization form must be manually completed and sent to billing. Mail to: PO Box 31210 Tampa FL 33631-3210

 

Blue Cross Blueshield of South Carolina extends ACA February payment deadline

4 Feb , 2016,
jtdickerson
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Payment Extension for Individual Affordable Care Act (ACA) Members

BlueCross BlueShield of South Carolina is offering members with an effectuation date of Feb. 1 a one-time extension to pay their binder payments (i.e., their first premium payments). Premiums must be paid by Friday, Feb. 12.

Bluecross Blueshield SC: 19% rate increase for Grandfathered Plans

29 Jan , 2016,
jtdickerson
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BlueCross BlueShield of South Carolina is applying a 19 percent rate increase for Under 65, grandfathered plans ONLY (plans and freestanding drug benefits that became effective before March 23, 2010). BCBS-SC 19% rate increase
Under 65, non-grandfathered plans (plans that became effective between March 24, 2010 and December 15, 2013) WILL NOT receive a rate increase.

BCBS-SC members will have FOUR options:

Keep their current health plan. Many members will find that keeping their current health plans will be the best option. By keeping their grandfathered plans, members can keep their larger network of doctors and all their current benefits.

Change benefits within their current health plans. As long as they stay within their plan types, members could lower their monthly premiums by changing their deductibles, out of pocket or coinsurance.

Please know that certain benefit changes could cause you to lose your grandfathered status. If members lose their grandfathered status, they must choose new Affordable Care Act (ACA) plans.

Shop on the Private Exchange. Members who want to make significant benefit changes but do not qualify for an Advanced Premium Tax Credit (APTC) have the option to shop for an ACA plan through the BlueCross Marketplace with the Special Enrollment Period (SEP) Qualifying Life Event (QLE) called “Loss of Minimum Essential Coverage.”

Note: Members moving from a grandfathered plan to an ACA plan will receive a new benefit period. Deductible carryover is not an option.

Members can visit www.SChealthconnector.org to quickly get a quote and compare new ACA plans to their current plans.

Shop on the Federally Facilitated Marketplace (Marketplace). Members who qualify for an APTC and want to make significant changes to their benefits have the option to shop through the Marketplace on their anniversary date, also known as their benefit period date.

 

BCBS-SC: CareOnDemand℠ now available to most members!

26 Jan , 2016,
jtdickerson
No Comments

Yesterday, Bluecross Blueshield of South Carolina (BCBS-SC) announced that a new telehealth service, Blue CareOnDemand℠ is now available to most group and individual members! Blue CareOnDemand is available to all Group and Individual members except Medicare Supplement and Business BlueSM Exclusive Upstate I members.

This is great news for Bluecross Blueshield of South Carolina members who purchased a health plan through the marketplace!

What is Blue CareOnDemand?

Blue CareOnDemand is a new telehealth offering from Bluecross Blueshield of South Carolina that gives allows members to connect to board certified physicians and other licensed healthcare professionals 24 hours a day, 7 days a week, 365 days per year through video visits!

Accessing Blue CareOnDemand:

There are two ways for members to register and create their patient profiles:

Search “Blue CareOnDemand” on iTunes or Google Play and download the mobile app.
Visit www.BlueCareOnDemandSC.com from a desktop or laptop computer.
Once registered, members can log in to the mobile app or website as needed and consult with doctors through video visits.