Your Texas clients need to understand your options when it comes to health insurance. With the changing landscape of healthcare, it’s essential for consumers to know if they are eligible for a Special Enrollment Period (SEP). It’s also important for your customers to understand their Aetna Medicare options in Texas.

A special enrollment period is a window of time outside of the annual Open Enrollment Period when a customer can enroll in a health plan. A qualifying event, such as the birth of a child, a move, or a change in employment typically triggers the SEP period.

The following are specific SEPs in Texas:

  1. Disaster SEP: If a customer is affected by a major disaster declared by the President, they may be eligible for a Disaster SEP.
  2. Medicaid/CHIP SEP: Medicaid and CHIP provide free or low-cost health coverage to eligible children in Texas. If a consumer is eligible, they may enroll in a Medicaid/CHIP SEP all year round.
  3. SEP for Indian tribes: If your client is a member of a federally recognized Indian tribe, they may be eligible for a SEP all year round.
  4. SEP for Alaska Native Claims Settlement Act (ANCSA) Corporations: If someone is an Alaska Native, they may be eligible for a SEP all year round.
  5. General SEP: This SEP is available to individuals who didn’t enroll during the Open Enrollment Period and are not eligible for any of the other SEPs listed above.
If your Aetna Medicare customers are eligible for a SEP, they may need to act quickly. You typically have 60 days from the event to enroll in a health plan.

If your customers are considering enrolling in an Aetna Medicare plan in Texas, they may be eligible for a SEP. Aetna offers a range of Medicare plans with different levels of coverage, so you can help them find the plan that best fits your needs.

Agility agents can access resources for selling Aetna Medicare plans here!

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

Blue Cross & Blue Shield of Texas: Medicare, Group & Retail

BCBSTX Expands Medicare Advantage Market Area, Choices As you may have just heard, Blue Cross and Blue Shield of Texas (BCBSTX) is increasing its footprint in the Medicare Advantage (MAPD) market. In addition to expanding the market area to 59 Texas counties, new MAPD products will be introduced.

 

 

Get Certified and Receive a Gift Card

In
recognition of your costs related to training and testing to become
Medicare Certified to sell our Blue Cross Medicare AdvantageSM and Blue Cross MedicareRxSM plans, we will provide a $50 Visa Gift Card to agents who complete our required 2022 product certification no later than Sept. 1, 2021.
 

The gift card is not compensation for the sale or renewal of
any policy or enrollment. Supplies are limited to the first 5,000
agents.
 

To take advantage of this offer:

  • You must be a current resident licensed agent within the state of Texas to qualify.
  • No sales or marketing of 2022 Medicare plans is allowed until your annual Medicare certification is complete.
  • Only agents within our GA, NMO and directly-contracted channels are eligible.
  • Those under our TMO, EGA and preferred channels do not qualify.

Your time is valuable – we hope this small effort will help you complete our 2022 product certification by Sept. 1.


Group

Transparency in Coverage, Consolidated Appropriations Act: August Update

The Consolidated Appropriations Act of 2021, which includes the No Surprises Act, is the most significant health care law since the Affordable Care Act. The Transparency in Coverage Final Rule,
which imposes significant federal transparency obligations on
insurers, is one of the first of its kind. Both sets of requirements
impose significant requirements on health insurance issuers and group
health plans.
 

What you need to know: Review our update about the impact of the new Acts.


*A Change in 90-Day Supply Coverage to Apply for Some 2022 Pharmacy Networks

Based on the group’s pharmacy
network, some members may only have 90-day supply retail coverage at an
Extended Supply Network pharmacy starting Jan. 1, 2022.
 

The impact: The change applies to some Custom Fully Insured and Administrative Services Only (ASO) Large Group and National Accounts. Learn more about this supply coverage change and the advantages it offers.


*2022 Drug List Change for BCBSTX Pharmacy Custom Fully Insured Groups

Starting Jan. 1, 2022, and upon
renewal, BCBSTX will be moving our pharmacy benefit Custom Fully
Insured groups to the Performance drug list from the Basic or Enhanced
drug lists.
 

What to expect: The change applies to Custom Fully
Insured groups (Large Groups and National Accounts). There are some
exceptions to this change. Learn more about this drug list transition.


Deadline Approaching: MSP Data Collection Required via BAESM by Sept. 8

Next week, we will begin sending “reminder” emails to renewing groups
with 1-150 employees that haven’t provided their 2021 Medicare
Secondary Payer (MSP) information to us. The easiest way to provide this
information is via Blue Access for EmployersSM (BAE).

Action needed: Remind your groups to submit the required information by Sept. 8. Read the FAQs to get all the details.


*Blue DirectionsSM Offers Options for Employers of Varying Sizes, Join Aug. 24 Webinar

Blue Directions has three options
available to fit the needs of your clients, regardless of their size
or benefits administration needs. Available to groups with 51+
employees.
 

How it works: Join the Aug. 24 webinar to get the details.


Retail

American Rescue Plan SEP Ends Sunday

Resuming standard SEP enrollment.
The American Rescue Plan (ARP) Special Enrollment Period (SEP) is
ending Sunday, Aug. 15. Beginning Monday, Aug. 16, we’ll resume
standard SEP enrollment processes.
 

Suspending training requirements: This year,
writing producers selling off-exchange policies because of an SEP do
not have to affirm completion of the SEP training in order for them or
their agencies to be eligible for compensation. The suspension of SEP
training requirements is for plan year 2021 only.
 

Reference and resource tool: Our 2021 SEP training for off-exchange enrollment PDF is
a great tool to help you and your clients have a smooth enrollment
process. Although the training requirement has been suspended for plan
year 2021, we encourage you to save and use the training as a resource.


Reminder: Marketplace Automatically Lowering Premiums for Some Members

What’s changing: Last week,
we told you that Marketplace members who are eligible for premium tax
credits, but who haven’t updated their income information on healthcare.gov 
Leaving site icon
 since April 2021, will soon have their premiums reduced automatically. Lower premiums are a result of the American Rescue Plan Act Leaving site icon.

When? The premiums will be adjusted starting with September invoices, which are delivered mid-August.

Member communications: The Marketplace is notifying affected members by mail PDF.
We’re sending a notice of the billing change to affected members with
their September bill, delivered around mid-August. We’re also sending a
separate email to the same audience. The
billing insert
 PDF and the email share the same content.

Who’s affected: Marketplace members who will see lower premiums in September are those who:

  • Currently qualify for premium tax credits
  • Haven’t updated their household income data since April 2021, and
  • Haven’t opted out of receiving premium tax credits

Who’s NOT affected: Members who actively
redetermined during this SEP won’t be impacted; their premiums were
already adjusted. Also, members who opted out of subsidy payments won’t
see any changes. They can opt back in by updating their accounts via healthcare.gov Leaving site icon.

Are You Ready for Medicare AEP?
The Medicare Annual Enrollment Period (AEP) opens Oct. 15 and runs through Dec. 7.
 

Certification required: As a reminder, you must complete both the AHIP certification Leaving site icon and Blue Cross and Blue Shield of Texas’ (BCBSTX) annual training 
Leaving site icon to begin marketing/selling our Medicare Advantage/PDP products.
 

Take advantage of Medicare training: In just
30 minutes, these webinars can help you prepare to sell Medicare, and
learn how to help clients select and enroll in a plan.
 

Next sessions:

  • Aug. 12 – Certify with BCBSTX
  • Aug. 17 – Virtual selling and DocuSign
  • Aug. 19 – BCBSTX Supply Portal
Help Small Group and Mid-Market Sales and Renewal Kits

Find all the tips, tools, forms and product information to sell or renew your Small (1-50) and Mid-Market (51-150) groups.
 

Next Small Group deadlines:
  • Oct. 1 renewals: paperwork is due Sept. 1
  • Nov. 1 renewals: paperwork is due Oct. 4
  • See all 2021 PDF due dates.
 

Why it matters:
The expansion increases access to and choice for new coverage options
for Medicare-eligible individuals throughout Texas and the growing
population of adults aging into Medicare. These changes will be
implemented for the Medicare Annual Enrollment Period, which opens Oct.
15.
 

  • Some of the new markets are located in rural and underserved areas.
  • Some new MAPD plans (HMO and PPO) include $0 premiums and enhanced benefits beyond traditional Medicare.   

More information coming: The expanded market
areas and new products will be discussed in detail during the upcoming
Producer Road Shows beginning in September. Watch for your invitations.

Get your BCBSTX Contracting Today >


Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

Aetna, CVS Health to enter the Affordable Care Act (ACA) individual insurance marketplace in Texas for January 1, 2022

This combines the health coverage of Aetna®, a CVS Health company, with local care at CVS Pharmacy®, MinuteClinic® and CVS® HealthHUB™ locations to deliver a quality, affordable health care experience.

 

WOONSOCKET, R.I., Aug. 4, 2021 /PRNewswire/ — Aetna and CVS Health (NYSE: CVS) will enter the individual insurance marketplace in Texas (specifically in select counties in the Austin, El Paso, Houston and San Antonio
markets) with the first Aetna CVS Health hybrid-branded insurance
product, providing access to health care for more Texans. Aetna and CVS
Health bring together quality along with convenience and expanded
services to meet consumer health needs, simply and affordably. 

“With the combined strength of Aetna and CVS Health, we’re uniquely
positioned to provide greater value for consumers, particularly the
millions of Americans who are uninsured or underinsured,” said Dan Finke,
Executive Vice President, CVS Health, President, Aetna. “We are taking a
human-centered approach to health care by connecting people to the
services and support they want – in their neighborhood, home and
virtually anywhere they need us.”

With these plans, members will have access to Aetna’s high-quality
network of health care providers and telemedicine services.
Additionally, the plan provides members with unique and convenient
health care offerings at MinuteClinic, HealthHUB and CVS Pharmacy
locations across the country.

Along with an enhanced direct enrollment experience via Aetna’s website, the plans feature:

  • No-cost or low-cost visits at any of the more than 50 MinuteClinic locations in Texas and over 1,100 MinuteClinic locations across the country.
  • Access to a Care Concierge at CVS HealthHUB locations, who is
    available to assist members by helping them navigate health care
    services and products.
  • 20% off select CVS Health Brand health and wellness products at any one of the 10,000 CVS Pharmacy stores. 
  • 90-day refills members can have delivered directly to their door for free.
  • Simplified member experience that lets members pay their premium at the store and manage their account with our mobile app or through the web.

“A key priority is providing people with access to the care they
need – simply, easily and affordably,” said Neela Montgomery, Executive
Vice President, CVS Health and President, CVS Pharmacy. “Whether it be
through our health plan, MinuteClinic, CVS HealthHUB, CVS Pharmacy or
any of our virtual care options, we are committed to helping simplify
health care and enable healthier outcomes.”

Additional CVS Health services include:

  • Added convenience with access to virtual care, including through MinuteClinic
  • Quality guidance and treatment for maternity care, as well conditions such as diabetes, hypertension, kidney disease
  • Help staying on track to better health with Pharmacy Advisor counseling and data-driven Next Best Actions or health nudges
  • Convenient, total health support with Destination Behavioral Health
  • Care in the comfort of the member’s home with Coram Home Infusion

The select Texas counties this new offering will be available in include Bexar, Brazoria, Comal, El Paso, Fort Bend, Galveston, Guadalupe, Harris, Hays, Kendall, Montgomery, Travis, and Williamson.

In addition to Texas, CVS Health is entering the individual exchange market in Arizona (Banner | Aetna), Florida, Georgia, Missouri, Nevada, North Carolina, Northern Virginia (Innovation Health) and Virginia.*

*Filings in each state are complete. Final approval to entry is pending state and federal reviews/certifications. 

About CVS Health

CVS
Health is the leading health solutions company, delivering care in ways
no one else can. We reach more people and improve the health of
communities across America through our local presence, digital channels
and our nearly 300,000 dedicated colleagues – including more than 40,000
physicians, pharmacists, nurses, and nurse practitioners. Wherever and
whenever people need us, we help them with their health – whether that’s
managing chronic diseases, staying compliant with their medications, or
accessing affordable health and wellness services in the most
convenient ways. We help people navigate the health care system – and
their personal health care – by improving access, lowering costs and
being a trusted partner for every meaningful moment of health. And we do
it all with heart, each and every day. Learn more at www.cvshealth.com.

About Aetna

Aetna,
a CVS Health business, serves an estimated 34 million people with
information and resources to help them make better informed decisions
about their health care. Aetna offers a broad range of traditional,
voluntary and consumer-directed health insurance products and related
services, including medical, pharmacy, dental and behavioral health
plans, and medical management capabilities, Medicaid health care
management services, workers’ compensation administrative services and
health information technology products and services. Aetna’s customers
include employer groups, individuals, college students, part-time and
hourly workers, health plans, health care providers, governmental units,
government-sponsored plans, labor groups and expatriates. For more
information, visit www.aetna.com and explore how Aetna is helping to build a healthier world.

 

ACA Contracting Available Here > 

 

News provided by


Aetna


Aug 04, 2021, 08:30 ET

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com