Thursday, March 29, 2012

UHC designates Prescription Solutions for oral oncology medications

Beginning May 1, 2012, Prescription Solutions by OptumRx will become UnitedHealthcare’s specialty designated pharmacy provider for oral oncology medications prescribed under the pharmacy benefit. As part of this designation, UHC's contract with Walgreens Specialty Pharmacy will be terminated effective May 1, 2012. Members who fill their oral oncology prescriptions at Walgreens will be transitioned to Prescription Solutions by OptumRx.

This change only impacts members with a UnitedHealthcare commercial plan that includes the Specialty Designated Pharmacy Program. Most members will be transitioned to Prescription Solutions by OptumRx. This network change does not affect members with State of New York (Empire Plan), Community & State, or Medicare & Retirement plans.

UnitedHealthcare has prepared members for this change. Targeted letters and phone calls in March explained the change and provided instructions for transferring oral oncology prescriptions to a specialty designated network pharmacy. Members who choose to use Walgreens Specialty Pharmacy for oral oncology medications after May 1, 2012, may be using out-of-network benefits, and will be required to pay the full cost of their medications and seek reimbursement afterward.

UnitedHealth Group earns top ranking among health insurers

UnitedHealth Group earned the top overall ranking among health insurance and managed care companies, according to the March 19 Fortune article.  The selection was based on the following nine attributes: innovation, people management, use of corporate assets, social responsibility, quality of management, financial soundness, long-term investment, quality of products/services, and global competitiveness.

BCBSNC customer service support for transition to Prime Therapeutics

The Prime Therapeutics transition for BCBSNC will take place on Sunday, April 1st.  While BCBSNC does not expect there to be any issues with the transition, they plan to have customer service/phone support available on a limited basis.  Details are as follows:

·         On April 1, 2012, from 10 am – 7 pm, the Durham call center will be open to assist members with pharmacy issues.
·        The interactive voice response system will alert callers that BCBSNC is open to pharmacy issues only, and members that choose the pharmacy prompt will be routed to a customer service representative for assistance. 
·         A closed message will be received if a non-pharmacy prompt is selected.
·         Based on call volume, BCBSNC may elect to extend hours until 9 pm.

Tuesday, March 27, 2012

BCBSNC announces Health Innovation Challenge

Last week, BCBSNC announced the launch of their Health Innovation Challenge, which invites North Carolina's entrepreneurs, community leaders, citizens and university students to submit solutions to help reduce obesity across the state and increase the competitiveness of the North Carolina economy.

Applications will be accepted until April 16, 2012 and winners will receive mentoring and financial support to help implement their ideas.

For more information, view the press release or

Friday, March 23, 2012

Webinar on 5500 filing review

Senn Dunn invites you to participate in an Assurex Global webinar on April 26 from 3:00 to 4:30 PM EST.

Reserve your seat now at:

It’s the time of year when many employers with calendar year plans must file their 5500s.  While the requirement has been around for years, employers still have many questions regarding the filing rules.  This session will focus on health and welfare plan 5500 filing requirements (we will not be addressing retirement plans in this webinar).  We will review the basic filing requirements, but will also address typical areas of confusion and employer questions including:
  • Should you design your plans to file a single 5500 or separate ones for each benefit?
  • Why do some employers needlessly include Schedule C information with their welfare plan 5500?
  • Why are short plan years so dangerous?
  • What to do if you have made a mistake in filing a 5500
  • How to take advantage of the Delinquent Filer Voluntary Compliance Program (DFVCP) if an employer has not filed all required 5500s
    Please note: times for AG webinars vary and are listed for the Eastern time zone.
Presented by: Fritz Hewelt, Principal Consultant, Benefit Comply, LLC 
Fred W. (“Fritz”) Hewelt brings over thirty years of experience to his clients, assisting them with a broad range of issues related to the evaluation and remediation of employee benefit and human resource compliance challenges.  Fritz has also assisted numerous clients with welfare benefit plan due diligence in merger and acquisition situations.  Fritz holds a BS in Business Administration from Elmhurst College, Elmhurst, Illinois.  He also has earned designation as a Chartered Life Underwriter (CLU), a Certified Employee Benefits Specialist (CEBS) and a Fellow, Life Management Institute (FLMI).

Agencies release FAQs on SBC requirement of health reform law

On March 19th, the Departments of Labor, Health and Human Services (HHS), and the Treasury (the Departments) released Part VIII of their FAQs about implementation of the health reform law. The FAQs specifically addresses the Summary of Benefits and Coverage (SBC) requirements.  The agencies explain that the aim of the FAQs is to explain some of the questions that have been raised so far, but acknowledge that further FAQs will also be released.

Some of the key points include:
  • the effective date of the SBC requirements remains as the first open enrollment period that begins on or after September 23, 2012 and the first plan year that begins on or after that date (for enrollments occuring outside of open enrollment)
  • SBCs must be provided at the same time open enrollment materials are distributed
  • SBCs may be provided to a participant on behalf of a beneficiary
  • SBCs will not be required for different plan features (meaning that different coverage tiers and different plan designs may be included in a single SBC), provided the appearance is understandable
For more information on the SBC requirements, please refer to the FAQs and our previous posts on this topic:

Wednesday, March 21, 2012

BCBSNC recognized as one of the world's most ethical companies

Blue Cross and Blue Shield of North Carolina (BCBSNC) was recognized on March 15 as one of the World’s Most Ethical Companies in 2012 by Ethisphere Institute, a leading international ethics think-tank.  View the related press release for more information.

Thursday, March 15, 2012

UHC releases PDL video and newsletter with pharmacy updates

UnitedHealthcare has released the following video, showing how their prescription drug list (PDL) helps control costs.  You can also refer to UHC's Pharmacy InFocus newsletter for information on trend forecasts, an update on Hepatitis C and UHC's PDL.

UHC launches Healthy LifeCycles video series to promote health and wellness

As part of UHC's focus on empowering consumers through innovation, a series of videos called Healthy LifeCycles is available for UnitedHealthcare clients to use with their employees to help drive engagement. The 90-second videos exemplify UnitedHealthcare’s mission to help people live healthier lives by teaching them in a new and compelling way to use the information provided in each tip to manage their health and wellness.
A new video, including a health tip from an athlete on the UnitedHealthcare cycling team, will be posted each month.

The topics align with the national annual health and wellness concepts are seasonally relevant, and range from general health and wellness to exercise and fitness equipment.
  • Video 1: Smart eating, March
  • Video 2: Eating a healthy breakfast, April
  • Video 3: Exercise and arthritis, May
  • Video 4: Men’s health, June
  • Video 5: Sun safety, July
  • Video 6: Stress management, August
  • Video 7: Childhood obesity, September
  • Video 8: Breast cancer awareness, October
  • Video 9: Diabetes management, November
  • Video 10: Bike safety, December
  • Video 11: Weight management, January 2013
  • Video 12: Healthy heart tips, February 2013
Employers can post links to the videos on their intranets or include them in employee communications as appropriate.  Links to the videos will be available from UHC's websites, UHC.TV,, and in the Customer Connection newsletter each month.

Advance notice protocol announced for UHC commercial clients

With a goal of helping members make informed decisions and control their out-of-pocket healthcare costs, beginning April 1, 2012, participating physicians and other health care professionals are required to discuss with UnitedHealthcare members, prior to rendering services, the option to use a participating provider of the provider types or for the services listed below:
  • Ambulatory Surgery – free-standing and hospital outpatient settings
  • Home Health
  • Laboratory Services – for specimens collected in the physician’s office and sent to a non-participating laboratory for processing
  • Outpatient dialysis
  • Specialty drug vendors
The physician or other health care professional must also complete the Member Advance Notice Form and obtain the member’s signature on the form, prior to rendering services, to confirm the member’s decision to receive services from a non-participating provider. A separate Member Advance Notice Form must be completed for each provider type or service listed above. Members who have out-of-network benefits can continue to exercise their right to use their benefits at any time.

This protocol does not apply in emergent situations. Also, this protocol does not apply when the participating provider or member has obtained an in-network exception to utilize a non-participating physician, facility or other health care provider.

UHC releases redesigned EOB

UnitedHealthcare (UHC) is introducing a new Explanation of Benefits (EOB) design to help members more readily understand what their health plan and/or consumer account has paid on claims and how much they may owe their provider.

Currently the redesigned EOB is in an internal testing phase with a select group of early-adopter clients, with the intention to “go live” on March 26, 2012. The new design has been tested with member focus groups to determine how it can best improve the member experience.

By using more white space, clearer type and shaded boxes to highlight important information, the new EOB offers an “at-a-glance” claims summary that easily displays these critical elements to show “the math” on how the claim was paid and define what each means:
  • Amount Billed
  • Plan Discounts
  • Your Plan Paid
  • Total Amount You Owe the Provider(s)
In addition, the new EOB features a claim detail page that identifies the type of service rendered as well as itemized responsibility for items such as deductibles, copays, coinsurance and non-covered expenses.

Finally, an account summary is included that provides an up-to-date accounting of deductibles and out-of-pocket maximums for both the member and the covered family if the subscriber has dependents on his or her account.

Upon receipt of the EOB, members will clearly see the following statement: “This is not a bill. Do not pay. This is to notify you that we processed your claim.” Under that, they’ll find the shaded Claims Summary box with the important details highlighted.

For more information, view the EOB flyer.

Monday, March 12, 2012

Details on BCBSNC mobile website

Blue Cross and Blue Shield of North Carolina (BCBSNC) recently launched a mobile website that provides its more than 3.6 million customers with easy access to their health care information on the go. BCBSNC worked with Kony Solutions, a leading mobile platform provider, to develop and deploy the site.

What is BCBSNC Mobile and what does it offer?
BCBSNC mobile was created to help users (BCBSNC members and customers) find the information they need, when they need it.
The new mobile website features the ability for users to:
  • View claims (authenticated users)
  • See current plan benefit information (authenticated users)
  • Find a doctor
  • Get estimated treatment costs (authenticated users)
  • Find the closest urgent care centers (based on GPS location)
  • Find less expensive prescription drugs
  • Compare and shop for individual and family under 65 plans
  • Contact customer service
How does a user find and use the new mobile website?
Users can simply type into their mobile device. The new mobile website will automatically detect the device used and display accordingly. Members can then log in to the mobile website just like today on Non-logged in users can also use the new mobile website to shop for and compare health plans, find the closest urgent care center, find a doctor or find drug information.
What mobile platforms do we support?
BCBSNC currently supports:
  • Android (2.1 or later)
  • iPhone, iPod Touch, iPad (OS 3.0 or later)
In order for the urgent care navigator to work properly, users will need to have a device with GPS.

How can a user learn more about our mobile experience?
Users can learn more about the new mobile website or the current mobile app at

Friday, March 9, 2012

UHC pharmacy benefits update for July 1, 2012

The following UnitedHealthcare (UHC) Prescription Drug List (PDL) and benefit coverage updates will take place for Advantage and Traditional PDLs on July 1, 2012:

For Self-funded Customers:
Advantage PDL Updates
Traditional PDL Updates

For Fully Insured Customers:
Advantage PDL Updates
Traditional PDL Updates

Learn More at the March 14 Webcast

Fully Insured Registration Webcast
Self-funded Registration Webcast

Members taking select maintenance medications impacted by a change will receive a letter in June; lower cost alternatives may be listed.

BCBSNC launches

Since 2007, the number of individuals on HSA plans in the U.S. has grown by 153%, according to AHIP. But, despite being the fastest growing health plans, HSA plans (High Deductible Health Plans paired with Health Savings Accounts) still remain a mystery to many.

BCBSNC has released a website,, to help consumers understand HSAs.  Through 12 fun, engaging video animations, viewers receive an overview, learn how to use these plans, and experience various life scenarios and how their HSA play a role.

BCBSNC provides update on PPACA Uniform Coverage Documents requirement

The government ruling for complying with the Uniform Coverage Documents (UCD) project has moved to September 23, 2012 (the original date was March 23, 2012).   The regulations of this ruling are broken into 3 requirements:
  • The Standardization and the Provision of the Summary of Benefits and Coverage (SBC)
  • The Standardization and the Provision of the Uniform Glossary
  • 60-Day Notice of Material Modification
Effective September 23, 2012, each Summary of Benefits and Coverage (SBC) must include:
  • A description of the coverage
  • Exceptions, reductions and limitations of coverage
  • Cost-sharing provisions of the coverage
  • Renewability and continuation of coverage provisions 
  • “Coverage Examples”
This SBC must be provided at initial and annual enrollment.  Here are the major changes in the final ruling:
  • Regulations apply beginning September 23, 2012
  • Health plans are no longer required to disclose the premium amount on the SBC 
  • There is some flexibility with the template.  In general, the required SBC format and instructions must be followed.  However, if a particular plan cannot reasonably be described consistent with the template and instructions, the insurer or employer must use its “best efforts” to describe the relevant plan terms and conditions while following the requirements as much as “reasonably possible”
  • Employers and insurers in the group market are allowed to combine the SBC with other consumer materials as long as the SBC is displayed at the beginning of the materials
  • Electronic delivery of SBCs will be permitted in some situations, as long as paper copies are made available on request
  • Health and Human Services will provide templates in alternative languages (Spanish, Chinese, Navaho and Tagalog)

Thursday, March 1, 2012

BCBSNC releases 2011 finances

Today BCBSNC released their 2011 financial results.  Highlights include a net income margin of 3.2% and an overall membership exceeding 3.6 million members.  For more details, please see the full Press Release.