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WELCOME TO NEWS FROM BLUE,SM CREATED TO HELP YOU BETTER MANAGE YOUR HEALTH PLAN BY KEEPING YOU UP-TO-DATE ON THE LATEST INFORMATION FROM WELLMARK BLUE CROSS AND BLUE SHIELD. NEWS FROM BLUE WILL BE E-MAILED TO YOU MONTHLY, AND ARCHIVED ON WWW.WELLMARK.COM.
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Changes to Health Management Programs
Pregnancy Care Program — Wellmark’s prenatal program is expanding to include all Wellmark Blue Cross and Blue Shield fully insured plans. Wellmark’s pregnancy program offers online access to valuable tools and information for moms-to-be to help them avoid pregnancy complications that may cause preterm birth or other poor birth outcomes. Members will be identified for the program through claims data, a clinician referral, or a self-referral. Members enrolled in Wellmark’s current Better Beginnings maternity program remain with that program through their pregnancy. Members filing new pregnancy-related claims in March roll into the new pregnancy care program.
Disease Management — The disease management program included with all fully insured plans is being enhanced to deliver even greater value to you and your employees. Plans include five disease management programs: asthma, diabetes, coronary (heart) artery disease, congestive heart failure, and chronic obstructive pulmonary disease (COPD). Impact conditions are available as buy-up options. |
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Keep reading News From Blue for more information on additional enhancements to Wellmark’s health management programs. |
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Late Fees Take Effect with March Billing Cycle
As a reminder, Wellmark begins assessing late fees on all premium payments received and posted after the fifth calendar day of the month, beginning with the March billing cycle. The late fee will be calculated at the prime rate (as published in the Midwest edition of The Wall Street Journal) plus two percent of the group’s monthly premium amount due. |
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Please note that in May and August the 5th falls on a weekend, and payments will be due on the Friday before. |
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Cost and Quality Tools Help Employees Become Better Health Care Consumers
Better health care decisions start with informed consumers. Wellmark Blue Cross and Blue Shield has two new cost and quality tools available through the Blue Cross and Blue Shield Association Doctor and Hospital Finder at www.bcbs.com.
Select Quality Care — Hospital quality data to help decide where to seek medical care.
Select Quality Care is an online tool powered by WebMD® Quality Services where employees can look up and compare data for 161 procedures or diagnoses for hospitals throughout the United States. Data includes the number of patients treated at the hospital for that procedure or diagnosis, the complications rate, and the length of stay.
Treatment Cost Estimator — Tool to research treatment costs.
Use the Treatment Cost Estimator to look up cost estimates for more than 600 common medical conditions and get information on a complete episode of care — e.g. hospital costs, physician costs, prescription drug costs, etc. The tool uses national claims data from Blue Plans, which means your employees can get nationwide pricing information and use it no matter where they live, work, or travel.
The tools can be accessed on www.wellmark.com, click on the Find a Doctor link under Quick Links; then click on National Doctor & Hospital Finder (BlueCard) in the left navigation. Once on the site, you will need to enter the three letter alpha prefix from your Wellmark Blue Cross and Blue Shield member ID card to continue. |
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Keep an eye out later this spring for Decisions Count® materials on these tools you can order from the Employer Toolkit on www.wellmark.com. |
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Prior Authorization Changes
Wellbutrin SR/XL — Effective March 15, 2007, the prior authorization criteria for Wellbutrin SR/XL is changing. Wellbutrin SR/XL is an antidepressant that can also be used for smoking cessation.
- If you cover smoking cessation as a benefit, a prior authorization will no longer be required
- If a member has filled a prescription for any antidepressant within the past 12 months, a prior authorization will not be required
Butorphanol (Stadol) Nasal Spray — Prior authorization is no longer required for butorphanol, which is used to treat pain. Utilization of this drug has decreased with the addition of newer drugs. Because the drug has a significant risk for dependence, a quantity limit of four bottles (10 ml. per month) remains.
Noxafil — Noxafil, an antifungal drug, now requires prior authorization to ensure appropriate use and decrease risk of resistance. |
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If your employees have questions regarding prior authorizations, they can call the customer service number listed on their Wellmark ID card.
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Treasury Releases Guidance Regarding Rollovers Into Health Savings Accounts (HSAs)
Recently, the Treasury Department released guidance regarding how employers can rollover their health Flexible Spending Account (FSAs) and Health Reimbursement Account (HRAs) to Health Savings Accounts (HSAs) for their employees. Tax Relief and Health Care Act of 2006, enacted in December 2006, allows employees to amend their health FSAs or HRAs, with balances on September 21, 2006, for a one-time rollover to an HSA by 2012. The guidance (Notice 2007-22) clarifies the requirements for these rollovers, which must be made directly to the custodian or trustee of the HSA. |
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Click here for complete information on the guidance.
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Wear Your Walking Shoes to Work on April 18th
On Wednesday, April 18, thousands of Americans across the nation will champion wellness by taking a 30 minute walk during their lunch break as part of National Walk@Lunch DaySM — an exciting, all-new workplace walking initiative brought to you by The Blues®! Along with encouraging walkers to wear athletic shoes to work, Wellmark will provide printable posters, tent cards, and awards, among other materials, to all
participating groups. Each walker will also receive a free giveaway item — compliments of Wellmark!
National Walk@Lunch Day is an extension of WalkingWorks,® a Blue company program created to help consumers live healthier lives and reduce unnecessary medical costs due to physical inactivity. The WalkingWorks program was developed in cooperation with the Presidents Council on Physical Fitness and Sports. |
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