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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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Wellmark Names Blue Distinction Centers for Heart and Bariatric
Wellmark Blue Cross and Blue Shield of South Dakota has identified specialty centers for cardiac (heart) care and bariatric surgery (weight reduction) in Iowa as part of the Blue Cross and Blue Shield nationwide program, Blue Distinction. The facilities selected as national Blue Distinction Centers for cardiac care and bariatric surgery meet or exceed certain criteria that demonstrate reliability in delivering care and better overall outcomes for patients.
The criteria include nationally endorsed quality measures, developed in collaboration with medical experts and national organizations. Facilities selected for Cardiac Care must be accredited inpatient hospitals, provide a full range of cardiac services, and meet certain outcomes and volume requirements for specific procedures and surgeries. A Blue Distinction Center for Bariatric Surgery must be a full-service, accredited inpatient hospital that has been performing bariatric surgery for the most recent 18- to 24-month period, meeting a required volume of bariatric surgical cases. |
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Click here for a complete listing of Blue Distinction Centers in Iowa and South Dakota. For Blue Distinction Centers across the United States, visit www. bcbsa.com and select Blue Distinction. |
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New and Improved Employer Toolkit
Wellmark Blue Cross and Blue Shield makes it easier than ever to administer and manage your benefits. When you log into the Employer Toolkit on www.wellmark.com, you’ll notice some new and exciting changes, including:
- More user-friendly design
- Enhanced search functions
- Centralized ordering
With the Employer Toolkit, you can quickly and easily order Decisions Count,® WalkingWorks,® and other marketing materials to share with employees. Please note that the new toolkit requires a BlueConnection® log-in to view and download forms. |
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Not a registered user yet? Contact your Wellmark account team to get signed up today. If you are a Toolkit user, don’t forget to update your bookmarks. |
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New EOB Engages Employees in the Health Care Cost Equation
You can take steps to help your employees understand the cost of health care services — starting with education on our new, redesigned Explanation of Benefits (EOB). With the implementation of our new EOB, we want to give you tools for teaching employees how to read this document, and details on the important information it provides. The EOB exposes employees to health care costs and can help them take some of the guesswork out of their health care spending. By examining the charges listed on their EOB, employees can see that health care services cost more than a copayment or coinsurance amount. Each time an employee receives an EOB, they should:
- Compare charges on the EOB to the charges listed on the health care provider’s bill
- Make sure services listed on the EOB/bill were received
- Contact Customer Service about any discrepancies
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Order flyers and posters from the Employer Toolkit on www.wellmark.com to help teach your employees how to read their EOB. |
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Zoloft Moving to Tier 3
The antidepressant, Zoloft, is moving to the third tier of the Wellmark Drug List on November 1 because a generic option will be available . Encourage your employees to ask their physician if Zoloft’s generic equivalent — Sertraline — would be an effective alternative that would help save money. |
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Prilosec OTC Now Covered
Wellmark Blue Cross and Blue Shield now covers the over-the-counter drug Prilosec OTC for the cost of a generic copayment or coinsurance. Here’s how the program works:
- Members get a prescription for Prilosec OTC; no prior authorization is required. Other brand-name prescription proton
pump inhibitors (PPIs) require a prior
authorization after a 90-day supply is filled in a rolling calendar year.
- Members fill the prescription at a participating pharmacy.
- The pharmacist collects the member’s generic copayment or coinsurance.
Members who have filled a PPI prescription since January 2006 received a letter explaining the program and encouraging them to ask their doctor to call in a prescription for Prilosec OTC to a network pharmacy. Prilosec OTC is one-sixth the cost of brand-name PPIs. PPIs are a popular option for treating heartburn. |
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Medicare Part D Update: Creditable Coverage Deadline Approaches
November 15, 2006 is the annual deadline for employers who provide drug coverage to send creditable coverage notices to their Medicare-eligible members. The Centers of Medicare and Medicaid Services (CMS) require employers and unions that offer drug coverage to send a notice of creditable coverage to all Medicare eligibles annually, at a minimum. Coverage is creditable if the actuarial value of the coverage equals or exceeds the actuarial value of standard prescription drug coverage under Medicare Part D. Click on the following links for sample notices of Creditable Coverage or to download our Issue Brief:
Wellmark also provides a print and mail service at an affordable rate to assist groups with meeting the deadline. |
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Retiree Drug Subsidy Update: Applications for 2007 Given Extension
Plan Sponsors that will participate in the RDS Program for the 2007 plan year must submit a new application no later than 90 days prior to the start of the plan year. This means that for all groups with a January 1, 2007 effective date, subsidy applications were due October 1, 2007. The RDS recently updated Wellmark that all groups that started the application process prior to October 2, 2006 have automatically been granted a 30-day extension. |
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If your group has not started the application process, the RDS advises you to begin to do so and then apply for the 30-day extension. For more information on the Retiree Drug Subsidy and the application process, visit rds.cms.hhs.gov/. |
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Flex Changes Streamline Processes and Lower Administration Costs
In September, Wellmark made the following changes in a continuing effort to streamline processes and keep flex administration costs down:
- YTD statements are no longer sent quarterly as claims detail is now printed on the pay stub of each participant’s reimbursement check. Flex participants can access claim detail at any time through myflexonline.com.
- Generic enrollment kits will no longer include a reimbursement calendar; only those who enroll in a spending account will see a calendar in their confirmation statement.
- A stock of general information sheets (identifying specifics regarding the group’s plan) is now mailed along with the generic enrollment kits for the employer to distribute.
- For 1Q 2007, generic kits will no longer include the reimbursement form; a form is included with participant confirmation statements and can be accessed at any time through www.wellmark.com.
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Employer groups received a cover letter along with the general information sheets and kits explaining the change of process. |
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Wellmark Expands Provider Networks
Wellmark Blue Cross and Blue Shield is adding two new provider types to its already broad provider networks. Starting January 1, 2007, you can go to licensed professional counselors in mental health and licensed marriage and family therapists to receive behavioral health services that are covered under your health plan. |
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Licensed professional counselors in mental health and licensed marriage and family therapists who contract with Wellmark will be listed in the Doctor & Hospital Finder on www.wellmark.com starting on January 1. |
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Possible Network Change — Spearfish Regional Hospital
Over the past few months, Spearfish Regional Hospital and Wellmark have
been discussing our current hospital contract and possible alternatives that are acceptable to both organizations. If an agreement is not reached, Spearfish Regional Hospital’s contract will expire on October 31, 2006. This means that services received on or after November 1 at Spearfish Regional Hospital will be reimbursed at the non-network level. We are communicating this possible network change in a letter to your employees living in the Western part of the state who are Wellmark Blue Cross and Blue Shield of South Dakota members. |
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