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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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Late Fee Assessment to Fully Insured Groups
Beginning with the March 2007 billing period, Wellmark Blue Cross and Blue Shield will assess a late fee on all premium payments received and posted after the fifth calendar day of the month. The late fee will be calculated at the prime rate (as published in the Midwest edition of The Wall Street Journal) plus 2 percent of the group’s monthly
premium amount due.
A recent review of payment procedures showed that the majority of groups make timely payments — and some do not. Late payments are not consistent with group contracts and how rates are set; therefore, it leads to increased costs for all groups. Rather than increasing rates to all groups to accommodate those that pay late, Wellmark will begin
to assess a late fee for only those groups that pay late. This is the most equitable way to keep premiums as low as possible for all groups and is consistent with group financial agreements. |
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Information on the new late fee assessment was mailed earlier this month and is also available in the Employer News Section on www.wellmark.com. Contact your account manager or broker for questions or concerns regarding this payment process change. |
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Learn About Consumer-Directed Health Care
As medical costs increase, you may be asking your employees to pay more of the cost of their health care through higher deductible and copayment amounts. Consumer-directed health care (CDHC) plans can provide immediate cost relief to your health care budget, and help you achieve better fixed costs for your benefit plan. If you’re thinking about a CDHC plan, but not sure if it’s right for your small business, Wellmark Blue Cross and Blue Shield introduces a new Blue PrioritySM Solutions tool that can help you.
Blue PrioritySM Decision Center FLASH Movie
New on the Blue Priority Decision Center at BluePriority.wellmark.com, is a Flash movie that explains how a high-deductible health plan (HDHP) works with a health savings account (HSA), and smart strategies once opening an HSA. You’ll see “real-life” scenarios — both single (self-only) and family plans — to help illustrate how different health plan members can use and benefit from an HDHP paired with an HSA. The scenarios place an emphasis on:
- Health plan basics; what’s a “deductible” and how does it relate to health plan premiums and member cost sharing
- The flow of funds from an HSA or when paying medical costs out-of-pocket
- Exposure to health care costs, rather than the copayment or coinsurance members may be used to paying
- Account compounding, and the advantages of opening and maintaining an HSA over the long term
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Find out how to put Blue Priority Solutions to work for you. Talk with your account manager or broker today. Or call 888-232-2200, or visit www.wellmark.com. |
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Reminder: New Wellmark Drug List Changes
Several months of evaluation of clinical, safety, utilization, and drug alternative data resulted in changes to the Wellmark Drug List that were effective this month:
- Drugs moving from Tier 2 to Tier 3 because AB-rated generics are now available
- Drugs moving from Tier 2 to Tier 3 because therapeutically similar options are available on Tier 1 and/or Tier 2 and/or over-the-counter
- Drugs requiring prior authorization
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Wellmark Expands Its Provider Networks
Wellmark Blue Cross and Blue Shield has added two new provider types to its already broad provider networks. As of January 1, you can go to licensed mental health counselors and licensed marriage and family therapists to receive behavioral health services that are covered under your health plan. |
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Licensed mental health counselors and licensed marriage and family therapists who contract with Wellmark are listed in the Doctor & Hospital Finder on www.wellmark.com. |
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Upcoming Changes to Blue PrioritySM FLEX Invoices In addition to new Blue Priority branding for Flex in 2007, we’re continuing efforts to streamline our administrative processes and make it easier for you to do business with Wellmark Blue Cross and Blue Shield. Beginning January 2007, you’ll notice a couple of changes to Flex invoices:
- Format — The new invoice includes a tear-off stub that should be remitted with the invoice payment to ensure payments are applied accurately upon receipt.
- Timing — Invoices for both Flexible Spending Account (FSA) and Premium Only Plan (POP) groups will be prepared and mailed once a month — on approximately the 15th (a little later than expected for POP groups; a little earlier for FSA).
Timely payment on all invoices is important as it will help ensure uninterrupted service to all Blue Priority Flex participants. If timely payment is not received, participant reimbursements will be suspended until the full payment is made. Be sure to include the invoice stub along with your payment in the enclosed return envelope. This change in process will make it easier for you to submit timely and accurate payments that can be properly applied within the Wellmark accounting system. |
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If you have questions or need additional information on these changes, contact Wellmark’s Flexible Benefits department at (800) 624-2755. |
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New Coordination of Benefits (COB) Secondary Payer Policy
Effective January 1, 2007, Wellmark Blue Cross and Blue Shield will pay up to our provider allowance (e.g. Maximum Allowable Fee) when processing as the secondary payer for professional and facility services. This Coordination of Benefits (COB) calculation is changing to adopt National Association of Insurance Commissioners (NAIC) model law. Currently, Wellmark uses the higher of the two carriers’ allowance to determine liability as a secondary payer. The change brings Wellmark in line with industry standard, and should result in lower overall health expenses to groups, while having no impact on your employees’ claim liability.
Slightly different amendment forms apply to the Benefits Certificate and to the Coverage Manual. You’ll need to determine which document your group currently has, download it, and make copies to share with your employees.
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The amendment provides extensive details on rules of coordination and is part of the coverage contract. Your employees should retain it with their coverage document. |
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