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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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Personal Health Assistant 24/7 Enhancements
This spring, Wellmark is making two enhancements to Personal Health Assistant 24/7 that will make this around-the-clock phone health support service even more valuable to your employees.
Decision Support Enhancement
Additional decision support educational materials can be provided, if requested by the caller. Healthwise Knowledgebase, a well-respected industry leader for consumer educational materials, is the source of the written materials.
Decision support helps your employees make informed health care choices by providing support and information from the Personal Health Assistant 24/7 registered nurse. Decision support services include consultation on treatment options, preparation for upcoming doctor appointments, and assistance in exploring care options. The nurse does not make a decision on behalf of the caller, but provides information so the caller who is facing a treatment decision can make an informed decision.
ER/911 Enhancement
Based on information provided by the caller, the Personal Health Assistant 24/7 nurse will communicate with the caller’s primary clinician if a referral to the emergency room or a call to 911 is recommended by a program nurse. This enhancement is initially rolling out to Iowa and South Dakota clinicians. This outreach supports the medical home – the relationship members have with their primary clinician.
*Personal Health Assistant 24/7 is available to all fully insured groups at no cost and is a buy-up option for self-funded groups.
Promote Personal Health Assistant 24/7
Keep the Personal Health Assistant 24/7 program in front of your employees by ordering posters and flyers from the Employer Toolkit on www.wellmark.com. Select the Whole Dimensions Resource Center, then Promotional Materials/Personal Health Assistant 24/7. |
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Personal Health Assistant 24/7 marketing materials are available in both English and Spanish. |
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Wellness Stations Help Employees Engage in Health and Wellness
The Wellness Stations section of the Whole Health Dimensions Employer Resource Center provides pre-packaged kits to help educate employees on health and wellness topics. Check the Wellness Stations monthly for the latest kits:
- Build the Foundation focuses on the medical home concept and building a relationship with a health care provider for better health. It also encourages employees to complete their personal health assessments (PHAs).
- Get Your Heart Pumping includes tips on keeping your heart healthy through exercise and nutrition. It also provides the steps to access the Health & Wellness Tools section of www.wellmark.com. (The Health & Wellness Tools are available to all members 18 and older of fully insured groups and as a buy-up option for members of self-funded groups.)
- Food for Thought provides information on reading and understanding nutrition labels, as well as ways to eat healthy at the workplace.
- WalkingWorks® is Wellmark Blue Cross and Blue Shield’s initiative get Americans out walking. Materials include posters, stuffers, table tents, and newsletter articles to educate employees on the benefits of walking. It also provides information on starting a walking program at work.
Each station is divided into three sections:
- Learn More – background information and educational fact sheets and articles on the monthly topic.
- Create Awareness – suggestions for promoting a health or wellness theme to employees.
- Take Action – steps employees can take to help improve or maintain their health.
Look for these Wellness Stations in the coming months:
- May: Make It a Team Effort
- June: Provide Information
- July: Stay Hydrated
- August: Put Down the Latte and Muffin
- September: Think Ergonomically
- October: Reduce the Risk of Colds and Flu
- November: Let There Be Light
- December: Finding Work/Life Balance
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A few of the printed materials are available as PDFs only. You can download these PDFs from the Employer Toolkit on www.wellmark.com and print on your own, or have a print vendor print them for you. It is noted in the description of each piece on the Employer Toolkit if it is available as “Download Only.”
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Coverage to be Available for Vaccines Administered at the Pharmacy
Your employees will soon have another option for receiving vaccinations and immunizations.
Effective August 1, 2008, your employees can receive vaccinations at the pharmacy and have the service covered under their drug card benefits. Only vaccinations and immunizations currently covered under their health benefits are eligible for coverage at the pharmacy.
This enhancement will be implemented across-the-board for all fully insured plans except for groups that have a preventive benefit maximum as part of their health plan design. This program is not available for groups that have a preventive benefit maximum in place. In addition, groups must cover vaccines and immunizations under their health plan in order to cover them as part of their drug plan as well.
Self-funded groups will need to decide whether to add coverage for vaccinations and immunizations at the pharmacy. Self-funded groups must have drug card coverage with Wellmark.
Employees who receive vaccination and immunization services at the pharmacy will be responsible for paying a Tier Two cost-sharing for each immunization or vaccination received.
Vaccinations will be available at pharmacies that employ a pharmacist who is certified to administer vaccinations. Therefore, not all pharmacies that contract with Catalyst Rx will be able to provide vaccinations. In addition, hours that vaccinations are available may be different than the normal pharmacy operating hours. |
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Look for more information about this change in the August edition of NEWS FROM BLUE. |
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Pristiq to Require Prior Authorization
Pristiq, a new antidepressant which is chemically the same as Effexor XR, requires prior authorization by Wellmark Blue Cross and Blue Shield. Pristiq was recently approved by the FDA for the treatment of depression and is expected to be available by this month.
To encourage the use of established antidepressants, your employees need to try and fail a generic (Tier 1) and a preferred brand (Tier 2) antidepressant before coverage is available for Pristiq. The prior authorization is set up so that approval is not needed if the steps are followed and there is prior history in the claims system of the lower level drugs. Because this prior authorization was implemented before the drug was available, there is no need for communications to existing users. |
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New BluePrioritySM Flex Web Site
This month, Wellmark refreshed the Blue Priority Flex Web site www.wellmark.com/flex. The new site now offers tools, applications, and information needed to help employers and employees better understand their flex plans.
Employers can:
- Request a quote on flex plans
- View eligible expenses
- Calculate tax savings
- Compare flex plans
- Get answers to frequently asked questions
- Learn more about the new Blue Priority Flex debit card
- Manage group flex plans by viewing reports and downloading flex benefit forms
Employees can:
- View eligible expenses
- Calculate tax savings
- Track Flex Spending Account (FSA) expenses
- Find forms
- Fill out flex claims forms electronically
- View claims and flex debit card transactions
- Verify personal and benefit information
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Reminder: Date of Event Determines Cancellation Date
When submitting member cancellations (e.g., termination of employment, death, dependent marriage) via the Group Membership Change Form (M-53143) or on a prior month’s Group Statement, you should enter the actual date of the event rather than the expected cancellation date. By doing this, you will:
- Eliminate re-work.
- Reduce number of inquires from Wellmark.
- Speed member maintenance process.
Wellmark processes cancellation dates based on event dates. For example:
Date of Event |
Wellmark Receipt Date |
Wellmark Processed Cancel Date |
July 31 |
August 4 |
August 1 |
September 15 |
September 18 |
October 1 |
May 22 |
June 10 |
June 1 |
February 1 |
February 9 |
March 1 |
*When the event occurs the first day of the month, the member will be canceled the first day of the following month.
If Wellmark does not receive timely notification, cancellation effective dates will be limited to three months prior to the date Wellmark is notified.
Date of Event |
Wellmark Receipt Date |
Wellmark Processed Cancel Date |
May 10 |
September 10 |
July 1 |
October 1 |
January 20 |
November 1 |
June 1 |
December 1 |
October 1 |
Electronic Submissions
If you submit cancellations in BluesEnroll, please enter the reason for the benefit cancellation and the date of the event that caused your employee to lose coverage. The system will automatically apply the benefit end date based upon your group’s termination rules. Please verify the benefit cancellation date for each benefit available is accurate.
NOTE: This does not apply to groups submitting cancellations via Electronic Data Interchange (EDI) files.
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Please refer to your Enrollment and Administrative Guide for additional information on submitting cancellations.
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