No Rescission of Coverage
The Affordable Care Act (ACA) prohibits rescission of coverage under 45 CFR § 147.128 which under the regulations is termination of an individual’s coverage that is retrospective and not related to fraud or misrepresentation on the part of the individual. Once an individual is covered under a group or individual health plan, the plan, in most instances, may not rescind that individual’s coverage except in cases of fraud or misrepresentation. This legislation is applicable to employers as well as to carriers. This legislation is applicable to all groups, grandfathered and non-grandfathered, small, mid-size, and large. Read more...
ID Card Reissue for CVS Caremark PBM
Effective April 1, 2013 CVS Caremark becomes the new pharmacy benefits manager (PBM) for Blue Cross of Idaho. Beginning this week, we’re sending letters to our commercial group and individual members to inform them of the change. A PDF copy of the letter is available here.
We will begin issuing new ID cards with updated PBM information to all existing members with pharmacy benefits in March 2013, but it’s important they continue to use their old card until April 1, the date their new card becomes active.
The WellConnected PHA website is more useful than ever!
Blue Cross of Idaho revamped the personal health assessment (PHA) portion of our WellConnected website so your employees now have a powerful wellness resource, available 24/7, with a host of health related interactive applications and multimedia tools. We’ve reworked the PHA interface and incorporated a variety of new features designed to help your employees live a healthy, active lifestyle.
Every aspect of the new WellConnected PHA component will educate, entertain, and put your employees on the right path to wellness. Tell your employees to do their health a favor and visit the new WellConnected PHA website today, register as a member, and get access to our most comprehensive personal healthcare resource available.
Change to External Review Procedures for Members
Blue Cross of Idaho made changes to the external review section of group medical policies to comply with the Idaho External Review Act effective January 1, 2010.
The changes affect a member’s right to appeal a grievance after exhausting all options within Blue Cross of Idaho’s internal grievance and appeal process. If Blue Cross of Idaho denies a member’s final appeal to provide or pay for a healthcare service or supply, a member may have the right to have the decision reviewed by healthcare professionals who have no association with Blue Cross of Idaho.
We are mailing a Notice of Changes to group administrators and individual members notifying them of the amendment. Select either the individual or the group notice to view a PDF copy of the change. Feel free to print and distribute this information to your employees. You may also contact Blue Cross of Idaho with questions or request additional copies of the Notice of Change at 800-365-2345.
Dependent Age Change
House Bill No. 108 recently passed by the Idaho State Legislature now requires health insurers to change the eligible dependent age to 25 for an unmarried child receiving more than half (½) of his/her financial support from the parent named on the healthcare contract.
Blue Cross of Idaho will apply the law as follows:
- Unmarried children who became ineligible for dependent coverage because they aged off prior to June 1, 2009 become eligible for re-enrollment as newly eligible dependents under their parent’s policy on July 1, 2009 if they meet the qualifications of an eligible dependent.
- Dependents who are now eligible can submit an application for re-enrollment by August 31, 2009.
- The underwriting department will handle new applications and may issue a new rate.
- Coverage will become effective the first of the month following receipt of the application, but no later than September 1, 2009.
- Dependents who do not submit an application by August 31, 2009 may apply for coverage under a separate non-group policy on or after September 1, 2009.
Coverage continues uninterrupted for unmarried child dependents turning 21 years old in June 2009.
It is extremely important that your employees are made aware of this change because they must re-enroll newly eligible dependents. If you need additional copies of the notices of changes, click on the link below to access the notice of changes related to your coverage.
Notice of Changes (27KB)