Independence Edge | Announcing Teladoc Health, Formulary Updates, GPAHU Panel Discussion

Independence Edge | Announcing Teladoc Health, Formulary Updates, GPAHU Panel Discussion

Independence Edge | Announcing Teladoc Health, Formulary Updates, GPAHU Panel Discussion
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Announcing Teladoc: Our new vendor for virtual visits

We are pleased to announce that Independence has chosen Teladoc Health (Teladoc) as our vendor for telemedicine, telebehavioral health, and teledermatology virtual care services! Teladoc will replace MDLIVE as our provider for these services effective January 1, 2024.  FULL ARTICLE

Value and Select formulary changes in July

We are making our quarterly updates to our Value and Select drug program formularies on July 1. Affected members have been notified.  FULL ARTICLE

Premium formulary changes in July

We are making changes on July 1 to the Premium formulary drug program that is available to self‑funded customers.  FULL ARTICLE

June Medicare business updates

The 2024 Medicare AEP season is just around the corner, and we invite you to “bee” our guest for our annual broker kickoff event! Also, learn about new guidance from CMS that will impact communications, marketing, and sales for the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All‑Inclusive Care for the Elderly.  FULL ARTICLE

Join us for our live GPAHU Virtual Panel

Independence is strongly committed to whole‑person health and equitable health care. We’re pleased to present a Greater Philadelphia Association of Health Underwriters virtual panel discussion to share our approach and strategy for achieving these goals.  FULL ARTICLE

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

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Clover Health | Jefferson Health System Contract Termination

Clover Health | Jefferson Health System Contract Termination

Clover Health | Jefferson Health System Contract Termination
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Clover’s contract with the Jefferson Health System’s hospitals, primary care and specialist providers will terminate as of August 5, 2023. This network change may affect your clients if they have accessed care with the Jefferson Health System.

As always, it is important to Clover that our members’ healthcare is not affected by this change. This includes their ongoing medical care and authorizations for services.

We are sending letters to members identified as having received care from a Jefferson Health System provider or hospital advising them of this network change. In an effort to further put members at ease, we will be making outbound calls to these members that will include helping them find other providers, schedule alternate appointments, and provide any support they might need.

Of course, members may continue to use Jefferson Health System hospitals and providers (if the provider/facility agrees to accept Clover Health members). But please make sure they understand that after the August 5th date, they may have to pay higher costs.

Please reach out to your clients who might be affected by this change and help them navigate to alternate care options. We will provide them with a list of in-network primary care providers in their area and our online Provider Directory is available on-demand to help as well.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

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1 (800) 772-6881
support@pfsinsurance.com

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Wellcare | Important Updates and Reminders

Wellcare | Important Updates and Reminders

Wellcare | Important Updates and Reminders
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Welcome to the latest edition of Wellcare Insider, your source for important updates and reminders to help you provide excellent service and grow your business.

Today’s edition has information on the following topics:

  • Key Dates for PY2024 – Mark those calendars for AHIP, First Look, and ACT
  • RFI Resources – Review how best to resolve Requests For Information
  • No. 25 on Fortune 500 – We’re growing stronger together with you

Key Dates – Plan Year 2024 (PY2024)

The 2024 Annual Medicare Certification period is nearly upon us and we’re working hard to make sure you are prepared with resources to help you become familiar with the 2024 Wellcare products and prepare you for annual certifications.

Please take note of these important launch dates:

June 21, 2023 2024 AHIP Training

July 10, 2023, 2024 Wellcare First Look

July 11, 2023, 2024 Wellcare Annual Certification Training 

  • Accessible through the Centene Learning Center
  • Note: Last day to complete onboarding cases in Centene Workbench and 2023 Wellcare ACT – June 30, 2023

Please be on the lookout for more information on the 2024 Wellcare Annual Certification Training process and other important communications to ensure you are fully equipped to support clients heading into the 2024 Medicare Annual Enrollment Period.

Resolving Requests For Information (RFI)

Request for Information (RFI) status occurs when a submitted application is either incomplete or contains incorrect information. Applications in RFI status will be pended in the system, delaying processing. The best way to avoid those delays is to review each application to ensure accurate and complete information has been provided.

You will be informed through email and text message if you have applications in RFI status. Please be on the lookout for these notifications and act promptly to resolve them. Important: RFIs must be resolved within 21 days of application receipt from the member, or the application will be denied.

RFIs may also be viewed in Centene Workbench by selecting Application Status from the Dashboard menu and using the search term RFI.

There are two ways to resolve outstanding RFIs:

  1. Create a Centene Workbench Support ticket on Centene Workbench, using the Enrollment ticket type and RFI subtype.
  2. Contact Broker Support at 1-866-822-1339 and select prompt 3. Note: Prior to calling Broker Support, please have all required information to resolve the RFI (e.g., NPN, Beneficiary Information – MBI, First Name, Last Name, DOB).

Please review the RFI Resource Page for further instructions on how to resolve RFIs.

Centene Ranks #25 on New Fortune 500

As Centene’s brand of Medicare, Wellcare is proud to have played an important role in Centene’s new #25 ranking on the recently released 2023 Fortune 500 list. Beyond the recognition of the financial strength of the company, the ranking gives all of the companies under the Centene umbrella a powerful voice in moving forward in our mission to transform the health of our local communities, one person at a time.

As a valued partner, we want to recognize your contribution to this success and thank you for your continued role as a trusted advisor to our valued members. As we move toward the 2024 sales season, you can count on us to provide not only the new launch of the high-quality, value-based products you expect from a healthcare leader but also the resources and support you need to successfully drive your business. We’re excited to be on this journey with you and look forward to all we will accomplish together this year.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

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Devoted | TPMO Marketing & Communication Guidelines 2023- 2024

Devoted | TPMO Marketing & Communication Guidelines 2023- 2024

Devoted | TPMO Marketing & Communication Guidelines 2023- 2024
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To align with CMS’ recently updated Definition of Marketing, Devoted Health is requesting TPMOS that they use marketing or communication materials to take the following (3)  actions:  

  • CMS’ Updated Marketing Definition – Impacted Materials
  • Reminder – Prior Review of Marketing Materials
  • Current Communication Materials

We ask that you review this communication and take any actions that apply to you.

1. CMS’ Updated Marketing Definition – Impacted Materials

With this latest memo, CMS clarified that any material or activity distributed via any means (e.g., mailing, television, social media, etc.) that mentions any benefit, will be considered marketing and must be submitted in HPMS. Previously, CMS allowed “communication” materials to include benefits offered by the majority of MA plans, like dental, vision, and hearing.   

To comply with the CMS July 10, 2023 deadline for this requirement, Devoted Health needs all of our partners currently using such communication materials to take the following actions no later than June 30, 2023: 

  • Review all of your current “communication” materials;
  • Revise any existing/active communication pieces that are now clarified as “marketing”, adding CMS marketing ID (a.k.a. “SMID”) and appropriate disclaimer(s); 
  • Submit these revised marketing materials to Devoted Health for review and approval PRIOR to submitting them to HPMS.

Please submit these materials to agencyoversight@devoted.com; damien.cameron@devoted.com; paulomi.bhatt@devoted.com using this template for your submission:  DH TPMO Marketing Update & Communication Survey 2023 Template.

In your email, please use “CMS Definition – Updated Marketing Materials” as your subject line. 

2. Reminder – Prior Review of Marketing Materials:

With this recent clarification and the issuance of CMS final marketing regulations in April 2023, all marketing materials must be submitted for Devoted Health’s review and approval prior to submitting the material to CMS. Our team is committed to conducting these pre-reviews timely.  

As a reminder, all materials submitted for review must meet current CMS marketing guidelines, including having a unique marketing ID (i.e. “SMID”).

Please submit any materials for pre-review to agencyoversight@devoted.com; damien.cameron@devoted.com; paulomi.bhatt@devoted.comPlease use the marketing tab of the previous template. 

COMING SOON!  We have heard you and we will be updating our submission process to make it easier for our partners to submit materials for review. Stay tuned!

3. List of Current Communication Materials

Finally, to ensure we have a comprehensive understanding of all communications in the marketplace driving potential sales, we also ask that you submit a list of all active communication pieces, if any, that you currently have in the market. We are not asking for copies of these actual communications; however, we do want a list of all communications that you have and may later request as materials for review. 

Please also submit this list of communications to us no later than June 30, 2023, using the template above.  In your email, please use “Current Communication Materials” as your email subject line.  

If you have any questions on this request and guidance, please do not hesitate to reach out to our team at damien.cameron@devoted.com or paulomi.bhatt@devoted.com

Stay tuned for the updates concerning Devoted Health’s marketing review & submission handbook in the next few weeks. 

Thanks as always for your partnership! We are here to support you and your teams through the changes and new processes.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

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Aetna | Accendo Medicare Supplement discontinuation in five states effective July 28

Aetna | Accendo Medicare Supplement discontinuation in five states effective July 28

Aetna | Accendo Medicare Supplement discontinuation in five states effective July 28
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Effective July 28, we will be discontinuing ourAccendo Medicare Supplement offering in the following states:

  • North Dakota
  • New Jersey
  • Ohio
  • Oregon
  • Pennsylvania

Sales materials for Accendo Medicare Supplement plans in these states will be available until July 14

This change does not affect the availability of our other Aetna Medicare Supplement insurance plans.

No impact on existing policyholders or renewal commissions

The closure of the Accendo Medicare Supplement product in the above states will not impact your existing policyholders. Commission renewals will continue to be paid on your existing Accendo Medicare Supplement policies.

You can submit applications through July 28

The last application submission and signature date for Accendo Medicare Supplement plans in these states will be July 28, 2023. This applies to both electronic and paper applications. We will no longer accept new applications for Accendo Medicare Supplement policies in these states after July 28.

You have other Aetna Medicare Supplement options available

We’re committed to maintaining competitive Medicare Supplement offerings in these states. Here are the plans we will continue to offer:

  • North Dakota
    (ACI)
  • New Jersey
    (AHIC 7% household discount)
  • Ohio
    (CLI 7% household discount)
  • Oregon
    (CLI 5% household discount)
  • Pennsylvania
    (AHIC 7% household discount)

Thank you for your continued business.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

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