Due to the economy, we realize that many of our clients may have difficulty meeting their financial obligations in a timely manner.  As a result, we would like to share important information that has recently come to light from our dealings with Aetna.

We recently learned that if an employer with group insurance coverage through Aetna is termed three times within a twelve month period, upon the third termination, Aetna will not allow the group to be reinstated.

Unfortunately we are not always notified by the insurance carrier that one of our clients is in jeopardy of being canceled.  If you ever receive a late payment or cancellation notice, please contact us immediately so that we may intervene with the insurance carrier on your behalf and avoid possible termination of your insurance coverage.

Thank you for your attention to this matter.  Please contact us if you ever have any questions or concerns regarding your insurance coverage.

We recently received a notice from Independence Blue Cross regarding standard quarterly changes to the Select Drug Program formulary, effective July 1, 2012.  Some of the changes include:

• additions of generic and brand drugs to the formulary;
• deletions of brand drugs from the formulary;
• additions to the list of drugs that require a physician to obtain prior authorization.

Full list of formulary updates

Prior Authorization Changes

Independence Blue Cross is making changes to their guidelines concerning procedures that support safe prescribing of prescription drugs.  Prescription medications are necessary to effectively treat certain medical conditions; However, they have the potential to be unsafe when not used properly.  In order to ensure that IBC members are using prescription drugs safely, IBC implements saf prescribing procedures, which includes applying prior authorization requirements to certain medications.

Prior authorization requirements were placed on the following drugs when they entered the marketplace:

• Edarbyclor
• Ervedge
• Inlyta
• Jentadueto
• Kalydeco
• Picatol

Communications

Members affected will be notified by IBC regarding changes to the formulary and their options.  Also, changes will be detailed in the IBC August edtition of Update magazine.

If you have any questions regarding these changes, please do not hesitate to contact us.  

The Affordable Care Act (ACA, or Health Care Reform law), as you may know, includes changes that are being phased in over a number of years.  Additional benefits for certain Women's Preventive Health Services is the latest set of changes to take effect.

Women's Preventive Health Benefits

For plans that renew or become effective on or after August 1, 2012, all of the following women's health services will be considered preventive.  Some of these services may have already been covered*. When provided in-network, these services generally will be covered at no cost share: 

• Well-woman visits (annually)
• Prenatal visits (routine preventive visits)
• Screening for gestational diabetes
• Human papillomavirus (HPV) DNA testing
• Counseling for sexually transmitted infections
• Screening and counseling for human immunodeficiency virus (HIV)
• Counseling and screening for interpersonal and domestic violence
• Breastfeeding support, supplies and counseling
• Generic formulary contraceptives, certain brand formulary contraceptives, and FDA-approved, over-the-counter female contraceptives with prescription are covered without member cost share (for example, no copayment).  Certain religious organizations or religious employers may be exempt from offering contraceptive services.   

For more information on this latest change, please visit:

www.healthcare.gov/law/resources/regulations/womensprevention.html 

If you have any questions regarding this update or Health Care Reform in general, please do not hesitate to contact us.

*Some plans may be grandfathered and not subject to all of the requirements of the health care reform law.  Grandfathered plans may not include all of these benefits or member cost-sharing may apply.