June 23, 2017
Anthem announced that they will pull out of the individual health insurance marketplace in Ohio for 2018. First and foremost we want you to know that we are here to support you. All current Anthem policies will remain in-force with no changes until 12/31/2017.
We will be doing outreach soon to set up time to review your policy options for the 2018 year, please be on the look-out for that correspondence. If you have an Anthem individual policy that is Grandmothered (effective on or before 12/31/2013), Medicare and group coverage offered through your employer you will be unaffected by this change.
Cheryl Washburn is available if you have questions and concerns. She can be reached directly at 614-336-3636 ex 1008.
Change in Network Information
June 20, 2017
We would like to remind you that you should always check the network prior to going to appointments or having labs and procedures done. Doctors and Hospitals can leave any given network through-out the year and therefore, networks are subject to change and we want to make sure that you do not end up with an unknown out of network or uncovered claim.
You can access all the doctors that are available to you by logging on to your personal carrier portal and searching for providers. To make it easier for you, we have created a list of network look-ups for each carrier below.
You can also call the number on the back of your ID card as well.
Contacting your physician is not recommended as they are not properly trained to understand all insurance products available and the myriad of corresponding networks. The best practice is to use the carrier website to confirm your provider still participates in the network that is connected to the insurance coverage you have or you can call the insurance company directly.
InHealth Mutual (in liquidation) Current Contact Information
July 15, 2016
InHealth has requested the following to be distributed to any remaining policy holders regarding methods of contact.
For claims, billing and benefit assistance: 800-580-8502 or email@example.com
For off-exchange and group cancellations: firstname.lastname@example.org
For any other issue: email@example.com
United Healthcare: 2016 Coverage Ending December 31st
June 2, 2016
United Healthcare (UHC) announced today that they will not offer individual insurance plans in Ohio for the 2017 Open Enrollment season. This means for our clients that your current coverage will not renew in January 2017, and the plan you currently have will end on December 31, 2016.
Please note, this change does not affect vision, dental, accident, critical illness nor hospital rider plans. We will review all client options beginning in October 2016 for the Open Enrollment season of 2017, at which time we can help you decide what plan would be best for your specific situation.
Still have questions? Please email us at: firstname.lastname@example.org
Anthem: Reporting for Individual and Fully Insured (FI) Group Business
June 2, 2016
Employers, insurance companies and others who provide MEC will be required to report who’s covered with them to the IRS. This is called Minimum Essential Coverage Reporting, or IRS Code Section 6055 Reporting, and it will take place each year. This is how the federal government will make sure people have MEC. It’s also how the IRS will determine who may owe a penalty for not having coverage. As required by law, Anthem will now file the 1095-B form for our fully insured groups and send a copy to the plan members. When we send the IRS reports, we’ll list all individuals covered under a group’s plan by their Social Security numbers (SSNs). For some of our members and dependents, we are missing their SSNs. In these cases, the IRS requires us to collect them for reporting purposes. A staggered mailing began in early June and will continue through the summer and early fall to gather this data.
InHealth Pharmacy Benefits
June 2, 2016
InHealth is working with the Ohio Department of Insurance and the Prescription Benefits Manager to reinstate pharmacy benefits as quickly as possible. Based upon the court order; pharmacies and providers must continue to serve InHealth members without interruption. If you are being denied service, please contact the Ohio Department of Insurance Consumer Services Division at 1-800-686-1526. Alternatively, you may call the Customer Care Team at 1-800-580-8502 to alert them to the specific pharmacy and/or provider who has denied service so that we can work to address individual concerns as we come to the larger resolution.
InHealth Closure: Answers regarding the liquidation (per the Ohio Department of Insurance)
May 27, 2016
The Ohio Department of Insurance determined that Coordinated Health Mutual, Inc. (InHealth Mutual) is in a hazardous financial condition. On May 26, 2016, the Franklin County District Court issued an order appointing the Superintendent as liquidator of InHealth Mutual. The company will to serve existing policyholders, but the Superintendent is granted authority to manage the company.
An insurance company is ordered into liquidation when it no longer has the necessary cash and assets to meet its financial obligations. A state liquidation proceeding for insurance companies is similar in many ways to a federal bankruptcy proceeding for other types of companies. When a company is liquidated, the liquidator collects the remaining assets of the company, verifies the amount that the company owes and works through the Court to pay off the unpaid liabilities.
No, the law provides for the continuation of coverage if an insurance company goes out of business. However, any continued coverage would be subject to a $500,000 maximum.
There are a number of factors to consider when deciding which is the best option for you, including whether you are receiving a federal subsidy and how much of your deductible and out of pocket expenses remain on your policy. It is best to discuss with a broker your individual situation. You may schedule at www.calendly.com/insurancereview
The liquidation of Coordinated may cause the plan to no longer qualify as minimum essential coverage. This means it may not satisfy the individual mandate. Loss of minimum essential coverage allows you to apply for a Special Enrollment Period (SEP) to find coverage with another carrier.
Yes, to avoid a gap in coverage, you must pay your monthly premiums when due. Payment methods should continue as normal for as long as you choose to keep the plan or until you secure other coverage.
Your individual coverage will end when you either switch to another plan, your plan year ends or you reach the $500,000 maximum provided by Ohio law.
Yes, submit your claims to InHealth as usual.
Yes, claims will be paid up to $500,000 per individual.
No, Providers (your doctors, hospitals, pharmacies, etc.) are required by their contracts to continue treating you. If a doctor in your network refuses to honor their network agreements, contact the Consumer Services Division of the Ohio Department of Insurance at 1-800-686-1526.
Your coverage with InHealth Mutual will stop and claims will not be paid after cancellation. If you do not purchase replacement insurance to continue minimum essential coverage, you may be subject to the individual mandate penalty.
Yes, if you are eligible for a subsidies, your subsidy is likely affected. You will need to contact your broker, agent or Marketplace to discuss your subsidy.
You will need to ensure that your coverage is in effect the day of the procedure. If you switch plans, you will need to ensure that the procedure and providers are covered under your new plan. You may have to reschedule to ensure your coverage is in place.
Anthem: Consultant Anesthesia June 1 Provider Termination
May 17, 2016
Consultant Anesthesia, which provides services at Mount Carmel East, Mount Carmel St. Ann’s Hospital, Eastwind Surgical Center, Sullivan Centre, Taylor Station Surgery Center, and 5969 East Broad Street, has chosen to terminate its provider contract with Anthem effective 6/1/16 for the following Anthem products: Blue Traditional, Blue Access, Blue Preferred, Blue Access I & II Tier I, and Ohio Exchange PPO and HMO plans. So far, our efforts to negotiate a new agreement to bring them back into the Anthem network have been unsuccessful.
Unless agreement on a new contract is reached in the interim, as of 6/1/16, Consultant Anesthesia will leave the Anthem network. Consequently, Anthem members may be billed by Consultant Anesthesia for any balance not covered by Anthem. However, since our members do not have a choice of anesthesiologists for surgeries performed at Mount Carmel East, Mount Carmel St. Ann’s, Eastwind Surgical Center, and Sullivan Centre, Anthem will apply the equivalent of any member liability amounts such as copays, deductibles, etc., at the member’s in-network level (rather than the out-of-network benefit level equivalent). In most circumstances, payment for services will be issued to the member, who will then be responsible for making payment to Consultant Anesthesia.
MMO: New Online Payment System for Individual Members
Effective May 3, 2016
Medical Mutual transitioned all online payment activity for individual members from BenefitFocus E-Billing, to the FirsTech FUSION system. Members currently enrolled in auto pay have been notified and instructed to re-enroll in auto pay on FirsTech. Members can log into My Health Plan (see our carrier phone numbers link and select MMO to find the website for the My Health Plan setup page) to set up auto pay or call a Customer Care payment specialist at (800) 544-8920 for assistance. Members who have elected not to receive paper invoices, but are not on auto pay, do not need to do anything. They will receive emails from FirsTech when their next invoice is available online.
Applies to policies for: Individual insurance products; excludes Medicare Advantage and Medicare Supplement.