Beginning January 1, 2020, we will make several changes to our health plans and benefits. Because of these changes, it is important to always check your patient’s Blue Cross member ID card and to verify their eligibility and benefits using Online Services, or another similar technology.
We are pleased to announce that Blue Cross members – except Medicare Advantage – will have coverage for acupuncture services beginning on their account anniversary. Federal Employee Program members already have this benefit.
Blue Cross members will now have coverage for 12 acupuncture visits by a contracted licensed acupuncturist each calendar year. Eligible members pay the same cost as a specialist office visit for these services. No referral or authorization is required.
We will allow large employers (100 employees or more) to exclude this coverage or customize the number of covered visits and member cost.
Members seeking lactation counseling services from providers in our local network will be able to use telehealth to increase their access to this service. This service will also be available to out-of-state (BlueCard®) members receiving care in Massachusetts from a provider in our local network.
Large employers (51 employees or more) will be able to offer a lower copay for their members.
To learn more, log in, go to News>Claims, Coding, Payment and look for the November 1, 2019 News Alert: Lactation counseling added to Telehealth payment policy.
Higher deductible plans
To meet employers’ needs for high-deductible plan options, we’re introducing the following new plans:
|For employers with fewer than 51 employees||For large employers with 51 employees or more|
||These plans are available with health savings and health reimbursement options
* Authorization for chiropractic services is required for these plans after the initial 12 visits.
New simpler plan
For large employers (51 employees or more), we’re also introducing HMO Blue New England $3,000 Deductible with First $500 Coverage:
Prior authorization requirements
Effective January 1, 2020, prior authorization will be required for repetitive transcranial magnetic stimulation (rTMS) services when performed in an outpatient setting using these CPT codes:
New opioid treatment benefit
Pending Centers for Medicare & Medicaid (CMS) approval, we’ll cover the following opioid use disorder treatment services when administered through a certified opioid treatment provider enrolled in Medicare:
Opioid treatment programs are certified through the Substance Abuse and Mental Health Services Administration.
Please note that this benefit may become effective on or after January 1, 2020 as directed by CMS.
Hearing aid coverage
Members of HMO Saver, HMO Value, and PPO Value plans now have a $400 hearing aid allowance every three years. This coverage includes the cost of hearing aids, fittings, evaluations, dispensing fees, and repairs. Please bill us for these services first, before charging the member.
Lower cost share
Members of HMO PlusRx, HMO SaverRx, and HMO ValueRx will have lower costs for:
Introducing Medex Sapphire®
Starting January 1, 2020, we will offer a new Medicare supplement plan called Medex Sapphire that will cover member’s co-insurance and Part A deductible. Members will now be responsible for their annual Medicare Part B deductible.
Sample ID Card
A new federal law
Due to changes in the federal law (Medicare Access and CHIP Reauthorization Act), we will no longer offer Medex Bronze® or Medex Choice® to newly eligible beneficiaries as of January 1, 2020. Current members who have these plans can continue with their coverage.
We are making changes to our members’ medication benefits and formulary coverage. This includes changes to our Medicare Advantage and Blue MedicareRx® formularies, including moving medications to non-covered, tier changes, and more.
To learn more, log in, go to News>Clinical & Pharmacy and look for the August 30, 2019 News Alert: Medication coverage changes.
If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.
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