This article is for all providers caring for our members
Beginning January 1, 2022, we will make changes to our health plans and benefits. Because of these changes, it is important to always check your patient’s Blue Cross ID card and to verify their eligibility and benefits. You can do this using ConnectCenterTM, which will replace Online Services starting in January 2022, or you can use another similar technology.
Telehealth in 2022
As we communicated in August, we plan to make changes to our telehealth payment policies in April 2022 and will notify you of these changes via a News Alert in January. Until then, please continue to reference the COVID-19 Temporary payment policy, and follow the guidance in that policy.
As a reminder, effective July 1, 2021, member cost share was reinstated for non-COVID telehealth services. We reinstated member copayments, co-insurance, and deductibles for non-COVID telehealth visits, including all mental and behavioral health services. Note: These changes do not apply to our Medicare Advantage members. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. For more details, please see fepblue.org.
For COVID-related visits, please continue to bill members for their cost share once the claim has processed. When you are checking eligibility, Online Services (soon to be ConnectCenter) will show the standard telehealth cost share. The system will not distinguish between a COVID visit and a non-COVID visit; therefore, we recommend that you bill the member for the applicable cost share once the claim has processed to ensure you do not have to reimburse the member.
Value care offerings
Large employers can choose to offer their employees $0 cost share* for a set number of visits. (They can opt to have the first one, three, or six outpatient visits per member, per plan year at $0 cost share before regular cost share begins to apply.) This is an option for the following outpatient visits that are rendered in person or via telehealth:
*For Health Savings Account qualified high-deductible health plans (Saver plans), the deductible must be met up-front, then any copayment or co-insurance will be waived for the rest of the year.
Solutions supporting health and well-being
We’re expanding our fitness-related benefits and promoting healthier lifestyles with a variety of new offerings:
Medical second opinion benefit
Certain large, self-funded accounts may purchase a benefit that will provide independent second opinions through a vendor called 2nd.MD. With this benefit, members can get a second opinion from a 2nd.MD physician. After the consult, the vendor will:
Please respond promptly to medical record requests you may receive from 2nd.MD for your patients.
Federal transparency initiatives
We’re continuing to review guidance from the federal government on the Consolidated Appropriations Act (CAA) and other federal transparency initiatives. We’ll notify you of any impacts or changes as we learn of them.
Starting January 1, we will offer our members BlueFit, the next generation proactive health plan. BlueFit guides members to lower annual costs and helps boost their Health Savings Account (HSA) over time, avoid cost surprises, and invest in their future health care.
Here’s a highlight of what BlueFit offers to our members:
BlueFit HMO plan members can use any provider in the HMO Blue New England network. Primary care provider (PCP) referrals are not needed to see a specialist.
BlueFit PPO plan members have extensive nationwide access to the entire Blue Cross Blue Shield network, including access to providers outside of the network, for a higher cost. PCPs and referrals are not needed.
Please follow the same procedures to file claims, and check eligibility and benefits as you would for any of our members.
Members are enrolling in our Advantage Blue Performance plans
We’ve recently increased our membership in plans that use our newest national limited network, the Blue High Performance NetworkSM (BlueHPNSM). In Massachusetts, we’re enrolling members in Advantage Blue Performance plans that pair with the BlueHPN limited network. Read here for more information to help you recognize these members.
New plan design for our employer group retirees: Medicare PPO Blue FreedomRx Option
To help our Medicare members with out-of-pocket costs, we’re introducing a new Medicare Advantage plan option: Medicare PPO Blue FreedomRx Option. This plan offers coverage for all Medicare-covered medical services, both in- and out-of-network, with a $0 member cost share and includes extra benefits such as fitness and weight loss reimbursements, routine vision, hearing, and dental. These members will use the Medicare Advantage formulary.
To recognize Medicare PPO Blue FreedomRx patients, look for the OV and ER copays of $0 on the front of the member’s Blue Cross ID card (shown below).
New low primary care copays
Three of our Medicare Advantage plans— Medicare HMO Blue PlusRx, Medicare PPO Blue ValueRx, and Medicare PPO Blue SaverRx—will have a $0 member copay for primary care visits. Medicare PPO PlusRx will have a $5 primary care visit copay. The three remaining direct pay Medicare Advantage plans will continue with a $10 copay.
New low outpatient mental health copays
All of our direct pay Medicare Advantage plans will have lower copays ranging from $10 to $30 per visit for outpatient mental health visits.
Expanded fitness benefit
We are expanding coverage to include virtual fitness programs and home exercise equipment. This includes virtual fitness memberships, subscriptions, programs, or classes that provide cardiovascular and strength-training using a digital platform. We’ll also cover home fitness equipment like stationary bikes, weights, exercise bands, treadmills, and fitness machines. Members have a yearly allowance of between $150 to $250 towards membership fees, in-person and virtual class fees, and home fitness equipment.
Expanded meal program
We have expanded the eligibility for our meals benefit. In addition to post-discharge after an inpatient stay at a hospital, members who are post-outpatient day surgery may be eligible for up to eight weeks of meals delivered to their home, at no cost, while they recover from their illness or injury.
This benefit is managed by our Care Management team who will work with you to coordinate medically tailored meals. To refer a member for this program, please send an email to MedAdvCMReferrals@bcbsma.com.
Medication coverage changes
In an October 1 News Alert, we announced changes to our members’ benefits and coverage for their medications. These include:
To access our News Alert, log in and go to News. Look for the News Alert (indicated with an exclamation mark) dated October 1, 2021, called "Medication coverage changes starting Jan 1."
New prior authorization requirements for EPO, PPO, Medicare Advantage
We’ll begin applying prior authorization to services listed in our medical policies for EPO, PPO, and Medicare Advantage members, including:
To see the complete list of services, access our September 1 News Alert by logging in and going to News. Look for the News Alert (indicated with an exclamation mark) called, "Expanding authorizations to EPO, PPO, Medicare Advantage members."