This article is for all providers caring for our members
Beginning January 1, 2024, 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.
We are updating our formularies and our medication benefits. In a September 1 News Alert and subsequent October 17 update, we announced changes to our members’ benefits and coverage for their medications. These include:
- Prescription benefit changes
- Medical benefit changes
- Medical policy updates
To access our News Alert, log in and go to News. Look for the News Alert (indicated with an exclamation mark) dated September 1, called "Medication coverage changes starting Jan 1."
To support medication adherence, we’re introducing a new program for members taking select medications for chronic conditions. When members opt in and choose their communication preferences, they can reduce their out-of-pocket costs by filling their medication on time at an in-network retail pharmacy. Members will receive refill reminders and discounted cost information prior to picking up their medication.
Sempre Health, an independent company, will administer this program. Members do not need to change where or how they fill their medications, so prescribers do not need to do anything.
This program will be added on renewal starting on January 1, 2024 for large group plans and as an option for self-insured employers. The program is not available for any groups who offer a high deductible or HSA-compliant health plan, or for Medicare plans.
Throughout 2024 as commercial members renew their health plans with us, they’ll no longer have our value-based pharmacy benefits that offered reduced mail service co-payments for certain medications used for chronic conditions.
We’re ending these benefits and replacing them with opportunities for members to get access to chronic condition medications without any out-of-pocket cost at both retail and mail such as:
- No-cost generic medications for certain conditions
- Riders that employers can purchase that provide $0 copayments for certain medications
Small group employers and individuals purchasing health insurance from us will have the option of selecting one of our Advantage Blue® Preferred plans. These Exclusive Provider Organization (EPO) plans offer access to our National BlueCard® network with no out-of-network coverage, except for emergencies. Members are not required to select a PCP or obtain referrals to see a specialist.
Beginning January 1, 2024, we’ll expand our Blue High Performance NetworkSM to include providers in Worcester County and add providers from the existing counties, Bristol, Essex, Middlesex, Norfolk, Plymouth, and Suffolk, to the network.
We’ll also add virtual primary care providers, Firefly Health and Carbon Health, to the Blue High Performance Network, including for members who live outside of Massachusetts. Members who choose a virtual primary care provider will have access to a dedicated virtual care team that will help manage the member’s health, including mental health.
Members who select a virtual primary care provider will receive a welcome kit with connected medical devices, such as a blood pressure monitor, to use for virtual visits. When in-person care is needed, members have access to their plan’s full network of providers. Their virtual care team can refer members for in-person care, and securely share medical records to ensure continuity of care. In most cases, the member has no cost share for primary care and mental health services provided by the member’s virtual care team. Deductibles will apply to these services on HSA-compatible, high deductible plans.
Your patients may ask you to attest that they have certain medical conditions that make them eligible for Enhanced Dental Benefits. These are additional dental health services that we offer for our Dental Blue plan members who have medical conditions that have been connected to improved overall health: coronary artery disease, diabetes, intellectual and/or developmental disabilities*, mental health conditions*, oral cancer, stroke, Sjögren’s syndrome, or pregnancy.
If asked, please help your patients by completing the attestation form in a timely manner so they can take full advantage of their benefits. You’ll need to sign the form and add your contact information.
- Dental Blue 65 Enhanced Dental Benefits Enrollment Form
- Enhanced Dental Benefits Enrollment Form (all other eligible members)
*Starting for commercial members when they renew their benefits on and after October 1, 2023, and Dental Blue 65 members on and after January 1, 2024.
A new benefit will allow members to visit limited services clinics at no cost (deductibles will apply to these services on HSA-compatible, high deductible plans). This will apply to members in small employer groups and individuals purchasing their health insurance from us.
Limited services clinics, such as CVS MinuteClinic, are typically staffed by a professional care team and located within the CVS pharmacy. They can provide vaccinations and routine health checkups, as well as diagnosis and treatment for simple medical concerns.
We’ve started to offer our commercial members in fully insured accounts a new program for chronic back and joint pain with Hinge Health. This program will also be offered to Medicare Advantage members starting on January 1, 2024.
Hinge’s pain management program helps adults proactively manage joint and muscle pain through a 12-week, coach-led, digital experience that aims to reduce anxiety and depression, improve strength and mobility, and introduce alternatives to surgery. Participants will continue to have access to all components of the Hinge Health Program, including coaching and/or facilitated social interaction and educational content for 12 months following their engagement in the Hinge Health Program.
We’ll identify eligible members based on claims history for qualified diagnosis codes. Members will then be able to enroll via the Hinge website.
Hinge’s program does not replace the physical therapy benefit for our members, and no claims will be submitted. This program offers exercise therapy, not physical therapy.
Fully insured employers with 100+ employees can elect to expand the benefit to include:
- Bicycles and bicycle helmets
- Athletic shoes
- Sports activity fees, such as ski passes, adult or child league sports fees, and race participation fees
In January 2023, the Executive Office of Health and Human Services designated a network of Community Behavioral Health Centers (CBHCs) to offer emergency services in community-based settings as an alternative to emergency departments and urgent care centers. Twenty of our participating providers (representing 30 practice locations) have been designated as CBHCs. Consistent with the Division of Insurance guidelines, we will cover and reimburse emergency services rendered by these designated providers retroactive to June 22, 2023. Read more here.
Last year we began offering a real-time member cost estimation tool with a limited set of codes as part of the Transparency in Coverage mandate. For 2024, the Billing Code Cost Estimator will include all billing codes. The Billing Code Cost Estimator provides members with personalized and customized out-of-pocket cost information and negotiated rates for in-network providers.
In addition to offering members the Billing Code Cost Estimator as a tool for understanding their potential costs, we will continue to maintain our cost estimator embedded in our ‘Find a Doctor & Estimate Cost’ tool. This tool takes a different approach to cost estimates that we believe more fully represents the experience a member will have when seeking services.
For members of our HMO Saver and PPO Saver plans, we’re increasing the over-the-counter (OTC) allowance to $100 per quarter. This will be loaded onto members’ new Flex Cards for them to use on OTC health and wellness items, such as first aid, cold or allergy medication, pain relievers, and vitamins. This allowance must be used in the specific quarter; any unused balance will not be rolled over to the following quarter.
We’re also increasing fitness and weight loss allowances from $150 to $250 per year. This benefit is available to all our Medicare Advantage members and will be loaded onto their Flex Card.
In 2024, Medicare Advantage members will be able to use their new Flex Card to easily access plan benefits and rewards, such as:
- Dental, vision, and hearing allowance
- Quarterly over-the-counter allowance
- Fitness and weight loss benefits
- Wellness Rewards for health screenings like $25 incentives for completing an annual wellness visit and $10 incentives for completing in-home health risk assessments
The Flex Card functions like a debit card. Blue Cross will auto-load money for members to use on eligible products and services.
We will lower the copay or cost share for the following services:
- Physical therapy, occupational therapy, and speech therapy services for members of our PPO Saver, HMO Saver, and HMO Value plans
- Cardiac rehabilitation and intensive cardiac rehabilitation to $35 for PPO Saver and HMO Saver
- Pulmonary rehabilitation to $15 for PPO Saver, PPO Value, and HMO Saver
- High-tech radiology copay will be charged per day instead of per service per day
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