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Introducing two key health care reform projects

Improving the health of our members is central to our mission, and that includes their experiences with health care. We’ve invested significant time and resources to support primary care, and to enhance the features and usability of digital tools like our provider directory and mobile app. Now, we’re also working to implement new government regulations that, in several ways, align with our existing efforts.

In December, the Consolidated Appropriations Act (CAA) became law. Its primary purpose was funding the federal government’s operating budget, but it also contained elements that will have a major impact on our operations. In fact, it’s the largest expansion of health care reform since the Affordable Care Act (ACA) passed in March 2010. Many of the requirements go into effect in 2022, so we want to share the scope of the new rules — and how we’re working to implement these changes for the benefit of our members.

Here’s what you need to know about two key changes:

Member ID card changes — effective Jan. 1, 2022

The CAA requires health insurance ID cards to show:

  • In-network deductibles and out-of-pocket maximum amounts
  • Out-of-network deductibles and out-of-pocket maximum amounts
  • Websites and phone numbers for members to get more information

We already include some of these details, and now we’re making sure the appropriate deductibles and out-of-pocket maximums are listed. And we tested the new ID card design with our members to make sure the changes are easy to read and understand.

Advance estimates for health care — effective Jan. 1, 2022

The CAA requires that members will be able to request cost estimates for upcoming health care services. And these “advance explanation of benefits” (AEOB) will be a joint effort with health care providers.

  • Providers will send us the billing and diagnostic codes for the scheduled care, including anything expected to be offered by other providers or facilities
  • We will give the member information on the:
    • Provider’s network participation and rates
    • Member’s remaining deductible and out-of-pocket balances
    • Member’s expected financial responsibility

After we get the information we need from the provider, we’ll make the AEOB available on the member’s secure account (or mail it) within one to three business days, depending on when the service is scheduled.

These AEOBs will leverage the redesigned claims summary documents we introduced in 2019, making them clear and easy to understand. And they’re another way to build on our ongoing cost transparency efforts, including the cost estimates available in our Find Care tool today.

Continuing the work and keeping you informed

Teams from all over our company are working to make sure we implement changes related to the CAA in a way that provides value to customers and members. We’re also continuing to monitor regulatory guidance from the relevant federal agencies, and we will update you throughout the year as we learn more.

About Henry Smith, SVP, Ops & Chief Marketing Officer

A photo of the authorHenry oversees sales and account management, product development, group and member customer service, membership administration, claims administration, and commercial financial management.

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