Two-Tier Generic Pharmacy Benefit

April 23, 2019

We’re excited to extend the two-tier generic pharmacy benefit to large group (Illinois only) and self-funded (all states) new sales and renewals with an effective date of July 1, 2019, or later. Currently, the two-tier generic pharmacy benefit is offered to small groups and individuals on 2019 ACA plans.

The benefit consists of two tiers:

  • Tier 1: $0 preferred generics (except HSA-compatible plans)
  • Tier 2: Non-preferred generics at the standard generic cost-sharing amount

This replaces the Rxtra program and will allow members to use any Health Alliance-contracted pharmacy.

Renewing groups with an effective date of July 1, 2019, or later can renew on their existing one-tier generic pharmacy benefit, or they can select their current plan with the new two-tier generic pharmacy benefit.

All alternate standard plan offerings (listed in the rate portfolio) will include the two-tier generic pharmacy benefit. If you would like to see an alternate plan with the one-tier generic pharmacy benefit, please contact your client consultant.  

Call your client consultant with any questions, or contact Broker Support at 1-877-917-8489 or BrokerServices@healthalliance.org.

Annual Health Plan Survey Underway

April 2, 2019

The Consumer Assessment of Healthcare Providers & Systems (CAHPS) is currently conducting the telephone phase of the annual Health Plan Survey for commercial, Medicare Advantage and Marketplace members. These calls are coming from the phone number 817-665-8325. The end date for these calls is April 5, 2019.

The CAHPS Health Plan Survey is a tool for collecting standardized information on members’ experiences with health plans and their services.

We participate in the CAHPS survey voluntarily as part of our accreditation by the National Committee for Quality Assurance. We use the data collected to improve members’ experiences with providers and the health plan.

We administer the survey with the assistance of a vendor, DSS Research, which has been approved by the Department of Health & Human Services.

If any of your clients contact you about this, please encourage them to participate in the survey so that we can help improve the experience for all of our members.

If you have questions, call Broker Support at 1-877-917-8489 or email BrokerServices@healthalliance.org.

Special Enrollment Period Updates

March 19, 2019

Online Enrollment

You spoke, and we listened. We’ve updated the online enrollment form posted on Your Health Alliance for brokers and employers with the following Special Enrollment Period (SEP) qualifying events.

  • Involuntary loss of eligibility (termination or reduction in hours)
  • Going from non-benefits eligible to benefits eligible (part-time to full-time employment)

Another Your Health Alliance update is that employers and brokers can once again print temporary ID cards for members.

New SEP Effective Date for Small Groups

We are changing the effective date for small group members who have an involuntary loss of coverage SEP due to any of these qualifying events.

  • Termination of employment
  • Reduction in hours
  • Termination of employer contributions
  • Termination in a class of coverage
  • Notice of the loss of minimum essential coverage

Previously, the effective date for these qualifying events was based on the date we received the application. We’ve heard your feedback that this is confusing for employer groups, and the process creates a gap in coverage for members.

Starting with qualifying events on or after April 1, applications for this qualifying event will be processed with an effective date of the day after the qualifying event.

Other SEP Updates

  • We are creating SEP fliers to outline coverage effective dates for all qualifying events for all our group products. These fliers should be completed in early April, and we’ll let you know when they’re ready for you to use.
  • If a commercial fully insured group member experiences an event that qualifies them for an SEP and the group offers more than one plan, the member must be offered all the benefit packages available to similarly situated individuals who enroll when first eligible.

If you have questions, call Broker Support at 1-877-917-8489 or email BrokerServices@healthalliance.org.

Small Group Online Quoting and Enrollment Tool

March 4, 2019

Health Alliance has decided to discontinue the small group online quoting, enrollment and renewal tool. The tool will be shut down on March 6, 2019. Over the past years, the small group market has changed, and we no longer find this tool to be the best solution for the small group line of business. We continue to investigate the best solution for our small group business line, and we value the feedback you have provided.

Moving forward, small group renewals will be delivered via email. You can get a small group new quote by sending a request to Quotes@healthalliance.org. You can find more information on plans, rates and who to email for new quotes on Your Health Alliance for brokers. You will still be able to use our online quoting and enrollment tool for individual direct sales.

If you have questions, please contact your client consultant or Broker Support at 1-877-917-8489 or  BrokerServices@healthalliance.org.

Small Group April ACA Quotes Coming Soon

February 13, 2019

We are excited to announce April small group renewal and prospective quotes are ready. If you quoted a group, but didn’t think we were competitive, please check out our new April rates.

We will begin sending 2019 April ACA renewal and prospective quotes by email in the next week. It may take up to 10 business days to send out all renewals, so we ask for your patience through this process. The Health Alliance online enrollment tool is not quite ready for 4/1/2019 and later effective dates. We will communicate updated information with you.

Please contact your Client Consultant or call Client Support at 217-902-8151 if you have questions.