Archive for the ‘Broker Updates’ Category

Humana – Walmart and Sam’s Club Added to Vision Network

With an expansive network, Humana Vision offers a choice of more than 135,000 provider locations nationwide, including independent providers, retail, and online options (LensCrafters, Pearle Vision, Target Optical, Ray-Ban, Glasses.com, and ContactsDirect.com).

Starting January 1, 2023, Humana’s network will include Walmart® and Sam’s Club™ vision and optical centers. Current and new Humana Vision members can visit Walmart and Sam’s Club vision and optical centers for eyeglass frames, lenses, and contact lenses as part of their in-network vision benefits. Learn more.

Please note: some optometrists with Walmart and Sam’s Club are independent contractors and may not participate in the Humana Vision network for eye care services like exams. Members can use Humana’s “Find an Eye Doctor” tool or call the provider in advance to confirm if the provider is in network.

Contact us today for a Humana Vision quote.

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Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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Celebrating Two Claremont Milestone Work Anniversaries

Please join us in celebrating Chris Kersey and Crystal Nelson on their milestone work anniversaries.

Chris Kersey, Applications Developer, is celebrating 15 years. “Chris always has the needs of our clients and team members front of mind when he is designing and coding,” says Ken Ruotolo, Claremont COO. “Inevitably, Chris will point out something that we hadn’t thought of and then will implement it in a thoughtful, easy-to-use and comprehensive way. I know I speak for all his teammates when I say it is a real pleasure to work with Chris. Congratulations on 15 years of service!”

Crystal Nelson, Broker Service Representative, is celebrating five years. Crystal initially came aboard as a temporary employee but quickly demonstrated that she should be a permanent member of the team. “Our broker customers have nothing but good things to say about Crystal,” says Laura Hogsed, Service Manager. “She is thoughtful, thorough, and goes above and beyond in everything that she does. Crystal is a great example of Claremont’s core values of Thoughtfulness, Innovation, Professionalism, Positivity, and Collaboration. She is truly a joy to work with. Please join me in congratulating Crystal on her five years of great service!”

You can reach Chris at ckersey@claremontcompanies.com or 925.296.8849 and Crystal at crystal@claremontcompanies.com or 925.296.8826.

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Blue Shield – San Diego Provider Network Expansion

Effective January 1, 2023, Blue Shield of California Trio HMO and Local Access+ networks will expand in San Diego to include UC San Diego (UCSD) Health.

Not all UCSD Health locations or providers will be in the Trio HMO or Local Access+ networks. Blue Shield recommends using their Find a Doctor tool which has been updated to reflect this network expansion. You can also reference Blue Shield’s Network Comparison Tool for network options in San Diego.

Blue Shield members enrolled in a Trio HMO or Local Access+ plan can select primary care physicians, and gain access to specialists and facilities at these UCSD Health clinics:

• UC San Diego Health – Community Group
  Vista, Downtown
• UC San Diego Health – Monica Perlman Clinic
  Vista, Downtown, Mira Mesa, La Mesa
• UC San Diego Health – One Medical
  Downtown, Carlsbad
• UC San Diego Health
  Owen Clinic, La Jolla, Kearny Mesa, Scripps Ranch
• UC San Diego Health – Physicians Network
  College Area, Sorrento Valley

Contact us today for a Blue Shield quote!

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Resources

• 2022 Broker Renewal Guide
• Medical Plan Cheat Sheet
• Q1-2023 Medical Sales Guide
• Q1-2023 Specialty Sales Guide
• Blue Shield News Center
• Product Cycle Updates
• Employer Connection Plus (EC+)
• Employer Enrollment Platform Resources
• Broker Communications
• Broker Connection
• Broker Open Enrollment Tool for Small Business [Video]
• Plan Comparison Tool and Network Comparison Tool
• Small Business Plan Documents
• Relaxed Participation Program
• Teledoc
• Wellvolution Mental Health
• Mandates
• Renewal Center
• Broker Bonus Calculator
• Forms and Applications
• Blue Shield Small Business Library
• Small Business Service Support

COVID-19 Resources

• COVID-19 Resources for brokers and employers.
• COVID-19 Resources Broker Connection
• COVID-19 Member Resource Page
• California Coronavirus Response Website
• California Department of Managed Health Care (DMHC) FAQs
• DMHC COVID-19 Response and Guidelines
• CDC COVID-19 Testing Overview

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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New Law Requires Your Individual Insurance License Number on Emails

Starting January 1, 2023, a new California law requires most insurance producers, including life, accident and health agents, to include their individual license number on emails. For details, read the Notice from California Insurance Commissioner Ricardo Lara.

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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Delta Dental PPO and Premier – How The Dual Network Works

Delta Dental PPO™ plan members have access to two Delta Dental networks – Delta Dental PPO and Delta Dental Premier®. Together, they make up the largest network of dentists in the nation, according to Zelis Network360®. In fact, four out of five dentists in the United States are Delta Dental network dentists. The main difference between the two networks is the amount members can save.

Member Savings

There are three options: PPO, Premier, and non-Delta Dental dentists. Members save the most when visiting a Delta Dental PPO dentist, a little less at a Premier dentist, and the least at a non-Delta Dental dentist.

Delta Dental PPO Network
With this large, high-quality and reliable network of dentists, members don’t need to carry paper ID cards or submit claims, since Delta Dental works directly with dentists to manage identification and claims.

By visiting a dentist in the PPO network, members pay less out-of-pocket and make their plan maximum go farther. PPO dentists have agreed to reduced fees, which means added savings and no unexpected out-of-pocket costs.

But members don’t have to sacrifice plan savings if their dentist isn’t in the PPO network.

Delta Dental Premier Network
By visiting a dentist in the Premier network, members can expect the same advantages of a high-quality network and easy access, but with more limited out-of-pocket savings.

Delta Dental Premier dentists have also agreed to discounted fees, as part of their contract with Delta Dental. Premier fees are typically higher than Delta Dental PPO fees. Like with PPO dentists, members won’t pay more than their expected share — so there are no surprise bills.

Non-Delta Dental dentists can set any price they wish.

Plan Configuration Can Encourage PPO Utilization

To encourage in-network visits long term, it’s best to build incentives into plan designs that encourage visiting in-network dentists. Groups may have the following options:

• Reward employees who stay in network with a higher maximum and lower (or no) deductible for in-network visits.
• Cover services at a higher benefit level for in-network care. For example, a plan with a benefit network differential might cover diagnostic and preventive services at 100% at PPO dentists, 90% at Premier dentists and 80% at non-Delta Dental dentists. This makes it clear to members that PPO dentists offer the greatest savings.
• Lower out-of-network reimbursement to encourage PPO and Premier network usage and potentially lower the plan’s cost.

Reimbursements

The amount the plan bases its payment on is the reimbursement, also known as the maximum plan allowance. This is separate from the percentage at which certain services are covered.

Under a Delta Dental PPO plan, PPO dentists are reimbursed at PPO fees and Premier dentists are reimbursed at either Premier or PPO fees. How Premier dentists are reimbursed under a PPO plan is up to the plan’s benefits administrator, but there are advantages to each of the two options:

• When choosing to reimburse Premier dentists at Premier fees, members enjoy the lowest out-of-pocket costs, but the plan pays more and may cost more overall.
• When choosing to reimburse Premier dentists at PPO fees, members face higher out-of-pocket expenses at Premier dentists, but the plan may cost less overall. This option also creates a greater incentive for members to visit a PPO dentist.

In-Network Dentists

With the Find a Dentist tool, members can check a dentist’s network by entering their own location and choosing their preferred network from the ‘Select a Network’ drop-down menu. Each dentist’s directory listing indicates which networks the dentist participates in.

With Delta Dental’s dual network, your clients and their employees can make informed choices about their care and costs, without sacrificing quality.

Contact us today for a Delta Dental quote.

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Resources

• Elevate Your Smile flyer.
• Get to Know The Delta Dental PPO and Delta Dental Premier Networks video.
• Delta Dental Small Business Program brochure.
• Delta Dental’s SBP plan comparison.

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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CaliforniaChoice – Designed For Brokers to Sell

With complex provider networks and competing underwriting requirements of the various carriers in California, selling group health insurance isn’t easy. That’s why CaliforniaChoice, the private exchange with the state’s largest portfolio of plans and networks, has spent 26 years simplifying the employee benefits process so you can focus on building your business.

You Get

• Online enrollment and account management resources.
• Competitive commissions.
• Easy renewals. Each year, clients and employees can adjust their contribution and plan selection to meet any budget.

Advantages

• Cost control through Defined Contribution.
  Employers define their budget and lock it in for 12 months. Employees apply their employer’s contribution to the health plan and benefit design they choose. If an employee selects an option that costs more, they simply pay the difference.
• Huge selection of HMO, PPO, FSA, EPO, and high deductible plan options.
  Employees can choose from 70+ options from eight top California carriers and health plans. No minimum participation between health plans. Includes the new Member Marketplace supplemental products.
• Smart Decision technology.
  Tools designed to help your clients enroll and find the right health plan for their individual needs, including online enrollment, online provider and Rx directories, and a plan comparison tool.
• Access to 80,000+ doctors and 400+ hospitals.
• Discount dental, vision, chiropractic/acupuncture, and life plan benefits.
• No-cost extras like Premium Only Plans, COBRA, and Mineral HR.
• Cal Perks Discount Program
  Discounts on movie tickets, theme and water parks, sporting events, hotels, car rentals, vacation packages, tax services, weight management and more.
• California Rx Card
  Savings of up to 75% at more than 68,000 pharmacies nationwide including CVS, Rite Aid, Target, and Walgreens.
• Easy single-source administration.
  One consolidated bill for simple administration.

CaliforniaChoice Plans

Medical Partners
You can offer multiple health plans side-by-side in a single employee benefits package. That means you only have to learn one product and run one quote, while still giving your clients the value of choice.

Optional Benefit Partners
Dental, vision, chiropractic, acupuncture, and life benefits that can be bundled in a single package.

Additional Product and Service Partners
Your clients have access to a range of value-added benefits at no extra cost.

CaliforniaChoice Resources

• CaliforniaChoice Program Highlights
• CaliforniaChoice Optional Benefits for Employers
• CaliforniaChoice Underwriting Guidelines (Partial)
• CaliforniaChoice Fast Facts
• CaliforniaChoice Small Group Solution

Contact us today for a CaliforniaChoice quote!

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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MetLife – The Workforce Priorities of Your Clients Are Changing

To effectively address your clients’ changing benefits needs and scale your business, MetLife has improved its level of service and support with the following enhancements:

Trusted Local Expertise and Guidance

MetLife is dedicating more local resources to bring expertise, support, and know-how where and when it’s needed the most with:

• Competitive pricing enabled by local market focus.
• Faster delivery on your needs and speedier resolution of issues.
• Greater access to senior leaders and product specialists.
• Dedicated local market broker relationship teams that understand your book of business and your ways of working to help you meet your goals
• Over 150 years of group benefits experience.

Industry-Leading Innovative Solutions

$100 million annual technology investment and continuous service improvement including:

• Integration of medical provider information for enhanced Connected Benefits Experience.
• Data-driven recommendations based on industry trends can help you benchmark for measured success.
• Upwise by MetLife – a no-cost financial wellness app.
• New digital self-servicing capabilities across multiple products available 24/7.
• New online statement of Health for Life.

Expanded Comprehensive Benefits Portfolio

Your groups get the simplicity they desire and their employees get the choice they want with:

• New market-leading bundle options.
• Expanded plan optionality with a full suite of voluntary benefits.
• Addition of Superior Vision and Davis Vision plans.
• Incentive dental plan designs that make employees’ benefits go farther.
• Group whole life – standard guaranteed issue and portability benefit.

Simplified Service and Support

MetLife is alleviating administrative burdens with:

• A dedicated team from implementation to service for a smooth process from start to finish.
• Direct contact to a client service consultant familiar with you and your clients makes it easy to address day-to-day needs.
• New third-party integrations.
• Insight-driven employee communications for enhanced enrollment and engagement.
• Resources aligned to sales team providing holistic account management and proactive engagement.

Download the MetLife flyer to learn more.

Contact us today for a MetLife quote!

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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KFF 2022 Employer Health Benefits Survey

Given today’s tight labor market and rising wages, employers are concerned about the cost of health premiums, especially since recent inflation suggests larger increases are imminent. And as disclosed in the Kaiser Family Foundation (KFF) survey, employers continue to be anxious about meeting the mental health needs of their employees and their dependents.

Conducted from February through July 2022, the KFF 2022 Employer Health Benefits Survey, of 2,188 randomly selected private and non-federal public firms of three or more workers, reveals that workers at small firms pay more in premiums and face higher deductibles than workers at large firms.

In 2022, the average annual premiums for employer-sponsored health insurance are $7,911 for single coverage and $22,463 for family coverage. In contrast to the lack of premium growth in 2022, workers’ wages increased 6.7% and inflation increased 8%.

Key Findings

• The modest change in premiums in 2022 may not continue as inflation continues to grow and catches up in 2023 contracts.
• 33% percent of covered workers at small firms are enrolled in a plan where the employer pays the entire premium for single coverage versus 6% of covered workers at large firms.
• Many employers continue to be anxious about meeting the mental health needs of their employees and their dependents. 48% of large employers see a growing demand for mental health services; 3 in 10 say their plan has too few behavioral health providers to ensure timely access to care. And more than 29% of workers are asking for family leave due to mental health issues.
• PPOs remain the most common plan type in 2022 with 49% of covered workers enrolled in a PPO, 29% in a high-deductible plan with with a savings option (HDHP/SO), 12% in an HMO, 9% in a POS plan, and 1% in a conventional (aka indemnity) plan.
• Many employers expressed satisfaction with key elements of their plans. Over 75% of employers responded that they were either “very satisfied” or “satisfied” with the components of their plans, including cost of care, quality of providers, and enrollees’ timely access to services.

Additional Findings

• Employer-sponsored coverage availability.
  99% of large firms (200+ employees) offer health benefits to at least some of their workers, smaller firms (3-199 employees) are significantly less likely to do so.
  Overall, 89% of workers employed at firms with three or more workers are employed at a firm that offers health benefits to at least some of its workers.
  Among all workers, across firms that offer health benefits and firms that do not, 54% are covered by health plans offered by their employer.
• Telemedicine.
  Employers remain optimistic about the future of telemedicine, with over half of large employers indicating they believe it will be “very important” to provide access to behavioral health services, and care to enrollees in remote settings, going forward. Over a third of large employers expected telemedicine use to increase this year.
  Among firms with 50 or more workers offering health benefits, 87% of small firms and 96% of large firms cover the provision of some health care services through telemedicine in their largest health plan.
• Health and wellness programs.
  Most firms offering health benefits offer programs to help workers identify and address health risks and manage chronic conditions. 54% of small firms and 85% of large firms offer a program in at least one of these areas: smoking cessation, weight management, and behavioral or lifestyle coaching.
• Coverage for insulin and statins.
  Most covered workers are in plans that cover the cost of at least some insulin products (70%) and statins for treating high cholesterol (71%) before they meet their general annual deductible. This follows a 2019 change in policies that allowed plans eligible for use with a Health Savings Account plans to cover these expenses as preventive services.

Check out the KFF 2022 Employer Health Benefits Survey to ensure that you and your clients are up to date with the latest employer-sponsored coverage data. Contact us today to develop tailored benefits solutions that address your clients’ needs.

KFF 2022 Employer Health Benefits Survey

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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MetLife – Block Strategies for Your Book of Business

Identify new business opportunities and create valuable administrative efficiencies for your firm and for your clients with a block strategy from MetLife.

With a wide range of solutions, service delivery, and focused support, MetLife will help you deliver the most updated contracts, plan designs, and competitive pricing available to each block of business.

MetLife Block Strategy Program

• Comprehensive Book of Business Review and Proposal Development
  MetLife collaborates with you to assess the unique needs of each block and industry vertical to identify the right solutions, including opportunities to expand the offering to add voluntary and worksite product options.
• Streamlined Implementation
  Consistent and predictable implementation that makes the transition easy for you and your clients.
• Experienced Service Teams
  Responsive service, smooth claims handling, and overall administrative efficiencies.
• Enrollment Support
  Access valuable decision-making tools and resources that drive employee engagement and client participation.
• Increased Earning Potential
  Along with competitive commissions, all new business may count toward your qualification for MetLife’s broker compensation program.

Download the MetLife flyer to learn more.

Contact us today for help with your book of business!

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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Small Group Special Enrollment Period Starts November 15

The 2023 Small Group Special Enrollment Period (SEP) starts November 15, 2022.

The Small Group SEP is the opportunity for employers to enroll in coverage with a $0 contribution requirement and no minimum participation requirement (at least 1 employee must enroll). The limited application period is from November 15 to December 15, 2022, for coverage effective January 1, 2023. Learn more.

Contact us to help your clients take advantage of the SEP.

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

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