BROKER NEWSLETTER JULY 2023
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NEW: LGBTQ+ Health
from Included Health
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Starting August 1, 2023, Harvard Pilgrim fully-insured accounts will now have access to LGBTQ+ Health from Included Health. This comprehensive care navigation platform supports LGBTQ+ members and their families with managing a range of specific health care needs, related to physical health, gender-affirming care and health plan benefit navigation.
LGBTQ+ Health from Included Health is part of our Family-centered care program, which offers access to complementary services and support that aim to improve our members’ overall health and well-being across areas of emerging or unmet needs. Eligible health plan members will continue to receive opportunities for engagement (via dedicated email campaigns) with these programs throughout 2023.
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Important information and updates to help you manage your clients’ needs.
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As we’ve restored our primary systems and tools (including our broker, employer and member portals), the Harvard Pilgrim website and core transactional functions including premium billing and invoicing, we wanted to share a few key updates to support you and your employer clients:
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- Broker Commission Payments
July commissions were processed on July 15, 2023 - based on actual membership activity per our standard program calculations. Please note, this July payment also includes reconciliations against the estimated May and June payments for Harvard Pilgrim membership activity. As a reminder, all payments are issued around the 15th of each month. - Premium Billing for Harvard Pilgrim Employer Groups
Harvard Pilgrim employer groups that were either renewed or sold during the system outage did not receive invoices for their June and July premiums and/or administrative fees. As a reminder these groups have recently been billed for June, July and August, with a due date of August 1. For groups enrolled in ACH/automatic payments, payments will be deducted on August 1. -
Prior Authorization Policy Update
For dates of service between April 15 - July 23, 2023, prior authorization requirements and related utilization management requirements, excluding pharmacy and medical benefit drugs, for all Harvard Pilgrim Health Care members, were previously waived. As of July 24, 2023, this waiver will no longer be in effect. All providers and members (who received services without a medical necessity review) have been made aware of this policy reinstatement.
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Coming Soon:
Online Quoting & Renewals for Maine and New Hampshire Small Groups
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Small group brokers who do business in Maine and New Hampshire will be able to manage their 2024 quoting and renewals through the new broker portal. Pre-renewals for 2024 will begin in September, followed by online quoting and renewal activities later this fall. Brokers can simply log in to the new broker portal to manage all their 2024 small group business on one site/platform. More details will be available soon.
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- Any remaining 2023 Maine and New Hampshire small group activity will continue to be managed in the heritage portal, HPOQ/R.
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If you have not used our portals previously, we encourage you to contact your Broker Administrator and log in for this best-in-class tool.
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COVID-19 Public Health Emergency (PHE) Update
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On May 11, 2023, the federal COVID-19 Public Health Emergency (PHE) ended. As such, we have updated the Harvard Pilgrim website to reflect these changes in coverage for COVID-19 vaccines, tests, and treatments effective May 12, 2023. You can view the updates here.
In addition, we created state-specific overviews that compare coverage and benefits during the pandemic/public health emergency vs. our current policies.
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Unwinding of the Public Health Emergency (PHE) |
In March 2020, the federal government implemented a ‘continuous coverage’ requirement to prevent people from losing health care coverage during the pandemic. This continuous coverage requirement expired at the end of March 2023 which began a process known as the “unwinding” of the continuous coverage requirement. It is estimated that at least 150,000 to 200,000 Granite Staters and Mainers will be disenrolled from the Medicaid programs in each state. We share this with you as you may get requests to add members, such as dependents of subscribers who are no longer eligible for Medicaid. We appreciate your partnership to help ensure that our communities continue to gain access to top-quality care from Harvard Pilgrim.
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HMO Enrollment Area Changes |
As a reminder, the HMO enrollment area will change on January 1, 2024, to include fewer Connecticut zip codes applicable to our HMO plans. Employer groups may need to consider adding a PPO or POS plan design upon 2023 renewal to accommodate their employees residing in Connecticut.
Learn More ›
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We are pleased to share our 2022 Corporate Citizenship Report highlighting our efforts to support, advocate for and advance healthier lives for the communities we serve throughout New England.
Read the Report ›
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Helping your clients live well and work well.
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We are committed to providing convenient and affordable care through innovative solutions to meet our members' needs. Through our trusted telehealth partners, members can receive care and support from U.S. board-certified doctors anytime — available 24/7 via phone or video. Services include:
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Doctor on Demand:1 Licensed providers who can support employees and their dependents for concerns such as general medical care, anxiety, depression, seasonal affective disorder, medication management or PTSD.
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AbleTo:2 A personalized coaching program that guides members through an effective 8-week journey to reduce depression, stress, and anxiety.
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1Telehealth virtual health care services (provided by Doctor on Demand) are available to Harvard Pilgrim commercial members that have this benefit. Cost share may apply.
2AbleTo Virtual Therapy is available to Harvard Pilgrim fully insured groups and will be available to self-insured groups later this year. Cost share applies to members with high deductible plans with an HSA.
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A Seamless Onboarding Experience |
We offer new Harvard Pilgrim members access to specialized tools to simplify plan selection. Decision Doc from MyHealthMath helps new members choose their preferred plan. Once a plan is chosen, they can talk to a dedicated team of experts from SmartStart who can get them enrolled, answer additional questions, offer clinical transition support and more.
Contact your account manager for more information.
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Bikeshare Rolls into Portland, Maine |
In partnership with the City of Portland MaineDOT and Harvard Pilgrim, Tandem Mobility launched Portland Bikeshare for the 2023 season. You may see our Harvard Pilgrim bikes in and around the city. Portland residents and visitors will enjoy convenient access to 150 traditional geared bikes and 50 electric assist bikes staged at over 40 parking hubs throughout the peninsula. This initiative reinforces Harvard Pilgrim’s commitment to the health and well-being of all Maine communities, while offering access to an affordable, convenient, and fun way to get around the city for residents and visitors alike.
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Save the Date for our Fall 2023 Broker Updates.
Details and registration to follow.
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Visit our broker events page for the most recent information.
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