Web-DENIS, CAREN, online information key to navigating product and other health care reform changes

Over the past few months, we’ve received many questions about the changes that are coming as a result of health care reform. We offer several sources of information to help you navigate this new, complex environment. Here are some of the key changes.

Product changes

• Some of our old products are being discontinued. Under health care reform guidelines, products must cover certain benefits, known as essential health benefits, in order to be considered compliant with the Affordable Care Act. Noncompliant plans could not be sold under these guidelines. BCBSM discontinued any product that didn’t meet the requirements.
• In November, President Barack Obama announced an option for insurers to keep some plans open for individual and small group members. To make sure that Michigan consumers have a choice of the best and most affordable health insurance, the Blues decided to transition these members into plans that are ACA-compliant.
• Members enrolled in all products, with the exception of Keep Fit (an individual market product eligible to extend through 2014 because of its policy year) will need to transition to a new ACA-compliant health plan.

How will a health care provider know when a patient has a new plan?

We encourage all our health care providers to check web-DENIS and CAREN for eligibility and benefit information. While we continue to educate our members about their benefits and how to use them, it’s a good idea to check with patients to see if they have new ID cards or if their coverage has changed when they come in for visits.

We’re also taking steps to ensure member and claim payments are minimally impacted during this time. Submitting claims for payment soon after the date of service will help to eliminate claim payment errors.

Other changes to note

• New plans introduced. If you want to know the basics about the new plans that the Blues offer, we provided a comprehensive overview in the October Record. For specific information about a patient’s plan, benefits and eligibility, be sure to check web-DENIS or CAREN.
• New benefits added. There has also been a lot of conversation around the new plans and their essential health benefits. For general information about these benefits, see this article from the August Record. Again, for specific benefit information, check web-DENIS or CAREN.
• Changes in cost-sharing. Cost-sharing amounts for plans on and off the Health Insurance Marketplace must be limited according to the federal government, and that limit may vary depending on the plan design. In addition, what we refer to when we talk about cost-sharing and how it’s calculated is also changing.

To sum up, it’s critical that you continue to check web-DENIS and CAREN for eligibility and benefit information during this time of change.