Quick links to state-specific news: Idaho News, Oregon News
Group Contract Changes Effective July 1
Beginning with July renewals, and new groups, we will make changes to our group contracts to bring them in line with the federal healthcare reform recommendations. More information about the recommended preventive services is available on the Healthcare.gov Recommended Preventive Services page.
Oregon July Group Contract Changes Approved
We have received approval from the Oregon Insurance Division (OID) on our filing of changes to our group medical contract, group dental contract, and related forms. The changes are effective as groups renew starting with July 2011 renewals. The changes apply to all size employer groups and associations, regardless of group size, unless otherwise noted. The only exception is if a custom large employer group or association currently has a limitation or eligibility provision that is better than the corresponding filed change.
Our Notice of Change letter outlines the medical and dental changes and will be enclosed with renewal rates for July 2011 and later renewals.
Idaho July Group Contract Changes Submitted to State
We have submitted changes to our group medical contracts and group dental contract to the Idaho Department of Insurance (DOI). As soon as the DOI accepts these filings, we will notify you and post the changes on our Web site. These changes will be effective as groups renew starting with July 2011 renewals.
New Plan Summaries Online
The Optional Benefits section of our Oregon and Idaho Plan Summaries pages now includes pharmacy and alternative care/chiropractic plan summaries with a July 1, 2011, effective date. Dental summaries have also been updated on our Web site for both states.
As always, please feel free to contact us if you have any questions.
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Provider Network Change for Eastern Washington
Effective June 1, 2011, InterWest Health will replace First Health as the primary provider network for members who live in, or seek services in, the following Eastern Washington counties: Adams, Asotin, Columbia, Ferry, Garfield, Lincoln, Pend Oreille, Spokane, Stevens, Walla Walla, and Whitman. Our Find a Provider page at PacificSource.com includes a link to the InterWest Network directory.
Members in these counties have been sent notification of the change, and will receive new PacificSource ID cards by mail in May for use starting June 1, 2011. Members in surrounding areas have also been notified.
In addition to these member communications, our Client Service Representatives e-mailed advance notification to group clients in the affected regions, and an article will appear in this month’s Benefit Matters employer newsletter.
While we currently have no self-insured group clients based in this area of Washington, this change will affect the travel wrap network utilized if plan members travel to Eastern Washington for services. If you have PacificSource Administrators clients whose plans include a travel wrap benefit, you will receive more information via e-mail.
Providing our members with access to a wide variety of doctors and medical practitioners is important to us. The addition of InterWest will provide access to a significantly greater number of providers in these areas.
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E-mail Queue Set Up for Agent Administrative Documents
We have set up agentcoordinator@pacificsource.com [Ed.: the email queue address changed to agentcoordinator@pacificsource.com from groupsales@pacificsource.com effective 8/2/11] as an e-mail queue for your agency or agent administrative documents. The queue will ensure your documents are received by the first available Marketing Agent Coordinator, and will allow us to process your documents in a timely manner, even when a staff member is absent. Instead of e-mailing Candice Manning or Nick Firth directly, we ask that you use the queue for agency-related administrative messages, such as Producer of Record (POR) changes, license verifications, E&O documents, appointment paperwork, and contracts.
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Flu Shot Clinic List Updated
If a plan has a pharmacy benefit, members can show their PacificSource ID card to obtain a flu vaccine shot from our participating flu shot pharmacy network no cost!
Most, but not all, of the pharmacies in major chain stores and their affiliates have contracted with us to provide these vaccinations. Please note, Walgreens® is not currently part of our flu shot network. PacificSource will be billed directly by participating pharmacies, with no paperwork, deductibles, or copayments required.
Please refer to our CVS Caremark® Pharmacy Network directories to determine if a pharmacy is part of our flu shot pharmacy network. (The note “Flu Shot” will be shown in the right column.) For member convenience, we’ve created separate directories for Idaho, Montana, Oregon, and Washington pharmacies. The directories and more information about flu shot coverage are available at our Flu Vaccination Coverage and General Information page.
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Helpful Descriptions Added to EOB Statements
Our explanation of benefits (EOB) statements will soon include additional information to help members understand the services listed and how their benefits have been applied. Beginning July 1, 2011, the revised statements will include the following text:
- The Benefit Explanation of Remark/Reason Code section will list the service code with a brief, general description of how the benefit is applied.
- “Appeal process” and “other resources” paragraphs will explain options for appealing a decision and offer contact information for additional assistance that is specific to the member’s location.
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Individual Billing Statements to Get New Look
Beginning with July individual billing statements, which mail in June, we are making some changes to simplify the statements and make them easier for members to read and understand. We informed individual subscribers about the upcoming change through a note on their June billing statements. The July statements will include a guide to reading the new bill.
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Individual Reminder: List Billing Is Prohibited
The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits “list billing” for group health benefit plans (see 29 CFR 2590.702(c)(2)(ii)). Under state and federal law, a plan is considered a group health plan if the employer contributes directly or indirectly to the premiums.
In accordance with HIPAA law prohibiting list billing, we may only accept individual policy premium checks from personal accounts. If we receive a business check with an individual acceptance letter, we must return the check. The only exception would be for a single-person or husband-and-wife type of business.
For details regarding list billing and state and federal law, please see the following state bulletins:
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Additional Notice Reminds Clients of Past Due Payments
[Correction: Only agents will receive the second reminder notice.]
Beginning this month, employers and individuals who are past due on premium payments will receive a second reminder notice on the 25th of the month. If a group is new, this may be their first reminder. As always, you will receive a copy if we mail this notice to any of your clients.
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Employer Newsletter Mails this Month
The June/July issue of Benefit Matters, our newsletter for employers, mails this month with June group billing statements. Top stories include the Veggie U nutrition education program in Oregon classrooms, updates to our flu shot clinic list, provider network change for Eastern Washington, and new names for Clear One and COIHS (Oregon edition). This issue and recent issues are available on our Web site in our Benefit Matters newsletter archive.
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Idaho Agent Events
Idaho DOI Hosts Free Law Class June 9
The registration deadline is June 2!
The Idaho Department of Insurance will host the class from 1:30 p.m. to 4:30 p.m. at the Transportation Department in Boise. It will be presented by Consumer Affairs Supervisor Michelle Bucher, Producer Licensing Supervisor Lisa Tordjman, and Consumer Affairs Officer Sandy Metro. Topics include: handling money and trust accounts, the producer licensing Web site and how to use it, a legislative update, and what’s new at the DOI. The class is worth three continuing education credits. For more information and to register, please see the DOI class registration page.
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Eugene Marketing Sales Assistant Staff Change
We are pleased to announce Kim Nesbitt has accepted the position of Marketing Sales Assistant with the Marketing Sales Department in our Eugene office. Terry Goodman, formerly the Marketing Sales Assistant for seven years, has accepted the position of Provider Service Specialist with the Provider Network Department. Terry and Kim began their new duties on May 9.
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Kim Nesbitt, Marketing Sales Assistant
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“Terry has done a phenomenal job for all of us, and I wish her nothing but the best in her new position,” says Eugene Regional Manager Doug Sheffer. “And Kim’s past experience in this role in our Bend office is sure to be invaluable. Congratulations to both Terry and Kim!”
Please take a moment update your e-mail address book with Kim’s e-mail—knesbitt@pacificsource.com. When e-mailing Doug, please copy Kim instead of Terry effective immediately.
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Community Events
PacificSource is proud to sponsor Northwest community events that support healthy communities and health-focused organizations. We hope you will join us in supporting these events:
Pole Pedal Paddle
May 21, Bend, Oregon
Drop by the PacificSource booth for slices of organic fruit paired with healthy dips. While you're there, take advantage of a complimentary blood pressure check.
Reach the Beach
May 21, Pacific City, Oregon
Springfield Education Day—Gift of Literacy
June 2, Springfield, Oregon
Capital Classic—St. Alphonsus Foundation
June 4, Boise, Idaho
Heaven Can Wait Run/Walk
June 5, Bend, Oregon
Commute Options Week
June 16-19, Central Oregon
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