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California members page

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At MNJ Insurance Solutions, our hearts and prayers are with everyone affected by the Southern California wildfires. In these challenging times, the health and safety of the community is the utmost priority. Below, we have provided our carrier partners’ responses and resources to the fires.  We hope that you find this helpful.

 

Aetna: To assist affected members, Aetna created a dedicated disaster resources for California members page where you can find detailed information about the services and support Aetna is offering during this crisis.

  • Aetna’s Resources for Living℠ has published a resource guide with valuable information for all individuals and organizations affected by the Southern California wildfires — regardless of whether they have an Aetna plan. In addition, the following phone lines are available:
  • Individuals without access to Resources for Living may call (833) 327-2386 for resource referrals.
  • Members with access to Resources for Living (Small Group | AFA) should call their assigned RFL number to access services.
  • All Aetna clients, brokers, and members can also access important information on Aetna’s dedicated web page for the wildfires.
  • Members can call (888) 802-3862 for customer service or (800) 238-6279 for pharmacy management.

Anthem Blue Cross:  https://www.anthem.com/ca/blog/cawildfire

  • Anthem Blue Cross is making changes to health plan benefits to provide relief and ensure healthcare access for our members who live in Los Angeles and Ventura counties in California and are impacted by the Palisades wildfire and windstorm conditions. The changes are in effect January 7 through February 5, 2025.
  • Anthem is also offering FREE access to its online health option, LiveHealth Online to anyone living in the impacted area. LiveHealth Online offers video visits with U.S.-based board-certified doctors on a mobile device or computer from anywhere for non-emergency health conditions. The free visit offer will be available through the end of the state of emergency.
  • Anthem’s Employee Assistance Program (EAP) offers mental health support and resources to help with legal and financial concerns, dependent-care needs, and other life challenges. Call the 24/7 EAP crisis line at 877-208-8240.
  • For assistance during this emergency, please call us at 833-285-4030. Anthem is here to help make sure you have access to the healthcare you need. They can help with finding available doctors, refilling prescription drugs, and other health plan questions and are available by phone Monday through Friday, 8 a.m. to 6 p.m. PT.

Blue Shield of California

  • Blue Shield of California is, as always, working hard to ensure the safety and care of all Blue Shield of California members. The following is a centralized resource for how Blue Shield of California members: https://news.blueshieldca.com/2025/01/08/january-8-2025-blue-shield-of-california-offers-assistance-to-members-affected-by-wildfires
  • Here are the key resources available to assist those impacted:
    • Immediate Prescription Refills: Members in mandatory evacuation zones can receive immediate refills of their prescriptions, even if they are not yet due for a refill.
    • Continuity of Care: Blue Shield Medical Care Solutions will proactively reach out to members enrolled in care and disease management programs in mandatory evacuation zones to ensure they continue receiving the care they need.
    • Virtual Care Options: Members can access various telehealth services, including Teladoc and NurseHelp 24/7℠. Visit blueshieldca.com to review the specific virtual care options available under your plan.
    • Mental Health Support: The mental health service administrator provides free access to resources, materials, and counseling services through a dedicated hotline: (800) 327-7451.
    • Vision Plan Assistance: Vision plan members in affected areas who have lost or broken eyewear may be eligible for replacement lenses and/or frames. For assistance, call Vision Customer Service at (855) 492-9028 (TTY: 711) during operating hours, Monday through Saturday, 8 a.m. to 8 p.m. PST.
    • Out-of-Network Provider Access: Displaced members can see an appropriate out-of-network provider at in-network benefit levels and can replace medical equipment and supplies if needed.
    • Member Identification (ID) Card Replacement: If members have lost their ID card, they can view and print a new card by logging into their online account at www.blueshieldca.com/login. Alternatively, the Blue Shield of California mobile app allows access to the ID card on mobile devices.

    If a member needs assistance, please have them call the Customer Service number on the back of their ID card. Blue Shield wants to respond to the urgent needs of all affected members.

 

Additional Special Assistance Information for Members Affected by Palisades Fire and Windstorm Conditions

Cigna

  • Cigna Disaster Resource Center: click here
  • EAP Tools for HR and Managers: https://eapmanager.cigna.com/
  • Mental Health Support line (open to non-members): call (866) 912-1687
  • Veteran Support Line: call (855) 244-6211
  • Coping with loss due to fire: click here

Health Net

  • To ensure members have uninterrupted access to essential prescription medications and healthcare services, Health Net is providing special assistance to members affected by the Los Angeles and Ventura County Fires and windstorm conditions. Click here for up-to-date information.
  • Virtual visits: If members cannot reach their Primary Care Provider, Health Net is providing access to telehealth services at no cost.
  • Serving Those In Need
    • To better serve medically vulnerable members in the evacuation zones, Health Net has proactively reached out to members who may need to the most help, including those identified as experiencing homelessness and members who are wheelchair-bound, oxygen dependent and homebound to check in.
    • Health Net has connected with over 800 members to provide information about:

 

Kaiser Permanente:  https://healthy.kaiserpermanente.org/southern-california/alerts/southern-california-fires

  • News for members impacted in SoCal: click here
  • Appointment and Advice Center: call (833) 574-2273
  • Mental health and wellness support: click here
  • Member Services: call (800) 464-4000; be sure to let the representative know you’ve been affected by the fires

MetLife

Mutual of Omaha

  • Mutual of Omaha Wildfire information: click here
  • Claims assistance: call (800) 877-5176
  • Member Services: call (800) 369-3809
  • 24/7 Employee Assistance Program: call (800) 316-2796

UnitedHealthcare

  • UHC Disaster Relief Info: https://www.uhc.com/disaster-relief-info
  • A free emotional support hotline is available during this time of need at 866-447-3573, Monday through Friday, 8 a.m. to 8 p.m. Central Time.
  • Emotional support resources and information are also available online at www.liveandworkwell.com.
  • If a member needs help seeing a health care provider right now, there are options. They can use the UnitedHealthcare mobile app or website to find a network provider or to schedule a Virtual Visit1.

 

If you have any questions and need additional resources regarding your plan, please reach out to MNJ Insurance Solutions at (714) 716-4303.

May is Mental Health Awareness

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May is Mental Health Awareness Month, a time to raise awareness about the importance of mental health and wellbeing. Taking care of your mental health is just as important as taking care of your physical health.

Here are five tips for better mental health:

  1. Take time to re-group and re-center: Take time to do things that make you happy and relaxed, such as reading a book, taking a bath, or practicing a hobby.
  2. Connect with others: Community is important for good mental health. Spend time with friends and family.
  3. Get 7-8 hours of sleep per night: Adequate sleep is important for good mental health.
  4. Exercise on a regular basis: Physical activity can help reduce stress, improve mood, and boost overall mental health.
  5. Seek help if needed: Don’t hesitate to seek help from a mental health professional if you’re struggling with your mental health.

 

One more tip: If needed, you can call “988,” which is a suicide and crisis hotline number, similar to “911” for emergencies.  When you contact the new mental health crisis hotline number, a trained crisis worker will offer emotional support and connect you with any needed resources.

Your mental health is important and we encourage you to get the help you need.  Let’s all work together to break the stigma surrounding mental health and prioritize our mental wellbeing.

Please contact MNJ Insurance Solutions for more information and how we can help with your Employee Benefits.

What is the Difference Between an EAP vs. Mental Health Benefits?

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Mental Health is a serious matter!

Watch and share our brief video, as we explore and clarify the distinction between Employee Assistance Programs (EAP) and Mental Health benefits available in your health insurance plan.

Whether you are an employer wanting to enhance your benefit offerings or an employee seeing assistance, this video will provide you with some insights to make informed decisions about your mental health support options.

If you have any questions regarding your mental health benefits and/or resources, please reach out to MNJ Insurance Solutions.

#mentalhealthawareness #mentalhealthmatters #endthestigma

Benefits of a Grandfathered Plan

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Grandfathered Plan Overview

The grandfathered plan was created on March 23, 2010, with few changes implemented since then. Plans with grandfathered status are exempt from some Affordable Care Act (ACA) regulations, but if that status is lost, the plan must adhere to more ACA criteria. An attempt by employers to scale back the benefits of plans or raise participant expenses will result in the loss of grandfathered status. So, it is essential to note that employers are limited in what changes they can make to grandfathered plans’ benefits and costs. It is also important to note that an employer can decide it makes sense to give up the plan’s grandfathered status and adhere to the new ACA standards to make more significant changes to its health plan.

 

Grandfathered Health Plans are exempt from the following ACA requirements:

Coverage of Preventive Health Services

For plan years beginning on or after September 23, 2010, certain preventive health care must be covered by company health plans and group or individual health insurance policies without requiring cost-sharing requirements. In addition, for years beginning on or after August 1, 2012, preventative health treatments for women must be offered without cost-sharing.

 

Patient Protections (for plan years beginning before January 1, 2022)

The ACA requires the following patient protections that are effective for plan years beginning on or after September 23, 2010:

  • Any primary care physician, including a pediatrician for children, who are available and participates in the plan or network must be available to enrollees.
  • Emergency services provided by group health plans and group or individual health insurance policies are not subject to increased cost-sharing or pre-authorization restrictions.
  • For OB/GYN care, corporate health plans and individual or group health insurance policies may not demand preauthorization or referral.

*For plan years beginning on or after January 1, 2022, the No surprise act (NSA) has expanded the ACA’s patient protection, which applies to protections for patients under health plans with grandfathered status.*

 

Nondiscrimination Rules for Fully Insured Plans

Once regulations are issued, fully insured plans must comply with section 105(h)(2) of the Internal Revenue Code. According to that clause, a plan and the benefits provided in the plan may not favor highly compensated people when determining who is eligible to participate.

 

Quality of Care Reporting

Reporting requirements will be implemented for group health plans and health insurance providers who provide group or individual health insurance coverage. The reports will deal with benefit and payment plans that are intended to enhance patient safety, lower medical errors, avoid readmissions to the hospital, and implement wellness programs.

 

Improved Appeals Process

For plan years starting on or after September 23, 2010, group health plans and health insurance providers that provide group or individual health insurance coverage must strengthen their internal appeals procedures and adhere to minimum standards for external reviews.

 

Insurance Premium Restrictions.

Premiums for health insurance coverage in the individual or small group market may not be discriminatory. They may differ solely by individual or family coverage, rating region, age, and tobacco use for plan years beginning on or after January 1, 2014.

 

Guaranteed Issue and Renewal of Coverage

For plan years starting on or after January 1, 2014, health insurance issuers that provide health insurance coverage in a state’s individual or group market must accept every employer and person who applies for coverage in the state. They also must renew or continue the coverage at the individual’s or plan sponsor’s discretion.

 

Nondiscrimination in Health Care

Group health plans and health insurance providers that provide group or individual insurance coverage may not discriminate against any provider practicing within their scope of practice as of January 1, 2014, or for plan years beginning on or after that date. This clause, however, does not mandate that a plan only work with agreeable providers or forbid tiered networks. In addition, plans and issuers are prohibited from treating people differently based on whether they accept subsidies or assist an inquiry under the Fair Labor Standards Act.

 

Comprehensive Health Insurance Coverage

For plan years beginning on or after January 1, 2014, health insurance issues that offer group or individual health insurance coverage need to provide the minimum set of benefits demanded of policies sold through health insurance exchanges.

 

Limits on Cost-Sharing.

For their coverage of essential health benefits, plan years starting on or after January 1, 2014, must employ a cost-sharing limit (total yearly limit) for solo and family coverage.

 

Coverage for Clinical Trials

For plan years beginning on or after January 1, 2014, group health plans and health insurance providers providing group or individual insurance coverage must allow certain enrollees to participate in specific clinical trials, with the recurring costs covered for participation. In addition, discrimination against the enrollees for the trial is prohibited.

 

Key Considerations for Employers

At each renewal, employers will need to decide whether to renew with their current Grandfathered plans or make changes to ACA plans.  It is important to know that once an employer no longer offers a Grandfathered plan or moves to a new carrier, the employer can no longer go back to the Grandfathered status. It is important to weigh all of your options, the pros and cons, at your renewal period.

If you are an employer, who still has Grandfathered plans, and are interested in a second opinion or evaluation of your benefits, please contact MNJ Insurance Solutions at (714) 716-4303 ext. 102 or sales@mnjinsurance.com.

 

This Grandfathered Plan Overview is provided for informational purposes only and should not be construed as legal or a recommendation of any kind. While we have attempted to provide current, accurate, and clearly expressed information, this information is provided “as is,” and MNJ Insurance Solutions makes no representations or warranties regarding its accuracy and completeness.

 

*source:https://content.zywave.com/file/4180adb7-d393-4c8f-9210-f99b31832eb8/Health%20Care%20Reform%3A%20What%20Are%20the%20Benefits%20of%20Having%20a%20Grandfathered%20Plan%3F%20.pdf *

The Basics Employers Need to Know About CAA Prescription Drug Reporting

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Rx reporting is a federal mandate that requires insurance companies and group health plans to provide a report of prescription drug data to the government. Logistics regarding the act can be found under Section 204 (of Title II, Division BB) of the Consolidated Appropriations Act, 2021 (CAA).

 

CAA Submission Requirements

The following list includes the information that the CAA requires insurance companies and employer-based health plans to submit:

  • Prescription drugs that are the most frequently prescribed
  • Prescription drugs that account for the most spending
  • Spending reports on prescription drugs and healthcare services
  • Prescription drug rebates from drug manufacturers
  • Premiums and cost-sharing that patients pay

 

            What does the government do with this information?

The federal government wants to use the information and data to examine the prescription drug industry with the potential to make legislative or regulatory changes. Centers for Medicare & Medicaid Services (CMS.gov) expresses that this information will be helpful to:

  • Identify the central causes of increases in prescription drug and healthcare spending
  • Understand how prescription drug rebates impact premiums and out-of-pocket costs
  • Promote transparency in prescription drug pricing

 

Important information and deadlines

This is an annual reporting requirement; plans an issuers will generally submit these reports in June each year, reporting information for the prior calendar year. Please note that it is required to comply with this mandate regardless if your company is fully insured or self-funded. The following deadlines should be noted:

 

Calendar Year to Report Deadline
2022 June 1, 2023
Subsequent calendar years June 1st of each year

 

For more information on this topic, please contact MNJ Insurance Solutions.

 

This Rx reporting summary is provided for informational purposes only and should not be construed as legal or a recommendation of any kind. While we have attempted to provide current, accurate, and clearly expressed information, this information is provided “as is,” and MNJ Insurance Solutions makes no representations or warranties regarding its accuracy and completeness.

 

Resources

CMS.gov provides the following resource:

  • On Nov. 23, 2021, the Departments published an interim final ruleregarding the requirement to report pharmacy and drug costs.
  • Transparency in coverage FAQswere released on Aug. 20, 2021.
  • An FAQabout the submission grace period and reporting flexibilities for 2020 and 2021 data was released on Dec. 23, 2022.
  • More information, including RxDC reporting instructions, is available through the HHS’ RxDC website.
  • Prescription Drug Data Collection (RxDC) Reporting Instructions: https://regtap.cms.gov/reg_librarye.php?i=3860

 

 

No Surprises Act Summary and What Employers and Employees Need to Know

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As of January 2022, the “No Surprise Act” provides protection for consumers from unexpected bills for out-of-network care in an emergency and certain non-emergency settings. By enforcing better consumer protection and price transparency, the new regulations will help create better patient experiences and provide better financial protection for individuals.

Here are a few of the protections you should be aware of:

  1. The No Surprise Act protects patients from receiving surprise medical bills or balance billing resulting from emergency services from out-of-network providers or out-of-network air ambulance services without prior authorization. In other words, you should not be charged more than in-network cost-sharing for specific out-of-network services.
  2. The Act bans out-of-network charges for certain services if the individual is at an in-network facility, including services such as anesthesiology or radiology provided by out-of-network providers. The reason for this is because individuals would not know that the provider is out-of-network if they are at an in-network facility.
  3. The Act requires health care providers and facilities to provide individuals with an easy-to-understand notice explaining the applicable billing provisions and who to contact if the provider or facility has violated the individual’s new protections.
  4. The Act also includes requirements that facilities provide “Good Faith Estimates” to individuals and Advance Explanation of Benefits. More guidance on this provision are still being formalized as of 2022.

We believe that The No Surprise Act creates better financial protection for consumers.

For more information on how MNJ Insurance Solutions can help your company and employees, please contact us today.

Insurance Carriers’ Responses to COVID-19

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We recognize this is a challenging time for everyone and MNJ Insurance Solutions remains committed to be a resource to those we serve, our clients, our prospect clients, our business partners, our insurance carriers, and our communities.

We continue to monitor the spread of COVID-19 and the impact around us.  One of the most common questions that we are receiving from our clients is “How are the insurance carriers covering COVID-19?”

Use the links below for Frequently Asked Questions, resources, and more information on how our carriers are covering COVID-19:

Our work does not stop in light of this pandemic and our team is here to answer your questions and help with you and your employees’ insurance needs.  Contact us at (714) 716-4303 if you have any questions regarding your health insurance plans and COVID-19 and we will do our best to help find solutions.

Disclaimer:  Information is subject to change at any time.  For the most current information on COVID-19 and recommendations on how to protect yourself and others during this pandemic, please visit the CDC for more details.