In this issue:

• Complete Access EPO^SM plan available to individuals and small businesses in 2025
• Merged Market resources and 2025 plan changes
• Update on the Consolidated Appropriations Act (CAA) Prohibition on Gag Clauses
• Medical Loss Ratio (MLR) rebate update 
• Broker webinar recording now available
• Minimum Creditable Coverage vs Medicare Part D Creditable Coverage: What’s the difference?
• Choice Easy Tier plan provider tier changes
• October is Cybersecurity Awareness Month
• Steve Tringale joins healthcare industry podcast on creating an exceptional member experience
• Meet Jim Delisle, our new Municipal Strategy and Business Development lead
• Mass General Brigham Health Plan names new SVP of State Programs
• Newsletter feedback survey
• Toolkit: Share these resources with your clients
  
  

Complete Access EPO^SM plan available to individuals and small businesses in 2025

Mass General Brigham Health Plan announced its new Complete Access EPO^SM (Exclusive Provider Organization) plan will be available to individuals and small businesses on January 1, 2025 to expand affordable coverage solutions.

“We are excited to offer our top-requested Complete Access EPO product to small employers across the Commonwealth,” said Jennifer St. Thomas, Senior Vice President, Commercial and Medicare Markets, Mass General Brigham Health Plan. “This is another way that Mass General Brigham Health Plan is listening to feedback and responding to demand for competitive and affordably priced options to support our members and the business community.” Read the full announcement.

Merged Market resources and 2025 plan changes

To support brokers selling to small groups in the Merged Market, we have a variety of resources available. Please visit our website for plan info and view this document outlining our 2025 plan changes. 

Starting in 2025, a change for all standard plans requires members to use our mail order service to obtain the copay discount for 90-day preventive medication prescriptions. While members can still get 90-day prescriptions from retail pharmacies, the discount is only available through mail order. Our Pharmacy Benefit Manager, Optum, is initiating promotions for members who can benefit from the mail order program. This change will take effect as plans renew their 2025 coverage.

Update on the Consolidated Appropriations Act (CAA) Prohibition on Gag Clauses 

As you may know, the CAA Prohibition on Gag Clauses provision prohibits health plans and insurers from entering into contracts with health care providers, third-party administrators, or other service providers that would restrict the plan or insurer from providing, accessing, or sharing certain information about provider price and quality and deidentified claims.

Our provider contracts comply with the CAA Prohibition on Gag Clauses provision. In addition, as required by the CAA, employer accounts must submit an annual Gag Clause Prohibition Compliance Attestation (GCPCA) to the Department of Health and Human Services portal through the designated GCPCA webform by December 31, 2024. This year’s GCPCA submission covers the reporting period of January 1, 2024 through December 31, 2024.

Mass General Brigham Health Plan will submit attestations on behalf of our fully insured groups. There is no action required for these groups. We will also submit attestations on behalf of self-insured groups who do not carve out prescription drug coverage. No action will be required for these groups either. 

We are pleased to be able to submit attestations on behalf of the vast majority of our fully and self-insured employer accounts.

Medical Loss Ratio (MLR) rebate update 

Please note that our recent notifications to small employer clients regarding the Medical Loss Ratio (MLR) rebates for 2023 listed only one policy number for customers who offered more than one benefit plan with us. If you have multiple policies with Mass General Brigham Health Plan, the MLR rebate was allocated toward all your policies. We only listed the policy number with the largest membership in our notification.

Broker webinar recording now available

A big thank you to everyone who joined us for our Fall Broker Meeting on October 2! You can check out the webinar recording and some handy resources in the broker portal. The webinar covered:

• Product portfolio enhancements
• Merged Market updates, including new EPO product
• New Medicare products for 2025

If you have any questions, feel free to reach out to your sales or account executive.

Minimum Creditable Coverage vs Medicare Part D Creditable Coverage:
What’s the difference?

Changes to the Part D creditable coverage threshold for CY 2025 has sparked questions about the difference between Medicare Part D Creditable Coverage (MCC) and Minimum Creditable Coverage. Due to the Inflation Reduction Act, CMS enriched the Part D benefit significantly, capping the max out of pocket (OOP) cost per member to $2,000 for CY 2025. This raised the threshold that commercial Rx plans need to meet or exceed to remain compliant and at this time all of Mass General Brigham Health Plan's commercial plans are compliant. 

Below is a breakdown of Medicare Part D Creditable Coverage and Minimum Creditable Coverage:

Medicare Part D Creditable Coverage refers to prescription drug coverage that is at least as good as the standard Medicare Part D prescription drug coverage. If you have other prescription drug coverage, from a current or former employer, that is considered creditable, you may not face a late enrollment penalty if you decide to enroll in a Medicare Part D plan later on. This is important for individuals who are eligible for Medicare and want to make sure they maintain their current coverage without incurring penalties in the future.  

Minimum Creditable Coverage (MCC) is a requirement under Massachusetts state law, designed to ensure residents have a basic level of health insurance coverage. Plans must meet specific standards set by the Massachusetts Health Connector, which includes comprehensive benefits and limits on out-of-pocket costs. Individuals who do not have a plan that meets MCC may face penalties when filing their state taxes.

Key differences
 
1. Purpose:

• Medicare Part D Creditable Coverage: Specifically relates to Medicare Part D prescription drug coverage.
• Minimum Creditable Coverage: A requirement for all residents, 18 years and older, in Massachusetts to have a minimum level of health insurance coverage.

2. Applicability:

• Medicare Part D Creditable Coverage: Applies to individuals who are Medicare eligible but have other coverage through a current or former employer. 
• Minimum Creditable Coverage: Applies to all residents of Massachusetts, 18 years and older.

3. Consequences of non-compliance:

• Medicare Part D Creditable Coverage: Not having it can result in penalties for delaying enrollment in Medicare Part D.
• Minimum Creditable Coverage: Failing to have it can lead to financial penalties during tax filing.

Choice Easy Tier plan provider tier changes

Next week, we'll be sending out a letter to let our members know about tier changes to the Choice Easy Tier plan providers. Effective January 1, 2025, Shriners Children’s Hospital, Boston and Shriners Children’s Hospital, New England, Springfield will be in Tier 2 (higher-cost). There are no other tier changes for 2025.  We are directing our members to contact our Customer Service team if they have questions or need assistance. 

October is Cybersecurity Awareness Month

In recognition of Cybersecurity Awareness Month in October, we want to follow up and remind you about the importance of staying alert and protected against healthcare scams.

In today’s digital world, people and businesses can be targeted through a variety of ways, including phone, email, or social media, to fraudulently obtain health or financial information. Oftentimes, these scams can be highly sophisticated and difficult to notice through common practices, such as:

• Spoofing – A cybercrime in which criminals impersonate a known contact or organization, by altering their phone number, email, or website domain to look familiar in order to gain trust and request sensitive financial, customer-related, or other protected information.
• Phishing – A cyberattack where criminals attempt to trick recipients into clicking on malicious links to steal credentials or sensitive information. Phishing scams often use spoofing techniques to attempt to make their email or text look legitimate.
• Vishing – A type of phishing attack where criminals use phone calls to trick individuals into revealing personal information, such as passwords or credit card numbers, by pretending to be a legitimate entity.

To help our customers avoid these schemes, we compiled the following list of tips:

• Remain vigilant – Pay attention to your texts, calls, and emails to notice unusual or urgent requests. Double check email addresses for spelling errors and do not click on any links or attachments if you are unsure.
• Check before you click – Hover over any links before you click to verify the URL. If you do click, confirm the URL after the page loads to ensure you weren’t redirected. Stick to sites that use HTTPS encryption. Again – do not click on links if you are unsure of the source.
• Reach out to confirm – Contact the supposed sender separately using known contact information to confirm their ask. Do not reply directly or reach out using any of the contact information from a potentially suspicious email, call, or text. 
• Regularly change your passwords – This will help protect your information.

For more information and additional resources, please visit the Cybersecurity and Infrastructure Security Agency (CISA) website.

Steve Tringale joins healthcare industry podcast on creating an exceptional member experience

Mass General Brigham Health Plan President, Steve Tringale, joined an episode of HIMSSCast – a healthcare industry podcast – to discuss how we can provide an exceptional member experience as part of an integrated healthcare system.

"We're looking at using not only the clinical capacity but the enormous research and intellectual capacity that's resident inside both our health plan directly and in our relationship with Mass General Brigham to provide what we believe is a substantially different service than some of our competitors, who are more traditional insurers, can provide.” – Steve Tringale, President, Mass General Brigham Health Plan

For more, listen to Steve Tringale’s conversation with Susan Morse, Executive Editor of Healthcare Finance News.

Meet Jim Delisle, our new Municipal Strategy and Business Development lead

We're pleased to announce that Jim Delisle has joined Mass General Brigham Health Plan as the Municipal Strategy and Business Development lead

as we expand our footprint in the Municipal Market. Jim joins the plan with over 20 years of health plan sales, client services, and leadership experience. In his role Jim will work consultatively with you to identify opportunities and build strategies to create innovative solutions to the unique needs of municipal organizations.

During his time at Tufts Health Plan and Point32Health, he led teams that worked with brokers, consultants, and Massachusetts-based clients and most recently he led the commercial team growth strategy in the Rhode Island market.

As always, we appreciate and value your continued partnership. Please join us in welcoming Jim!

Mass General Brigham Health Plan names new SVP of State Programs

Mass General Brigham Health Plan announced that Ashley Hague has joined the organization as Senior Vice President of State Programs.

In this role, Hague will lead government programs to ensure high-quality, affordable care, including Medicaid and preparations to serve Massachusetts residents who are dually eligible for Medicaid and Medicare as part of the state’s process to provide Dual Eligible Special Needs Plans (D-SNP) in 2026.

“As part of an integrated healthcare system, we are building a foundation within Mass General Brigham to serve a broader range of populations,” said Steve Tringale, President, Mass General Brigham Health Plan. “We are pleased that Ashley has joined our organization, and her breadth of experience and commitment will support our mission to ensure equitable healthcare access for communities across the Commonwealth.” Read the full announcement.

Newsletter feedback survey

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Tips for sharing these articles and resources

• Include in an email blast to your clients
• Post on your social media or blog

Articles and resources for your clients

• 4 Alternative therapies for pain management
  Suggested text to share with clients: "Chronic pain affects millions of individuals annually. According to the CDC's 2021 report, more than 20% of adults in the United States experience chronic pain. As Mass General Brigham Health Plan members, your employees can access alternative treatments for pain management. Read more."

• • • • Optum critical support center
        Suggested text to share with clients: "As hurricane season impacts communities throughout the country, there are resources available to help members with storm preparation and in the aftermath. Explore Optum's critical support center to access on-demand support resources for navigating challenging times."