In this issue:
Mass General Brigham Health Plan announced its new Complete Access EPOSM (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.
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.
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.
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.
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:
If you have any questions, feel free to reach out to your sales or account executive.
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:
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.
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:
To help our customers avoid these schemes, we compiled the following list of tips:
For more information and additional resources, please visit the Cybersecurity and Infrastructure Security Agency (CISA) website.
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.
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 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.
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