HIGHLIGHTS OF THIS ISSUE IDENTITY PROTECTION SERVICES AVAILABLE FOR ELIGIBLE HIGHMARK MEMBERS 1095 FORMS FOR REPORTING MINIMUM ESSENTIAL COVERAGE HEALTH CARE REFORM UPDATE: DEFINITION OF SMALL GROUP NOT CHANGING ALLEGHENY HEALTH NETWORK FACILITY EARNS NATIONAL RECOGNITION FOR ITS PULMONARY HYPERTENSION PROGRAM WHAT’S NEW IN WOMEN’S HEALTH CARE AT ALLEGHENY HEALTH NETWORK? CREATING A NEW APPROACH TO CANCER CARE COVERAGE FOR 3D MAMMOGRAMS CHANGES TO 2016 PHARMACY NETWORKS CHANGES TO Rx CLINICAL MANAGEMENT PROGRAMS IDENTITY PROTECTION SERVICES AVAILABLE FOR ELIGIBLE HIGHMARK MEMBERS Earlier this year, in response to growing concerns about data security, the Blue Cross and Blue Shield Association announced that identity protection services would be available at no cost to all eligible Blue members, beginning Jan. 1, 2016. Highmark has selected AllClear ID as the vendor for this new service, and we are giving employers the option of making this service available to their Highmark members. If you have not yet elected this service for your Highmark members, you can learn more by visiting highmarkprotect.com. This site has detailed information about AllClear Secure identity repair service. If you elect this protection for your eligible Highmark members, it will automatically be available to them. You can also learn about AllClear Pro credit monitoring service, additional protection that eligible members can choose — all at no cost to the member. A Frequently Asked Questions section on the site addresses questions employers are likely to have about this initiative, including possible income tax implications and resulting employer responsibilities. If you have not yet done so, please visit this site. Then, if you want this protection for your Highmark members, use the interactive feature to indicate your agreement. The deadline to provide protection for your Highmark members in 2016 is Dec. 18, 2015. Back to top 1095 FORMS FOR REPORTING MINIMUM ESSENTIAL COVERAGE The Affordable Care Act (ACA) requires individuals to have basic health insurance coverage (“minimum essential coverage”) for themselves and their dependents. Individuals who do not maintain minimum essential coverage may have to pay tax penalties. Health insurers and plan sponsors of self-funded group benefit plans must report data on their covered members to the Internal Revenue Service (IRS) for all benefit plans providing minimum essential coverage. That data is reported to the IRS on Form 1095-b or Form 1095-c and includes: • Members’ names, addresses and Tax Identification Numbers (TINs) • Names and TINs of each members’ dependents • Identification about the health insurer or other entity providing coverage • Months that each member was enrolled in the benefit plan A copy of the applicable form must also be sent to each responsible individual, which generally means the primary insured. As a health insurer, Highmark is required to issue Form 1095-b to our fully insured members. Depending upon their size, Highmark’s self-funded group customers are responsible for their own reporting on Form 1095-b or Form 1095-c. Highmark’s Responsibilities for Form 1095-b Reporting Beginning in 2016, Highmark must file Form 1095-b with the IRS for each primary insured covered under an insured Highmark benefit plan providing minimum essential coverage. Highmark will file these forms with the IRS by the required due date and mail a separate copy to the primary insured by Jan. 31, 2016, for the 2015 tax year. IRS regulations do not require Highmark to send a Form 1095-b to primary insured’s dependents, including spouses. Primary insureds may receive multiple forms. A different form will be mailed for each group number in which the primary insured was enrolled. Under the ACA, certain types of benefit plans are exempt from reporting requirements, including: • Dental and vision coverage that is not part of a comprehensive health insurance plan • Accident and disability coverage • Workers’ compensation coverage • Medicare complement coverage Highmark will not be reporting or issuing a Form 1095-b for these types of coverage. Highmark is required to make reasonable attempts to obtain TINs for all covered individuals, including dependents. If we do not have a TIN (either a Social Security Number or Individual Tax Identification Number) on file for a member, we will send the primary insured a letter to ask for that information. Self-Funded Clients Self-funded (ASO, ASC and Cost Plus) group customers are responsible for reporting information for their benefit plans providing minimum essential coverage. We have created several enrollment reports to help self-funded clients with their reporting requirements: • A missing SSN/TIN Report, which identifies all members for whom Highmark does not have a SSN/TIN on file. Plan sponsors that provide minimum essential coverage are required to solicit this information from all enrollees in their plans. Plan sponsors should contact their Highmark representatives to request these reports. Regulations do not require Highmark to collect or solicit member SSN/TIN information on behalf of our self-funded customers. • A Minimum Essential Coverage (MEC) Report, which provides enrollment information for self-funded medical plan sponsors. The MEC Report, which contains member TINs, will be delivered via the Employer Portal. To retrieve these reports, plan administrators will need access to the MEC Reports tab of the Employer Portal. Plan sponsors should contact their Highmark representatives if they are having problems with accessing these reports. Highmark is committed to protecting SSNs/TINs and other personal data. We maintain extensive safeguards to reduce the risk of unauthorized use of, or access to, personal data. Government-Sponsored Plans The Federal government will report minimum essential coverage for government- sponsored plans, including Medicare (including Medicare Advantage), Medicaid and Children’s Health Insurance Program (CHIP) and issue Form 1095-b. Highmark will not report information on members enrolled in Medicare Advantage products, such as Freedom BlueSM and Security BlueSM. In addition, minimum essential coverage that supplements Medicare, such as Signature 65®, is not subject to reporting. Have Questions? Primary insureds who receive a Form 1095-b from us with information they think is incorrect should call the toll-free number on the back of their member ID cards. You should consult with your tax advisers or visit irs.gov for tax-related questions. Freedom Blue and Security Blue are service marks of the Blue Cross and Blue Shield Association. Signature 65 is a registered mark of Highmark Inc. Back to top HEALTH CARE REFORM UPDATE: DEFINITION OF SMALL GROUP NOT CHANGING The definition of small group for Pennsylvania, West Virginia and Delaware remains 50 and fewer. Bipartisan legislation (HR 1624 and S. 1099) was passed unanimously by Congress and signed into law by President Barack Obama on Oct. 7, 2015. Referred to as the “Protecting Affordable Coverage for Employees Act,” it amends the Affordable Care Act (ACA) and lets states decide whether to maintain their current definition for small employer. Highmark supported this legislation. The amendment represents an important step toward maintaining affordability and stability of coverage for millions of employees and their families. For the purposes of health insurance, states have traditionally determined their own definition of a small group, with almost all states defining a small group as an employer with no greater than 50 employees. States know their specific health insurance market and are ultimately best suited to make this determination. Back to top ALLEGHENY HEALTH NETWORK FACILITY EARNS NATIONAL RECOGNITION FOR ITS PULMONARY HYPERTENSION PROGRAM Allegheny General Hospital (AGH), part of the Allegheny Health Network, has earned an accreditation that places it in exclusive company as one of just 29 health care facilities in the United States — and the only one in western Pennsylvania — to be recognized for the quality of its pulmonary hypertension (PH) program. AGH joins the University of Pennsylvania as the only medical centers in the state to receive Pulmonary Hypertension Care Center (PHCC) accreditation by the Pulmonary Hypertension Association (PHA). This accreditation means a health care facility’s PH program excels in its diagnostic capabilities and has the capacity to appropriately and comprehensively manage PH patients through a set of criteria established by the PHA. As part of the PHCC accreditation process, the PHA is developing a registry of patients with pulmonary hypertension. This will allow researchers to track diagnostic and treatment patterns at the national level, ultimately demonstrating improvements in quality of care and life for PH patients. What Is Pulmonary Hypertension? Pulmonary hypertension is a debilitating disease of the lungs that affects the functioning of the heart and can lead to heart failure. It occurs when the pressure in the blood vessels leading from the heart to the lungs is too high. The heart pumps blood from the right ventricle to the lungs to get oxygen. Because the blood does not have to travel very far, the pressure in this side of the heart and in the artery taking blood from the right ventricle to the lungs is normally low. But when the pressure in this artery gets too high, the arteries in the lungs can narrow and then the blood does not flow as well as it should. This results in less oxygen in the blood. AHN’s Approach to Treating