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1. Individual Market: Additional Documentation Now Required with SEP Enrollments
2. DELAYED: Small Group Plan Year Change Information
3. RESPONSE REQUIRED: New Agent Agreements
4. Small Group: Changes to Job Service Report (JSR)
5. RSVP REQUIRED: Spring Training - April 26
6. Wellmark COOP Dollars Available
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| INDIVIDUAL MARKET: ADDITIONAL DOCUMENTATION NOW REQUIRED WITH SEP ENROLLMENTS |
Changes to take effect for Special Enrollment Periods (SEPs)
Wellmark is changing the paperwork required for Special Enrollment Periods (SEP) in the Individual Under 65 market. Individuals who enroll during SEPs will need to provide proof of eligibility to ensure they are qualified for coverage. The documentation requirement change takes place for SEPs with a signature date of 4/1/16 or later for an effective date of 5/1/16 or later. This change is being made not only for new SEP contracts, but also SEP contract changes. In order to ensure adherence to the documentation requirements, Wellmark will also be instituting an audit process of individuals enrolled through a SEP. We will be sending out an Agent Alert communication that outlines this audit process in more detail.
If a member enrolls during a SEP they don't qualify for, and then cancels that coverage soon after receiving their insurance benefits, it has an adverse effect on the entire Wellmark insured population. By requiring proof of SEP eligibility, we better protect our current members from unnecessary risk and the increased costs it can generate.
Attached
is a summary of the SEPs and the paperwork required to meet proof of eligibility as mentioned above. Producers will need to gather the required SEP documentation for individuals, submit it to Wellmark, and maintain the documentation in their files/records. These SEP documents will then be subject to Wellmark audits to maintain accuracy.
Across the industry, the individual market continues to be financially challenging. We know you support our goals to encourage a stable market and to keep coverage affordable for our members. By working together, we can manage the risks that our members are exposed to. Thank you in advance for your support of these updates that can help us accomplish our mutual goals.
Please note that if Partners Health Insurance helps you enroll applications or change forms, the applications cannot be submitted until we also have the additional documentation on file.
For additional questions, please contact your Individual Account Rep:
Jamie Kamerman - [email protected]
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DELAYED: SMALL GROUP PLAN YEAR CHANGE INFORMATION
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A couple weeks ago, the Centers for Medicare and Medicaid Services (CMS)
extended the end of small group transitional relief
from Sept. 30, 2017 to Dec. 31, 2017. Moving forward, the group extension must be approved by the Iowa and South Dakota Insurance Divisions.
I
n the meantime, Wellmark is reviewing options regarding the transitional relief extension. Until further instruction, please hold on to any outstanding plan year change mailing responses. More information will be available soon.
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WELLMARK SENDING OUT AGENT AGREEMENTS STARTING 4/4/16
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Wellmark will be sending out new Agent Agreements starting April 4, 2016, to all Wellmark appointed Agents.
The new Agent Agreements must be electronically signed by all appointed Agents via DocuSign in order to remain appointed with Wellmark. Failure to electronically sign these agreements will result in termination of Wellmark appointment effective 9/1/16.
The Agent Agreement updates will include:
- Changes to the electronic notification of amendments
- Business Associate language changes
- Notification of termination changes
- Simplification of documents with less duplication
Additionally, public exchange language will be added to all agreements.
These Agreements will still be sent via the DocuSign application. The agreements will start being distributed April 4th, with all agreements distributed by mid-April.
Please note the following important dates:
4/4/16
- Wellmark to start sending out Agent Agreements to active agents
March - May 2016
- reminders released via Blue Briefings
7/1/16
- Termination letters sent to agents who have not signed agreements
9/1/16
- Termination of Agents who have not signed the agreement
Any additional questions regarding the agreements should be directed to your designated Account Manager with Partners Health Insurance.
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SMALL BUSINESS: CHANGES TO JOB SERVICE REPORT (JSR)
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For May 1 effective dates, starting April 1, all new small business sales will require a full reconciled Job Service Report (JSR), also known as a Quarterly Wage Report. Wellmark will no longer accept just the first page of the report. New sale paperwork for small business sales will not be processed without the reconciled JSR, so it's important that the form is filled out correctly.
Key reminders on reconciling JSRs:
- Each employee who is enrolling in the group plan must be represented on the submitted JSR.
- Employees who are not included on the printed JSR must be added in writing.
- Consult the administrative guide if the group does not have a JSR for additional paperwork that may be accepted in lieu of the JSR.
See the table below to review the JSR codes and their uses.
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Codes for JSR Reconciliation
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Meaning of Code
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Interpretation
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| NE |
Not Eligible |
Not Eligible
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| C or COBRA |
COBRA |
COBRA employee |
| R or Retiree |
Retiree |
Retired employee |
| E or ETC |
Elibile - taking coverage |
Enrolling in coverage |
| W, EW, EWC, or Waive |
Eligible - waiving coverage |
Waiving coverage when eligible |
| T |
Terminated |
Terminated employee |
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Our
Spring
Wellmark training will be held
Tuesday, April 26
at the Ridge Golf Club in Sioux Center! Join us for
this informative training and receive
3 hours of CE
credit
. Lunch and snacks will be provided.
Topics will include:
*ACA Timeline: Past, Present, Future
*Wellmark ACA Product Expertise - Beyond the Product Comparison Guides
*What's up with Special Enrollment Periods?
*Producer Connections - (re)connecting you to resources
WHERE: The Ridge Golf Club,
2595 Ridge Road, Sioux Center, IA
*Use the North parking lot and entrance
DATE:
Tuesday, April 26
TIME:
9:00 AM - NOON (Lunch will follow)
**Please arrive about 15 minutes early to check in for CE credits.
Directions:
The Ridge is located just South of Sioux Center on Highway 75. From Highway 75 go East on 20
th
street SE. After approximately ½ mile you will take a right on to Ridge Road. As you proceed you will enter a "Y" in the road, continue to the right which will lead you to the clubhouse. Use the North parking lot and North entrance to enter the facility.
**Please note, Wellmark will have General Sessions available in May, however, they are not yet available for registration.
It is recommended that you attend our April 26 training session if possible, however if this date does not work, then please sign up for a General Session once available.**
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Want to advertise, but don't want to pay the full cost? Partners Health Insurance Agents have access to Wellmark COOP dollars - up to 50% reimbursement!
What items are eligible?
Print ads, radio commercials, out-of-home ads (i.e. billboards, gas pump toppers, transit ads), digital ads.
What items are not eligible?
Telephone directory advertising, television advertising, community or event sponsorships, including signage on scoreboards, office and building signage, sales promotion materials, specialty items (golf items, pens, etc.) or trade show or event exhibits.
Where can I find Wellmark Ads?
Wellmark COOP ads, signage, Blue Store is all located in the Marketing Toolkit on your Producer Connection page.
What is the deadline to get reimbursed?
All reimbursements for 2016 ads are due by December 15, 2016. Partners Health Insurance has a budgeted amount from Wellmark, so don't delay your reimbursement request!
Who can help me with my questions?
All questions regarding COOP ads and reimbursement should be directed to:
Tonya Helmers located in our Sioux Center location
712-722-3333
800-722-2578
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Agent Resources
You can access Wellmark BCBS of Iowa forms on our website.
Click Here
http://partnershealthinsurance.com/resources-2/
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Coop Advertising
Did you know you could be eligible for 50% reimbursement on eligible Wellmark BCBS advertising? Login in to your Wellmark.com Producer Connection page - locate the Sales Tookit - N
ew ads are now available! Contact Tonya to find out more information about this program.
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Wellmark Annual Agent Certification
SCHEDULED FOR: June 1 - July 1, 2016
This is an annual training specific to Wellmark BCBS and must be completed each year in order to continue to sell Wellmark BCBS group and individual products. This is a separate requirement from the Medicare PDP certification.
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WELLMARK SPRING TRAINING
Tuesday, April 26 - 2016
Agenda Items to Include:
WHERE: Ridge Golf Club, Sioux Center
TIME: 9:00 AM to noon
RSVP Now to:
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MedicareBlueRx (PDP) Certification
This is an annual training that needs to be completed each year in order to service and sell MedicareBlueRx products.
Access 2016 Training Guide
here
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| WELLMARK NEW AGENT TRAINING Newly appointed agents with Wellmark BCBS are required to go to New Agent Classroom Training within 180 days of appointment date. Register for training in the Blue Learning Center located under your Wellmark.com agent login. Click herefor a Job Aid to assist in the registration
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