New Diabetes Prevention Program

We are pleased to offer the Lark Diabetes Prevention Program as of January 1, 2023. This smartphone-based program is recognized by the Centers for Disease Control (CDC) and is based on their well-known Prevent T2 curriculum.

Lark is a personalized digital health coaching that provides education, resources, and support to members at risk for diabetes, accessed through the Anthem Sydney Health app. Eligible members receive a free wireless smart scale upon enrollment.

You can engage in the program at your own pace. It provides digital weight loss support, nutrition therapy with customized feedback through daily check-ins, and customized guidance on sleep and physical activity.

Lark Diabetes Prevention Program Flier

IngenioRx name change

In June Anthem, Inc., the parent company of Anthem Blue Cross Blue Shield Maine, changed their name to
Elevance Health and created Carelon, a new healthcare services brand. Anthem Maine will continue to use
their current name.

Effective January 1, 2023, Anthem Maine’s pharmacy benefit manager IngenioRx will join the Carelon
company and change its name to CarelonRx. As a result of this change, IngenioRx Home Delivery Pharmacy
will become CarelonRx Mail and IngenioRx Specialty Pharmacy will become CarelonRx Specialty
Pharmacy. This name change will have no impact on members’ benefits, coverage or how they fill their
prescriptions. Members using the home delivery and specialty pharmacies have been receiving updates on
this change for the past few months, and after January 1 will receive an insert in their first prescription filled
by either of these pharmacies noting the details of the new branding.

Annual Benefits Open Enrollment

The Health Trust’s Open Enrollment period will begin on November 15, 2022, and end on December 15, 2022, for a coverage effective date of January 1, 2023. Enrollment/Change Forms must be received by the Health Trust by December 15.  If no changes are being made to coverage, no forms are required.

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SBCs and Summary Documents for 2023 Now Available

Under the terms of the Affordable Care Act, employers must provide employees with a Summary of Benefits and Coverage (SBC) which follows a standard format prescribed by the federal government.  This document should be distributed to all benefits-eligible employees prior to the beginning of the plan’s open enrollment period each year.

The Health Trust’s open enrollment period will begin on November 15, 2022, and end on December 15, 2022, for a coverage effective date of January 1, 2023.  This means that SBCs must be distributed to all current benefits-eligible employees before November 15, in order to comply with the law.  SBCs must also be provided to any new benefits-eligible employees, so that they are able to review and compare benefits for any health plan(s) in which they are eligible to enroll.

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MaineHealth and Anthem Reach Agreement

MaineHealth and Anthem Blue Cross and Blue Shield in Maine announced on August 17, 2022 that they have reached an agreement to their contract dispute which will keep Maine Medical Center in Anthem’s care provider network for the next two years. This means all Anthem members can continue to receive in-network services at Maine Medical Center (MMC). All other MaineHealth facilities and providers also remain in Anthem’s network.

The Maine Municipal Employees Health Trust utilizes Anthem as the claims administrator for all of our medical plans, and we also utilize Anthem’s network. Therefore, this agreement means that MMEHT members will continue to have access to MMC in 2023.

Click here for details

Anthem and Maine Medical Center Contract Information – Update

As we previously communicated, Maine Medical Center (MMC) has announced its intention to leave the Anthem network on January 1, 2023.

The dispute between the Anthem and MMC is about how the hospital is paid, and if MMC is charging appropriately for services as per their existing contractual agreement.  Anthem and MaineHealth also have disagreements regarding other financial and policy-related terms of their current contract.

Update July 2022: At the request of the Governor, a new mediator has a been appointed to work with Anthem and Maine Health, with the goal of resolving this dispute as soon as possible.  We speak frequently with leadership of both parties, and continue to urge them to resolve these issues without further delay.  We remain hopeful that the parties will work out their differences and that MMC will remain in the network.

Please note that MaineHealth has stated that they are withdrawing only the Maine Medical Center (MMC) hospital facility from the Anthem network.  MaineHealth has confirmed (on their own website) that “MaineHealth has no plans to remove its physicians and other providers in its system-wide medical group from the Anthem network.”

We understand the concerns raised by this announcement and this potential change. The Health Trust continues to work on contingency plans in the event an agreement cannot be reached.

We are monitoring this situation very closely, and are doing all we can to push for a quick resolution and to limit the impacts on our members.

 

2022 Health Trust Annual Reporting Meetings – Coming Soon!

The Health Trust will hold its Annual Reporting Meetings early this fall. These meetings provide the Health Trust staff with an opportunity to report on program operations, finances and activities, and allow members an opportunity to raise questions or concerns.

Members may participate in the Annual Meetings on one of the following dates:

  • Wednesday, September 28 from 9:00 – 10:00 a.m. via Zoom
  • Thursday, September 29 from 2:00 – 3:00 p.m. via Zoom
  • Thursday, October 6 from 9:30 – 10:30 at the MMA Convention in Bangor

To reserve your space at one of the Annual Reporting Meetings, please click on the registration link below. If you are registering for one of the meetings being held via Zoom, you will receive a confirmation via e-mail with a link and password to participate in the Zoom meeting. No registration is required if you plan to join us at the session being held in conjunction with the MMA Convention.

Click here to register

 

If you have any questions regarding the Health Trust Annual Reporting Meetings, please e-mail Kristy Gould, Director of Health Trust Services, at kgould@memun.org or Lisa Rigoulot, Assistant Director of Health Trust Services, at lrigoulot@memun.org

Please note that the Annual Reporting Meeting is different than the Workshops designed specifically for Health Trust Retirees, which have been held in the fall.  These meetings will not be held in 2022.  Updates will be distributed to retirees via mail later this fall. Please visit the Health Trust website for information about medical coverage for retirees at https://www.mmeht.org/medical-plans/retiree-group-companion-plan/ or you may call the Health Trust at 1800-852-8300.

Anthem and Maine Medical Center Contract Information – Update

As we previously communicated, Maine Medical Center (MMC) has announced its intention to leave the Anthem network on January 1, 2023.

The dispute between the Anthem and MMC is about how the hospital is paid, and if MMC is charging appropriately for services as per their existing contractual agreement.  Anthem and MaineHealth have been working with a mediator for several months to address disagreements regarding terms of their current contract. We have spoken with leadership of both parties, and recently learned that they have resumed talking to each other, to attempt to resolve these issues, which is very encouraging.  We remain hopeful that the parties will work out their differences and that MMC will remain in the network.

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Anthem Network Changes – UPDATE

As you may have heard in the news, two large Southern Maine practices have recently notified patients that they have decided to withdraw from Anthem’s network, effective in late summer.   Anthem has been negotiating with these organizations, but they have been unable to settle on a new contract.

The Health Trust is dismayed and concerned about the lack of access to these established providers, Coastal Women’s Healthcare and Fore River Urology.  However, we do also understand that there is a balance to be maintained in order to control the costs of healthcare.  Both organizations have asked for very large increases (between 50 to 70%) in the amounts they are paid for services provided.

State law requires that 60 days notice be provided to members if their doctor leaves the network.  Anthem will be sending out letters to all impacted members if an agreement cannot be reached by that timeframe.

Under the Continuity of Coverage provisions, you may be able to stay with your current doctor(s) for a limited time if you are receiving certain types of care.

Under federal law, this includes care if you are:

  • In treatment for a serious and complex condition. This can be a sudden (acute) illness that requires specialized treatment in order to avoid death or permanent harm. It can also be an ongoing (chronic) illness that is life threatening or potentially disabling and requires specialized care over a long period of time.
  • In a hospital or other inpatient facility.
  • Scheduled for nonelective surgery by your current doctor, including your post-operative care for the surgery.
  • Pregnant
  • Terminally ill.

Continuity of Care Application Form

Please contact MMEHT Member Services so that we can assist you with the Continuity of Coverage process, or in finding a new in-network provider if you so choose.  Member Service representatives are available Monday through Friday form 8:00 a.m. – 4:30 p.m. at 1-800-852-8300.

Anthem and Maine Medical Center Contract Information

As you probably have heard, Maine Medical Center (MMC) has announced its intention to leave the Anthem network on January 1, 2023. We note that MMC and Anthem have been negotiating their contract for a few months and both parties are continuing to mediate their contract concerns. Since the effective date of this change is nine months away, we remain hopeful that both parties can work out their differences and that MMC will remain in the network. We are monitoring the situation on behalf of our members and employer groups, and we are looking into contingency plans in the event an agreement cannot be reached. We will continue to be in close contact with Anthem management.

We understand the concerns raised by this announcement and this potential change. As this has just been announced, we appreciate your patience as we maneuver this evolving situation.

For the latest updates please visit:  https://www.mmeht.org/anthem-and-maine-medical-center-contract-dispute/

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