Healthcare Service Provider Medical Mutual Signs Partnership with CVS Caremark for Pharmacy Benefits Management
In the realm of healthcare, compliance with federal regulations is paramount, and Medical Mutual is no exception. Recently, the insurance provider has been working diligently to ensure adherence to the No Surprises Act, enacted as part of the Consolidated Appropriations Act, 2021.
This legislation is designed to protect patients from surprise medical bills and increase transparency in healthcare coverage. Key provisions of the No Surprises Act include surprise billing protection for emergency services, transparency requirements for insurers, price transparency, and compliance and enforcement mechanisms.
Under the surprise billing protection, Medical Mutual is implementing systems to prevent surprise billing for emergency and non-emergency services. The transparency requirements mandate that insurers provide clear, accurate information about their network and coverage, including whether a provider is in-network or out-of-network and the costs associated with out-of-network care.
Price transparency is another crucial aspect of the Consolidated Appropriations Act, with hospitals required to publicly disclose their standard charges for items and services. While this specific requirement applies more directly to healthcare providers, Medical Mutual is committed to promoting transparency in healthcare pricing.
Compliance with these provisions is enforced through federal and state agencies, and insurers must adhere to these rules to avoid penalties and maintain compliance with federal regulations.
In terms of documentation, Medical Mutual has a secure Box folder for submitting documentation related to benefits enrollment, qualifying events, or changes. This includes new hire documentation, as well as documentation for qualifying events or changes to HSA Contributions. The secure Box folder is a means for employees to submit documentation related to their benefits enrollment, qualifying events, or changes electronically.
For active employees who wish to cancel their benefits enrollment, a Cancellation Form is available for submission to the secure Box folder. Benefit-eligible employees can enroll in a health plan within 31 days from date of hire, qualifying event, or during the annual Open Enrollment period held in October.
It's worth noting that outside of the annual Open Enrollment period, a qualifying event, such as loss of coverage, marriage, birth/adoption, divorce, legal separation or annulment, or death, must take place to change or cancel enrollment. Changes can be made within 31 days from the date of the qualifying event.
In other news, Oberlin College is making no changes to the health plan coverage regarding reproductive health or rights. This comes in response to the Supreme Court's ruling that employers and universities can deny contraceptive coverage to their employees and students based on religious objections.
Medical Mutual remains committed to full compliance with federal laws and regulations concerning surprise billing and transparency of coverage. For more information, employees are encouraged to visit the Medical Mutual website or contact their HR department.
[1] Centers for Medicare & Medicaid Services. (n.d.). Audit and Enforcement. Retrieved March 16, 2023, from https://www.cms.gov/CCIIO/Programs-and-Initiatives/HealthCare-Reform-Law/MarketReformAuditEnforcement.html [2] No Surprises Act. (n.d.). Retrieved March 16, 2023, from https://www.cms.gov/nosurprises/about
Medical Mutual is working to implement systems that prevent surprise billing for emergency and non-emergency services, aligning with the surprise billing protection aspect of the No Surprises Act. Equally important, the insurance provider is focus of fostering transparency in healthcare coverage, aiming to provide clear and accurate information about network and coverage, falling under the transparency requirements mandate of the Act.
