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Health Net News Now

Health Net News Now Broker Newsletter

Talking Trend

Employer-Provided Health Plans Generate Major ROI for Companies, Employees

Employee Wellness

Employer-provided coverage helps create a stronger workforce and gives employers valuable benefits to provide to their employees as published in a March 5 article by the National Association, America's Health Insurance Plans (AHIP).

According to the article, more than half of all Americans – over 180 million hardworking individuals and their families – receive their health coverage through their jobs.

Employer-provided coverage delivers affordable access to care, effective ways to improve health, and peace-of-mind. A study from Avalere Health found that employers with 100 or more workers saw a 47% return on investment (ROI) for offering health coverage in 2022. That ROI came in the form of increased recruitment and retention, better employee productivity, reductions in medical costs and disability claims, and tax benefits. That ROI is expected to jump to 52% by 2026, according to estimates from Avalere.

Employers should see a return of $346.6 billion in 2026, including $108 billion in direct medical cost reductions, and $139.70 billion in tax benefits according to Avalere.


Industry News

No Surprises

The No Surprises Act (NSA) May Affect Your Clients

The No Surprises Act (NSA), enacted as part of the Consolidated Appropriations Act, 2021 (CAA), includes transparency provisions requiring both grandfathered and nongrandfathered employer group health plans, and health insurance issuers in the individual and employer group markets, to submit information on prescription drugs and health care spending to the Departments of Labor Health and Human Services, the Department of Treasury, and the Office of Personnel Management (The Departments). This prescription drug data submission is called the RxDC report and is collected by the Centers for Medicare and Medicaid Services (CMS). RxDC Report for 2023 reference year is due on 06/01/2024.
 


What Health Net of California Inc. and Health Net of Oregon (Health Net) Are Doing

  • In 2023 calendar year, Health Net successfully filed the RxDC report for 2022 reference year on behalf of its employer groups.
  • In 2024 calendar year, Health Net will meet all regulatory obligations for RxDC reporting of 2023 reference year due on 06/01/2024.
  • Health Net’s employer groups do not need to submit any data to Health Net for completion of Plan List (P1, 2, 3) and Data Files ( D 1 through 8) files. The aggregated data necessary for reporting of plan list P2 and data file D1 on behalf of the employer groups can be pulled from Health Net’s database.
  • The employer groups do not need to take any actions regarding the reporting or pay any fees to Health Net for the reporting.
  • Health Net will notify brokers about the completion of the RXDC report for 2023 reference year through Broker Blast Communication on or before June 25, 2024.

Questions?

If you have any questions, please contact your Health Net Account Representative.


Health Net News

Exciting Additions to our Health Net Large Group Family!

Randy Ebersberger

We are thrilled to announce the newest members of our team at Health Net, bringing a wealth of experience and dedication to our mission of serving our clients with excellence.

First, please join us in welcoming Randy Ebersberger as our new Vice President of Commercial Large Group Sales & Account Management.

With a remarkable career spanning over three decades in sales, account management, and leadership within the employee benefits sector, Randy brings invaluable expertise and insights to our team.

You can reach out to Randy directly via email at randy.ebersberger@healthnet.com.

Dan Minahan

Additionally, we are delighted to welcome back Dan Minahan to Health Net!

Dan previously worked with us from March 2000 to July 2021, during which he made significant contributions to our organization. After pursuing other opportunities, Dan has returned to us as a Senior Account Executive, Large Group.

Drawing upon his extensive experience in the healthcare industry, Dan will lead growth initiatives for Large Employers, Public Sector, and Labor and Trust.

For inquiries or collaboration opportunities, please feel free to contact Dan at Dan.j.minahan@healthnet.com.

Let's work together to discover new opportunities and achieve even greater success as a team.


Tools You Can Use

Cost Comparison Tool

Transparency in Coverage - Cost Comparison Tool

The Transparency in Coverage rule requires Commercial and Marketplace plans to offer a self-service online tool so that members can get cost estimates, and better understand their potential cost-sharing for covered items and services.

What are the Benefits?

Price transparency may help members to make more informed healthcare decisions. If consumers have greater access to information on the prices for care, they may be better able to shop for more costeffective providers, helping to lower healthcare spending. Health Net has partnered with Sapphire Digital to offer this cost comparison tool, using Sapphire’s S365 product. S365 provides the ability to search by billing code or billing code short description for negotiated rates. S365 versions 23.4 and above are compliant with the Transparency in Coverage mandate for 1/1/24 that requires that members be able to search for billing rates for all covered services and items.

What you need to know

  • Members can access Sapphire S365 self-service internet-based tool from the HN.com member portal). 
  • If the member requests cost estimates in other formats, they can contact the Customer Contact Center (CCC) number on their ID card and ask for the estimate by email or by phone. The CCC will e-mail paper format estimates to the member. 
  • The tool does not store the cost estimates. However, members may save a PDF copy if they are using the self-service tool. 
  • The tool provides estimates only. The final costs may differ. 
  • Members may use the “Download” option to save information about the costs, or doctors, on the S365 tool as a PDF. 
  • Members may also share the cost estimates via email. 
  • For general troubleshooting help with the cost comparison tool members should contact the number on their ID card.

IMPORTANT: Please note that pharmacy cost estimates are not included in the Sapphire S365 self-service internetbased tool.

To allow members and visitors to look up a drug in a particular formulary, Health Net has added links to the public member and provider pages to allow visitors to look up a drug. This won’t provide pricing on a specific drug. However, it will confirm whether a particular drug is in on the visitor’s formulary of interest.

To obtain information regarding pricing of a specific drug, members will need to call call the number on their ID card or look it up via CVS’s lookup tool.

To utilize the CVS lookup tool, member’s need to be logged into their HealthNet.com member portal account. Upload these instructions for details on how to look up a drug on a Health Net formulary and how to utilize the CVS lookup tool.

If you have any questions, please contact your Account Representative.


In the Community

California Students Find New Hope and Friendships on No One Eats Alone® Day

No One Eats Alone® Day

On February 16, more than 2,000 schools nationwide participated in No One Eats Alone® Day, a prevention initiative to foster inclusion and a culture of belonging in middle schools.

In California, Health Net and the Centene Foundation sponsored events to ensure no student felt alone during mealtimes.

“Social isolation has emerged as a significant concern in our society, with various studies highlighting its impact on mental and physical health,” said Amber Kemp, vice president, Medi-Cal regional lead at Health Net. “Partnering with the nonprofit organization Beyond Differences® to support No One Eats Alone® Day allows us to encourage students to break out of their comfort zones, make new connections and foster a sense of community with their peers. This community building is essential to the overall well-being of our youth.”

Social isolation has a negative impact1 on the mental wellbeing of children. It can lead to issues such as depression, anxiety, self-harm, thoughts of suicide and higher chances of substance abuse.

Beyond Differences found that when students learn about social isolation and get tools to connect with classmates, nearly 85 percent felt empowered to lead and create a culture of acceptance and belonging at their school.

The nonprofit organization Beyond Differences® established No One Eats Alone as an initiative to combat social isolation. This year, more than one million students participated in activities designed to teach them about social isolation and the negative impact it can have on health and academic performance. Students worked together on in-class lessons, interactive exercises and a creative art project that focused on stronger social connections to help make their schools better places of welcome and acceptance for all.

1 Royal Society for Public Health (RSPH)


JUST FOR FUN

April 8, 2024 -Total Solar Eclipse!

Total Solar Eclipse

This will be the first total solar eclipse in the continental U.S. in 7 years.

The last one occurred August 21, 2017. It crossed the country from Oregon to South Carolina, and millions of people viewed it successfully. Before that one, you have to go back to February 26, 1979.

And, it will be 20 years until the next one: August 23, 2044.

If you want to be the first person to experience the total eclipse in the continental U.S., be at the Mexican border in Las Quintas Fronterizas, Texas, at 1:27:21 p.m. CDT. There, the total phase lasts 4 minutes 22 seconds.

 

The center line will cross through 15 states. Unfortunately, those of us in California and Oregon will only be able to see a partial eclipse.

Texas, Oklahoma, Arkansas, Missouri, Tennessee, a small part of far-western Kentucky, a large section of southern Illinois Indiana and Ohio will see the total eclipse. Even before the eclipse passes out of Ohio, a tiny tip of southeastern Michigan technically sees totality. The last stages in the U.S. see the path cover areas of Pennsylvania, New York, Vermont, New Hampshire, and Maine. If you have friends or relatives in those states, let them know!

Find out what time the partial eclipse will be seen in your area, and for more interesting facts about the total eclipse, check out this article on Astronomy.com.

Last Updated: 03/29/2024