There are several ways for you to keep updated about product changes, news releases, and other information about Blue Cross Blue Shield of Massachusetts.
Just select a section below to access our most up-to-date information.
Action is Needed from Self-Insured Accounts
As required by the CAA, self-insured accounts must submit a Gag Clause Prohibition Compliance Attestation (GCPCA) to the Health and Human Services (HHS) portal by December 31, 2024. Fully insured accounts don’t need to take any action: we’ll submit attestations on their behalf. Learn more.
Update on the Change Healthcare Privacy Incident
After a comprehensive analysis, Change Healthcare (CHC) provided us with the file of Blue Cross members who were impacted by the cybersecurity event that CHC experienced previously. On September 10, 2024, we completed our review and identified that information pertaining to a small number of our members was affected. We’ve notified impacted self-insured accounts. Due to the size of this unprecedented breach, the CHC analysis is still ongoing and CHC may identify more impacted individuals. Learn more.
The CVS Weight Management ProgramTM Aims to Turn Meaningful Weight Loss into a Healthier Bottom Line
Starting January 1, 2025, self-insured accounts with 100+ members can add the CVS Weight Management Program to their plan. A holistic, high-touch approach to weight management, the program is designed to help members taking weight-management medications achieve long-term success. Learn more.
Offer Your Employees Peace of Mind With Voluntary Life Insurance
Indigo Insurance ServicesTM, the preferred agency of Blue Cross Blue Shield of Massachusetts, offers a variety of voluntary life insurance plans that provide affordability, dependability, and plan customization. These plans enhance your benefit packages with comprehensive coverage, peace of mind, and financial protection for your employees. Learn more.
Effective January 1, 2025, Changes to the Blue Cross Blue Shield of Massachusetts Formulary and Medical Policy Updates
Effective January 1, 2025, we're updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´* plans with a three-tier pharmacy benefit. Learn more.
Effective January 1, 2025, Changes to the Standard Control with Advanced Control Specialty Formulary
Effective January 1, 2025, CVS Caremark®´, an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
Member Months Coverage Report Available for Self-insured Accounts at No Cost
We’re offering a Member Months Coverage Report to our self-insured accounts for the 2024 tax year at no cost. The member information in the report is required by the Internal Revenue Service (IRS) under the Affordable Care Act (ACA). Accounts are responsible for sending the report file to their tax vendor and filing with the IRS. Learn more.
UPDATE - Effective October 1, 2024, Changes to the Standard Control with Advanced Control Specialty Formulary
Effective October 1, 2024, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
It’s Clear: Kids’ Eye Health Is Key To Their Overall Health
Correcting vision problems early can improve kids’ ability to learn. August is Children’s Eye Health and Safety Month, which is a great time to talk to your account executive about adding our Blue 20/20 vision plan to your benefits package. It's an affordable way to keep kids healthy. Learn more.
Regulatory Update: Medical Loss Ratio Rebates
We’ll be distributing Medical Loss Ratio (MLR) rebates to affected small group and connector employers this year. Learn more.
Update on the Change Healthcare Privacy Incident
Change Healthcare notified Blue Cross Blue Shield of Massachusetts on August 13, 2024, that a very small number of Blue Cross members are affected by the cybersecurity event it experienced. Learn more.
Introducing the new MyBlue app
The MyBlue app has been transformed to give members what they want: an easier way to understand and use their health plan. It guides them to the information and resources they need most to navigate their plan with confidence. Learn more.
Effective October 1, 2024, Changes to the Standard Control with Advanced Control Specialty Formulary
Effective October 1, 2024, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
Effective May 15, 2024, Select Diabetes and Weight-Loss Medications No Longer Available Through the Mail Service Pharmacy
Due to a medication shortage, members will no longer be able to fill select diabetes and weight-loss medications in 90-day supplies through the mail service pharmacy. These medications will continue to be available at in-network retail pharmacies. Learn more.
On August 1, 2024, AllianceRx Walgreens Specialty Pharmacy will become Walgreens Specialty Pharmacy
AllianceRx Walgreens Specialty Pharmacy is changing their name to Walgreens Specialty Pharmacy. Members don’t need to take any action as the pharmacy will continue to fill covered prescriptions. Learn more.
We Have Completed Submission of the CAA Prescription Drug Data Collection (RxDC) Report (2023 Reference Year)
We have successfully submitted plan sponsors’ 2023 RxDC information to CMS, based on benefits that Blue Cross administers and available data. Learn more.
Disability Insurance Offers Greater Peace of Mind
May is Disability Insurance Awareness Month and it’s the perfect time to focus on the importance of protecting income for when the unexpected happens. IndigoTM Insurance Services, a preferred agency of Blue Cross Blue Shield of Massachusetts, offers a variety of disability insurance benefits through Indigo preferred partners. Learn more.
Acaria Health Is Leaving Our Specialty Pharmacy Network
On July 1, 2024, Acaria Health will be leaving our specialty pharmacy network. Learn more.
UPDATE - Effective July 1, 2024, Changes to the Blue Cross Blue Shield of Massachusetts Formulary and Medical Policy Updates
Effective July 1, 2024, we’re updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´* plans with a three-tier pharmacy benefit. Learn more.
UPDATE - Effective July 1, 2024, Changes to the Standard Control with Advanced Control Specialty Formulary
Effective July 1, 2024, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary (SC-ACSF). Learn More.
See Our Latest Press Release on the Change Healthcare Event
We’ve posted a press release on our member site with the latest information from Change Healthcare including their offer of free credit monitoring. Learn more.
There’s more to Blue 20/20 than meets the eye
Did you know an eye exam can help with early detection of serious health conditions? May is Healthy Vision Month, and it’s the perfect time to focus on the link between eye health and overall health — and how Blue 20/20 vision plans can make a difference to members. Learn more.
Our statement on the Steward Health Care bankruptcy filing
We’re aware of the news that Steward Health Care has filed for bankruptcy. This includes all primary care physicians, specialty care physicians, and acute care hospitals that are part of Steward. The Steward providers remain in the Blue Cross network. Steward has publicly stated that their facilities remain open, and that they'll continue to provide care. Learn more.
Our Response to the Change Healthcare Event
Change Healthcare, a key player in health care that processes vast amounts of patient data and financial transactions, is experiencing a network interruption related to a cybersecurity incident. Many providers and health care companies, including Blue Cross, use Change Healthcare for various business functions, such as claims submission and confirmation of health care coverage and benefits. Learn more.
Little Eyes, Big Benefits
Eye care is so important — especially for kids. Effective July 1, 2024, we’re making sure kids get the right care at the right time by offering enhanced vision coverage, at no additional cost, for kids under 19 who are enrolled in select Blue 20/20 plans. Learn more.
New Coverage for Annual Mental Health Wellness Exam
Starting March 31, 2024, Blue Cross Blue Shield of Massachusetts will cover an annual mental health wellness exam. This exam may be conducted as part of a routine health checkup with a primary care provider (PCP), or as a standalone visit with a PCP or licensed mental health professional. Learn more.
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series, which allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts. Learn more.
Effective July 1, 2024, Upcoming Changes to the Standard Control with Advanced Control Specialty Formulary
Effective July 1, 2024, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
Effective July 1, 2024, Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary and Medical Policy Updates
Effective July 1, 2024, we’re updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´* plans with a three-tier pharmacy benefit. Learn more.
UPDATE - Effective April 1, 2024, Upcoming Changes to the Standard Control with Advanced Control Specialty Formulary
Effective April 1, 2024, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
Action Needed: Pharmacy Data Reporting Requirement for the Consolidated Appropriations Act (CAA)
The CAA requires us to annually report enrollment, premiums (or premium equivalents for self-insured accounts), prescription drug spending and medical cost data annually. To collect required information needed to complete the reporting for the 2023 reporting or “reference” year, we’ve sent accounts a survey to complete. We must receive these completed surveys by March 8, 2024. Learn more.
UPDATE: Effective April 1, 2024, Upcoming Medical Policy Change for the Blue Cross Blue Shield of Massachusetts Formulary
Effective April 1, 2024, we're updating a medical policy for our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´1 plans with a three-tier pharmacy benefit. Learn more.
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series, which allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts. Learn more.
A New Way for Members to Access BLUE 20/20 Vision Benefits
Effective November 13, 2023, Blue 20/20 members who also have a Blue Cross Blue Shield of Massachusetts medical plan, dental plan, or both can now use MyBlue to access their vision benefits. Learn More.
Effective April 1, 2024, Upcoming Medical Policy Change for the Blue Cross Blue Shield of Massachusetts Formulary
Effective April 1, 2024, we're updating a medical policy for our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex® ́1 plans with a three- tier pharmacy benefit. Learn More.
Some Previously Announced Medical Policy Changes for the Blue Cross Blue Shield of Massachusetts Formulary Are Being Delayed
Some of the previously announced medical policy changes are being delayed from January 1, 2024 to March 1, 2024. Learn more.
Effective April 1, 2024, Upcoming Changes to the Standard Control with Advanced Control Specialty Formulary
Effective April 1, 2024, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
AllianceRx Walgreens Pharmacy Will Join Our Specialty Pharmacy Network
On January 1, 2024, AllianceRx Walgreens Pharmacy will join our specialty pharmacy network. Learn more.
A REWARDING NEW WAY TO HELP MEMBERS STAY ADHERENT
Starting January 1, 2024, we’re introducing a new program that rewards members for filling certain medications on time, by lowering their out-of-pocket costs. The more adherent they are, the more they can save. Learn more.
A NEW WAY FOR MEMBERS TO ACCESS BLUE 20/20 VISION BENEFITS
Effective November 13, 2023, Blue 20/20 members who also have a Blue Cross Blue Shield of Massachusetts medical plan, dental plan, or both can now use MyBlue to access their vision benefits. Learn more.
Lowering Our Members’ Pharmacy Costs
We’re pleased to introduce Cost SaverTM, a new feature that automatically gives our pharmacy members the lowest possible out-of-pocket price on certain medications. Learn more.
YOUR SHOT TO STOP THE FLU AND COVID-19
Now’s the time for your employees to get their updated flu and COVID-19 shots. They’ll help protect your employees and everyone around them from getting seriously ill this season. Learn more.
UPDATE - Effective January 1, 2024, Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary and Medical Policy Updates
Effective January 1, 2024, we’re updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´1 plans with a three-tier pharmacy benefit. Learn more.
UPDATE - Effective January 1, 2024, Upcoming Changes to the Standard Control with Advanced Control Specialty Formulary
Effective January 1, 2024, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series, which allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts. Learn more.
Health Plan Updates for 2024
Effective January 1, 2024, and upon renewal, we’re enhancing our health plan offering to meet not only ongoing requirements, but also the market demand to provide high-quality, more affordable coverage you and your employees expect from Blue Cross. Learn More.
Effective January 1, 2024, Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary and Medical Policy Updates
Effective January 1, 2024, we're updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´* plans with a three-tier pharmacy benefit. Learn More.
Effective January 1, 2024, Upcoming Changes to the Standard Control with Advanced Control Specialty Formulary
Effective January 1, 2024, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
Important Information About Medicaid and Children’s Health Insurance Program Eligibility
States are restarting eligibility reviews for Medicaid and Children’s Health Insurance Program (CHIP). We encourage you to extend the period for special enrollment to help ensure that your employees and their families avoid gaps in care. Learn More.
Member Months Coverage Report available for self-insured accounts at no cost
We’re offering a Member Months Coverage Report to our self-insured accounts for the 2023 tax year at no cost. The member information in the report is required by the IRS under the Affordable Care Act (ACA). Accounts are responsible for sending the report file to their tax vendor and filing with the IRS. Read the full article.
UPDATE - Effective October 1, 2023, Upcoming Changes to the Standard Control with Advanced Control Specialty Formulary
Effective October 1, 2023, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
ahealthyme®’ Platform Reminder
Accounts are currently transitioning to the enhanced ahealthyme®’ platform. Learn more about the transition.
Keeping Children's Eye Health in Sight
August is Children’s Eye Health and Safety Month, and it’s the perfect time to raise awareness of the importance of vision care for kids as they go back to school. Our Blue 20/20 vision plan benefits can help your employees and their kids keep their eyes healthy. Learn more.
Self-Insured Accounts Must Submit a Gag Clause Prohibition Compliance Attestation
In compliance with the Consolidated Appropriations Act (CAA), we've removed all gag clauses from our provider contracts. As required by the CAA, self-insured accounts must submit a Gag Clause Prohibition Compliance Attestation to the Health and Human Services portal by December 31, 2023. Fully-insured accounts don't need to take any action: we'll submit attestations on their behalf. Learn more.
Effective October 1, 2023, Even More access to Oral Health Care
We’re offering two important Dental Blue® benefit enhancements: an expansion to Enhanced Dental Benefits for members with intellectual and/or developmental disabilities and mental health conditions, and 100% coverage for kids under the age of 13. These benefits will be effective on 10/1/2023 for new accounts, and existing accounts upon renewal. Learn More.
Medical Loss Ratio Rebates
We’ll be distributing Medical Loss Ratio (MLR) rebates to affected small group and connector employers this year. Learn more.
Effective October 1, 2023, Upcoming Changes to the Standard Control with Advanced Control Specialty Formulary
Effective October 1, 2023, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn More.
UPDATE - Effective July 1, 2023, Upcoming Changes to the Standard Control with Advanced Control Specialty Formulary
Effective July 1, 2023, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn More.
UPDATE - Effective July 1, 2023, Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary and Medical Policy Updates
Effective July 1, 2023, we’re updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´1 plans with a three-tier pharmacy benefit. Learn more.
Quality Care Dosing Limits Have Increased for Select Medications
To give doctors greater flexibility when prescribing certain controlled substances, we’ve doubled the quality care dosing limit for select medications. The change applies to plans that have pharmacy coverage through Blue Cross Blue Shield of Massachusetts and use the Blue Cross formulary. Learn more.
New Neonatal Intensive Care Unit (NICU) Program Begins September 1, 2023
Starting September 1, 2023, we’ll be working with ProgenyHealth®´, an independent health care company dedicated to maternity and infant health, to provide Neonatal Intensive Care Unit (NICU) utilization management and care management services for eligible commercial members. Learn more.
Introducing Blue 20/20 PLUS
Starting July 1, 2023, with the new Blue 20/20 PLUS enhanced coverage, members can get greater savings on their vision care. They will get enhanced benefits of a $0 eye exam copay and additional frame allowance. Learn More.
Announcing the Upgraded ahealthyme®' Platform with Enhanced Features
Learn about the launch of the upgraded ahealthyme®' wellness platform with enhanced features that make it easier for your employees improve their physical, mental, and social health. Learn more.
A Closer Look: Vision Loss and Mental Health
Did you know that one in four adults with vision loss experiences anxiety and depression?1 May is Healthy Vision Month, so it’s the perfect time to talk about the often overlooked connection between vision loss and mental health — and how our Blue 20/20 vision plans can make a difference. Learn more.
1. MyVision.org., "The Link Between Mental Health and Your Vision," April 9, 2022.
Preventive Care Mammograms for Adult Commercial Members at Any Age
All HMO and PPO plan members are covered for at least one preventive-care mammogram screening per year, without age restriction, when ordered by a provider. This benefit is $0 for members of commercial HMO/POS, EPO/PPO, and indemnity plans. Learn More.
Effective July 1, 2023, Upcoming Changes to the Standard Control with Advanced Control Specialty Formulary
Effective July 1, 2023, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
Effective July 1, 2023, Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary and Medical Policy Updates
Effective July 1, 2023, we’re updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´* plans with a three-tier pharmacy benefit. Learn more.
UPDATE - Effective April 1, 2023, Upcoming Changes to the Standard Control with Advanced Control Specialty Formulary
Effective April 1, 2023, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
Two Changes to Take Effect July 1, 2023, to Blue Distinction® Specialty Care
Under the first change, we’re revising our Blue Distinction Specialty Care rider to clarify that existing continuity of care allowances also apply to members with this rider. Under the second change, we’ll discontinue the Limited Benefit rider option for Blue Distinction Centers®. Learn More.
Change in Prior Authorization Requirements for Certain Musculoskeletal Services
We're updating our prior authorization requirements for certain musculoskeletal (MSK) services for all HMO and PPO plan members* to go into effect on April 1, 2023. Learn More.
Stop-Loss Reporting Fee Increase
We’re increasing the monthly rate for our stop-loss reporting, effective June 1, 2023, for accounts that buy this reinsurance coverage from a third party. The fee is assessed annually based on the monthly rate, which will increase to $550 per month. As an example, an account with 12 months of reporting would be charged a fee of $6,600 upon renewal. Reporting fees don’t apply to stop-loss reinsurance purchased directly from Blue Cross Blue Shield of Massachusetts. Learn More.
Mental Health Treatment: Prior Authorization Changes
We’ve removed prior authorization requirements for Intensive Community-Based Treatment (ICBAT), Community-Based Acute Treatment (CBAT), and inpatient psychiatric treatment. Learn More.
Post-Jan. 1 Communication Toolkit: Pharmacy Benefit Manager Transition
On January 1, 2023, CVS Caremark, an independent company, will begin administering pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts. We’ve developed a post-January 1 Pharmacy Benefit Manager (PBM) Communication Toolkit for you to share with your employees. Learn More.
Effective April 1, 2023, Upcoming Changes to the Standard Control with Advanced Control Specialty Formulary
Effective April 1, 2023, CVS Caremark®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is updating their formulary (list of covered medications) for select self-insured plans (500+) with the Standard Control with Advanced Control Specialty Formulary. Learn more.
Change in Prior Authorization Requirements for Certain Musculoskeletal Services in 2023
We're updating our prior authorization requirements for certain musculoskeletal (MSK) services for all HMO and PPO plan members* to go into effect the second quarter of 2023. Learn more.
Helping Blue 20/20 Members Set Their Sights on Eye Exams
Routine eye exams can help members detect health conditions, including diabetes. In November, we launched a vision awareness campaign to educate members about the benefits of routine eye exams and to highlight Blue 20/20’s vision coverage. Learn more.
STOPPING THE FLU STARTS WITH YOU
If your employees haven’t gotten their flu shot yet, now’s the time. It will help protect them and everyone around them from getting sick, especially young children and older adults, who are the most at risk. Learn more.
UPDATE - Effective January 1, 2023, the Standard Control with Advanced Control Specialty Formulary Will Be Offered
Effective January 1, 2023, the Standard Control with Advanced Control Specialty Formulary (SC-ACSF) will be a new formulary (list of covered medications) available to select self-insured plans (500+) with pharmacy benefits. The SC-ACSF will be replacing the National Preferred Formulary (NPF). The NPF will no longer be offered through Blue Cross Blue Shield of Massachusetts. Learn more.
Effective January 1, 2023, Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary
Effective January 1, 2023, we’re updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´* plans with a three-tier pharmacy benefit. Learn more.
What's New for 2023
Effective January 1, 2023, and upon renewal, we’re enhancing our health plan offering to not only meet ongoing requirements but also the market demand to provide high-quality, more affordable coverage you expect from Blue Cross. Learn more.
Effective January 1, 2023, the Standard Control with Advanced Control Specialty Formulary Will Be Offered
Effective January 1, 2023, the Standard Control with Advanced Control Specialty Formulary (SC-ACSF) will be a new formulary (list of covered medications) available to select self-insured plans (500+) with pharmacy benefits. The SC-ACSF will be replacing the National Preferred Formulary (NPF). The NPF will no longer be offered through Blue Cross Blue Shield of Massachusetts. Learn more.
The Healthy Actions Platform Has Been Enhanced
The wellness platform has a new look and feel, but the savings will be the same. Learn more.
New Communication Toolkit: Pharmacy Benefit Manager Transition
Starting January 1, 2023, CVS Caremark, an independent company, will administer pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts. We’ve developed a Pharmacy Benefit Manager (PBM) Communication Toolkit for you to proactively inform your employees about this change. Learn more.
Helping Members with Diabetes Get Recommended Screenings
In September 2022, we’re launching a new program with CVS Caremark®´, an independent health solutions company, that helps members with diabetes get recommended screenings and care. Learn more.
Regulatory Update: Medical Loss Ratio Rebates
We’ll be distributing Medical Loss Ratio (MLR) rebates to impacted small group account holders this year. Learn more.
Encompass Fertility™ Has Joined Our Specialty Pharmacy Network for Fertility Medications
Effective July 19, 2022, Encompass Fertility has joined our specialty pharmacy network for fertility medications. Learn more.
Update on Transparency in Coverage Rule (TCR) and Machine-Readable Files
Beginning July 1, 2022, machine-readable files (MRFs) of in-network provider negotiated rates and historical out-of-network allowed amounts required under the Transparency in Coverage Rule (TCR) will be available on our website. Learn more.
Making It Easier for Members to Submit Claims
By July 12, 2022, we will roll out online claims submission capabilities for all of our members. Learn more.
Give Vision Members the Power to Know Before They Go
Effective June 27, 2022, Blue 20/20 vision members can get a clear summary of their estimated out-of-pocket costs before meeting with their vision provider. The “Know Before You Go” tool on blue2020ma.com informs members about special offers, and allows them to search for providers and schedule appointments online. Learn more.
Important Employer Surveys: Medical Loss Ratios and Employer Group Size
In July, Blue Cross Blue Shield of Massachusetts will send the Patient Protection and Affordable Care Act (PPACA) survey and/or the federal Medicare Secondary Payer (MSP) survey in the mail to our fully insured accounts. Learn more.
Metro Drugs Is Leaving Our Specialty Pharmacy Network for Fertility Medications
Effective May 1, 2022, Metro Drugs, a fertility medication pharmacy, will be leaving our specialty pharmacy network. Learn more.
Members to Receive Updated ID Cards With New Cost Information
Beginning with May 2022 renewals, we’ll be issuing updated member ID cards that include deductible and maximum out-of-pocket cost information. Learn more.
UPDATE - Effective July 1, 2022, Medications No Longer Covered Under the National Preferred Formulary
Effective July 1, 2022, Express Scripts, Inc.®´, an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is removing medications from their formulary (list of covered medications) for medical plans with the National Preferred Formulary (NPF). Learn more.
Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary and Pharmacy Medical Policy Updates
Effective July 1, 2022, we’re updating the Blue Cross Blue Shield of Massachusetts formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´ plans with a three-tier pharmacy benefit. We’ve also discontinued a medical policy as of March 1, 2022, and we’re making additional medical policy changes on April 1, 2022 and July 1, 2022. Learn more.
Effective July 1, 2022, Medications No Longer Covered Under the National Preferred Formulary
Effective July 1, 2022, Express Scripts, Inc.®´, an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts, is removing medications from their formulary (list of covered medications) for medical plans with the National Preferred Formulary (NPF). Learn more.
IT’S STILL FLU SEASON. TIME TO GET THEIR SHOT.
It’s never been more important for your employees to get their flu shot. Flu season can last all the way through May, and getting vaccinated will help protect them and everyone around them from getting sick. Learn more.
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series, which allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts. Learn more.
Expanding outreach to collect member race, ethnicity and preferred language information
As part of our ongoing effort to address inequities in health care, we have expanded our race, ethnicity and language data collection outreach to include a mailed survey. Learn more.
We’re Decreasing Your Bill Lead-Time
Effective January 2022, you’ll have 10 more days to make enrollment changes and for your payment to reflect on your next invoice, since we’ll be generating invoices 15 days prior to their due date, instead of the current 25 days. Learn more.
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series, which allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts. Learn more.
Let's Beat Flu. Again!
If your employees haven’t gotten their flu shot yet, now’s the time. It will help protect them and everyone around them from getting sick, especially young children and the elderly, who are the most at risk. Learn more.
Update on Coverage Change for Infused, Injectable Medications Under the Medical Benefit, Effective January 1, 2022
We previously notified you that we planned to change the covered sites of service where members can have their infused or injectable medications administered. We’ve decided to make Site of Care a voluntary program rather than a requirement. Learn more.
Making Primary and Mental Health Care More Accessible
As part of our ongoing commitment to creating an unparalleled consumer experience, we're collaborating with innovative providers that offer expanded models of care and simpler, more consumer-focused care delivery. Learn more.
Improving Care and Quality of Life for Select Members with Chronic Kidney Disease
We’re launching two new programs in early 2022 to improve the care and quality of life for select members diagnosed with chronic kidney disease. Learn more.
ACS Accounts 500+ Can Now Offer Members Access to Virtual Second Opinions
We’re collaborating with 2nd.MD, an independent company that provides members with a virtual second opinion. ASC accounts 500+ can now add 2nd.MD for a fee. Learn more.
Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary, Effective January 1, 2022
Beginning January 1, 2022, we’re updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´ * plans with a three-tier pharmacy benefit. Learn more.
We’re Making Telehealth Services More Accessible
Effective January 1, 2022, we’ll be expanding access to telehealth services for members. Learn more.
Sunsetting Identity Protection Services
We’ll be sunsetting our Member Identity Protection Services offered through Experian as of November 2021. Learn more.
Health Plan Updates for 2022
Effective January 1, 2022, and upon renewal, we’re making changes to our health plans to ensure that we continue to meet the ongoing requirements of health care reform, while providing the high-quality, affordable coverage you and your employees expect from Blue Cross. Learn more.
Transparency in Coverage Rule (TCR) and Consolidated Appropriations Act (CAA)
On Aug. 20, 2021, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury jointly released guidance in the form of Frequently Asked Questions (FAQs) to clarify the requirements and timelines for implementation of certain provisions within the Transparency in Coverage (TCR) and Consolidated Appropriations Act (CAA).Learn more.
Three New Personal Spending Account Vendors Offer Choice and Flexibility
We’re excited to announce that we have added three new vendors to our personal spending account portfolio: Fidelity, London Health Administrators, and WEX (formerly Discovery Benefits, Inc.). Learn more.
HMO Blue Select Network Update
As a result of favorable improvements in certain physician group and hospital cost performance, we are adding them to the HMO Blue Select Network. Learn more.
Prior Authorization Change for Outpatient Services for EPO and PPO Plan Members
We're adding prior authorization requirements for certain outpatient services for EPO and PPO plan members, effective January 1, 2022. Learn more.
Expanded Coverage for Treatment of PANDA/PANS
As of January 1, 2022, Blue Cross Blue Shield of Massachusetts will expand coverage for the treatment of pediatric autoimmune neuropsychiatric disorders and pediatric acute-onset neuropsychiatric syndromes (PANDAS/PANS). This includes, but it is not limited to, intravenous immunoglobulin (IVIG) therapy. Learn more.
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series, which allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts. Learn more.
We’re Expanding Site-of-Care Coverage for Delivery and Maternity Care
On January 1, 2022, we’ll expand our coverage of routine deliveries and maternity care to include standalone birthing centers that aren’t affiliated with or attached to a hospital. Learn more.
Blue Cross Blue Shield of Massachusetts Surpassed 2020 Medical Loss Ratio Requirements
In 2020, Blue Cross Blue Shield of Massachusetts exceeded the state and federal medical loss ratio (MLR) requirements for all market segments. As a result, we won’t issue account rebates for 2020. Learn more.
Effective January 1, 2022, Coverage Changes for Infused or Injectable Medications Under the Medical Benefit
We previously communicated that we would implement coverage changes for infused or injectable medications under the medical benefit on September 1, 2021. Blue Cross has decided to delay the implementation of this coverage change until January 1, 2022. Learn more.
Transparency in Coverage Rule and the Consolidated Appropriations Act
Blue Cross continues to actively plan our support of and compliance with the required capabilities for applicable provisions within both the Transparency in Coverage Rule (TCR) and the Consolidated Appropriations Act (CAA). To keep you updated, we created this FAQ document to share important updates on how we will ensure compliance with new requirements. Learn more.
State of the Industry: The Path Forward, An Executive Briefing for Blue Cross Partners
On Monday, June 28 from 2:00 p.m. - 3:00 p.m. EST, join Blue Cross Blue Shield Executives for a discussion about the rapid changes in health care, the expected financial implications as we emerge from the pandemic, and our innovation and efforts underway to address costs and improve outcomes for all. Learn more.
Quality Care Cancer Program Launching in 2021
We’re launching our new Quality Care Cancer Program on July 1, 2021, to help ensure that our members receive cancer care that is evidence-based, clinically appropriate, safe, and affordable. Through this program, board-certified oncologists and oncology-trained nurses will be available to discuss covered treatment options with our members’ doctors Learn more.
Apply to Have Your Mini-COBRA Premiums Subsidized
Your business may be eligible for a subsidy towards your premium for any former employees and dependents who may be on mini-COBRA from April 1, 2021, through September 30, 2021, under the American Rescue Plan Act of 2021. We’ll cover the cost of these subsidies for eligible accounts. Accounts with 2–19 active employees are eligible for mini-COBRA. Learn more.
Well Connection Is Now Part of MyBlue
We've made it more convenient for members to get the care they need. As of June 10, 2021, members simply need to sign in to their MyBlue account to use Well Connection for their medical or mental health needs. Learn more.
Important Employer Surveys: Medical Loss Ratios and Employer Group Size
In July, we’ll be mailing surveys to fully insured accounts. Accounts will receive either one or two surveys, and should plan to respond as soon as possible. Learn more.
Changes to Telehealth Benefit
Effective July 1, 2021 we'll reinstate member cost share for non-COVID-19 covered services provided via telehealth, including care provided telephonically and via video chat. We're also expanding the types of services eligible for telehealth coverage. Details of these changes can be seen here. Learn more.
You're Invited to Our 2021 Inspirational Speaker Series
We're excited to invite you to join our family-friendly speaker series beginning this May. Each speaker has been carefully selected by our sales leaders and will share their stories of resilience and motivation during challenging times. Learn more.
Changes to the Telehealth Benefit
Starting on July 1, 2021, we will reinstate standard member costs for non-COVID medical- and mental-telehealth visits. How much the member will pay depends on the health plan’s benefits. Medicare members are excluded from this change. Learn more.
Upcoming Coverage Changes for Infused or Injectable Medications Under the Medical Benefit - DELAYED TO JANUARY 1, 2022
Effective September 1, 2021, we’re changing the covered sites of service where members can get infused or injectable medications administered. We’re also requiring prior authorization for these sites, as well as the medications listed below. These changes ensure that members are receiving care in clinically-appropriate, cost-effective settings. Learn more.
Dental Blue® and Blue 20/20 Member ID Cards Are on MyBlue
Dental Blue and Blue 20/20 member ID cards have been added to MyBlue. Members now have access to all of their ID cards digitally, whenever they sign in to their MyBlue accounts via the Web and app. Learn more.
See Our Electronic Enrollment Reminders
We’ve created an electronic enrollment fact sheet that will help answer common questions that might come up while submitting your eligibility files. Learn more.
Effective July 1, 2021, Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary
Beginning July 1, 2021, we’re updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´ plans* with a three-tier pharmacy benefit. Learn more.
Coverage for Certain Infused Oncology Medications Moving to the Medical Benefit
Effective July 1, 2021, certain infused oncology medications will only be covered under our medical benefit through the Quality Care Cancer Program. These medications will no longer be included in our pharmacy benefit. Learn more.
Effective July 1, 2021, New Opioid Safety Review to Be Implemented at Pharmacies
Effective July 1, 2021, pharmacists filling a member’s opioid prescription will be alerted if the member may be receiving a total level of opioids that’s potentially unsafe. This change applies to plans with the Blue Cross Blue Shield of Massachusetts formulary, as well as Medex®’ plans* with a three-tier pharmacy benefit and Managed Blue for Seniors plans. Learn more.
New Prior Authorization Requirements for Select Medications Under the Medical Benefit
Starting July 1, 2021, we’re adding medications to our utilization management program that will require prior authorization before being covered under our medical benefit. Learn more.
Upcoming Coverage Changes for Certain Medications Moving from Our Medical to Pharmacy Benefit
Effective July 1, 2021, coverage for select medications will move out of our medical benefit and only be included under our pharmacy benefit. This change will apply to all medical plans, except Managed Blue for Seniors, group Medicare Advantage, group Medex®´, and Federal Employee Program plans. Learn more.
1099-HC Tax Form Is Now Available on MyBlue
Subscribers can now view, download, and print their 1099-HC tax form for their 2020 taxes through MyBlue. Learn more.
Streamlined Authorization Management Tool for Providers
We recently launched the next phase of a tool called Authorization Manager, which allows providers to manage their authorizations and referrals for all of our members. Providers can use the tool to submit and view the status of all of their authorization requests, and to view the status of their referral submissions. You don’t need to take any action as a result of this change. Learn more.
Updates to Preventive Dental Benefits
On June 1, 2020, as part of our effort to support members during COVID-19, we relaxed the limits on the following preventive dental benefits: routine cleanings, periodic exams, and fluoride treatment. The changes allow members greater flexibility with access to these benefits twice in a calendar year rather than once every 6 months. In addition, bitewing x-rays and certain benefits included in our Total Health Solution will be updated. Learn more.
New Cost-Share Assistance Program Can Save Self-Insured Accounts and Their Members Money on Eligible Brand-Name Specialty Medications
Self-insured accounts and their members can see savings on eligible brand-name specialty medications,* when accounts add the Cost-Share Assistance Program to their pharmacy benefit. The Cost-Share Assistance Program uses coupons from manufacturers of medication to cover most or all of a member’s out-of-pocket costs for eligible medications. Learn more.
Well Connection Is Coming to MyBlue
Coming soon: Well Connection will be integrated into MyBlue, making it even easier for members to have video visits with licensed providers, therapists, and psychiatrists. Learn more.
Employees Should Make a Plan to Get Their Flu Shot
Flu season can last through the end of May. And with COVID-19, it’s more important than ever for your employees to get their no-cost flu shot. They can follow these steps to plan out the easiest and safest way to get vaccinated. Learn more.
Go Paperless Campaign Launching in February 2021
We’re launching a Go Paperless campaign, targeting members who have a medical, dental, or Medex®´ plan, and haven’t already selected a communication preference. This does not apply to Medicare Advantage members. Starting in February 2021, these members will receive a postcard and email (for those members that have provided an email) saying that they’ll no longer receive claim summary statements (Summary of Health Plan Payments, Explanation of Benefits, and Dental Predetermination of Benefits) in the mail unless they take action. Learn more.
Announcing Upcoming Webinars
We’re excited to announce upcoming webinars in our account webinar series, which allow your organization’s leadership and human resources teams to learn more about your health plan benefits from our subject matter experts. Learn more.
Effective October 1, 2020, Inflectra Is Now Preferred over Remicade for Members with Existing Prescriptions
Effective October 1, 2020, the immune-modulating medication Inflectra is now the preferred brand-name medication over Remicade. This affects members 18 years and older with existing prescriptions, and applies to prescriptions covered under the medical and pharmacy benefit. Learn more.
Coverage Update: Sam’s Club Staying in Our Pharmacy Network
We’re pleased to announce that Sam’s Club will remain in our pharmacy network. Members can continue to fill prescriptions at Sam’s Club pharmacy locations without interruption to their coverage. Learn more.
Upcoming Changes to Opioid Coverage
We’re making several changes to our coverage of opioids. Effective April 1, 2021, we’ll cover Xtampza ER, and with this change, we’ll no longer cover OxyContin and Oxycodone ER, as of July 1, 2021. Also, we’re expanding our Pain Management Policy. Prescribers who don’t have an approved authorization for coverage of a member’s opioid medication must request authorization for that member’s medication before July 1, 2021. Oncologists, palliative care providers, and pain management specialists in the Blue Cross Blue Shield of Massachusetts network are exempt from this prior authorization requirement. Learn more.
Dental Blue® 65 Plans Will Include Enhanced Dental Benefits
Effective January 1, 2021, Dental Blue® 65 plans will be expanded to include Enhanced Dental Benefits for at-risk members with qualifying medical conditions. We’ll provide eligible members with additional, condition-specific support. Learn more.
Addressing Inequities in Health Care: Race and Ethnicity Data Collection on MyBlue
Effective January 1, 2021, as part of our ongoing effort to address inequities in health care, we’re updating the MyProfile section of MyBlue to encourage our members to share information about their race, ethnicity, and language preference with us. Learn more.
Blue 20/20 Online HR Portal Adds Enrollment Management
We’ve expanded the Blue 20/20 HR portal, so new and existing accounts will soon be able to manage member and dependent enrollment online. Learn more.
Additional Behavioral Health Coverage for Children and Adolescents
Beginning January 1, 2021, and effective upon account renewal, Blue Cross Blue Shield of Massachusetts will cover additional behavioral health services for children and adolescents. Learn more.
A Flu Shot Is Crucial for Members This Year
COVID-19 means it’s extra important for members to stay healthy during the flu season. Getting a flu shot is safe, and available at no cost* for members. It can also keep members out of the hospital at a time when others desperately need critical care. Learn more.
Benefits of Choosing Indigo for Your Massachusetts Paid Family Medical Leave (MA PFML) Plan
Beginning January 1, 2021, most employers in Massachusetts are required to provide paid family medical leave to their employees. You can opt out of the state plan and save valuable administrative resources by choosing a private plan through Indigo InsuranceTM Services, the preferred agency of Blue Cross Blue Shield of Massachusetts for ancillary insurance. Learn more.
Updates to the Blue Cross Blue Shield of Massachusetts Formulary Changes, Effective January 1, 2021
We’ve updated the Blue Cross Blue Shield of Massachusetts formulary changes going into effect January 1, 2021. Learn more.
Updates to Blue 20/20 Member Website
We've refreshed the Blue 20/20 website, powered by EyeMed®´ Vision Care, an independent vision benefits company, to help our members more easily find information about their vision plan benefits. Learn more.
Updates to Our Fitness Reimbursement
Effective as of January 1, 2020, we’ve added virtual fitness programs to our fitness reimbursement. We’ve also created an online reimbursement process to make it easier for our members to get rewarded. Learn more.
Protect Your Organization from Wire Fraud
These best practices can help you identify potential wire fraud and protect your organization from fraudulent activity. Learn more.
Introducing Our Plan Comparison Tool
We’re excited to announce the launch of our updated plan comparison tool. With this tool, you can view and compare up to three plans including the corresponding SOB, SBC, and Benefit Change Fact Sheet (if applicable). Learn more.
Introducing Our Account Webinar Series
You asked and we listened! Blue Cross Blue Shield of Massachusetts is excited to host live webinars, featuring subject matter experts and designed to help your organization’s leaders and human resources team learn more about your health plan benefits. Learn more.
Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary, Effective January 1, 2021
Beginning January 1, 2021, we’re updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´* plans with a three-tier pharmacy benefit. Learn more.
No-Cost Online Behavioral Health Seminars
We’re offering live, online seminars each month, at no additional cost, to help our members cope with feelings of stress, anxiety, and grief, as well as other behavioral health issues, during these unprecedented times. Learn more.
Health Plan Updates for 2021
Effective January 1, 2021, and upon renewal, we’re making changes to our portfolio of health plans to ensure we are continuing to provide high-quality, affordable coverage you and your employees expect from Blue Cross. Learn more.
Quality Care Cancer Program Launching in 2021
We’re launching our new Quality Care Cancer Program on July 1, 2021, to help ensure that our members receive cancer care that is evidence-based, clinically appropriate, safe, and affordable. Through this program, board-certified oncologists and oncology-trained nurses will be available to discuss covered treatment options with our members’ doctors. Learn more.
Personal Protective Equipment Assistance for Dental Blue®´ Providers
For dental services provided from June 1 to August 31, 2020, we’ll be reimbursing our Dental Blue providers in Massachusetts an additional $10 per covered visit. This new reimbursement will help our providers with personal protective equipment (PPE) costs as they returned to practice. PPE is essential to ensuring visits are safe for patients and providers alike. Learn more.
Upcoming Prior Authorization Changes for Medications Covered Under the PPO and EPO Medical Benefit
Beginning January 1, 2021, we’re adding Prior Authorization requirements for our members with PPO and EPO plans for certain medications when covered under the medical benefit. Members currently using these medications, and those newly prescribed on or after January 1, 2021, will need an approved authorization to receive coverage. Learn more.
Acceptable Enrollment Formats for New Business One Time Files
When submitting new business enrollment files, it’s important to submit them in the required format to populate your data. This ensures an accurate enrollment experience and avoids delays. Learn more.
Member Months Coverage Report Available for ASC Accounts at No Cost
We’re offering a Member Months Coverage Report to our ASC accounts for the 2020 tax year at no cost. This information is required by the Internal Revenue Service (IRS) under the Affordable Care Act (ACA). Accounts are responsible for sending the report file to their tax vendor, and filing the data with the IRS. Learn more.
Changes to Our Specialty Pharmacy Network for Fertility Medications
Effective August 31, 2020, AcariaHealth™ Fertility will be leaving our specialty pharmacy network for fertility medications. This change applies to plans with the Blue Cross Blue Shield of Massachusetts formulary, and the National Preferred Formulary (NPF). Learn more.
Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary, Effective October 1, 2020
Effective October 1, 2020, we're updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´* plans with a three-tier pharmacy benefit. This update includes the changes that were originally scheduled to go into effect on May 1 and July 1. Learn more.
Upcoming 4th Quarter Changes to the Blue Cross Blue Shield of Massachusetts Formulary
In the fourth quarter of 2020, we're updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´ plans with a three-tier pharmacy benefit. This update includes changes that were originally scheduled to go into effect on May 1 and July 1. Learn more.
Coverage Change for Breast Cancer Risk-Reduction Medications
On October 1, 2020, we’ll begin covering the following generic oral medications in the class of aromatase inhibitors at no additional cost for members when the medications are prescribed to reduce breast cancer risk. Learn more.
Coverage Update for Truvada
On July 1, 2020, we’ll begin covering Truvada, an HIV pre-exposure prophylaxis (PrEP) medication, at no additional cost for members who aren’t currently filling other HIV medications. This change applies to new prescriptions and refills, and to plans with either the Blue Cross Blue Shield of Massachusetts Formulary or National Preferred Formulary. Learn more.
Well Connection Now Offers Psychiatry Care
Well Connection is expanding its behavioral health services to include video-based psychiatry. With this new service, board-certified psychiatrists provide medication management for behavioral health conditions. The psychiatrists can evaluate health, assess the benefits of medications, and prescribe them. Learn more.
Medications That Now Require Prior Authorization, Effective April 1, 2020
Effective April 1, 2020, until further notice, the following medications will have quantity limits for first-time prescriptions for new therapies. Learn more.
July 1st Formulary Changes Temporarily Delayed
In a recent Important Administrative Information (IAI) newsletter we notified you of upcoming formulary (list of covered medications) changes for July 1st that affected medical plans with pharmacy benefits as well as Medex® ́ plans with a three-tier pharmacy benefit. Learn more.
May 1st Formulary Changes Temporarily Delayed
We recently notified you of upcoming formulary (list of covered medications) changes for May 1st that affected medical plans with pharmacy benefits as well as Medex® ́ plans with a three-tier pharmacy benefit. Learn more.
Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary, Effective May 1, 2020 - DELAYED
Beginning May 1, 2020, we're updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´ plans with a three-tier pharmacy benefit. Learn more.
Changes to Our Specialty Pharmacy Network
Effective March 31, 2020, BriovaRx®' will be leaving our specialty pharmacy network. This change applies to the Blue Cross Blue Shield of Massachusetts formulary, and the National Preferred Formulary (NPF). This does not affect members who have Medicare Advantage with a Part D prescription drug plan; they can continue to use BriovaRx without interruption. Learn more.
How to Help Transition Eligible Employees to a Medicare Plan
You can customize your own Medicare handout by simply adding your company’s logo. This professionally designed flyer will inform both upcoming and late retirees on how to get started, so they can decide which plan is right for them. Learn more.
Changes to Dental Maximum Liability
Effective January 1, 2020, members with a Blue Cross dental plan may only be charged up to the fee schedule amount for additional covered services, according to the in-network dental provider’s contracted fee schedule, even after reaching their benefit maximums. Learn more.
Change to Blue 20/20 Retail Provider Network
Starting February 1, 2020, EyeMed Vision Care®', an independent vision benefits company that administers our Blue 20/20 plans, will no longer contract with Sears Optical, JC Penney Optical, or Stanton Optical. Learn more.
New Online Behavioral Health Resource – Learn to Live
Our new innovative online resource provides support for members who are struggling with depression, insomnia, stress, and anxiety. Learn to Live provides online, self-directed programs and self-assessments based on the principles of Cognitive Behavioral Therapy for employees and their family members (ages 13 or older). Learn more.
No-Cost Flu Vaccine Available for Members
We’re committed to limiting the spread of the flu this season. That’s why there is no cost to the member for the flu vaccine when administered by a participating or preferred health care provider, such as a doctor or nurse practitioner, or at an urgent care center, limited services clinic, or pharmacy-based clinic (like CVS MinuteClinic®’). Learn more.
Weight-Management Program StepIn®´´ Available for Select Self-Funded Accounts
Effective January 1, 2020, StepIn, a new weight-management program, will be included at no additional cost for self-funded accounts with pharmacy benefits who have enrolled in Diabetes Care Value program. Learn more.
Updated List of 2020 Plans Impacted by Member ID Card Distribution Changes
We’ve released a new list of 2020 plans that will be affected by our recent change to the timeline for when we send new member ID cards to Small Group (under 50) accounts that have members in certain plans. Learn more.
Pathway to Savings Now Includes Massachusetts Paid Family and Medical Leave (MA PFML) Products
We’re excited to announce the expansion of our Pathway to Savings program to include MA PFML-compliant products, through our preferred carriers with Indigo InsuranceTM Services. When you choose a MA PFML-compliant plan with one of Indigo’s preferred carriers (USAble, Hartford, AXA, or Symetra) plus one other group line of coverage, you’re eligible to receive .5% off your medical rates for the first year, and .25% off your medical rates for the second year. Learn more.
Members Can Go Paperless
Very soon, members with commercial medical, dental, or Medex®´ plans can choose whether they want to continue receiving claim summary statements (Summary of Health Plan Payments, and Explanation of Benefits) on paper, or go green and view them online using MyBlue. Learn More.
An Easier Way for Members to Manage Their Maintenance Medications
Managing more than one maintenance medication can be complicated and time-consuming. With PillPack, a full-service, in-network pharmacy, members won’t have to worry about going to the pharmacy, organizing their medications, or missing a dose again. That’s because PillPack presorts their medications by day, date, and time, then delivers them to their door in clearly-marked packets, so members know which pills to take and when. PillPack will be available only for fully insured accounts, starting October 22, 2019. Learn more.
Exclusive Savings and Rebates for Blue 20/20 Members
Blue 20/20 members can now take advantage of exclusive savings, discounts, and rebates on eye care products and services. Learn more.
Get Your Employees to Participate in Drug Take Back Day on October 26, 2019
Medications don’t last forever. Over time, their chemical properties change, making them less potent—and even dangerous. Encourage your employees to go through their medicine cabinets and check for any expired or unwanted medications—this includes everything from aspirin to prescription medications. Learn more.
January 2020: Updates to Our Pharmacy Formulary
Beginning January 1, 2020, we're updating our list of covered medications for medical plans with pharmacy benefits, as well as Medex®' plans with a three-tier pharmacy benefit. Learn more.
Enhancements to Our Find a Doctor & Estimate Costs Tool
Find a Doctor and Estimate Costs tool is now available within MyBlue, making it even easier for members to take control of their health care. Learn more.
Enhancements to the MyBlue App
Throughout 2019, we’ve been making several enhancements to the MyBlue App that offers our members a better user experience, improved performance, and full integration with the MyBlue website. Learn more.
Health Plan Updates for 2020
Effective January 1, 2020, and upon renewal, we’re making changes to our health plans to ensure that we continue to meet the ongoing requirements of health care reform, while providing the high-quality, affordable coverage you and your employees expect from Blue Cross. Learn more.
Introducing ScreenRx®´ for Self-Insured Accounts
To help our members manage chronic conditions and stay on track with their medications, we’re offering ScreenRx to self-insured accounts, starting January 1, 2020. Learn more.
Introducing RationalMed®´ for Self-Insured Accounts
Effective January 1, 2020, we’re adding RationalMed, a new medication safety solution, as a core benefit to our pharmacy program for self-insured accounts. Learn more.
Smart90®´ Now Included in Core Benefits for Self-Insured Accounts with Pharmacy Benefits
Starting January 1, 2020, upon renewal, self-insured accounts with pharmacy benefits will include the Smart90 program, which allows members to get a 90-day supply of certain maintenance medications through the mail order pharmacy, or from the more than 9,800 CVS PharmacyTM retail locations nationwide. Learn more.
Blue Cross Blue Shield of Massachusetts Surpassed 2018 Medical Loss Ratio Requirements
In 2018, Blue Cross Blue Shield of Massachusetts exceeded the state and federal medical loss ratio (MLR) requirements for all market segments. As a result, we don’t need to issue account rebates for 2018. Learn more.
Upcoming Changes to Member ID Card Distribution
Beginning November 1, 2019, we’re changing the timeline for when we send new Member ID cards to members in certain plans for Small Group (under 50) accounts. Learn more.
New Federal Medicare Mandate (MACRA)
A federal law will change Medicare Supplement plan options for those who are newly eligible for Medicare on or after January 1, 2020. As of that date, we’ll no longer offer our Medex®´Bronze plan to people who are newly eligible for Medicare. However, benefits for our current Medex Bronze, Choice, or Core plan members won’t change. Learn more.
New Self-Service Reporting Tool for Accounts with 100+ Employees
We’re introducing a new self-service claims analytics tool later this year called BlueInsights. It will be available to all employers with 100+ employees. At that time, we’ll also retire the current ReportBlue system. Learn more.
Member Months Coverage Report Available for ASC Accounts at No Cost
We’re offering a Member Months Coverage Report to our ASC accounts for the 2019 tax year at no cost. This service must be requested prior to November 1, 2019. Learn more.
Updates to Our Dental Blue® Total Health Solution
Effective September 1, 2019 for new and renewing accounts, we’re expanding our list of chronic conditions that qualify members for Enhanced Dental Benefits. Learn more.
Important Employer Surveys
In July, some accounts received at least one of two surveys in the mail from us that require a timely response: the Patient Protection and Affordable Care Act (PPACA) survey, and the federal Medicare Secondary Payer (MSP) survey. These surveys help us determine if an account is eligible to receive a rebate for 2019 (to be issued in 2020), and ensure that employees are enrolled correctly and their claims are properly adjudicated. Learn more about these surveys, medical loss ratios, and national health care reform.
Changes to Specialty Pharmacies and Updated Medication List
Effective July 1, 2019, we’ll implement changes to our retail specialty pharmacy network and to the medications these pharmacies can fill. Learn more. Learn more.
Upcoming Change to Member ID Cards
Beginning in June for July renewals and beyond, member ID cards will no longer include the two-digit member suffix. Learn more.
Introducing the Enhanced Diabetes Eye Care Benefit
To help members with type 1 and 2 diabetes better manage their care, we have added an enhanced diabetes eye care benefit to our Blue 20/20 Exam Only and Exam Plus plans, effective July 1, 2019. Learn more.
Introducing Our New Medication Lookup Tool
With our new and improved Medication Lookup tool, members, prospective members, and providers can easily find important information about any medication, including coverage, strength, and additional requirements. Learn more.
We’re Expanding Our Behavioral Health Coverage for Children and Adolescents
Beginning July 1, 2019, Blue Cross Blue Shield of Massachusetts will cover the following services for members under 19 years old:
Read the full article for more information.
Support for Members Affected by Midwest Flooding
In response to the recent Missouri River flooding, we are expediting access to care for members who live in affected areas of Iowa and Nebraska. Learn more.
Safely Dispose of Expired or Unwanted Drugs on April 27, 2019
Medications don’t last forever. Over time, their chemical properties change, making them less potent—and even dangerous. Learn more.
Expanded Coverage for Osteoporosis Screening in Women
As of June 1, 2019, we’re expanding our commercial plan coverage to provide osteoporosis screenings for women under 65 years old who are at increased risk. Learn more.
Enrollment Kits and Benefits@Blue Changes for Small Group Accounts
Starting January 14, 2019, electronic enrollment kits (eKits) and our customized Benefits@Blue websites will be generated automatically for small group accounts in the Inside Sales and Small Groups - 25–50 segments. Learn more.
Flu Shot Program Changes
Our greatest priorities at Blue Cross Blue Shield of Massachusetts (“Blue Cross”) are to assist our members in accessing affordable, quality care, and to provide them with the best consumer experience possible. In support of these priorities, we regularly review our programs and services to ensure that they are still meeting the needs of our account partners and members.
With that in mind, we are announcing a change to our offering. Learn more.
Updates to Our Prior Authorization Requirements
Beginning July 1, 2019, our prior authorization requirements for the medications listed below are changing for members with our HMO, Access Blue, and Blue Choice® plans. Read More.
Upcoming Changes to Our Pharmacy Program
Beginning July 1, 2019, we’re making changes to our list of covered medications for medical plans with pharmacy benefits, as well as Medex®´plans with a three-tier pharmacy benefit. As part of these updates, certain medications may no longer be covered, may be excluded from pharmacy benefit coverage, may switch cost tiers, or might require prior authorization. Read the full article for a complete list of affected medications.
New Orthodontic Payment Schedule
For all comprehensive orthodontic claims, with dates of service on or after January 1, 2019, payment will now be processed on a monthly schedule. This is a change from the previous arrangement, when these benefits were administered in two payments, six months apart. Learn more.
Updates to Our Employer Website
We want to let you know that we’ve added several improvements to our website for Employers. These updates will enhance the user experience and enable additional capabilities in the future. Learn more.
We’re Partnering with Virgin Pulse®´´ to Encourage Employee Health and Well-being
In 2018, Blue Cross and Virgin Pulse created and launched ahealthyme®´ Rewards, a fully-funded turnkey wellness program, as well as Healthy Together, a team-oriented fitness challenge concept. Both initiatives have been successful, and the two companies will build on their partnership with an expanded offering in January 2019. Learn more.
With New Website Design, Promoting ahealthyme Rewards Is Even Easier
Now all the marketing materials you need to spread the word about your new wellness program can be viewed and accessed—right from our newly-designed website. Learn more.
New Health Education and Engagement Services Through Wellness Concepts
We’re excited to announce that beginning January 1, 2019, our health education and engagement services will expand significantly to incorporate a wide range of new topics and events. Learn more.
No-Cost Flu Vaccine Available for Members
For the 2018-2019 flu season, we cover the cost of the flu shot (for all members ages six months and older), and now the nasal spray flu vaccine, commonly known as FluMist (for specific populations), when a member gets the vaccine from a health care professional, a pharmacy-based clinic (like CVS MinuteClinic®’), or another qualified facility. Coverage depends on an individual member’s plan type and the nature of the care received. Members should consult with their health care professional before receiving a flu vaccine. Learn more.
Help for Members Affected by California Wildfires
As deadly wildfires continue to burn in California, Blue Cross Blue Shield is committed to providing support to all of our members who live in affected areas. Learn more.
Safely Dispose of Expired or Unwanted Drugs on October 27, 2018
Medications don't last forever. Over time, their chemical properties change, making them less potent—and even dangerous. Learn more.
Help for Members Affected by Hurricane Michael
Blue Cross Blue Shield of Massachusetts is saddened by the impact of Hurricane Florence. We're committed to providing support to all members who live in affected areas of Florida. Learn more.
ACA Member Months Coverage Report Available for ASC Accounts
Our Administrative Services Contract (ASC) accounts will gain access to a tax reporting service, which follows the Affordable Care Act (ACA) guidelines. As part of our continued efforts to provide service enhancements, we will once again give you the choice to have us run your Member Months Coverage Report at no cost. Learn more.
Prepayment Inpatient Claim Review
As previously communicated in a June IAI, we've partnered with Equian, a nationally known payment integrity vendor, to help continue to manage costs and improve the accuracy of claim payments. Learn more.
Expanded Fitness and Weight-Loss Reimbursement Benefits
Effective upon renewal starting January 1, 2019, we'll expand the definition of qualifying programs for our Fitness and Weight-Loss Reimbursements. This will provide more options for members who use these types of programs and reward them for a broader range of healthy behaviors. Learn more.
Upcoming Changes to Our Pharmacy Program
Beginning January 1, 2019, we're making changes to our list of covered medications for medical plans with pharmacy benefits, as well as Medex®' plans with a three-tier pharmacy benefit. As part of these updates, certain medications will no longer be covered, switch tiers, have a new dosing limit, require prior authorization, or have a change in cost. Learn more.
Help for Members Affected by Hurricane Florence
Blue Cross Blue Shield of Massachusetts is saddened by the impact of Hurricane Florence. We're committed to providing support to all members who live in affected areas of the Carolinas and Virginia. To help expedite access to care, we're adjusting the following policies for members in impacted areas. Learn more.
We Surpassed Medical Loss Ratio Requirements for 2017
For the reporting year of 2017, Blue Cross Blue Shield of Massachusetts won't issue rebates, as our loss ratio exceeded state and federal requirements for all market segments. Learn more.
New Electronic Benefits Enrollment Process for Businesses with 10-150 Enrolled Subscribers
We're pleased to offer a new electronic enrollment support solution for businesses with 10-150 enrolled subscribers (20+ eligible employees) to help simplify benefits administration. As a first-in-market solution, we've partnered with five leading technology platforms and three channel partners to offer a better education, shopping, and administration experience. Learn more.
Introducing Prepayment Inpatient Claim Review
To help manage costs and improve the accuracy of claim payments, we've partnered with Equian, a nationally-known payment integrity vendor, to review certain inpatient claims prior to payment. Effective April 1, 2018 for fully insured accounts and January 1, 2019 on renewal for ASC accounts, inpatient claims that meet identified criteria will be reviewed prior to payment to ensure accurate reimbursement. Learn more.
Introducing Well Connection, Our New Doctor Video Visit Tool for Members
Beginning April 2, 2018, we'll be launching Well Connection, a new digital tool that lets members have live doctor video visits using their smartphone, tablet, or computer. Well Connection is replacing the telehealth platform that our members currently use. This updated service will have a refreshed look and feel, as well as a new app and website. Well Connection will use a new platform that can be seamlessly upgraded to enhance the member experience. Learn more.
Introducing the Future High-Cost Member Report for ASC Accounts
We're pleased to introduce the Future High-Cost Member report for ASC accounts, which uses new predictive modeling logic to better identify members likely to incur high claims. Learn more.
New Massachusetts State Mandate - Contraceptives
On Monday November 20, 2017, Governor Baker signed into law the contraceptive ACCESS bill (An Act advancing contraceptive coverage and economic security in our state). This bill is effective May 20, 2018, and mandates coverage for the following contraceptive methods and services for females, with no cost sharing. Learn more.
Your Employees Are Getting Access to More Dentists
Beginning January 1, 2018, Dental Blue® members will be able to get service from nearly 122,000 dentists, and 300,000 provider locations across the country through our Dental Blue National Network. This new network is one of the largest in the country, and is nearly twice the size of our current national network. Learn more.
Limiting Spread of the Flu Virus
We make it easy for members and their families to get vaccinated. This flu season, we're offering a range of provider, workplace, and pharmacy-based vaccine locations. Coverage depends on the plan type and the nature of the care received. Learn more.
Low-Cost Generic Drug Benefit
Did you know that if your plan includes a mail service pharmacy benefit, covered employees can get a 90-day supply of select generic medications for only $9 when filled through Express Scripts?