Important Administrative Information (IAI) is a quarterly mailing that delivers the latest news about Blue Cross Blue Shield of Massachusetts products and services to employers and consultants.
Current Editions:
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.
2022 Annual Report: Making Health Care Work for Everyone
We're proud to share our company's Annual Report with you. We've expanded access to primary care and mental health services, helped make health care more accessible and affordable for our 2.9 million members, and so much more. Learn more.
Change in Prior Authorization Requirements for Certain Mental Health Treatments
We’ve removed prior authorization requirements for Intensive Community-Based Treatment (ICBAT), Community-Based Acute Treatment (CBAT), and inpatient psychiatric treatment, consistent with the Massachusetts Chapter 177 of the Acts of 2022, an act aimed at addressing barriers to care for mental health. Learn more.
Change in Prior Authorization Requirements for Certain Musculoskeletal Services
We're updating our prior authorization requirements for certain musculoskeletal 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. 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.
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, Two Changes 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.
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.
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.
State Legislation’s Impact on Reproductive Health Coverage
With Chapter 127 of the Acts of 2022 signed into Massachusetts state law on July 29, 2022, there are new requirements for how abortion and abortion-related care will be covered by insurance carriers, including Blue Cross Blue Shield of Massachusetts. 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.
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.
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.
What’s New for 2023
Choosing the right health plan is essential to attracting and retaining top talent. 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, 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.
Helping Members with Diabetes Get Recommended Screenings
In September 2022, we launched a new program with CVS Caremark®´, an independent health solutions company, that helps members with diabetes get recommended screenings and care. 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 self-insured plans 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.
We've Updated Our Specialty Pharmacy Network for Fertility Medications
Effective July 19, 2022, Encompass Fertility™, an independent company, has joined our specialty pharmacy network for fertility medications. 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.
Making It Easier for Members to Submit Claims
By June 30, 2022, we will roll out online claims submission capabilities for all of our members. 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.
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.
ASC 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.
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.
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.
We're Decreasing the Bill Lead-Time for Fully Insured Accounts
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.
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.
Transparency in Coverage Rule (TCR) and Consolidated Appropriations Act (CAA)
We continue to actively plan our support of and compliance with the required capabilities for applicable provisions in both the Transparency in Coverage Rule and the Consolidated Appropriations Act. Learn more.