As many of you know, January is THE most popular renewal date, which means fourth quarter is ARC’s busiest time of the year. This year, however, there are some major challenges we expect to affect all clients due to Humana’s decision to exit the group medical market. While we’re doing all that we can to ensure this renewal season runs as smoothly as possible, we wanted to make you aware of the season we’re walking in now.
Humana’s decision directly impacts many groups throughout Kentucky and in the Cincinnati area, but could also create a cascade of issues with carrier service statewide. As a result, we expect to see the longer wait times for the following with medical carriers:
- Quotes and re-quotes
- Updates to eligibility if not done online
- Installation of new groups and plan changes
- Some member eligibility showing active in the system, ID card generation
- Billing updates
- Access to care for new members or groups of members. Slow member eligibility means members can’t fill prescriptions unless paying out of pocket and providers can’t confirm coverage or benefits or prior authorize services, and may push back on care delivery.
What can you do to minimize issues for your employees?
- ALL CLIENTS: Please attempt to get new hire and enrollment changes to us before the 10th of the month for January effective dates. Let employees know that delays can occur during this time.
- If you’re renewing in January, please make decisions on renewals and plan changes as early as possible—ideally in November. We expect our volume of clients making carrier changes to be 30 percent higher this year and we’ll need early December to prepare sold case paperwork and member communications.
- Members on maintenance medications should think about obtaining their supply early and getting doctor appointments set up before the end of the year. For clients going through a carrier change, we have a member educational piece called “Waiting for Coverage to Start,” which provides guidance on how to discuss the situation with their doctors and pharmacies.
- If you’re making a change in carrier for January, give employees a hard deadline for making their open enrollment decisions. We understand that some changes are necessary and not the member’s fault, however, final enrollment has to match the signed, sold case proposal. That means we have to re-quote your group, wait on underwriting, and when the quote comes back, you have to sign it, and then your group goes to the end of the line again. Last-minute changes impact everyone on the plan.
Note: UnitedHealthcare just announced they will waive the re-quote requirement in some situations. We hope other carriers will follow suit.
If you wait too long to make decisions, that’s okay! But we may advise that you to accept a renewal and then shop for a February or March option simply because we and the insurance company cannot get the work done in time to avoid major issues with member access to care.
This enrollment season will be challenging, but we appreciate your patience as we navigate these immense changes in our industry so we can ensure that your employees are receiving the benefits they need for 2024. ARC’s client advisors are dedicated to continually providing you with the best in service and support, so if you have any questions about deadlines or your renewal, feel free to contact us today.