ACA Individual Market Update – Pennsylvania

ACA Individual Market Update – Pennsylvania

From Highmark,

Pa members will see a december premium reduction

Highmark is giving Pennsylvania ACA Individual Market members a 25% reduction to their pre-APTC premium total for the month of December. The one-time rate reduction will be provided since the COVID-19 pandemic has prevented members from accessing regular care, which has resulted in less health care utilization. Members will receive notification of this in their December invoice that will be received in mid-November.

Action required for pa on-exchange members who enrolled after 9/9/2020

Highmark on-exchange PA members who submitted enrollment applications after 9/9/2020 will not be renewed into a 2021 Highmark plan. Pennie was not able to provide Highmark with2021 auto-enrollment files for these members. If they don’t submit an active enrollment for 2021, they will lose coverage at the end of December. If you are submitting a Special Enrollment Period application, please ensure you also submit a 2021 application for your client so that they are covered. Pennie indicated that they will be sending communications to these members. In addition, Highmark will also be sending out communications and directing them to you if we have your phone number on file in Litmos. These members will not receive a Highmark renewal package or an early 2021 member ID card. We appreciate your patience as we work through this. We will follow up as we receive more information.

Provider directory search issue – central and northeastern pa only

There is a current issue with the Highmark provider directory. This issue is not impacting the provider directories on Pennie and HealthSherpa and is confined to Highmark’s online provider directory. We are working to address the issue as soon as possible.

Please review the information below regarding the errors for impacted plans:

NEPA – my Priority Flex Blue EPO

  • Some Lehigh Valley Health Network facilities are returning as Standard when they should be Enhanced
  • Berwick is not returning but should be Enhanced
  • Geisinger is not returning but should be Standard

CPA – my Direct Blue EPO and my Direct Blue Major Events EPO

The following hospitals are showing as in-network but they are out-of-network:
  • St. Luke’s Health Network
  • Reading Hospital
  • Easton Hospital

Please use provider directories on Pennie or HealthSherpa when reviewing CPA – my Direct Blue EPO, my Direct Blue Major Events EPO, and NEPA – my Priority Blue Flex EPO plans with customers. Please also refer to the network guides on the Producer Portal and Litmos. We’ll let you know when this issue has been resolved.