September 2024

New Sales & Underwriting Directors

Two longtime Allied National employees who have years’ of experience in the health benefit industry have been promoted to key positions. 

Jason Gibson has taken the role of Sales, Marketing & Communications Director. Patti Graves is now the Underwriting & Coverage Administration Director, replacing Ann Bornsheuer, who recently retired after serving as director of the Underwriting & Client Services Departments for more almost 30 years.

In Time for 4th Quarter: 15+ Process

As you help your employer groups renew their health benefit plans before the end of the year, don’t forget that Allied’s new application process, for groups of 15 members or more, will help you get a quote more quickly. 

For groups of 15+ enrolled employees, there will be no IHQs as long as the required support materials are provided and the groups are not virgin groups. The minimum employee participation rate is 50% and no waivers are required; and there’s no minimum dependent participation.

Freedom Plans offer these benefits:

• Choose any provider without restrictions or penalties
• PPO-like discounts
• The only out-of-pocket expenses are copays, deductibles and coinsurance

Visit our Freedom Plan page for plan details or visit the Group Submissions page for underwriting guidelines for 15+, as well as groups 2-14 employees.

Allied’s Elite Experience Team Takes the Fear Out of Balance Bills

CONCERN: Will using reference-based pricing lead to members getting balance bills?

SOLUTION: Allied’s Elite Experience Team makes balance bills a non-issue.

Allied National's Freedom Plan members can see any doctor they choose. However, some providers decline to accept the reference based price. This can result in the member receiving a bill for the remaining balance.

Members are only responsible for copays, deductibles, and coinsurance payments. After receiving care, Allied will send an Explanation of Benefits (EOB) that outlines the member’s responsibility. Members should use this information to determine if any additional billing has occurred.

If the bill exceeds the member's responsibility, the member should call the Elite Experience team at 866-332-1987 or send a copy of the bill to balancebilling@alliednational.com. The Elite Experience team will work on the member’s behalf to resolve any excess amount billed.

If you have any questions, contact your General Agent or elite@alliednational.com.

Medicare Part D Notices - Due Oct. 14

Employers who provide a health care plan that includes a prescription drug benefit have until Oct. 14 to notify all Medicare-eligible members as to whether their current prescription plan is considered "creditable" or "non-creditable" coverage. They also need to tell members what their options are through the federal Medicare Part D program.

Prescription drug coverage is considered creditable when it is at least "actuarially equivalent" in value to Medicare's standard Part D coverage.

How Allied helps employers

The notification process for groups covered under one of Allied National's Funding Advantage group health plans is simple. During the first part of October, Allied will provide notices to anyone in the groups age 64 or over (along with a copy for the employer). The letter informs employers and their employees if their prescription drug plan is considered creditable coverage or non-creditable and the consequences of employees' decisions on Part D coverage.

What employers need to do

All an employer has to do is complete an online report with CMS (the Centers for

Medicare and Medicaid Services) indicating whether or not they have "creditable

coverage". A link to the "Disclosure to CMS form" is below.

What members need to do

If Medicare-eligible members have creditable prescription drug coverage, they can

opt to delay enrollment in Medicare Part D to a later date without penalty. Members

with non-creditable coverage, and who elect not to enroll in Medicare Part D until a

later date, will be subject to late entrant penalties.

Short-Term Med - As Simple as 1-3-12

On Sept. 1, the short-term medical (STM) insurance market entered a new era of limited durations. Federal regulations now restrict STM to a maximum of 4 months per insurance carrier within a 12-month timeframe. This limited duration option is now available on the Pivot Health portal for all three insurance carrier STM Plans Pivot offers.

To help provide a longer solution for agents, Pivot Health also launched its 1–3–12 solution. The 1-3-12 solution enables licensed brokers and consumers to secure up to 12 months of continuous STM coverage through consecutive policies from multiple carriers*. This groundbreaking industry concept provides licensed brokers and consumers the ability to enroll in short-term medical products while complying with the federal mandate.

How is it done? With one enrollment, Pivot Health’s 1–3–12 solution brings together three individual insurance carrier partners, all with an “A”-level rating by A.M. Best, and allows consumers to receive coverage for up to 12 months if they so choose. Insureds may cancel at any time, and other options are available where there are state variables.

When purchasing online, contracted brokers have the option to enroll clients in STM plans for under four months or for a longer duration. If they select coverage for more than four months, they are presented with two to three plans (depending on state variations) with the ability to compare benefits and pricing side by side. This 1–3–12 solution provides brokers:

• One enrollment for three carriers
• 3 Individual insurance carriers each offer a 4 month policy
• 12 months of coverage
• When one carrier’s policy ends the next carrier’s policy begins
• No new underwriting
• No gap in coverage
• No new pre-ex look back period
• One enrollment fee

Pivot Health is excited to work with brokers looking for another option during the Open Enrollment Period. Contact your General Agent or the Allied sales team today at 888-767-7133 to learn more about the 1–3–12 solution for STM.

*state availability varies 

Pivot has Fast Track to Coverage Bonus

View as Webpage

CONNECT WITH US!