Carrier Review

Carrier   Review    Capital BlueCross SBC Distribution


Groups enrolled with Capital   BlueCross will be responsible for distributing the SBC to their   enrollees. Capital will provide inforce groups with information on   accessing their SBC for their specific benefit plan(s) with the group’s   renewal document. The renewal and related notifications will provide   information to the group on how and when they can locate their specific SBCs.


If a group is not amenable to   using web access, upon request Capital will email the documents to the   group in .pdf file format. It is essential that Capital has current email   addresses for policy holders and group policy makers to ensure receipt of   SBCs at all group locations.



MLR Rebates


Capital BlueCross and its   subsidiaries appear to have met all MLR requirements in accordance to   guidance from the National Association of Insurance Commissioners (NAIC).   However, these calculations for Capital BlueCross and its subsidiaries only   include data as of Dec. 31, 2011, and are subject to change based on the   development of unpaid claim estimates to be finalized after the first quarter   of 2012.


Highmark, Inc.SBC Distribution  

Highmark will provide an   electronic copy of the SBC to fully-insured and self-funded clients free of   charge.


Beginning September 23,   2012, groups can obtain a copy of your SBC by going to If you do not have   access to the internet, you can request a free paper copy by calling (800)   345-3806.


MLR Rebates


Highmark will not be required   to issue MLR rebates.



Bethlehem Hospital Agreement   Terminated


Effective Friday, Aug. 31,   2012, the hospital agreement between Coordinated Health – Bethlehem Hospital   in Bethlehem, PA, and Highmark will be terminated.


Highmark believes it made   reasonable offers to Coordinated Health/Bethlehem Hospital that reflected the   delicate balance of paying hospitals fairly and striving to offer affordable   health benefit programs and felt the Hospital’s proposal was unreasonable and   not in the best interests of the community.


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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.