- On October 15, 2024
2024 Women’s Health and Cancer Rights Act (WHCRA) Mailing
Topic: Mailings | Applies to: All except Medicare
The Women’s Health and Cancer Rights Act of 1998 (WHCRA) requires group health plans and health insurers to notify members regarding coverage required under the law. Medical Mutual will send their annual mailing to group officials and Individual members in late October.
These letters advise both group officials and Individual/non-group members that Medical Mutual covers reconstructive surgery following a mastectomy, as well as prostheses and treatment of physical complications at all stages of a mastectomy. The mailing to group officials will also include a sample notice that groups may distribute to their employees.
Please contact your ExpressLink representative with any questions.
Use MMO’s Updated Quoting/Enrollment Documents for Faster Turnaround Times
Topic: Broker Relations | Applies to: Midsize Group Business (51-99)
In an effort to improve their turnaround times, Medical Mutual has updated some of the most often-used forms and documents for 51-99 quoting and sold group installation. Medical Mutual appreciates your business and is committed to making it easier to do business with them.
Please begin using the updated documents listed below, which are posted on MyBrokerLink > Producer’s Guide > Mid-Size Group > Quoting, Enrollment and Alliance Product Information. As a reminder, you should always go to MyBrokerLink for the most up-to-date forms.
Please help expedite turnaround time by providing all required documents with your initial RFP submission.
Incomplete submissions will be pended until such time that we have everything complete for underwriting review. They can reduce loopbacks, work more efficiently and improve turnaround time with your complete submission.
- Employer Risk Assessment Form: Medical Mutual’s new one-page Employer Risk Assessment Form (ERAF) was developed to focus on only the information absolutely necessary for underwriting to evaluate a prospect.
- Broker Checklists: The 51-99 Broker Quoting Checklist and 51-99 Broker Sold Case Submission Checklist have been updated and condensed where possible. The checklists include direction for both fully insured and Balanced Solutions 51-99.
- Quoting & Sold Census: An updated Quoting Census Template to use in absence of FormFire when MHQs are not required. The new template is member-level, and it is a pared down version of their traditional membership census, which can be used as a starting point for your sold submission. Medical Mutual feels it is easier to work with and aligns more closely with the format required by other carriers.
Please contact your ExpressLink representative with any questions.
Additional Limits Removed For Mental Health and Substance Use Disorder Services Claims
Topic: Broker Relations | Applies to: Midsize Group Business (51-99), Large Group (100+)
Last year, visit limits were removed for physical therapy, occupational therapy and speech therapy services in accordance with the Federal Mental Health Parity law. Effective Jan. 1, 2025, day/visit limits will be removed for additional services that currently have a limit when a claim is submitted with a mental health or substance use disorder (MH/SUD) diagnosis.
This does not apply to Small Group grandfathered/grandmothered and Individual grandmothered and short-term products.
Please note that standard day/visit limits will apply if the diagnosis does not include a MH/SUD diagnosis.
See this Amendment for more information.
In late October, Medical Mutual will send this email to groups to let them know about the change.
Please contact your ExpressLink representative with any questions.
New Small Group Dental Plans Effective Jan. 1, 2025
Topic: Product Updates | Applies to: Small Group (1-50), COSE Benefit Plan
Effective Jan. 1, 2025, MedMutual Dental will be replaced with Superior Dental Care (SDC) as the dental plan
offering for most new small group business, including groups of 1-50 through COSE Benefit Plan, 10-50 through
Balanced Solutions, and 2-50 through SDC.
New small group business in Ohio with an effective date of Jan. 1, 2025 or later may choose from a selection of new pre-designed SDC small group dental plans. Existing small groups in Ohio with an SDC or a MedMutual Dental plan may keep their current plan at their next and subsequent renewals but will need to move to a new SDC dental plan if they choose to make any plan design changes. MedMutual Dental GM/GF, ACA and GCADA plans are not impacted by this change.
SDC will continue to offer small group plans to groups of 2-50 in Kentucky and Indiana. No changes will be made to these plans for 2025.
2025 Small Group Dental Selection Sheets
The 2025 small group dental selection sheets are available below.
- SDC Small Group (1-50) Dental Plans for COSE Benefit Plan Effective Jan. 1, 2025: These sheets are available at COSEBenefitPlan.com.
- SDC Small Group (10-50) Dental Plans for Balanced Solutions Effective Jan. 1, 2025: This sheet is available through MyBrokerLink.
- SDC Small Group (2-50) Dental Plans Effective Jan. 1, 2025: These sheets are available through MyBrokerLink and SuperiorDental.com.
Please contact your ExpressLink representative with any questions.
New Medicare Advantage Resources to Help with Member Onboarding
Topic: Product Updates | Applies to: All including Medicare
MedMutual Advantage Travel PlusTM
MedMutual Advantage® members now receive $7,500 in coverage when traveling outside of Ohio with
the MedMutual Advantage Travel Plus Benefit. View an updated flyer with details on how this benefit
works.
Grocery Allowance
Medical Mutual is introducing a grocery benefit, available to qualifying members enrolled in our
MedMutual Advantage Secure HMO-POS plan (H6723-005-001).
Members who have a qualifying chronic condition will receive a $50 monthly allowance to
purchase healthy groceries in 2025. To view what chronic conditions apply for this allowance, click
here. To view a list of qualifying stores, click here. Note that the stores highlighted in green are some of
the most common retailers. For more information on this topic, please click here.
New Member Onboarding
If you have a member who is new to a MedMutual Advantage Plan, please review this onboarding flyer,
which outlines what they can expect after enrolling.
Correction to the 2025 Medicare Advantage Classic HMO Enrollment Kit
Topic: News | Applies to: All including Medicare
An error has been identified in the 2025 Medicare Advantage Classic HMO (H6723-001-003) enrollment
kit for Central Ohio, Cincinnati/Dayton and Toledo Counties. Pages 3 and 4 of the marketing brochure
incorrectly list the over-the-counter allowance as $320 quarterly when it should be $320 annually or $80
quarterly. Please note: the over-the-counter allowance listed in the Summary of Benefits for this plan is
correct.
A corrected marketing brochure can be downloaded here. Please print and use this brochure when
sharing the Classic HMO (H6723-001-003) kit with clients. If you would like to order a supply of corrected
brochures, please contact your Medical Mutual representative.
Upcoming Medicare Supplement to Medicare Advantage Marketing Campaign
Topic: News | Applies to: All including Medicare
Some Medicare Supplement members may benefit and even save money by switching to a 2025 MedMutual
Medicare Advantage Plan. To ensure that members are aware of all solutions available to them, Medical Mutual
will release 2-3 marketing pieces aimed at current Medicare Supplement members. All mailers will be customized with broker contact information, and members will be encouraged to reach out to you to discuss their options. Below, you’ll find two samples from the campaign:
- Renewal Letter: We’ve updated our renewal letter to highlight our Medicare Advantage options.
- Mailer: This marketing piece is designed specifically for your Medicare Supplement clients.
Why should your clients consider a Medical Mutual MAPD plan?
- Plans with $0 premium
- Plans with a maximum out-of-pocket limit as low as $3,300
- $0 copay for primary care providers and specialists
- No deductible for prescriptions, with $0 for Tier 1 & Tier 2 medications
- Up to $3,200 in dental benefits, including out-of-network options
- A $50 grocery card for those that are eligible
New Provider Look-Up Tool Now Available
Medical Mutual is excited to announce our new provider look-up tool. They value your feedback and understand the importance of a smooth experience, especially during this busy season. That’s why their new system allows you to access their MAPD network with just a few clicks—no more redundant information.
To explore the updated tool, visit the Medical Mutual website.