Highmark: URGENT UPDATE: 2025 MA and D-SNP Enrollment Kits

NEW 2025 MA and D-SNP Enrollment Kit Updates

Effective April 1st, CMS-required updates to 2025 Medicare Advantage (MA) and Dual Special Needs Plan (D-SNP) Enrollment Applications are now in effect.

Additionally, CMS has reversed the Disaster/Emergency SEP directive, resulting in additional changes to Enrollment Applications. Please review next steps as outlined below.

The following 2025 MA and D-SNP Enrollment Applications have been updated:

Medicare Advantage (MA):

• Blue Rx (PA & WV): English, Spanish
• Central Pennsylvania (CPA): English, Spanish
• Delaware (DE)
• Northeastern New York (NENY)
• Northeastern Pennsylvania (NEPA): English, Spanish
• Southeastern Pennsylvania (SEPA): English, Spanish
• West Virginia (WV)
• Western New York (WNY)
• Western Pennsylvania (WPA)

Dual Special Needs Plan (D-SNP):

• Highmark Wholecare Medicare Assured Diamond (PA): English, Spanish
• Highmark Wholecare Medicare Assured Ruby (PA): English, Spanish
• Highmark Health Options Duals (DE): English, Spanish

What You Need to Know

Medicare Advantage (MA):

Per updated CMS guidelines, the following changes have been implemented in both the MA and D-SNP enrollment applications:

• Section 2: The voluntary Sexual Orientation and Gender Identity questions have been removed.
• Reversal of Disaster/Emergency SEP Update: Consumers will no longer use the 1-800-MEDICARE number for disaster-related enrollment. Once revised, the Disaster/Emergency SEP section of the application will revert to the following language:
  • Attestation of Eligibility for an Enrollment Period (“Other Reason”): I was affected by an emergency or major disaster as declared by the Federal Emergency Management Agency (FEMA) or by a Federal, state, or local government entity. One of the other statements here applied to me, but I was unable to make my enrollment request because of the disaster.

Dual Special Needs Plan (D-SNP):

• All printed D-SNP enrollment kits in inventory were updated with an insert at the end of March notifying consumers to disregard Sexual Orientation and Gender Identity (SOGI) questions and advising them to call 1-800-MEDICARE for enrollment using the disaster/emergency SEP.
• The insert is being updated to remove direction to call 1-800-MEDICARE but keep the instruction to disregard SOGI questions. This new insert is expected to be ready to include in inventory in the next few weeks.
• Note: There may be some literature in circulation with the directive to call 1-800-MEDICARE for the disaster/emergency SEP, but the quantities should be small.  

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What You Need to Do

Medicare Advantage (MA):

• For Your Current Inventory:
  • You may continue using any Enrollment Kits ordered after March 14th. Highmark will be distributing one (1) insert per Enrollment Kit to match your current inventory. For example, if you ordered 20 kits, you will receive 20 inserts.
  • Please include one (1) insert per Kit. For your reference, Click Here for a copy of the forthcoming insert that will be included in the kits. Please review it so you’re prepared to distribute it accordingly.
• For New Enrollment Kit Orders:
  • All new Kit orders will include this Insert until the current stock is depleted. Once the existing stock is exhausted, you will begin receiving Kits with the updated 2025 Enrollment Applications
• Once CMS Approval is Received:
  • The newly updated 2025 Applications will be available:
    • In the digital Enrollment Kits in DCatalog
    • Online via Plan Documents

Dual Special Needs Plan (D-SNP):

• All new Enrollment Kit orders will include inserts clarifying that Sexual Orientation and Gender Identity questions are optional until the current stock is depleted. Once the existing stock is exhausted, you will begin receiving Kits with the updated 2025 Enrollment Applications.
• PA D-SNP Insert
• DE D-SNP Insert

We greatly appreciate your patience, support, and compliance with these ongoing CMS updates. If you have any questions in the meantime, please contact your regional Channel Sales Representative listed below.

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Rothman Orthopaedics (SEPA): Out-of-Network for Highmark MA Members Effective April 1, 2025

Effective April 1, 2025, Highmark Medicare Advantage members no longer have in-network access to Rothman Orthopaedics professional and Durable Medical Equipment services.

Highmark began sending notification letters in March to members who had utilized Rothman Orthopaedics services in the past 12 months. Members who have questions on finding alternative in-network providers and applying for continuity of care should call the member services number on the back of their ID card.

Rothman Orthopaedics is still in-network for Highmark's Commercial, FEP, ACA and CHIP members.

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