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Highmark: Welcome to AEP 2023!

October 14, 2022

Welcome to AEP 2023!

It's hard to believe AEP 2023 is only days away. The folks at Highmark are working around the clock to bring you all the resources you need to have a successful annual enrollment period.  The bottom line: they're here to help. Here are some of the most popular resources, as well as a few important announcements. HAVE A GREAT AEP!

Ordering Enrollment Materials

2023 Medicare Advantage enrollment materials can be ordered via the Producer Portal. After logging into your Medicare dashboard, click on Order Supplies - Over 65 (Marcom/ShopPro). This will take you to Marcom, the online marketing and sales material catalog. Select Medicare Enrollment Materials, then 2023 MA Enrollment Materials. From here, you'll be able to order things like region-specific enrollment guides, formularies, OTC catalogs, provider directories, and enrollment roadmaps.

2023 Agent Field Guide

One of the most comprehensive resources is the Highmark Agent Field Guide. This document is a comprehensive source of information about how to do business with Highmark, and includes detailed plan information for their products in all of their sales regions. And for those of you who also sell Affordable Care Act products, they've combined both lines of business into a single Field Guide this year! They will continue to update the Field Guide with more useful information throughout AEP, but to download a digital copy of the most current version, simply click here. Happy reading!


Regional Plan Highlight  Sheets

In addition to the Field Guide, Highmark has put together plan highlight overview documents that give you a quick snapshot and some fast facts about what they are offering in each of their sales regions. Click below to view and download these for a quick reference.

2023 MA and PDP Premiums With LIS

Recently Highmark shared a chart of their 2023 MA and PDP Premiums with LIS, broken down by state, region, county, and plan. If you missed it, or even if just like this kind of thing, click here to view and download this chart!

Scope of Appointment Form

In all sales situations, you're required to capture a Scope of Appointment(SOA). You are not required to submit an SOA with an application but you must retain a copy per CMS' record retention guidelines. Click below to download Highmark's SOAs.

Online Health Risk Assessment

Note: The following applies only to Pennsylvania, West Virginia, and Delaware. New York sales regions are updating their HRA submission process and that will be communicated separately.

Highmark recently launched an online Health Risk Assessment (for Pennsylvania, West Virginia, and Delaware sales regions) to help determine the best care for our Medicare Advantage members. This Health Risk Assessment (HRA)can be submitted in one of two ways:

  • Immediately following an online application submission from the Application Confirmation Page.
  • A link to complete the HRA is available on the Producer Portal dashboard, under Quick Links.

$50 compensation per completed HRA will be provided only for New to Medicare and Replacement policies.

  • New to Medicare and Replacement is defined as those who have not had Medicare coverage with Highmark at the start of AEP. This does not include any current member that is making a plan change to a different Highmark Medicare plan.
  • Reimbursements for 1/1 effectives will be paid after January 1, 2023.  They will be paid monthly thereafter.
  • HRAs must be submitted within 3 days of application submission to be eligible for compensation.
  • HRA assessments will only be compensated for MAPD or MA only plans.  Compensation will not be provided for HRAs completed for Medicare Supplement or PDP enrollments.
  • Submissions will only be accepted online. You will not be compensated for any paper submissions of the HRA Survey. To view and download a hard copy of the questionnaire to capture responses, and then submit them online, click here.
  • Agents are responsible for completing the HRA survey and submitting the information to Highmark. Surveys cannot be completed online by a beneficiary.

Kroger Pharmacies Exiting Pharmacy Network as of January 1, 2023

Kroger Pharmacies have elected to exit Highmark's Preferred Network as of January 1, 2023. This is subject to change, with additional contract negotiations expected through the end of the year. Any members who have filled prescriptions through Kroger in 2022 will be notified of this decision by mail. Additional updates will be made as they become available. As of now, the Preferred and Standard Networks include but are not limited to the following for 2023:

Please note this is not an all inclusive list of pharmacies - you should consult Highmark directories to confirm specific pharmacies. Please also note current printed directories may still show Kroger as In Network.

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