Anthem Blue Cross of CA – Small Group Medical Rate Action for April 2010

Anthem Blue Cross of CA – Small Group Medical Rate Action for April 2010
Anthem Blue Cross has announced their Small Group rates for April 2010. After two consecutive quarters of no increases (July and October 2009) and a moderate 4% increase in January, Anthem Blue Cross has announced moderate increases for April 2010. Anthem’s Small Group medical portfolio will experience an average increase of 4.7%. 

Here’s the breakdown:

EmployeeElect HMO plans will see a new business average increase of 4.8%. 

  • HMO 100% plans, Classic $20, Saver $20 and EmployeeChoice Saver HMO will receive an average increase of 5%.
  • Classic $30 and $40 plans, Saver $30 and $40 plans and both Select HMO plans ($25 and $35) will receive an average increase of 4%.

 EmployeeElect PPO plans will see a new business average increase of 4.3%.

Premier PPO Plans:

  • Premier PPO Copay $10/$20/$30 will receive an average increase of 4%.                       

PPO Copay Plans:

  • PPO Copay $20/$30/$40 will receive an average increase of 4%.

PPO GenRx Plans:

  • PPO Copay $25/$35 will receive an average increase of 4%.
  • GenRx PPO $45 will receive an average increase of 2%.

 Solution PPO Plans:

  • Solution 2500 and 3500 PPO will receive an average increase of 5%.
  • Solution 5000 will receive an average increase of 4%.  

Elements Plans:

  • Elements Hospital/Hospital Plus and Hospital Preferred will receive an average increase of 5%. 

EPO Plans:

  • EPO plans will receive an average increase of 5%. 

EmployeeElect Lumenos HIA+ Plans will receive an average increase of 5%.

  • Lumenos HIA+ 750 and Lumenos HIA+ 500 will receive an average increase of 5%. 

EmployeeElect Lumenos HSA Plans will see a new business average increase of 6.1%.

  •  Lumenos HSA 2000/3000/5000 (100/70) will receive an average increase of 8%.
  •  Lumenos HSA 1500 (80/50) will receive an average increase of 6%; Lumenos HSA 2500 (80/50) will receive an average increase of 3%; Lumenos HSA 3500 (80/50) will receive an average increase of 2%.

 EmployeeChoice plans will see a new business average increase of 7%. 

 BeneFits plans will  see a new business average increase of 4.7%.

Specialty April 2010 Rate Announcement

Anthem Blue Cross is lowering the rates on some of their most popular Dental Blue plans effective 4/1/10. 

  • 10% reduction on Dental Blue Silver 100-80
  • 11% reduction on Dental Blue Silver Plus 100-80
  • 5% reduction on Dental Blue Gold 100-80
  • 8.5% reduction on Dental Blue Gold Plus 100-80 

The Dental Blue Gold Plus 100-80 plan was their #1 selling Dental Blue plan in 2009. 

There will be a slight increase to the Dental Blue Platinum rates effective 4/1/10: 

  • 2.5% increase on Dental Blue Platinum 100-80
  • 5.6% increase on Dental Blue Platinum Plus 100-80

 There will be no changes to rates for their other dental plans on 4/1/10. 

Benefit change:

There is one benefit change for all Dental Blue members. Effective 4/1/10, pregnant women and diabetics will have access to a third cleaning per calendar year as deemed necessary by their dentist. The cleaning will not count towards their annual maximum benefit. 

This document is not intended to be authoritative, and its accuracy is not guaranteed. It is believed to be correct at the time of its printing. Any questions about official interpretations of the law should be directed to legal counsel.

Anthem Blue Cross of California – July 2010 Small Group Rate Action

Anthem Blue Cross Small Group has announced their July 2010 medical rate action. The good news is that the total average quarterly increase is a modest 1.9% with no reduction in benefits. Below are the average medical rate adjustments effective July 1, 2010.    

  • EmployeeElect PPO plans will see a new business average increase of 1.4%
  • EmployeeElect HMO plans will see a new business average increase of 1.1% 
  • EmployeeElect CDHP plans will see a new business average increase of  5.2% 
  • EmployeeChoice plans will see an average new business increase of 3.5% 
  • BeneFits plans will see an average new business increase of 3.5%

 July – September Renewal Increases  

The July through September renewal increases will vary greatly due to the rating changes Anthem Blue Cross has gone through in the past year. There has been a large variance by product and region, however, the average annual renewal increase for groups renewing during these three months is approximately 10%.

 Ancillary product changes  

Dental:

Small Group dental rates will have no rate increases with the exception of the Indian Tribes who will receive a 5% trend increase affecting approximately 1,000 members.

 Vision:

The Blue View Vision and Vision Plus plans will be receiving either a rate pass or a $1.00 increase depending on the rating tier of each plan.   

 Vision benefit enhancements include: 

  • Transition lens coverage for both children and adults. Children under age 19 may purchase transition lenses at no copay and adults may purchase them for a $75 copay
  • Factory scratch coating on eyeglass lenses will now be standard coverage
  • Tiered pricing for progressive lenses and anti-reflective coatings

 Life:

There will be no Life rate increases.

This document is not intended to be authoritative, and its accuracy is not guaranteed. It is believed to be correct at the time of its printing. Any questions about official interpretations of the law should be directed to legal counsel.

Final Regulations Issued for Claims Appeals

The Obama Administration released interim final regulations designed to create a system of checks and balances for the appeal process for health claims.

Under the Patient Protection and Affordable Care Act (PPACA), the interim final rule requires group health plans and insurers to establish a comprehensive appeals process for patients who appeal decisions on coverage, services and claim payments. The interim final regulations apply to self-funded health plans, but not to grandfathered plans under the PPACA.

The Departments of Health and Human Services, Labor and the Treasury issued the interim final rule, which will take effect on Sept. 21, 2010.

Health plans and insurers that are subjected to the regulations are required to establish an internal appeals process that:

• Allows consumers to appeal when a health plan denies a claim for a covered service or rescinds coverage;

• Gives consumers detailed information about the grounds for the denial of claims or coverage;

• Requires plans to notify consumers about their right to appeal and instructs them on how to begin the appeals process;

• Ensures a full and fair review of the denial; and

• Provides consumers with an expedited appeals process in urgent cases.

Under the regulations, a patient can have the case reviewed by an independent reviewer  if the appeal is denied by the health plan or insurer. 

Most states currently have external appeals handled by an independent agency, however, governing the process varies from state to state.  The interim final rule encourages a federal standard for external reviews.  For external appeals, federal regulators are encouraging states to adopt the guidelines created by the National Association of Insurance Commissioners. The interim final rule calls for states to implement the NAIC standards before July 1, 2011. The NAIC rules require:

• External review of plan decisions to deny coverage for care based on medical necessity, appropriateness, health care setting, level of care, or effectiveness of a covered benefit.

• Clear information for consumers about their right to both internal and external appeals – both in the standard plan materials and at the time the company denies a claim.

• Expedited access to external review in some cases – including emergency situations or cases where their health plan did not follow the rules in the internal appeal.

• Health plans must pay the cost of the external appeal under State law, and States may not require consumers to pay more than a nominal fee.

• Review by an independent body assigned by the State. The State must also ensure that the reviewers meet certain standards, keep written records, and are not affected by conflicts of interest.

• Emergency processes for urgent claims, and a process for experimental or investigational treatment.

• Final decisions must be binding so, if the consumer wins, the health plan is expected to pay for the benefit that was previously denied.

Employer Health involvement Encourages Employee Weight Loss and Better Health

 Employers who offer their employees health coaching programs to assist in controlling chronic health conditions find that these programs are also an effective weight-management tool.

In a study conducted by StayWell Health Management, a health promotion vendor, employee participants who completed a telephone-based health coaching program lost an average of 3 pounds, compared to 1 pound for those who did not complete the program.  Additionally, employees who followed the advice offered in the health coaching program were more likely to improve their overall eating habits and their physical activity levels.

In the study, the company examined the benefits of long-term weight management versus short-term weight loss. The final study sample size included 1,298 participants from 10 different employers and focused on clients who offered programs between 2004 and 2006.

Health experts believe that individuals who want to lose weight should focus on a lifetime goal of healthy eating and exercising and not on weight-loss challenges and programs aimed at dropping pounds over a short period.  Even a small amount of weight loss can contribute to an improvement in health, such as lower blood pressure and decrease in wear on knees and back.

StayWell points to hardware store giant Lowe’s Home Improvement as an example of how a health coaching program can promote weight manangement.

The company, which employs about 240,000 workers, rolled out a health coaching program that offered phone-based, mail-based coaching or a six-week interactive program to help workers identify and change unhealthy behaviors.  A total of 3,461 pounds was lost by participants with an average weight loss of 9.25 pounds per person; and the average body mass index among all participants decreased from 35.3 kg/m2 at pre-assessment to 33.9 kg/m2 at post-assessment; a decrease of 3.9%.

The recent Health Care Reform legislation offers a financial incentive of 30-50% off premium costs to employees for participation in approved wellness programs beginning in 2014.

July 1, 2010 – Kaiser CA Small Group changes

July 1, 2010 – Kaiser CA Small Group changes

Benefits and highlights of Kaiser Small Group plans in California

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