Anthem Blue Cross Small Group Updates, Effective October 1, 2011

Small Group Medical

After reasonable January and April increases, as well as a rate pass on most plans in July, Anthem is pleased to announce another low trend increase for October.

Small Group Rate change Overview*

The rate increases for Anthem’s 51–99 EmployeeElect portfolio are identical to Small Group for October. However, the total rates for these plans will vary slightly.

Rate Adjustments—EmployeeElect Portfolio

HMO Plans:

Anthem’s HMO plans will experience a new business average increase of approximately 4.9%.*

• The HMO 100% plans will receive an average increase of 4.5%.
• The HMO Classic plans will receive an average increase of 5.5%.
• The HMO Saver plans will receive an average increase of 4.5%.

PPO Plans:

Anthem’s PPO plans will experience a new business average increase of approximately 2.7%.*

• The PPO Premier plans will receive an average increase of 4.5%.
• The PPO Copay plans will receive an average increase of 4.5%.
• The EPO plans will receive an average increase of 2.5%.

These plans will not experience a rate increase:

• Solution PPO
• GenRx PPO
• Elements Hospital PPO

Lumenos Plans:

Anthem’s Lumenos Health Savings Account (HSA)-compatible plans will experience a new business average increase of approximately 3.4%.*

• The Lumenos HSA 80% plans will receive an average increase of 3.5%.

The Lumenos HIA+ plans will not experience a rate increase.

Fourth Quarter Renewal Increases

The October through December renewal increases will vary due to the rating changes Anthem Blue Cross has gone through in the past year. Anthem has had variances by product and region; however, they are pleased to announce an average renewal increase on their EmployeeElect plans for these three months of 10.6%.

New HRA Plans

Effective October 1, 2011, Anthem Blue Cross will have four Health Reimbursement Account (HRA) plans in their EmployeeElect portfolio.

• 3,000C and 5,000C plans—High-deductible HRA offerings with $20 or $30 copay amounts with the deductible waived for office visits.
• 3,000D and 5,000D plans—High-deductible HRA plans with 80% coinsurance amounts after the deductible is met.

Highlights:

• The employer may allocate up to 50% of the annual deductible dollar amount.
• The minimum amount recommended is no less than 10% of the annual deductible.
• The plans will allow for flexible rollover options.
• These plans promote healthy living with employer-sponsored incentives for employees.

Benefit Changes**

Effective October 1, 2011, all of Anthem’s Small Group plans will experience some benefit changes.

Highlights of Benefit Changes:

HMO Plans:

• Increase individual and family out-of-pocket maximums.
• Increase Emergency Room copays.
• All HMO plans will have a specialist copay.
• Durable Medical Equipment (DME)—Increase co-insurance from 20% to 50% (Exception: Co-insurance for special footwear and prosthetics remain unchanged.)

PPO Plans:

• The Emergency Room copay for all PPO plans increased to a $150 copay.
• Increase out-of-pocket maximum.
• Apply deductible to out-of-network office visits.

Elements Plans:

• Deductible and Out-of-Pocket Maximum:
  • Increase deductible and out-of-pocket maximum.
  • Separate in-network and out-of-network deductible, and out-of-pocket maximum.
  • Apply deductible to the out-of-pocket maximum.
  • Family maximum a flat dollar family maximum.
  • Deductible will apply to the following services (previously waived):
    • Out-of-network office visits
    • In-network and out-of-network Lab/X-ray
    • Out-of-network preventive care
• Infertility:
  • Additional $500 deductible will now apply to infertility services. It will not apply to out-of-pocket maximum and will continue to be required after the out-of-pocket is met.
• Specialty Drug Program:
  • Specialty drugs provided by a provider must be obtained through the Specialty Pharmacy Program.
• Behavioral Health Preservice Review:
  • Elements, BeneFitsPreferred, and Plus (except Basic)
  • Behavioral health out-patient visits require a preservice review after the twelfth visit.

To get details on the new Elements Hospital plan design, please contact us, your local LISI sales team.

Saver HMO Plans:

• Deductible replaced by predictable copays.
• In-patient admissions now subject to a per day copay, up to 3 days.
• Out-patient surgery now subject to a flat dollar copay.
• All other out-patient services now subject to a copay equal to the specialist copay.
• Specialist copay added to all plans.
• Out-of-pocket maximum increased.
• Pharmacy copays increased.

To get details on the new Elements Hospital plan design, please contact us, your local LISI sales team.

Pharmacy Plans

• Drug Tier Definition—Pharmacy drugs are now defined as:
  • Tier 1—Lowest copay; applies to most generics.
  • Tier 2—Medium copay; applies to most formulary.
  • Tier 3—Highest copay; applies to most non-formulary.
  • Tier 4—Coinsurance copay; applies to Specialty drugs and includes all forms of administration (self-injectable, oral, and inhaled).
  • In the future, generics and brands may be placed in any tier, depending on the appropriateness of the drug.
  • New Formulary.
• Increased Copays changed to 10/30/50.
• Tier 4 copay maximum increased to 30%, up to $150.
• Preventive care—Coverage for flu/pneumonia vaccine at retail pharmacy.
• EPO—Change to four-tier pharmacy copays.

Plan Discontinuation

In an effort to streamline Anthem’s HMO portfolio, they are discontinuing and migrating members off the Select HMO plans.

Ninety-day discontinuation notices will merge with the Lumenos Plan Discontinuation schedule beginning with October 1, 2011 Renewals.