This change is due to the addition of atorvastatin, a new generic for the brand name Lipitor, on their covered drug list.

This change impacts all of the commercial and individual business in California and New York. Medicare Part D and state-sponsored business are not impacted.

EmployeeElectTotal

• PPO 3.2%
• HMO 6.9%
• CDHP 12.8%

EmployeeChoice – 7.9%
BeneFits – 3.5%
Total – 5.0%
(These rates are for Small Group ONLY, the EmployeeElect 51-99 portfolio as well as the Small Group MHP compliant plans have slightly different rates than the Small Group portfolio.)
*These rate adjustments are averages and will vary by plan and region..

HMO Rate Adjustments –April 2012
The HMO plans within the Small Group EmployeeElect Portfolio will see a new business average increase of approximately 6.9%*.   All HMO plan families will receive an approximate 6.9% quarterly increase on average.

Quarterly increases on the HMO plan families will be as follows*:

• HMO 100% – 7.6%/Select HMO 100% – 3.8%
• Classic HMO – 7.5%/ Select Classic HMO – 3.8%
• Saver HMO – 7.5%/ Saver HMO – 3.7%

“Renewal” increases are as follows:

• HMO 100% – 15.2%/Select HMO 100% – 11.1%
• Classic HMO – 16.3%/ Select Classic HMO – 12.1%
• Saver HMO – 15.2%/ Saver HMO – 11.4%

*These rate adjustments are averages and will vary by plan and region.

PPO Rate Adjustments –April 2012
The PPO plans within the Small Group EmployeeElect Portfolio will see a new business average increase of approximately 3.2%*.

The PPO Increases will be as follows (quarterly/renewal)*:

• The PPO Premier Plans will receive an average increase of 3.5%/12.1%
• The PPO Copay Plans will receive an average increase of 3.5%/12%
• The Solution PPO Plans will receive an average increase of 3.3%/7%
• The GenRx PPO Plans will receive an average increase of 2.5%/3.2%
• The Elements Hospital PPO Plans will receive an average increase of 2.7%/2.9%
• The EPO Plans will receive an average increase of 3%/10.3%

*These rate adjustments are averages and will vary by plan and region.

RAF Promotion Update
The basic promotion will remain intact, however, Anthem will also now allow for the following:

• Groups with 6 or more enrolling subscribers, with a minimum of 50% participation in either the Gen Rx PPO plans and/or any of the Select Network HMO plans will receive an automatic .90 RAF –There will be no qualifying renewal RAF required on those groups.

• Groups with 6 or more enrolling in our BeneFitsplan portfolio will also receive an automatic .90 RAF -There will be no qualifying renewal RAF required on those groups.

Suppose you are an Anthem small group employer and you receive your January 1, 2012 bill for your employee health insurance. California small group employers have always been accustomed to having a 30 day grace period past the due date to pay their bill and that has not changed.  What has changed is the willingness of a carrier to extend the grace period for longer than 30 days.

In the past when clients went past their 30 day grace period, we would call Anthem and tell them that our client promises not to do that again and to please reinstate coverage for their employees as our client will overnight the check.  I can’t remember a time where Anthem did not approve the reinstatement.  If you read the recently released “Notice of Grace Period and Right to Request Review“, Anthem may no longer be accommodating.

What I do know is that Anthem pays out more in claims that what the State of California will allow them to charge some businesses.  Why would Anthem want to be accommodating to a business that loses them money?

Here is another question:  If a group plan is cancelled for non-payment and the employees and/or dependents incur claims, who is expected to pay those claims? 

Answer: Injured employees would seek their employer.

Our advice to employers: 

Please pay early as you may not receive a reminder from the insurance company.

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.

Important Dates

• July 11:RAF engines and rate guides are available on Anthem’s sites; rating are available through general agencies and quoting vendors.
• July 12:Online renewals are posted for October.
• July 13:Broker renewals for October will go out.
• July 15:A webinar will be offered to Anthem’s general agents.
• July 27:Group renewals for October will go out.
• August 1: Rating goes live on Anthem’s Web site.

Effective October 1, 2011, these new plans include:

• NEW BC Exclusive PPO plans — offers HMO-like benefits using the BlueCard PPO provider network for non-California employees.
• NEW Advantage Plus HMO plans – an additional option for Advantage HMO on the Select Plus HMO Network
• Lumenos HIA plans — available to Pooled business in addition to Non-Pooled.
• NEW Premier PPO plans to offer more choice.
• NEW pharmacy plans to complement certain medical plans in Pooled business. (Non-Pooled business continues to have a choice of pharmacy plans).

Some of their other changes include:

• Adjusted benefit structures to their HMO and PPO-type plans to make their plans more cost-effective.
• Simplified plan choices — to meet today’s needs.
• Logical product downgrade options.
• Demarketing of non-competitive, duplicative plans.
• Benefit changes — to maintain affordability and consistency between plans

Highlighted links are pdfs that show their HMO plans, PPO plans, CDHP plans and the RX plans that are effective October 1, 2011 And a Benefit Modification Grid that explains what benefit changes they are making to their plans.

As theye have demarketed some of their plans and have also renamed some, attached is a crosswalk brochure Quick Reference Guide illustrating the demarketed plans and corresponding suggested replacement plans, as well as the former and new plan names.

EmployeeElect Total
PPO 2.1 %
HMO 2.0 %
CDHP 8.2 %

EmployeeChoice – 7.3%
BeneFits – 4.4%
Total – 3.3 %

The Rate increases for the 51-99 EmployeeElect portfolio is identical to Small Group for April.  However, the TOTAL rate for these plans will vary slightly.
*These rate adjustments are averages and will vary by plan and region.

The Increases will be as follows: 

   The HMO Plans will receive an average increase of 2.0%
   The PPO Premier Plans will receive an average increase of 1%
   The PPO CopayPlans will receive an average increase of 1.7%
   The Solution PPO Plans will receive an average increase of 3.5%
   The GenRxPPO Plans will receive an average increase of 3.3%
   The Elements Hospital PPO Plans will receive an average increase of 3.8%
   The EPO Plans will receive an average increase of 1.0%
   The LumenosH.S.A. 100% Plans will receive an average increase of 9.5%
   The LumenosH.S.A. 80% Plans will receive an average increase of 7.6%
   The LumenosHIA+Plans will receive an average increase of 5%

The April, May & June 2011 renewal increase on EmployeeElect plans will average 13.1%.

…………………………………………………………………………………………………………………………………………………………………………………………

New PPO Plans added April 2011

The ID theft service assigns a fraud resolution specialist to members for an entire year to work closely with creditors, collection companies, collection law firms and credit reporting agencies in the event of an identity theft.

January 2010 – 4.0%
April 2010 – 4.7%
July 2010 – 1.9%
October 2010 – 2.8%

Renewal Increases:  

The January through March renewal increases will vary greatly due to the rating changes Anthem Blue Cross has gone through in the past year. We have had a large variance by product and region, however, we are pleased to announce an average renewal increase for these three months of 14.5%.   

EmployeeElect Total   Total – 4.7 %  

The PPO increases will be as follows

• Premier Plans will receive an average increase of 3.5% 
• PPO COPAY Plans will receive an average increase of 3.5%
• Solution PPO Plans will receive an average increase of 4.4%
• GenRx Plans will receive an average increase of 4.6%
• Elements Hospital Plans will receive an average increase of 5.0%
• EPO Plans will receive an average increase of 4.0%

The Lumenos HSA & HIA plan increases will be as follows

• HSA 100% plans will receive an average increase of 8.5% 
• HSA 80% plans will receive an average increase of 8%
• HIA+ plans will receive an average increase of 8%

 The HMO increases will be as follows

• All HMO plan families will receive an average increase of 3.5%

The total average quarterly increase is 2.8%.

Please note that these rates are for Small Group only. The 51-99 EmployeeElect and Small Group mental health parity compliant plan rates will no longer match small group rates. This is due to Anthem Blue Cross’ compliance with the Mental Health Parity Act, effective July 1, 2010. 

Here are the breakdowns:

• EmployeeElect PPO plans will see a new business average increase of 2.0%
• EmployeeElect HMO plans will see a new business average increase of 1.5%
• EmployeeElect CDHP plans will see a new business average increase of 7.0%

• EmployeeChoice plans will see a new business average increase of 3.6%

• BeneFits plans will see a new business average increase of 1.2%

In addition, there will be no rate or benefit changes for Small Group Dental, Life and Vision products.

Important Healthcare Reform Benefit Changes

Anthem Blue Cross has updated their benefits to comply with federal and state requirements, including applicable provisions of the recently enacted federal healthcare reform laws.

The following benefits have been updated to comply with the law:

• Removal of Lifetime Maximum on PPO plans
• Removal of Annual Dollar Maximums
• Preventive Care will now be covered at 100%

Grandfather Status:

• Effective October 1, 2010, Anthem Blue Cross will be making all of their EmployeeElect plans eligible for Grandfather Status
• The EmployeeChoice and BeneFits portfolios, as well as the Indian Tribes plans, will not maintain Grandfather Status

Specialty Product Discounts:
Anthem Blue Cross has lowered the rates on their most popular Dental Blue Gold Plus 100-80 plan by 8.5% in April…combine that sale with $25,000 of Life and the group receives an additional 6% off the rate for a total savings of 14.5%.

 And don’t forget the 1% RAF savings when a group buys at least $25,000 of Life coverage (down to a .90 RAF). In many cases, the 1% RAF savings can cover the entire cost of the life premium.

RAF Promotion Update:
Anthem Blue Cross is continuing with their current RAF promotion program through December 15th effective dates:

Groups with 6 or more enrolling medical subsribers with a renewal of 1.06 or less (with their current carrier) will receive an automatic .90 RAF.

There is one notable change for PEO groups:

Anthem Blue Cross will include PEO groups with 15 or more enrolling medical subscribers in the fourth quarter (assuming they meet all other eligibility requirements.)

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.

• 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.

• July 2009 – 0%

• October 2009 – 0% or slight decrease  

• January 2010 – 4.0%

• April 2010 – 4.7% 

July 2010 “Employee Elect”  

• PPO 1.4%  
• HMO 1.1%  
• CDHP 5.2%  

EmployeeChoiceTotal 3.5%  

BeneFitsTotal 3.5%  

Total Average Quarterly Increase: 1.9% 

There will be no benefit changes to current Small Group Medical Plans.

*These rate adjustments are averages and will vary by plan and region.