Changes to Anthem Blue Cross Large Group Portfolio

Anthem Blue Cross of California has made some exciting changes and are introducing new plans to their Large Group portfolio for business with 51 or more employees.

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.

Insurance Carriers Now Required To Justify Premium Increases

  U.S. health insurance carriers will have to justify big premium rate hikes effective September, 2011  under new rules issued by the U.S. Health and Human Service Department   Insurers will have to publicly post proposed rate increases for the small group and individual markets. Any increase of 10% or more will have to undergo review by independent experts at the state or federal level, the agency said.

These rules were signed into law last year under health care overhaul.  HHS Secretary Kathleen Sebelius said her department will provide greater scrutiny of health insurance premium rises at a time when insurers are demanding premium increases, even as they enjoy lower costs and huge profits.

“Even though insurers are seeing lower medical costs as people put off care and treatment in a recovering economy, insurance companies continue to raise their rates. Often these increases come without any explanation or justification,” she added.

Results of reviews will be posted on the HHS Website, and insurers will be required to post that information on their sites as well, she said.

While federal regulators cannot set health insurance rates, Sebelius said a growing number of states have this authority.  Sebelius said her agency was working closely with states to undertake the review process. HHS will take over in cases where a state does not take up the responsibility.

The 10% threshold will be replaced in September 2012 by a state-specific threshold that takes into account trends in a state’s health care market.

Steve Larsen, director of HHS’s Center for Consumer Information and Insurance Oversight, said the current rule applies only to the individual and small group market but that the agency was seeking comment on applying the rules to groups that purchase coverage through associations.

New Small Group Rate for Blue Shield in July 2011

New Small Group Rate for Blue Shield in July 2011

Blue Shield Group Rate ChangeThank you for your continued support of Blue Shield. Now more than ever, Health Plans Online is committed to helping you manage and grow your business. To help you prepare for the third quarter renewal period, we’ve outlined below some key details:

  • February 18  a rate pass for new second quarter business. In addition, Blue Shield offered renewal date change options for your second and third quarter new and renewing groups.
  • The second and third quarter renewing groups may choose between two specific medical contract/policy (“contract”) terms. New business has contract term choices as well.
  • For the July 2011 rate cycle, your small group rates will increase, however, the average increases are lower than previous cycles with rate actions. Below are some highlights of this quarter’s rate increases1 :
Plan Rate increase
PPO (other than HSA-compatible)
Dental, vision or life2
  • Detailed rates can be found obtained by contacting Health Plans Online.
  • By popular demand,  the RAF program is extended until December 15, 2011.
  • There will be no new benefit changes to medical or specialty products for third quarter 2011.

For the latest information on our July 2011 rate cycle, please contact your Health Plans Online.

Blue Shield Small Group (April, May, June 2011 rate pass details)

In February Blue Shield announced a second quarter rate pass for new small group business. Blue Shield also delayed the rate increase for small groups otherwise scheduled to renew in the second quarter.

Today Blue Shield has an update for your impacted small group clients.

Second Quarter Renewing Clients – Changed Renewal Period

For small groups currently scheduled to renew in the second quarter of 2011 ONLY, Blue Shield is extending their current contract/policy term and changing their renewal period. Your second quarter renewing clients will receive an endorsement/amendment that will extend their 2010 contracts/policies from 12 months to 15 months, under the current contract rates. So this year, they will renew in the third quarter and not in the second quarter.

  • Members will be able to add dependents in their original renewing month as well as the extended renewal month.
  • At their original open enrollment, employees may add or cancel dependents (including adult age dependants), late enrollees may enroll and members would be able to cancel their coverage.
  • Group level changes (including plan changes) will be deferred to their new open enrollment 7/1, 8/1, or 9/1.  Members will be able to change plans at this time.

2011/2012 Second Quarter Renewal Schedule

Original 2Q 2011 renewal month Revised 2011 renewal month New 2012 renewal month*
April July April
May August May
June September June

2011/2012 Third Quarter Renewal Schedule

Original 3Q 2011 renewal month 2012 standard renewal month 2012 renewal month – 9 month option**
July July April
August August May
September September June
 *Groups may opt for a new 12 month contract upon request
**Third quarter renewing groups may opt for a 9 month contract upon request

 The renewal contract/policy that is offered to these groups in 2011 will be for a term of 9 months, returning them to their original renewal month in 2012. However, the group may elect to receive a 12 month renewal contract/policy in 2011 and have their renewal month change permanently to the third quarter. If your clients would like to opt for this, please contact RBG who will notify Blue Shield of your clients’ election prior to their 2011 renewal date.

 Third Quarter Renewing Clients – Renewal Period

Small groups that already have a renewal date in the third quarter of 2011 will be offered a 12 month contract/policy. However, in 2011 ONLY, third quarter renewing groups may elect to receive a 9 month contract/policy and have their renewal month change permanently to the second quarter in 2012. Groups must notify Blue Shield of their election for a 9 month contract/policy prior to their 2011 renewal date. 

Second and Third Quarter New Business – Renewal Periods

New small group clients with effective dates in the second and third quarter of 2011 can receive a standard 12-month contract/policy. However, new second quarter accounts may elect to receive a one-time 15-month contract in 2011 only, and new third quarter accounts may elect to receive a one-time 9- month contract in 2011 only. New second and third quarter accounts must affirmatively select their preferred 2011 contract/policy period. Please contact your RBG representative who can provide you with the contract/policy term election form when it’s available.

Groups with Vision Coverage

Please note that groups with Vision Standard, Vision Plus, or Vision Deluxe plans have an initial contract term of 24 months.

Health Net Introduces “Dual Networks” Effective 5/1/2011

Health Net is debuting an expanded, dual network small business group plan portfolio called, “Offer More, Spend Less.” The dual network approach allows mixing and matching for just the right combination of coverage and price.

Small business clients will be able to offer a selection of full network and tailored network plans to their employees.

  1. Pick one or more of four new full network HMO plans. These plans were  modeled after those most favored by Health Net’s small business groups.  The chart below shows a summary of the difference in benefits.
MHPA plan code 1RX 5NP 1RY 5NQ
Non-MHPA plan code 1EK 5NK 1EL 5NL
Specialist Consultation $20 $30 $30 $40
Emergency Room $100 $150 $100 $150


MHPA plan code 1SR 5NR 1ST 5NN
Non-MHPA plan code 1EQ 5NM 1ER 5NJ
Specialist Consultation $30 $50 $40 $60
Emergency Room $100 $150 $100 $150


2.      Once you’ve selected the full network HMO plan(s), you can bundle them with either the Silver Choice or Bronze Choice portfolio.

These plans are now available for quoting. For more details on the new plan designs, click on the PDFs below.

More Standard and Value Designs
Health Net is also expanding their Standard and Value plan collections with more coverage/cost combinations for today’s small business owner.

  • Standard PPO Plans: four new choices
  • HMO and EOA: four more of each with choice of network
  • Value PPO Plans: four new choices
  • New $50 copayment plan in either an HMO or EOA

HRA Plan Benefit Enhancement
Also new for May 1, 2011, Health Net is enhancing their HRA plans. Members now have benefit coverage for in-network doctor visits at a set 50% coinsurance after their deductible is met.

New, Lower-cost PPO Dental Plans
Three of them to be exact. Healthy teeth are important, and so is making it easy and affordable for employers to provide dental coverage for their employees. For example, the Essential Value plan delivers savings by including endodontics, periodontics and major oral surgery under major benefits. Plus, all of the new plans include health promoting features like extra services for pregnant women.

Rates are effective May 1, 2011 through July 15, 2011 effective dates.

5.11 – HN Ancillary Programs Brochure.pdf
5.11 HN Benefits Guide.pdf
5.11 – HN Dual Network Option Brochure.pdf


 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.

UHC – California Small Business (2-50) Rate Action – Effective May 1, 2011

 Effective May 1, 2011 the average statewide rates for new business will increase by approximately 3.3% for the PPO product and 0.6% for the HMO product. See following averages by area:  

  • Los Angeles and Ventura Counties: 1.5% decrease for HMO; 3.0% increase for PPO/HSA 
  • Orange County: 1.5% decrease for HMO; 3% increase for PPO/HSA 
  • San Diego County: 3% increase for HMO; 3% increase for PPO/HSA 

For renewing customers, the average statewide annual rate increase is approximately 4% for HMO and 13% for PPO. See the Small Business 2-50 Product Catalog and Rate Guide below for more details. 

Product Catalog 

Rate Guide