Dental Procedures Demystified!

Fear of the dentist is not uncommon, in fact, about 50% of Americans admit some fear of dental procedures and about 10% are so frightened they actually avoid dental care.  It is far worse to avoid dental care, as dental pain and issues only get worse over time.  If you are afraid of dental treatments, you can talk to your dentist about sedatives designed to ease your anxiety and get you through dental procedures.

Once thing that can also help you is knowing more about the following common dental procedures:


Teeth may need to be pulled in the event of dental pain or infection.  A certain amount of blood and pain is to be expected, so anesthesia can be used to reduce pain.  You can also use an MP3 player to deaden any sound.  Remember that any blood you se is mixed with your saliva, so it actually looks like you are bleeding more than you actually are!


Cavities are small holes in teeth caused by germ-containing plaque, is treated by removing the surrounding area and filling the hole with materials to rebuild the tooth.  If cavities are not treated early, the bacteria will continue to eat away at the tooth, possibly resulting in a need for a root canal.  One way to lessen fear of the drilling and filling is to bring an MP3 player or similar device to listen to music while your dentist is working.

Root Canal

During a root canal, damaged tissue is cleaned out from inside a tooth. It’s a long procedure (sometimes lasting about two hours), but it can save your tooth. You can also bring along an MP3 player or you can break the treatment down into more manageable time periods.


X rays are designed to help your dentist find little problems before they become worse.  It can become a problem is you have a strong gag reflex or fear of radiation exposure.   Your dentist can use a little topical anesthesia to help control your gag reflex during this short dental procedure. It also may help to remember that the actual radiation exposure from dental X-rays is relatively minimal compared with the radiation exposure you get naturally each day.


Crowns are used to protect a worn-out or weakened tooth.  The worst part of the procedure is the gag-inducing mold made of your tooth to shape the crown.  One way to alleviate this problem is to sit upright and use a faster-setting mold.

Dental Implants

Implants are used to replace missing teeth. They look natural and are stable as they are molded to your bone below your gums.  If you are afraid you can consider anesthesia.

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*

EmployeeElect: HMO 4.9%
PPO 2.7%
CDHP 3.4%
EmployeeChoice: 3.0%
BeneFits: 0.8%
Total Average Rate Increase: 3.2%

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%.
Please select a topic to go to a section below:

Small Group Medical


Important Dates

Reminder: Select HMO is available with all of Anthem’s HMO plans and it can save groups approximately 11%.*

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.


  • 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.

Select 25 HMO Saver 30 HMO Select
Select 35 HMO Saver 40 HMO Select

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

* These rate adjustments are after benefit changes and are averages that will vary by plan and region.
** These are highlights only and not intended to be a complete view of the changes.

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.

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.

What Is Allowed as a Recission of Group Health Coverage Under Health Reform?

The federal health care reform law changed the way health plans and issuers approach rescissions in both the group and individual markets. 

It’s important to understand what constitutes a “rescission” for federal health care reform, as opposed to another type of coverage termination. A rescission is broadly defined as a retroactive termination of a member’s coverage. There are some important exceptions from this broad definition. For example, termination of coverage because of nonpayment of premium or contribution (either by the group or the member) is not a rescission. It is not considered a “rescission” when the member’s coverage is retroactively canceled to the last paid-to date if the member pays no premiums or contribution for periods of time after termination of employment or eligibility. The member’s coverage can be retroactively canceled to the last paid-to date.

 If a group health plan or carrier is faced with a “rescission,” certain restrictions apply for plan years that start on or after September 23, 2010.   The federal health care reform law does not allow the plan or carrier to rescind coverage, except in cases of fraud or intentional misrepresentation of material fact as specified in the contract. Examples of this include intentional misrepresentations of marital status or dependent eligibility.  When a policy or coverage is rescinded due to intentional misrepresentation of material fact or fraud, the plan or issuer must:

o Provide notice of the rescission 30 days in advance

o When providing notice carriers must inform the group or member of the opportunity to appeal the determination to rescind (as outlined in regulations for the appeals provision)

For group health plans, group policyholders control otice of membership eligibility. Therefore, when a member is removed from coverage, a carrier must be notified by the group .