Anthem Small Group is getting tough on late payments

Everyone forgets to pay a bill every now and then, so what?

Health Insurance Premium Past DueSuppose 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.

Mental Health Parity Interpretations and Clarifications

A Trio of Federal Agencies charged with interpreting the Mental Health Parity laws have determined that a plan cannot require pre-authorization of mental health treatments if the same requirement is not imposed on other non-mental health related procedures.

A plan may not, as a routine matter, approve significantly shorter stays for inpatient mental health and substance abuse treatment than it does for inpatient medical or surgical care, even if extensions of those stays are subject to review.

Plan sponsors should be aware of these interpretations of the rules not only in  regard to plan design, but with regard to their own (and their vendor’s) administrative practices.

Preventative Care Coverage Under Health Reform

Under Health reform, the following preventive care services are covered with no copays, deductibles or co-insurance percentages for group and individual plans in effect after Septmber 23, 2010  (Non-Grandfathered Plans) and must apply to all group and individual plans by 2014: :

All members

  • Yearly preventive medicine visits (Wellness visits)
  • All standard immunizations recommended by the American Committee on Immunization Practices

All members at an appropriate age or risk status

  • Screening for colorectal cancer, elevated cholesterol and lipids
  • Screening for certain sexually transmitted diseases and HIV
  • Screening and counseling in a primary care setting for alcohol or substance abuse, tobacco use, obesity, diet and nutrition
  • Screening for high blood pressure, diabetes and depression

Women’s health

Recently, the Department of Health and Human Services released new health plan coverage guidelines that will require health insurance plans to cover women?s preventive services without charging a copayment, coinsurance or a deductible effective for plans beginning or renewing Aug. 1, 2012, to now include:

  • Well-woman visits
  • Screening for gestational diabetes for all pregnant women
  • Human papilloma virus DNA testing for all women 30 years and older
  • Annual sexually transmitted infection counseling for all sexually active women
  • Annual counseling and screening for HIV for all sexually active women
  • FDA-approved contraception methods, sterilization procedures and contraceptive counseling
  • Breastfeeding support, supplies, and counseling, including costs for renting breastfeeding equipment
  • Domestic violence screening and counseling

The following guidelines were effective for plan years beginning on or after Sept. 23, 2010:

  • Screening mammography and evaluation for genetic testing for BRCA breast cancer gene
  • Screening for cervical cancer including Pap smears
  • Screening for gonorrhea, Chlamydia, syphilis
  • Screening pregnant women for anemia, iron deficiency, bacteriuria, hepatitis B virus, Rh incompatibility
  • Promotion of and counseling for breast-feeding
  • Osteoporosis screening (age 60 and older)
  • Counseling women at high risk of breast cancer for chemoprevention

Men’s health

  • Screening for prostate cancer for men (age 40 and older)
  • Screening for abdominal aortic aneurysm in men (age 65-75)


  • Screening newborns for hearing, thyroid disease, phenylketonuria and sickle cell anemia
  • Standard metabolic screening panel for inherited enzyme deficiency diseases
  • Counseling for fluoride treatment
  • Screening for major depressive disorders
  • Vision screening
  • Screening for developmental/autism screening
  • Screening for lead and tuberculosis
  • Counseling for obesity

In addition to these services, under the Preventive Benefit, UnitedHealthcare also provides screening using CT colonography, Prostate-Specific Antigen (PSA), and screening mammography without age limits.

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.

What Makes a Health Plan Enrollment Successful?

Its not an easy task to hold open enrollment meetings for your employees, and its also not easy for your employees to make decisions regarding their health plan choices.  Most employees are nervous about making a  decision, since their election must remain in place for the entire plan year.  Wouldn’t you be nervous too?

Below are some suggestions to assist you and your employees in making the best decision(s) regarding plan choices at open enrollment:

  • Allow employees adequate time to think about the choices and/or discuss the options with their family or providers.  One day or a weekend simply isn’t enough time.  Studies suggest that employees who are given three weeks to make a choice are 50% more likely to remain satisfied with their decision.
  •  Hold open enrollment meetings as far in advance as possible to the plan or carrier change.
  • Provide enough information regarding the plan choices available.  Research shows that employes can make an informed decision once they have an effective benefits education, with their personal questions addressed.  If at all possible provide printed information or access to information online.
  •  Personalized benefit statements can also help an employee to determine the amount they spend on insurance, and if this needs to be adjusted in light of their health care needs.
  •  Give employees the opportunity to ask personal or specific questions related to their health care needs.  Perhaps the enroller can remain on site to answer questions, or the employees can contact someone on their own time to ask questions.  Make someone available to your employees.

Our staff at can assist you and your employees with health plan choices and enrollment.  Please contact us at (888) 474-6627.


2012 Health Care Reform Checklist

Anthem Blue Cross of California has recently provided a checklist of key items employers may need to to make sure they are on target with Health Reform Rules.  This list can be found at:

Please contact our office at (888) 474-6627 to verify what you may need to do as an employer to stay in compliance.

copyright Anthem 2011 used with permission.