New Health Net Next Generation Health Plans- March 2012

Item 1: Health Net SmartCare – first innovation for 2012
A pioneer in the creation of tailored networks, Health Net is evolving its Bronze plans and network into Health Net SmartCare. Your clients can get the advantages of a tailored network, expanded benefits and health incentives in one simple package.More ways to protect health:

  • Convenient CVS MinuteClinics;
  • Acupuncture and chiropractic services included as valued-added benefits; and
  • Health incentives to help employees be well and productive.

More relevant to your clients:

  • Easy-to-understand, choose, and use HMO plans keep decision making clear and simple.
  • Sets employers up for the long-term. SmartCare is built to flex over time with planned expansions for 2012 (and beyond) in geographic coverage, prominent participating provider groups and other resources to match evolving employer and employee needs.

Health Net SmartCare is the health care solution that employers can afford, employees will use, and both will value.

Creating an easy migration from Bronze to SmartCare
Effective March 1, 2012, Health Net will no longer offer Bronze or Bronze Choice to new groups. Groups currently enrolled in a Bronze plan will be:

  • Notified 90 days in advance of their renewal date by letter that explains the change.
  • Offered the option to choose any one or more of the new SmartCare plans (six for SBG, five for Large), or any other Health Net group plan.

If a group wants to keep their plan design exactly as it is under their Bronze plan, they may do so by pairing those benefits with Health Net’s full HMO or Silver network.

Health Net has the Health Net SmartCare broker guide including a crosswalk and plan overviews available to support you and your brokers in client conversations.

Click here for SmartCare HMO Plans.

Item 2: Lower SBG PPO Advantage plan rates – San Diego
In conjunction with introducing SmartCare in San Diego (region 7), Health Net is also lowering rates for its PPO Advantage plans.

Item 3: Salud expands into Kern county
Health Net is expanding its Salud network with the addition of IPA Hispanic Physicians, which has eight PCPs and 74 specialists. The expansion makes Salud HMO y Más and Salud Mexico available to groups – both SBG and Large – in parts of Kern county effective March 1, 2012. More information and details about materials will be sent soon.

SeeChange Health Reports Substantial Growth in Value-Based Businesses, Projects a 600% Increase in Revenue for 2012

Innovative Provider of Value-Based Benefit Design Solutions for Employers Achieves 250% Growth Rate in SaaS-Based Health Solutions Business and 300% Growth Rate in California Health Insurance Business

SAN FRANCISCO, CA–(Marketwire -01/24/12)- SeeChange Health (, an innovator in value-based benefit design solutions to improve health and reduce health care costs, today announced that the company’s growth is accelerating and is on pace to exceed $50 million in revenue over the next 12 months.

SeeChange Health offers value-based benefit design solutions to meet the needs of businesses of all sizes. SeeChange Health Insurance provides value-based benefit plans to fully insured employer groups in California and is the first to bring this unique approach to small and midsize companies. SeeChange Health Insurance is now the fastest-growing health plan in the market, as brokers and employers alike are embracing the value-based model. Read full article here.

Anthem Blue Cross Small Group: April 2012 rate changes

April 2012 Rate Change Overview:


  • 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.

UnitedHealthcare (CA small group) Multi-State Guidelines

UnitedHealthCare is modifying the CA Small Business 2-50 underwriting requirements as follows: 

Per AB 1672, groups with 51% of the eligible employees employed in the State of California are considered guaranteed issue groups. 

Groups with more than 49% of the eligible employees employed outside the state of California are considered non-guaranteed issue in California. These groups require health statements and are not eligible for the RAF promotion. 

Underwriting will approve or decline these groups in accordance with the underwriting guidelines.

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.

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.