Post on 31-Mar-2015
Anthem’s Lumenos Consumer-Driven Health Plansfor 10/1/08 Effective Dates and Beyond
Georgia Group Plans
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Agenda/ Course Objectives
Consumerism and Why Employers Consider Consumer Driven Health Care Plans (CDHPs)
Start with Sound Clinical Strategy Back It Up With Account-based CDHPs:
• Health Savings Account (HSA)
• Health Reimbursement Account (HRA) and Health Incentive Account Plus (HIA Plus)
• Health Incentive Account (HIA)
Consumer Support Product Portfolio, Account Funding and Plan Considerations Consumer Communications Next Steps for Your Groups with BCBSGA
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How Do We Define Consumerism?
Consumerism is the process of engaging and enabling consumers to make better decisions about their health care.
Consumerism can help individuals understand how to:
• Maintain their good health
• Improve their risk factors
• Find the highest quality health care solutions at the best price
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An Engaged Consumer…
1. Understands his or her health status/medical conditions and demonstrates good health behaviors
2. Is a smart buyer of health care products and services because they are informed about the quality, value and cost of these products and services
3. Participates in a transformational consumer-focused health plan
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How Do Consumers Use Health Care?
Consumers today are “passive.”
They’re individuals who “fall into the system.”
They’re insulated from the real costs of health care (no price transparency)
They typically don’t question the recommendations of their “primary care physician” regarding:
• Prescriptions (brand vs. generic; cost)
• Procedures (alternatives)
• Specialists (competence/track record)
• Hospitals (price and quality transparency)
Why Employers Consider Consumer Driven Health Plans (CDHPs)
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Why Are Employers Considering CDHPs?
• Introduce consumerism
• Want employees to have a better understanding of the cost of care
• Offer employees more choice
• Improve employee health
• Improve employee satisfaction
• Offer employees opportunity to lower tax burden
• Increase employee contribution levels
• Long-term and retirement savings
• Manage medical costs through better employee health
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Rising Costs: The “Big 4” Risk Factors
62% of the rise in private insurance costs from 1987-2002 was due to population risk factors and their treatment
Average 10% of total claims costs attributable to obesity 60% of Americans exceed ideal BMI (body mass index) Soon to become the leading cause of death
Average 10% of total claims costs attributable to tobacco 21% of adult Americans smoke Remains leading cause of death
60% perform no substantial activity or exercise
Two-thirds of all office visits to family physicians are due to stress-related symptoms
More than one in four workers have taken a "mental health day" off from work to cope with stress
Costs U.S. businesses $300 billion annually in direct & indirect costs
Stress
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CDHP As A Health Care Strategy
Employers and Consumers:
Are becoming more sophisticated purchasers of health care benefits
Recognize that changing copays, deductibles and increasing employee contributions is not the solution
Realize that they must identify and address the fundamental causes of increasing health care costs
Are looking for new solutions
Are looking for partners that can help them formulate and execute a long term strategy
In this environment, a consultative and strategic approach
is essential to sales success
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With 66% of employers considering CDHP …
… can you afford to be on the sidelines?
Selling CDHP - Realities
10%
13%
12%
2%
31%
32%
Employer Perspectives on CDHP StrategiesEmployer Perspectives on CDHP Strategies
Not considering
Planning to offer CDHP as an option in the
short-term then move to a full replacement in the next few years
Planning to offer CDHP on a slice
basis going forward, don’t anticipate moving to full replacement
Moving or looking to move to a full replacement CDHP
option all at once
Had CDH plans but reverted back to HMO/PPO plans
Source: 2006 ChapterHouse/NAHU Survey
Looking at it, not yet offering
Start with Sound Clinical Strategy
Incentive-based Health Improvement
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• Provide rewards for updating or completing health risk assessment
• 80% completion goal
Identify, improve risk and care
Incentive-based Strategy
• Take optimal care of the sick
• Engage population to understand & reduce risks
• Provide incentives to complete risk reduction programs
• Maintain low risk group to a minimum of 70%
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Source: D.W. Edington Research GM-UAW LifeSteps Health Promotion Program
Risk Factors Reduction
Risk factors include:
• Smoking
• Physical inactivity
• BMI
• Alcohol drug use
• Job/personal dissatisfaction
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• $50 reward* for online completion (limited to one reward per family each year)
• $200 reward* for graduating from a health coaching program (limited to one reward per family member each year)
• Goals achieved with knowledge, skills and functional provider-patient relationship
• $100 reward* for enrollment for each eligible family member
• Participation in health coaching programs• Engaging with health coach to identify goals; and
understand and manage their health condition
Identify, improve risk and care
Incentive-based Strategy
IdentifyMyHealth
Assessment
EngageHealth Coaching
Participation
EngageHealth Coaching
Completion
*Rewards may be allocations to account or, for fully-insured HSA plans, credit dollars to redeem for gift cards to select health-focused retailers.
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Reward Programs & Eligibility
All GA Fully Insured plans with incentives use the following incentive amounts for activities that contribute to the better health and well-being
• $50 for completing MyHealth Assessment online health profile; one incentive per contract per contract year
• $100 for enrolling in a Health Coaching program; incentive offered once per contract year to all eligible members
• $200 for graduating from a Health Coaching program; incentive offered once per contract year to all eligible members
• $50 for completing the Tobacco-Free program; incentive offered once per lifetime to eligible members
• $50 for completing the Healthy Weight program; incentive offered once per lifetime to eligible members
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Tobacco Free Program
Counseling calls with tobacco treatment specialist
Personalized plan, decision support for pharmacotherapy and nicotine replacement fulfillment at no cost to consumer
Individualized participant and physician correspondence, unlimited access to toll-free support
Program is designed to be delivered over a 6-9 month period to meet the formal program completion criteria
Incentives available for this program, specific amount at employers discretion
Smoking Cessation
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Telephonic course sessions address diet and healthy eating, physical activity and exercise, stress management, maintenance and relapse prevention
Phone counseling facilitated by a registered dietician or health educator
Includes course manual containing educational lessons for additional phone counseling sessions
Calls scheduled at 1-to-2 week intervals. Over the course of the program, participants receive an average of 6 to 8 outreach-advising calls from a trained health professional
Incentives available for this program, specific amount at employers discretion
Healthy WeightProgram
Weight Management
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Anthem’s CDHP 360º Health Programs
360º Lumenos products• 24/7 NurseLine
• ComplexCare
• Future Moms
• MyHealth web tools
• ConditionCare*
• MyHealth Coach
• Healthy Lifestyles Online & Telephonic Coaching• Weight Management
• Smoking Cessation
* Asthma, COPD, CAD, Diabetes, and Heart Failure
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What programs are eligible for incentives?
Arthritis
OsteoarthritisOsteoporosisRA
Asthma Adult and Pediatric
Cardiology
Cardiology, Abnormal Cardiac Rhythm Cardiology, Angina Cardiology, CADCardiology, CardiomyopathyCardiology, CHFCardiology, EndocarditisCardiology, HyperlipidemiaCardiology, HypertensionCardiology, MI Coronary Artery BypassCardiology, PacemakersCardiology, Post Cardiac Surgery
COPD
Diabetes Type I and Type ll
Maternity
Oncology
Oncology, Breast Cancer Oncology, Colon Cancer Oncology, Lung Cancer Oncology, Prostate Cancer Oncology, Skin Cancer
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Requesting a Health Coach
• Anthem’s Lumenos plans utilize the most current MyHealth Assessment tool.
• Members are presented with a page to request a health coach contact the member by phone upon completion of the assessment.
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What does a member have to do to meet the Activity Achievement criteria?
The member must demonstrate to the health coach that they possess:
• Knowledge of their condition
• Self-management skills
• Ability to comply with the treatment plan
• Achievement of an effective relationship with a primary care physician
Back It Up With Account-based CDHPs
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Clinically Appropriate Plan Design
• Preventive care• Coverage for nationally recommended preventive
care services
• Health account• Health account should be sufficient for many people
• Out-of-pocket responsibility• The “bridge” to Traditional Health Coverage – the
amount consumer pays to satisfy their remaining deductible after health account funds are exhausted
• Traditional health plan coverage• Coinsurance and annual out-of-pocket protection
Sample Plan Design
Traditional Health Coverage
Health Account
and/or
Rewards
Preventive Care
Out-of-Pocket “bridge” to Traditional Health
Coverage
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Types of Lumenos Plans
• Health Savings Account (HSA)
• Health Reimbursement Account (HRA)
• Health Incentive Account Plus (HIA Plus)
• Health Incentive Account (HIA)
Anthem's Lumenos HSA Plan
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4.5 Million People Enrolled in HSA Plans
HSA plans accounted for 17% of new policies in the small group market and 8% of new policies in the large group market (2007)
Source: America’s Health Insurance Plans (AHIP) of U.S. 2007
Growth of HSA/HDHP Enrollment from March 2005 to January 2007
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Anthem's Lumenos HSA Plan
• Consumers can fund their HSA with pre-tax dollars and can use funds for health care expenses
• Employers can also contribute to employees’ HSAs
• Preventive services are covered at 100% In-Network
• Includes Traditional Health Coverage to cover expenses after the bridge
HSA
Funded by annual employee and/or
employer contributions
Preventive Care100% In-Network
Traditional Health Coverage
Out-of-Pocket “bridge” to Traditional Health Coverage
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HSA Plan Details At-a-Glance
Lumenos HSA Plan Single Coverage Family Coverage
Preventive Nationally recommended services
No cost, no deduction from HSA with in-network providers
HSA<Employer’s annual allocation>
Annual HSA contribution maximum
<$xxx>
$2900
<$xxx>
$5800
Traditional Health
Coverage
Bridge amount to satisfy deductible
Your bridge amount is your annual deductible, but can be reduced by any dollars you first use
from your HSA for covered services.
$2000 $4000
Then, you pay coinsurance for covered services
80%/80% for in-network services
60%/80% for out-of-network services
Plan pays 100% after annual out-of-pocket maximum (includes HSA, bridge and coinsurance)
In-Network
Out of
Network
In-Network
Out of
Network
$5000 $10000 $10000 $20000
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Sample HSA Consumer ExperiencePharmacy Service
1) Consumer visits pharmacy to fill a
prescription
2) Pharmacy connects to Anthem to determine consumer’s benefit
3) Anthem determines consumer’s benefits “real-time” and passes back to pharmacy the amount the consumer is
responsible for paying
4) Pharmacy provides consumer with
prescription and charges the
appropriate amount
5) Consumer uses HSA checkbook
or debit card to access
HSA funds and pay
pharmacy
Rx
$
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1) Consumer visits physician
2) Physician submits claim to Anthem
3) Anthem applies benefits and notifies physician of the
amount the consumer is responsible for paying
5) Physician sends bill to consumer
6) Consumer uses HSA checkbook
or debit card to access
HSA funds to pay
physician
4) Anthem sends consumer Claims Recap record of benefit applied
$
$
Sample HSA Consumer ExperiencePhysician Service
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HSA Integration
• Employer product set-up• One combined health plan and HSA employer application
• Consumer enrollment• One combined health plan and HSA consumer application
• Employer funding implementation• Plan-based resources and partner bank resources that will support employers’ efforts to
facilitate payroll-based funding
• Customer service• Customer Service Advocate can assist with all benefit information, level 1 HSA account
service, and warm-transfers to partner bank for level 2 support
• Consumer portal• Consumers will come to anthem.com for both their benefit and HSA details
• HSA consumer communications• Consumers will receive all of their benefit and banking enrollment materials from Anthem
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BNY Mellon 172
ACS 423
Bank of New York Mellon and ACS
The HSA product is administered by professionals in banking, employee benefits, insurance and administration.
• Market leader providing business process and IT outsourcing• More than 63,000 employees
• Human resource consulting and deep insurance expertise
• Nation’s largest HSA administrator in partnership with BNY Mellon
• Extensive footprint in benefits consulting and outsourcing services
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Interest Rates and Fee Overview
For the period July 1, 2008, through December 31, 2008, the interest rate to be credited to the Health Savings Account will be 1.0325%. (Rate fluctuates every 6 months)
Fee Overview:
One-time setup fee ($15) and monthly maintenance fees ($2.95) are paid by Employee (standard)
• 51-99 groups have rider option for ER to pay above fees
• 100+ groups have 3 fee payment options: • ER pays setup and monthly fees
• ER pays setup fee and EE pays monthly fees
• ER pays monthly fees and EE pays setup fee
Account Closure = Free, if closed by check
Checks
• No charge for initial checkbook(40); $10 for additional books
• No fees for writing checks; Replacement/ additional debit card $5
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Consumer Experience
After choosing Anthem’s Lumenos HSA plan, consumers will:
Receive an HSA Welcome Kit from Anthem at their home address with their account number; kit to include:
• Cover Letter with Account Activation Instructions
• Consumer Signature Card (Master Signature document)
• Fee & Rate Schedule
• Deposit ticket
• HSA Combined Deposit Agreement and Disclosure Documents
• Return envelope for Master Signature document
Complete paper signature card/eSignature to activate account
Receive debit card and checkbook
Receive monthly bank account statements and year end reports for tax purposes (include 1099-SA sent in January and 5498-SA sent in May)
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Incentive Rewards
Allocations to HSA for Self Insured Groups ONLY• Reward dollars earned are
deposited directly into the consumer’s HSA
• Reward allocations are tax-free to the employee, so amounts count toward the annual HSA contribution limit
• Use like any HSA funds -- tax-free if used for qualified medical expenses
Credit Dollars to redeem for Gift Cards for Fully Insured Groups • Provided through our partner, IncentOne
• When reward is earned, consumer receives notification by mail
• Consumer redeems reward dollars for a gift card, online or by phone, choosing from a select list of fitness and wellness-focused retailers like Foot Locker, Dick’s Sporting Goods and the Sports Authority
• Rewards are taxable, and consumer will receive a 1099 form if they redeem rewards over $600 in a single year
Anthem's Lumenos HRA and HIA Plus Plans
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Anthem's Lumenos HRA Plan
• Consumers use employer-funded HRA dollars to pay for covered expenses
• Earn more dollars for their HRA through rewards for healthy behaviors
• Preventive services are covered at 100% In-Network
• Unused HRA dollars roll over from year to year and can be used for future health care expenses; employer caps may apply
• Traditional Health Coverage covers expenses after the bridge
HRA
Funded by annual employer allocation
Plus
Additional reward dollars
Preventive Care100% In-Network
Traditional Health Coverage
Out-of-Pocket “bridge” to Traditional Health Coverage
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HRA Plan Details At-a-Glance
*Bridge = annual deductible minus annual HRA allocation
Lumenos HRA Single Coverage Family Coverage
Preventive Nationally recommended services
No cost, no deduction from HRA with in-network providers
HRA Employer’s annual allocation
$1000
$3000 rollover max
$2000
$6000 rollover max
Traditional Health
Coverage
Bridge* amount to satisfy deductible
$1500 $3000
Then, you pay coinsurance for covered services
100%/100% for in-network services
70%/100% for out-of-network services
Plan pays 100% after annual out-of-pocket maximum (includes HRA, bridge and coinsurance)
In-Network
Out of
Network
In-Network
Out of
Network
$2500 $5000 $5000 $10000
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Anthem's Lumenos HIA Plus Plan
• Works like an HRA, except the account allocations are provided by Anthem as a part of the health plan
• Consumers earn more dollars for their HIA through rewards for healthy behaviors
• Preventive services are covered at 100% In-Network
• Unused account dollars roll over from year to year; caps may apply.
• Traditional Health Coverage covers expenses after the bridge
HIA Plus
Funded by annual plan allocation
Plus
Additional reward dollars
Preventive Care100% In-Network
Traditional Health Coverage
Out-of-Pocket “bridge” to Traditional Health Coverage
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HIA Plus Plan Details At-a-Glance
*Bridge = annual deductible minus annual HIA allocation
Lumenos HIA Plus Plan Single Coverage Family Coverage
Preventive Nationally recommended services
No cost, no deduction from HIA with in-network providers
HIA Plus You receive an annual allocation $750 $1500
Traditional Health
Coverage
Bridge* amount to satisfy deductible
$2500 $5000
Then, you pay coinsurance for covered services
80%/80% for in-network services
60%/80% for out-of-network services
Plan pays 100% after annual out-of-pocket maximum (includes HIA, bridge and coinsurance)
In-Network
Out of
Network
In-Network
Out of
Network
$5000 $10000 $10000 $20000
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Integrated Plans
• Employer product set-up: • One combined health plan and HRA employer application (no additional
paperwork)
• Consumer enrollment: • One combined health plan and HRA member application (no additional
paperwork)
• Direct payment from plan to providers and pharmacy
• Customer service: • Customer Service Advocate can assist with all benefit information as
well as health account service
• Consumer portal: • Consumers go to anthem.com for both their benefit and plan details
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Sample HRA/HIA Plus Consumer ExperiencePharmacy Service
1) Consumer visits pharmacy to fill a
prescription
2) Pharmacy connects to Anthem to
determine consumer’s benefit and funds
available
3) Anthem determines consumer’s benefits
and HRA funds available “real-time”
4) Anthem debits consumer’s HRA and pays pharmacy for the
prescription
5) Pharmacy provides consumer with prescription.
Consumer pays nothing out of pocket. $
Rx
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1) Consumer visits physician
2) Physician submits claim to Anthem
3) Anthem determines consumer’s benefits
and HRA funds available
4) Anthem applies benefit and debits consumer’s
HRA then pays physician for the services
5) Anthem sends consumer Claims Recap record of benefit applied and account funds used
$
$
Sample HRA/HIA Plus Consumer ExperiencePhysician Service
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Account Proration10/1, 11/1 and 12/1 Effective Dates
• Annual allocation is prorated based on the month the member joins the plan. (1/12 for each month in the plan)
• 10/1 Members will receive 3/12th of full allocation
• 11/1 Members will receive 2/12th of full allocation
• 12/1 Members will receive 1/12th of full allocation
Available in 2009 for Large Groups Only
• Calendar year groups with HRA and HIA Plus can choose monthly or quarterly allocation
• Plan year groups with HRA and HIA Plus will have monthly allocation
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Monthly ProrationOption for All 12/1/2008 Groups
Monthly Proration Standard
Member #1 enrolls in Lumenos planon 1/1, member receives full HRA allocation
Member #2 enrolls in Lumenos plan on 7/1, member receives 6/12ths the full HRA allocation
Both Member #1 and Member #2 receivefull allocation 1/1/2010
Group Effective Date 1/1/2009
January 2009
July 2009
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Quarterly Proration ScenarioOption for Large Groups Only: HRA and HIA Plus
Quarterly Proration Standard
Member #1 enrolls in Lumenos planon 1/1, member receives full HRA allocation
Member #2 enrolls in Lumenos plan on 11/1, member receives one quarter of the full HRA allocation
Both Member #1 and Member #2 receivefull allocation 1/1/2010
Group Effective Date 1/1/2009
January 2009
November 2009
Anthem's Lumenos HIA Plan
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Anthem's Lumenos HIA Plan
• Companion product to introduce elements of consumerism
• Can replace an existing PPO offering with a similar PPO plan design
• Preventive services are covered at 100% In-Network
• Has the added benefit of financial rewards for healthy behaviors
• Includes Traditional Health Coverage to cover expenses after the bridge
• Also includes all of the tools, services and programs to encourage and reward positive consumer behavior Traditional Health
Coverage
HIA
Funded by reward dollars
Preventive Care100% In-Network
Out-of-Pocket “bridge” to Traditional Health Coverage
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HIA Plan Details At-a-Glance
Lumenos HIA Plan Single Coverage Family Coverage
Preventive Nationally recommended services
No cost, no deduction from HIA with in-network providers
HIA Earn reward dollars
Traditional Health
Coverage
Bridge amount to satisfy deductible
Your bridge amount is your annual deductible, but will be reduced by any
HIA dollars you have available.
$750 $1500
Then, you pay coinsurance for covered services
90%/80% for in-network services
70%/80% for out-of-network services
Plan pays 100% after annual out-of-pocket maximum (includes HIA, bridge and coinsurance)
In-Network
Out of
Network
In-Network
Out of
Network
$2750 $5500 $5500 $11000
Consumer Support
High-touch Service and
High-tech Online Health Site
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Help and Information When Members Need It
• Dedicated service centers
• Customer Service Advocates with in-depth Lumenos plan knowledge
• One single point of contact
• Plan and account information
• Monthly Health Statement and Claim Recap – combining benefits and account status information
• Online Health Site
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Sample Monthly Health Statement and Claim Recap
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Doctor Info
• Find a doctor by name, specialty or location
• See how much they’ll charge for typical services and if they offer network discounts
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360 Degree Health: Online Health Tools
• MyHealth Assessment
• Preventive Care Guides
• MyHealth Record
• Condition Centers
• Surgical Guides and Hospital Comparisons
• Traditional and Alternative Health Library
• And more
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Health Assessment Features:
• Consumer connect to assessment via Health Assessment link
• Completes assessment
• Views results
• Is presented with option to sign up for Personal Health Coach Services
360 Degree Health: Health Assessment Screen
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Prepare for Surgery Features:
• Search key phrases and view results
• View sample procedure, complete with audio
• Link to resources and FAQ’s to help prepare for the procedure
360 Degree Health: Prepare for Surgery Screen
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Healthcare Advisor (Subimo):
• Accessed via Hospital Comparison link in the left hand navigation of the MyHealth landing page
• Option to search en Espanol returns Subimo results page in Spanish (left nav will be in English)
• Includes:
– Hospital search options by:
• Procedure
• Name
• Geographical proximity
360 Degree Health: Subimo Content Screen
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• Label warnings
• Drug Interactions
• Side Effects
• Precautions
• Cost comparison:– Accessible via Drug Cost link in left hand navigation MyHealth landing page
– Consumer enters geographic search criteria
– Results are displayed per local pharmacy based on recent purchases of drug
360 Degree Health: Cost Comparison
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Online Tools to Manage Health Care Dollars
Account Analysis:
• Available via Account Analysis link from Account Activity page
• Results are displayed graphically by:
– How expenses were paid (shown)
– Type of service received
– Date parameters selected by the Consumer
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Monthly Health Statement and Claim RecapClaims Information:
• Available via “View Claims” button in Account Analysis screen, Claims link from left hand navigation or “Claims” tab in global header
• Displays:
– Claim summary
– Search options
– Display of claim in scrollable/print friendly table format
– Note - claim types (e.g., Rx, Medical) will not be integrated in a single screen as shown
Product Portfolio, Account Funding and Plan Considerations
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Offerings and Product Approaches
Full suite of CDHP options allows for personalized strategies for employers
• Single Lumenos CDHP offering
• Multiple CDHP pairings – for example, HRA or HSA paired with HIA to replace (transition from) existing PPO
• Lumenos CDHP offered alongside a non-CDHP
63
Anthem’s Lumenos Product Portfolio
19 HSA Plans:• 7 core plan designs with varying deductibles, coinsurance, OOP
maximum levels
• Plans can be sold with or without incentives
• Five incentive plans can be sold with embedded deductibles
26 HRA & 24 HIA Plus Plans• 7 core plan designs with varying deductibles, coinsurance, OOP
maximum levels
• Plans can be sold with either 3x maximum contribution rollover max or unlimited maximum rollover
6 HIA Plans• All HIA plans have Unlimited Rollover Contribution Max
All Products use the BCBSGA PPO Network
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HSA Embedded Deductible
Deductible amounts contributed by an individual family member will apply to the family deductible amount.
An individual family member is not required to contribute more to the family deductible than their single deductible amount.
Account funds are not embedded for individual family members, and can not be customized.
HSA plans meet all IRS requirements.
HSA Embedded Deductible has a higher premium than non-embedded HSA products.
65
Example HSA with embedded deductible:
Family of three.Family deductible: $5,000.Embedded individual deductible: $2,500 (each person).
Person 2 meets $800.
Remaining unmet family deductible: $1700 ($5,000 – $3,300).
The remaining $1700 can be fulfilled by any combination of Person 2 and Person 3.
Person 1 meets $2,500. That person’s individual deductible is now met. Future claims for that person are subject to coinsurance.
Embedded Deductible Example #1
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Example HSA with embedded deductible:
Family of four.Family deductible: $6,000.Embedded individual deductible: $3,000 (each person).
Person 2 meets $1,000.
Remaining unmet family deductible: $1000 ($6,000 – $5,000).
The remaining $1000 can be fulfilled by any combination between Person 2, Person 3 and Person 4.
Person 1 meets $3,000. That person’s individual deductible is now met. Future claims for that person are subject to
coinsurance.
Embedded Deductible Example #2
Person 3 meets $1,000.
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Local CDH Plans vs Lumenos CDH Plans
Benefit Description
Current Benefit
(Local GA CDHP)
New Benefit
(GA Lumenos)
TMJ $5,000 lifetime maximum $15,000 lifetime maximum
Hospice $10,000 lifetime maximum No lifetime maximum
PHP Not covered Plan to cover with 10 visits/yr once DOI approval received
IOP Covered unofficially using the visit limits under the regular MH outpatient benefit
Plan to cover as a real benefit with separate visit limits (10/yr) once DOI approval received
Mental Health Mental health services do not apply to the OOP max
Mental health services will apply to the OOP max
Urgent Care Center
Covered unofficially using the current specialist office visit coinsurance amount
Plan to cover using new UC benefit once DOI approval received
Mail Order Rx Not Covered Covered through Next Rx
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Account Funding Availability
Medical Funding
Account Funding
Contribution Dollars Incentive Dollars
HSA
-ASO N/A Employer Funded
-Fully Insured N/A Employer Funded
HIA
-ASO N/A Employer Funded
-Fully Insured N/A Plan Funded
HIA Plus ° -Fully Insured Plan Funded Plan Funded
HRA
-ASO Employer Funded Employer Funded
-Fully Insured Employer Funded Employer Funded
Blended Funding° Not available for ASO
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HRA Blended Funding
Medical is fully insured
Incentives and account are self-insured/ASO
Employer groups will receive:
• Premium bill
• Bill for account dollars and incentive dollars used
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Criteria for Qualifying Accounts for CDHP
Employer Drivers for CDHP
1. Interested to cost containment solutions along with empowering employees to take charge of their health care
2. Interest in health/disease management
3. Innovative and/or wellness oriented
4. Employee self-service oriented
5. Has a broker or consultant who is a proponent of CDHP
6. Internal CDHP champion or management support/imperative
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Plan Comparison
Feature HSA HRA HIA Plus HIAWho contributes? Employer and/or
EmployeeEmployer only Health Plan Earned through
incentives
Account funded? Yes No No No
Funds availability? When deposited in the account
Immediate Immediate When incentives are complete
Ownership balances at termination?
Remain with consumer
Return to employer Return to healthcare insurance provider
Return to employer
Contributed maximums?
Lesser of the annual deductible or IRS maximum
Dictated by plan design
Dictated by plan design
Dictated by plan design
Allowable medical expenses?
213(d) expenses – employee discretion
Plan covered - employer discretion
Plan covered - employer discretion
Plan covered - employer discretion
Account ownership? Employee Employer Health Plan Employer
Portability? Yes – completely Yes – employer discretion
Yes - employer discretion
Yes - employer discretion
Financial partner requirement?
Bank or Trust N/A - Notional Account
N/A - Notional Account
N/A - Notional Account
Investment options? Yes No No No
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Criteria for CDHP Product Selection
What is our optimal and/or desired
product strategy?
Where are we today and how much ground to
cover?
Short-term & long-term tactical
options?
Importance of plan choice
Organization's tolerance for change
Employee receptivity to change
Employee communication
Employee contribution
Avg employee income
Current plan design value
Cost control/trend mitigation goal
Employee turnover
Account portabilityNot Important Important
Moderate Aggressive
High Low
Low High
High Low
Passive Aggressive
Low High
Low High
Low High
High Low
HRA/HIA Plus HSA
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CDHP Key Features
Consumers have choices
Different ways to fund deductible
• HSA, HRA, HIA Plus, HIA
Expanded preventive care services
Superior tools for consumer
• RX drug cost info
• Hospital quality ratings
• Health Assessment
• Enhanced Surgical Decision Support
360 Degree Health and Personalized Health Coach
Consumer Communications
More than just an enrollment event!
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• Behavior change is more than an “enrollment” event
• Ongoing commitment by the organization to provide the “catalyst” and “cultural support system” to make these changes will impact both the short-term and long-term success
Individuals need constant reinforcement and support to process the change:
To change Need to change
In change activities
Maintenance of new healthy
lifestyle
Creating a Health Culture
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Sample consumer communications
MyHealth Assessment
Health Coaching
PrescriptionDrug Costs
Condition-specific mailings:Asthma
Fitness
High Blood Pressure
Lower Back Pain
Hypertension &High Cholesterol
Repetitive Education and Outreach
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Sample Online Health Site
78
Sample “Did You Know” Poster/E-mail
79
Sample Pre-Enrollment Website
80
Sample Open Enrollment Packet
81
Sample Open Enrollment Packet (cont’d)
82
Sample Open Enrollment Packet (cont’d)
Next Steps for Your Groups with BCBSGA
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Forms Needed – Small and Large Group
HSA Agreement
HSA Worksheet
HRA – HIA Agreement
Lumenos Blended Product Banking Form (HRA)
Member Enrollment Forms
All forms must be collected at front end of group set up process. For HSA’s with Bank of New York Mellon, paperwork must be received 30 days before effective date.
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Member Administrative Comparison
Anthem’s Lumenos Plans Paired with a BCBSGa Product (PPO, HMO or POS)
Member Customer Service
877-812-9777 800-441-2273
Member Portal www.anthem.com www.bcbsga.com
Member ID Card Anthem logo BCBSGa logo
Medical Claims Processing/Payment
PO Box 9907Columbus, GA 31908-6007
PO Box 9907Columbus, GA 31908-6007
Pharmacy Claims Processing/Payment
Next RX – 800 892 8562PO BOX 961025
Fort Worth, TX 76161-9863
PO BOX 9907Columbus, GA 31908-6007
Explanation of Benefits (EOB)
Claim Recap with Anthem logo
EOB with BCBSGa logo
Health Statement Monthly Health N/A
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Employer Administrative Comparison
Anthem’s Lumenos Plans Paired with a BCBSGa Product (PPO, HMO or POS)
Employer Customer Service
800-770-6226 800-770-6226
Employer Portal www.bcbsga.com www.bcbsga.com
Employer Access Not available Available for non Lumenos plans
Employer Invoice Anthem logo invoice Separate BCBSGa invoice
Purchased with Specialty Products (Dental, Life Disability, EAP, etc.)
Same current processes exist
Same current processes exist
Premium Payment by Phone (Groups only)
877-364-2003 877-364-2003
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Broker Administrative Comparison
Anthem’s Lumenos Plans Paired with a BCBSGa Product (PPO, HMO or POS)
Broker Customer Service (non-commissions)
800-770-6226, Option 2
(Post-Sale) 800-770-6226
Broker Customer Service (agent/broker commissions only)
800-922-7302
(Post-Sale) 404-842-8711 for BCBSGa
800-922-7302 for Lumenos
Broker Portal Same Agent/Broker portalwww.bcbsga.com
Same Agent/Broker portalwww.bcbsga.com
Broker Commission Rate Same Standard Commission Schedule Same Standard Commission Schedule
Broker Bonus Programs Anthem Lumenos included Anthem Lumenos included
Single Case Agreement Form Same existing BCBSGa form used Same existing BCBSGa form used; can submit all on one form
Broker Commission Statement Separate Anthem Lumenos Logo and format
Separate BCBSGa commission statement
Broker Commission Payment Schedule
First week of the month for the previous month’s earned/
paid/reconciled premiums. *.
First week of the month for the previous month’s earned/ paid/reconciled premiums.
Electronic Funds Transfer (EFT)
Functionality available Functionality available
* No supplemental commission payments if the group’s premium is paid/reconciled after the standard monthly schedule
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Step 4
ACS/Bank of New York
Mellon activates bank account and
confirms
Group Timeline for Lumenos HSA with Mellon
Member activates account
Welcome Kits mailed
to members’ home
address~ 15 days
Step 3
New group installed
Step 2Step 1
Employer and Member contribute to
account
Member receives
HSA Debit Card
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Renewing Groups
11/1 Renewing Groups:
• May stay on current HDHP plan
• Groups interested in changing HDHP plans are able to select a Lumenos plan
12/1 (and after) Renewing Groups:
• May stay on current HDHP plan
• Groups interested in changing HDHP plans must select a Lumenos plan
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Launch Update & Resources
Online quoting tool is updated (New Business 51-99)
Side by side comparison grids are available on website
Marketing Collateral available
HSA Agreement is available if choosing ACS/Mellon
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Five Ways Our CDH Plans Are the Best
1. Coherent clinical strategy with proactive health management
2. BCBS brand and BlueCard network
3. Innovation
4. Integrated product
5. Results
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Legal Disclaimer
The Anthem National Accounts business unit serves members of the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as Empire Blue Cross Blue Shield in 17 eastern and southeastern counties, including the 5 New York City counties, and as Empire Blue Cross in 11 upstate counties), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company in Ohio. In Virginia: Anthem Health Plans of Virginia, Inc. (serving Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123.) In most of Missouri: RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”) underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”) underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Blue Cross and Blue Shield of Georgia and Blue Cross Blue Shield Healthcare Plan of Georgia, Blue Cross of California and BC Life & Health Insurance Company, In New York: Empire Blue Cross Blue Shield is the trade name of Empire HealthChoice Assurance, Inc and Empire Blue Cross Blue Shield HMO is the trade name of Empire HealthChoice HMO, Inc. Independent licensees of the Blue Cross and Blue Shield Association. ® Anthem, Lumenos and 360°Health are registered trademarks. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.