2014 ACA Individual Products Overvie · Anthem HealthKeepers Core Direct Access w/HSA - cacd ;...

It’s a new world for health care and Anthem is leading the way!

1

Anthem Blue Cross Blue Shield

2014 ACA

Individual Products Overview

2

• This training information is strictly for Anthem’s use to train agents and for the agent’s personal reference thereafter

• This training information is never to be used for customer communication, any form of sales situations, and never to be shared with the competition

• Misuse of Anthem training materials, including the examples named above, will result in the loss of your appointment with Anthem

Important Reminder For Training Purposes Only

•Open Enrollment •Benefit Designs •Provider Network •Marketplace Subsidy Eligibility •Premiums •Transition Strategy For NGF Policies •Materials

Agenda – Individual Markets

3

Initial Open Enrollment 10/1/13 – 3/31/14

If Open Enrollment is missed:

▪ Tax penalty ▪ Wait until next Open

Enrollment, or… ▪ Enroll during Special

Enrollment Period (Requires a qualifying event)

Initial Open Enrollment Period

4

5

•Start submitting ACA applications October 1st •Effective date for applications received by Anthem prior to December 16th will be January 1st

•The earliest effective date for applications received by Anthem… ▪ December 16th through January 15th will be

February 1st ▪ January 16th through February 15th will be March 1st ▪ February 16th through March 15th will be April 1st ▪ March 16th through March 31st will be May 1st

Effective Date Guidelines

6

Anthem HealthKeepers Individual Portfolio

• Individual will offer Marketplace and off Exchange plans • All of Anthem’s Marketplace and off exchange products will utilize an HMO plan

type with open access • The new Pathway X Tiered Hospital network will be used on the Marketplace plans.

Off exchange products will use the new Pathway Tiered Hospital network.

Metal On-Exchange Off-Exchange

Bronze 5 plan options 5 plan options

Silver 4 plan options 4 plan options

Gold 2 plan options 2 plan options

Platinum Not available Not available

Catastrophic Available to those under age 30 before the plan year begins,

OR those that qualify for a hardship exemption.

For nationally registered American Indians under 300% of FPL; Bronze, Silver and Gold plans will have 0% cost shares for all EHB. This option is available on Marketplace plans only.

7

VA HealthKeepers Individual Marketplace Portfolio

Plan Name

Deductible S/F

Plan Coins.

Office Visit Annual OOPM

S/F Pharmacy

Inpatient / Outpatient Hospital

Emergency Room

(Facility) PCP Specialist CATASTROPHIC Anthem HealthKeepers Catastrophic Direct Access

$6,350/ $12,700 0%

3 before Ded @$40 * Ded / Coins

$6,350/ $12,700

Ded / Coins Ded / Coins Ded / Coins

BRONZE

Anthem HealthKeepers Bronze Direct Access - caam

$5,500/ $11,000 25%

$40 2 OV with copay;

3+ OV = Ded/Coins * Ded / Coins

$6,350/ $12,700

Ded / Coins

Tier 1 Hosp: Ded + 25% Tier 2 Hosp: Ded + 50% Ded + 35%

Anthem HealthKeepers Bronze Direct Access w/HSA - caas

$6,000/ $12,000 15% Ded / Coins Ded / Coins

$6,350/ $12,700

Ded / Coins Ded / Coins Ded + 15%

Anthem HealthKeepers Bronze Direct Access - cabw

$4,500/ $9,000 35%



$6,350/ $12,700

Ded / Coins

Tier 1 Hosp: Ded + 35%

Tier 2 Hosp: Ded + 50% Ded + 45%

Anthem HealthKeepers Bronze Direct Access w/ Child Dental – cdbw

$4,500/ $9,000 35%



$6,350/ $12,700

Ded / Coins



Anthem HealthKeepers Bronze Direct Access w/HSA - cacd


$6,200/ $12,400

Ded / Coins



* Office visit copays include the office visit only. Other services like lab work provided during the visit would be subject to the deductible and coinsurance.

8

VA HealthKeepers Individual Marketplace Portfolio continued…

Plan Name

Deductible S/F

Plan Coins.


S/F Pharmacy


Emergency Room

(Facility) PCP Specialist SILVER

Anthem HealthKeepers Silver Direct Access - cbau

$3,350/ $6,700 15% $45* Ded / Coins

$5,500/ $11,000

Tier 1: $15 Tier 2: $40

Tiers 3&4: Med Ded/ Coins



Anthem HealthKeepers Silver Direct Access - cbfs

$2,600/ $5,200 20%


4+ OV = Ded/Coins* Ded / Coins

$6,000/ $12,000

Tier 1: $15 Tier 2: $40



Anthem HealthKeepers Silver Direct Access - cbjs

$2,250/ $4,500 20% $35* Ded / Coins

$6,350/ $12,700

Tier 1: $15 Tier 2: $40


Tier 1 Hosp: Ded + 20% Tier 2 Hosp: Ded + 50%

Ded + 30%

Anthem HealthKeepers Silver Direct Access - cbky

$1,500/ $3,000 30%



$5,500/ $11,000

Tier 1: $15 Tier 2: $40



GOLD

Anthem HealthKeepers Gold Direct Access - ccam

$750/ $1,500 20% $30* Ded / Coins

$3,500/ $7,000

Tier 1: $15 Tier 2: $40



Ded + 30%

Anthem HealthKeepers Gold Direct Access w/ Child Dental - cdda

$750/ $1,500 20% $30* Ded / Coins

$3,500/ $7,000

Tier 1: $15 Tier 2: $40



Ded + 30%


9

VA HealthKeepers Individual Off Exchange Portfolio

Plan Name

Deductible S/F

Plan Coins


S/F Pharmacy


Emergency Room

(Facility) PCP Specialist

CATASTROPHIC

Anthem HealthKeepers Catastrophic Direct Access

$6,350/ $12,700 0%

3 before Ded @$40* Ded / Coins

$6,350/ $12,700

Ded / Coins Ded / Coins Ded / Coins

BRONZE

Anthem HealthKeepers Core Direct Access - caam

$5,500/ $11,000 25%



$6,350/ $12,700

Ded / Coins


Anthem HealthKeepers Core Direct Access w/HSA - caas


$6,350/ $12,700

Ded / Coins Ded / Coins Ded + 15%

Anthem HealthKeepers Core Direct Access - cabw

$4,500/ $9,000 35%



$6,350/ $12,700

Ded / Coins



Anthem HealthKeepers Core Direct Access w/ Child Dental – cdbw

$4,500/ $9,000 35%



$6,350/ $12,700

Ded / Coins



Anthem HealthKeepers Core Direct Access w/HSA - cacd


$6,200/ $12,400

Ded / Coins




10

VA HealthKeepers Individual Off Exchange Portfolio continued…

Plan Name

Deductible S/F

Plan Coins


S/F Pharmacy


Emergency Room

(Facility) PCP Specialist SILVER

Anthem HealthKeepers Essential Direct Access - cbau

$3,350/ $6,700 15% $45 * Ded / Coins

$5,500/ $11,000

Tier 1: $15 Tier 2: $40




Anthem HealthKeepers Essential Direct Access - cbfs

$2,600/ $5,200 20%



$6,000/ $12,000

Tier 1: $15 Tier 2: $40



Anthem HealthKeepers Essential Direct Access - cbjs

$2,250/ $4,500 20% $35 * Ded / Coins

$6,350/ $12,700

Tier 1: $15 Tier 2: $40



Ded + 30%

Anthem HealthKeepers Essential Direct Access - cbky

$1,500/ $3,000 30%



$5,500/ $11,000

Tier 1: $15 Tier 2: $40



GOLD

Anthem HealthKeepers Preferred Direct Access - ccam

$750/ $1,500 20% $30* Ded / Coins

$3,500/ $7,000

Tier 1: $15 Tier 2: $40



Ded + 30%

Anthem HealthKeepers Preferred Direct Access w/ Child Dental - cdda

$750/ $1,500 20% $30* Ded / Coins

$3,500/ $7,000

Tier 1: $15 Tier 2: $40



Ded + 30%


11

To be compliant in 2014, our Marketplace and off exchange plans will include the following 10 Essential Health Benefits (EHB).

• Preventive, wellness and chronic disease management services

• Outpatient (ambulatory) care • Emergency services, including emergency room or urgent care • Inpatient Care (hospital stays) • Laboratory services • Prescription drugs • Mental health and substance abuse • Maternity (pregnancy) and newborn care • Pediatric Services • Rehabilitative and habilitative services

Benefit Details

12

▪ All Individual plans will be based on calendar year. ▪ There will be no medical underwriting and no pre-existing condition waiting

periods for Marketplace and Off Exchange plans. Legacy grandfathered products will continue to work as they do today.

▪ Dependent children will be covered through the end of the month that they turn age 26.

▪ Federal Mental Health Parity laws will apply to Individual. All of Anthem’s plans are compliant.

▪ All Services are subject to the deductible except: • Preventive Services • PCP copays (when applicable) • Tier 1/Tier 2 pharmacy copays (when applicable)

▪ Embedded services including the deductible, copays, and prescription drugs expenses will apply to the out-of-pocket maximum. This does not include standalone dental plans.

Benefit Details

13

Standard benefit limits include: ▪ Physical / Occupational therapy – 30 combined visits per calendar year

▪ Speech therapy – 30 visits per calendar year

▪ Spinal Manipulation & Manual Medical Therapy Services: 30 visits per calendar year. Services must be received by providers that participate in the American Specialty Health Networks (ASHN)

▪ Skilled Nursing - 100 days per stay

▪ Home Health Care - 100 visits per calendar year

▪ Early Childhood Intervention is unlimited up to 3 years old and must be certified for Early Intervention.

Benefit Details

14

▪ Family Planning - No coverage for elective abortions, with the exception of rape and incest.

▪ Maternity benefits are embedded in all plans. In addition, this includes coverage for dependents. No conception waiting periods for maternity benefits.

Benefit Details

15

VA HealthKeepers Individual Pharmacy Coverage

• Marketplace and Off exchange plans will have 4 Tiers – Tiers 1 and 2 will include both generic and brand drugs; Tiers 3 & 4 will include higher priced brand and specialty drugs.

• The pharmacy designs will include:

Bronze Deductible/Coinsurance

Tier 1 Medical Deductible then Coinsurance




Silver/Gold 4 Tier Copay

Tier 1 $15 copay

Tier 2 $40 copay



Drug Lists: • “Closed” design • Drugs not on list (formulary) are not covered

•Meets ACA requirements

Drug Lists

16

17

VA Pharmacy Network

National Plus

network

Approximately 65,000 pharmacies which includes

Walgreens and CVS!

18

Mail Order

Home Delivery Education

• Voluntary mail order

• Members educated on convenience and savings

• Option of filling at mail or retail

Home Delivery Complete

• Mandatory mail order

• Allowed 2 courtesy fills at retail

• Member must fill maintenance medications at mail thereafter

Home Delivery Choice

• Members educated on convenience and savings

• Option of filling at mail or retail

• Must notify ESI of their choice before 3rd fill

19

Pharmacy Plans

Rx Design 1: Tier 1 $15 Copay Tier 2 $40 Copay Tier 3 Medical Ded & Coins Tier 4 Medical Ded & Coins

Rx Design 2: Tier 1 Medical Ded & Coins Tier 2 Medical Ded & Coin Tier 3 Medical Ded & Coins Tier 4 Medical Ded & Coins

Mail Order: (90 day supply) Tier 1 2 x Copay Tier 2 2.5 X Copay Tier 3 Medical Ded & Coins Tier 4 Not Covered

Ranges do not include the Silver Subsidy or Native American Marketplace plans.

20

• Pediatric Vision ▪ Embedded in all products both on the Marketplace and Off

Exchange • Pediatric Dental ▪ Embedded in one Bronze plan and one Gold plan both on the

Marketplace and off exchange ▪ Stand-alone dental plans are available for the other products

• Adult Vision ▪ Not offered as stand-alone on the Marketplace and Off

Exchange plans • Adult Dental ▪ Offered as stand-alone on the Marketplace and Off Exchange

plans

VA HealthKeepers Individual Specialty Coverage

21

▪ Consumers can purchase an optional Bariatric Surgery rider, with Marketplace and Off Exchange plans.

▪ Bariatric surgery is a mandated “make available” rider in VA and can be purchased with plan options during open enrollment or during a qualifying event.

▪ The rider’s premium is $1,250 per member per month for consumers 21 years of age and older.

▪ The rider will not be visible or quoted on the Marketplace or on Anthem’s Shopper Portal. Consumers will be advised to contact Anthem directly for additional information.

Optional Benefits (Riders)

22

▪ All Individual VA plans will utilize the new HMO networks • Pathway X Tiered Hospital – Marketplace plans(the “X”

signifies Marketplace) • Pathway Tiered Hospital – off exchange plans

▪ These plans will be “Direct Access” which means that a gatekeeper and referrals are not required.

▪ Coverage outside of the network will only cover emergency and urgent care.

▪ Covered chiropractic services must be received by providers that participate in the American Specialty Health Networks (ASHN) http://www.ashcompanies.com

Provider Network

http://www.ashcompanies.com/

Non-Par Hospital City/Town

1 Bedford Memorial Hospital Bedford

2 Bon Secours Memorial Regional Medical Center Mechanicsville

3 Bon Secours Richmond Community Hospital Richmond

4 Bon Secours St Francis Medical Center Midlothian

5 Bon Secours St Mary’s Hospital Richmond

Provider Network

Hospitals and providers are the same on the Marketplace and Off Exchange with the exception of the hospitals below. These hospitals are considered Out of Network on the Pathway X Tiered Hospital network.

23

The following in network hospitals are designated as Tier 2 hospitals both on Marketplace and off exchange plans.

Provider Network – Tier 2 Hospitals

IN-NETWORK TIER 2 HOSPITALS CITY

Medical College of Virginia Richmond

Carilion Medical Center Roanoke

University of Virginia Charlottesville

Mary Immaculate Hospital Peninsula

Bon Secours Maryview Medical Center Tidewater

Bon Secours DePaul Medical Center Tidewater

Mary Washington Hospital Fredericksburg

24

25

Two Types of Subsidies: ▪ Premium Subsidies ▪ Cost-Sharing Subsidies

Marketplace Premium & Cost Share Subsidies

On-Exchange

Only

To be eligible for Premium Subsidies, individuals must:

Have household income between 100% and 400% of the federal poverty level (FPL), and

not have access to minimum essential coverage through their employer or have access to coverage that is not affordable

In addition, Individuals with household incomes between 100% and 250% of the FPL, are eligible for Cost Sharing Subsidies on Marketplace Silver plan options only.

Individuals who qualify for a subsidy must enroll in a Marketplace plan to receive the assistance.

26

Marketplace - Cost Share Subsidy Example

Benefit subsidy example

> 250% of FPL

68 - 72%

200 to 250%

72 - 74%

150 to 200%

86 - 88%

100 to 150%

93 - 95%

Silver (Original plan) 68.0 - 72.0%

Ded/Coin/OOP $3350/15%/$5500

OV PCP - $45 SPC – Ded/15%

RX Tiers 1/2 :$15/$40 Tiers 3&4 : Med Ded/Coins

ER – 25%; Inpatient/Outpatient Hospital: Tier 1 - 15%; Tier 2 – 45%

Silver (Subsidy) 72 - 74%

Ded/Coin/OOP $2350/15%/$4500

OV PCP - $40 SPC – Ded/Coins




Ded/Coin/OOP $750/15%/$1500





Ded/Coin/OOP $200/15%/$650




Cost shares (deductibles, co-pays, coinsurance) cannot be greater than the base plan

Base Plan

27

ACA does not allow insurers to…

▪ Use health underwriting to determine rates. ▪ Impose pre-existing waiting periods on plans with January 1, 2014 or after

effective dates.

Insurers can only use the following to determine rates… • Age • Where the applicant lives and • Whether the applicant uses tobacco.

Gender cannot be a factor when determining rates.

How Does ACA Impact Insurers? Determining Rates

Changes that Affect Premium

28

Guaranteed issue No one can be denied coverage

Broader benefits and limits 10 types of Essential Health Benefits required, out-of-pocket limits and deductible restrictions

At least 60% actuarial value Plans pay at least 60% of covered services

Subsidies/credits Help those with low or moderate incomes pay for coverage

Reinsurance program Insurers / TPAs / self-funded plans contribute to fund high claims

New taxes and fees Apply to certain plans

Change in rating Rates based on age, address and tobacco use. Not gender and health status

29

•There will be 12 rating areas in Anthem’s Virginia service area.

•1st month premium is not required to be submitted with the application for Marketplace plans. However, Anthem will require payment of the 1st month’s premium prior to enrollment.

•1st month premium is required to be submitted with the application for Off Exchange plans.

•Quotes for ACA compliant plans will be done on the broker portal.

•You will continue to use the Prospector to run quotes for non-ACA plans sold prior to January 1, 2014.

Premiums

30

On Producer Online News… •Retaining Your Individual Clients (9/9/13)

•Open Enrollment mailing to your Clients (10/2/13)

Non-Grandfathered Members Plan Transition Options

31

•The materials for Marketplace and off exchange plans are different.

•Order ACA compliant materials the same way you order under age 65 materials today. Click on the Order Materials button on your broker portal.

•Materials are also available online for printing and emailing.

Materials

32

www.makinghealthcarereformwork.com

www.healthcarereformforyou.com

www.healthactionnetwork.com

www.healthcare.gov

ACA Websites

http://www.makinghealthcarereformwork.com/

http://www.healthcarereformforyou.com/

http://www.healthactionnetwork.com/

http://www.healthcare.gov/

33

1-866-255-4745

[email protected]

Call or email the new helpline for assistance with… ▪ Quoting new plans ▪ Subsidy eligibility ▪ Producer toolbox ▪ Application submission ▪ New product questions

ACA Support Team

mailto:[email protected]

mailto:[email protected]

34

Thank You!

ACA: What to do about it. Small Group

Anthem is ready to help with a range of compliant solutions, plans, tools and communications for your customers.

1

ONE OPTION: Your small group clients can buy some time by remaining on their current plan.

2

You and your client discuss early renewal option

Client completes the Renewal Selection Form no later than 12/1/2013.

You fax the form to Anthem Blue Cross and Blue Shield The number appears on the form.

The early renewal process

14

What this means for you

You have access to the tools you need for a seamless experience. You can get valuable time to evaluate all the options under the new PPACA guidelines. You can help your individual and small group clients find the right solution for their particular circumstances. 4

Another option: Our new plan portfolio—for January 2014 and beyond

Plan variety

Pharmacy

Comprehensive care

Stability

5

Four levels of plans, with plenty of options

PREMIER PLANS (PLATINUM) Highest level of benefits; members pay less for care but have highest monthly premiums PREFERRED PLANS (GOLD) Members pay slightly more for care, slightly less on monthly premiums ESSENTIAL PLANS (SILVER) Affordable monthly premiums, with slightly higher cost of care. Subsidies for lower deductibles and copays may be available CORE PLANS (BRONZE) Lowest monthly premiums with broad benefits; deductibles, copays and cost shares may be higher than other plans

1

2

3

4

6

New Naming Conventions

BRAND NAME Anthem or HealthKeepers BENEFIT LEVEL Premier / Preferred / Essential / Core Platinum/ Gold/ Silver/ Bronze GATEKEEPER OR OPEN ACCESS Guided Access (Gatekeeper) Direct Access (No Gatekeeper) OTHER FEATURES Plus: Includes a Healthy Support Plus Package With HSA, With HRA, With Dental PRODUCT CODE Four letters that will follow the name that identifies the unique benefit structure. This code will be important when you identify the corresponding SBC and enrollment.

1

2

3

5

7

4

8

1. Anthem Premier Direct Access

2. Anthem Preferred Direct Access w/HRA

3. Anthem HealthKeepers Essential Guided Access Plus w/Dental

4. Anthem HealthKeepers Core Guided Access Plus w/ HSA

And..

5. Anthem HealthKeepers GOLD Guided Access Plus

Let’s Practice the Names

9

Note the four-letter Product Code that is included in the plan name

Anthem Premier Direct Access - gwaa Anthem Preferred Direct Access – gjba Anthem Healthkeepers Preferred Direct Access - ghfa

Product Identifier

10

Strength – maintaining our strong network options in Small Group

Competitiveness – adding a new network

Managing Risk – balancing choice and access with utilization

Network Considerations

NETWORK OPTIONS OFF EXCHANGE • KeyCare PPO

– 94% of all Virginia providers

– 100% of all acute care facilities

– Includes BlueCard PPO

• HealthKeepers POS – 82% of all Virginia

providers – 92% of all acute care

facilities – Includes out-of network

benefits

SHOP MARKETPLACE • NEW Pathway X Tiered

Hospital – Built from HealthKeepers – Select Specialists – Tiered Hospitals – Includes out of network

benefits – All SHOP plans use this

new network

11

2014 VA Pathway X Tiered Hospital Network Differences

Non-Par Hospital City/Town

1 Bedford Memorial Hospital Bedford

2 Bon Secours Memorial Regional Medical Center Mechanicsville

3 Bon Secours Richmond Community Hospital Richmond

4 Bon Secours St Francis Medical Center Midlothian

5 Bon Secours St Mary’s Hospital Richmond

13

Small Group Product Strategy

1. Ensure compliance with HCR mandates. 2. Maintain existing book of business. 3. Grow business, offer new product features 4. Focus on Consumer Experience, Affordability, and

Access.

Attract new members with new plan features (Healthy Support Plus)

14 CONSUMER & COMMERCIAL PERFORMANCE SOLUTIONS | COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Meet the needs of current customers

(Retention Portfolio)

Products that are attractive to lower utilizers

Product designs similar to those offered in current SG markets

Leveraging existing drug lists

Plans targeted at lowest premiums at a given Metal level

Valuable to employees engaged in their health & wellness

Leveraging new medical & pharmacy networks and new leaner formulary

Leveraging existing medical & pharmacy Networks

Less Member abrasion with easier transition to new plan

Small Group Product Families

Prescription Drug Coverage Included.

• Plan design and drug list will meet ACA requirements

• ACA requirements may call for fewer drugs to be covered than what is currently covered today. Drug lists may be smaller.

• Hundreds of prescription drugs will be covered

• National network of in-network pharmacies

16

Small Group Product Overview

Feature Value Range

Deductibles $500 - $6,300

Out of Pocket Maximums $2,000 - $6,350

Co-insurance 0% - 50%

PCP Co-Pay $10 - $50

Specialist Co-Pay $20 - $75

17

PRODUCT PORTFOLIO Let’s get into the details.

New Product Designs not offered today

• HSAs with copays – Member pays copay for PCP,

Specialist, Urgent Care and Office based Surgery

– All copays are after deductible

• Healthy Support Plus Products with 3 office visit copays

– Provide three visits to a PCP or a Specialist at a copay

– After 3rd visit, all office visits paid at Deductible/coinsurance

– Any office visit (PCP or Specialist) applies to the 3 visits.

– The limit is per member, not per family

• Plans with Hospital Tiering

When a member goes to a Tiered 2 hospital they would have additional coinsurance for covered benefits.

2014 VA HealthKeepers Tier 2 Hospitals

• These hospitals are still considered In-Network, but designated as Tier 2 facilities.

• There will be two new plans that will include hospital tiering.

IN-NETWORK TIER 2 HOSPITALS CITY

Medical College of Virginia Richmond

Carilion Medical Center Roanoke

University of Virginia Charlottesville

Mary Immaculate Hospital Peninsula Bon Secours Maryview Medical Center Tidewater

Bon Secours DePaul Medical Center Tidewater

Mary Washington Hospital Fredericksburg

Two Plans with Hospital Tiering

• Anthem HealthKeepers Preferred Guided

Access Plus gnbf (20% Tier 1, 40% Tier 2)

• Anthem HealthKeepers Essential Guided

Access Plus gobf (40% Tier 1, 50% Tier 2)

21

A healthy dose of wellness

22

• 24/7 NurseLine • Utilization management • AIM • Case management/ComplexCare (integrated) • Quick care options • Disease management • Future Moms (w/proactive ID mailings) • ESRD program • Healthy Lifestyles Online • MyHealth Advantage • Behavioral health CM/DM CDH contains all of these, plus…

• Disease Management incentives ($300/year) • Future Moms incentives ($200/year) • Healthy Lifestyles Online incentives

($150/year)

23

New Healthy Support packages for small groups.

Package A: Healthy Lifestyles Online with incentives ($150/yr.) Tobacco-free certification with incentives ($50/yr.) Fitness reimbursement ($400/yr.) Utilization management AIM Case management/Complex Care Quick Care options Disease management Future Moms ESRD 24/7 Nurseline MyHealth Advantage Gold Behavioral Health UM/CM/DM Wellness Webinars Package C—everything in A, plus: FitOrbit Vision Dental

For those who are less likely to use insurance but still want coverage in case of emergency, we offer "Healthy Support" plans that have higher deductibles and copays, but also cover fitness reimbursement and incentives to award a healthy lifestyle.

24

Plan Comparison Tool

• Compare “old” plans with new plans or new to new

• Download to .pdf or Excel

• Tool will be specific to each state

• Available to you and brokers

25

Riders

Out of Pocket Accumulations

CDH Rules

Underwriting/Agent Guides

Riders and more

2014 Small Group Riders/Optional Coverage

Rider/Option Offered

Off SHOP Offered

On SHOP

Bariatric Surgery Yes Yes

Plan year/Calendar Year Yes Calendar Year Only

Contraceptive Exclusion Yes Yes

Services applied to Out of Pocket Currently Effective 1/1/2014

Cost Share Types In-network Out-of-network In-network Out-of-

network

Deductibles Apply Apply Apply Apply

Medical Copayments Apply Apply Apply Apply

Pharmacy Copayments

Apply Apply Apply Apply

Routine Eye Exam No No No No

Adult Dental-Package C N/A N/A No No

Combined Medical & Pharmacy OOP

No Except CDHP

No Except CDHP

Yes Yes

28

Accumulator Transfer Rules – Deductible and OOP

Groups that move from current SG products to Off Exchange products in 2014 will get credit for deductible and OOP accumulated YTD (calendar year only)

Starting Plan New Plan Post-2014 Ded/OOP Accum Credit Applied?

Pre 2014 SG Anthem Product Anthem SG Off SHOP Apply credit

Pre 2014 SG Anthem Product Anthem SG On SHOP No credit

Anthem SG Off SHOP Product (post 2014)

Anthem SG Off SHOP Apply credit

Anthem SG Off SHOP Product (post 2014)

Anthem SG On SHOP No credit

Anthem SG On SHOP (post 2014) Anthem SG Off SHOP Apply credit

Anthem SG On SHOP (post 2014) Anthem SG On SHOP No credit

Prior Carrier Group Anthem SG Off SHOP Apply credit Prior Carrier Group Anthem SG On SHOP No credit

Anthem or Prior Carrier Individual Product

Anthem SG On or Off SHOP/Exchange No credit

Starting Plan New Plan Post-2014 Benefit Limits Accum Applied?

Anthem SG On or Off SHOP/Exchange (post 2014)

Anthem SG Off SHOP Benefit Limits will be carried forward

CDHP Administration Rules

H S A HRA

Employer Contribution/Allocation Set by Plan Cash Funding

Set by Plan Notional Dollars

Allocation Rollover

N/A

2x

Allocation Proration

N/A

Monthly

Deductible Accumulation

-In Network/Out of Network Separate No Cross Accumulation

Separate No Cross Accumulation

-Upfront Deductible N/A N/A

Highlight of Underwriting

– 75% Participation & 50% Contribution – FT eligible: at least 30 hours per week – Waivers will be required for all eligibles – A valid waiver will be individual coverage, on

or off exchange, with any carrier – Husband and wife groups may not be eligible

depending on who else is employed in the group

– Groups of 2+ will be allowed up to 3 options

30

31

DENTAL & VISION

• Pediatric Vision EHB is INCLUDED in ALL plans

• Select a plan from “Retention Plan” family which also includes adult routine eye exams

• Select Healthy Support Plus – “Package C” includes adult vision

• Stand alone Anthem Blue View Vision – True “stand alone”, not tied to medical election

32

Vision Options

• Select one of the two plans with Ped Dental EHB embedded Anthem HK Preferred Guided Access Plus w/ Dental - gtoa – Anthem HK Essential Guided Access Plus w/ Dental

gcpa • ADD the Ped Dental EHB to any plan

– Anthem Dental Pediatric – Anthem Dental Pediatric Enhanced

• EXPAND that added coverage to include Adults – Anthem Dental Adult – Anthem Dental Adult Enhanced

• Stand alone dental Prime/Complete – Value, Classic, Enhanced, Voluntary

35

Dental Options

39

Strong Network Choice

Broad portfolio of options

Deductible Ranges

Co-pay Ranges

NEW Healthy Support Plus features

Specialty Product Integration

Winning Combination

2014 ACA Individual Products Overvie · Anthem HealthKeepers Core Direct Access w/HSA - cacd ;...

Documents

Transcript of 2014 ACA Individual Products Overvie · Anthem HealthKeepers Core Direct Access w/HSA - cacd ;...