Anthem Shared Funding – a more flexible and predictable ... · Anthem Shared Funding: PLAN...

Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. are independent licensees of the Blue Cross Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

Anthem Shared Funding – a more flexible and predictable way to manage your health care costs and enjoy savings potential!

Anthem Shared Funding is a new, self-funded arrangement available for January 1, 2014 effectives for employers with 25-99 enrolled lives. Enjoy the predictability of a fully insured plan and the savings potential of a self-funded plan.

Advantages of Anthem Shared Funding:

}} Not subject to health care reform product and rating restrictions

}} Predictable, fixed monthly payments}} Savings on premium tax and health care reform taxes}} Money-back savings potential when claims experience

is better than expected}} When claims are higher than expected, you will never

be billed more than your monthly fixed payment}} A cap on financial responsibility with integrated stop

loss coverage}} Allows access to Anthem’s broad networks, deep

discounts and effective care management programs}} Many plan design options}} Monthly reporting to total claims cost

Settlement Example:

For more information about Anthem Shared Funding, contact your Anthem Sales Representative or your Anthem Broker.

Favorable Claims Year

Annual Claims Funding

Paid Claims

$200,000.00

-$145,000.00

Potential Refund $55,000.00

Anthem Shared Funding A MORE FLEXIBLE AND PREDICTABLE WAY TO

MANAGE HEALTH CARE COSTS

Shift toward Self-Funding

•CURRENT STATE OF THE MARKET

• Insurance premiums continue to escalate

• Costs associated with Health Care Reform are

influencing the market and employer decision

making

A recent Anthem Market Insights Report shows 46% of

brokers expect a significant shift toward Self-Funding in

the 35-100* market over the next five years.

* ASF available for groups down to a minimum of 25 enrolled.

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Anthem Shared Funding: PLAN ADVANTAGES

ENJOY THE ADVANTAGES OF BOTH A FULLY INSURED AND SELF-FUNDED PLAN –

ALONG WITH INTEGRATED STOP LOSS

Fully Insured Self-Funded

Predictable, fixed monthly payments Money-back savings potential when claims

experience is better than expected

Coverage for claims run-out*

Standardized reports for a more

comprehensive understanding of plan costs**

A cap on financial responsibility

Savings on premium tax and health care

reform taxes

Plan design options

*Also known in the industry as terminal liability.

** Reports do not include PHI.

Specific and Aggregate Stop Loss provide additional financial protection from

higher than expected individual and group claims costs.

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And we don’t stop there

PLAN INCLUDES THE FOLLOWING

360° HEALTH PROGRAMS AT NO

ADDITIONAL COST:

24/7 NurseLine

Future Moms

ComplexCare

ConditionCare

MyHealth Advantage Gold

MyHealth Coach*

Healthy Lifestyles*

*MyHealth Coach and Healthy Lifestyles are

included as part of the standard program offerings

for the HSA plans only.

YOU ALSO HAVE THE OPTION TO

PURCHASE THESE ADDITIONAL

BENEFITS ON A FULLY INSURED

BASIS:

Dental

Vision

Life

Disability

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How does it work?

WITH ANTHEM SHARED FUNDING, YOU

MAKE A FIXED MONTHLY PAYMENT THAT

INCLUDES:

• Administrative fees

• Specific and Aggregate Stop Loss coverage

• A paid claims fund

• Coverage for claims run-out

At the end of the plan year when the claims

fund is settled, you can actually get money

back when claims experience is favorable.

BILLED RATES CLAIMS FUNDING

Employee $500.55 $286.07

Employee/Child $742.32 $429.10

Employee/Children $982.09 $514.93

Employee/Spouse $1115.40 $629.35

Family $1,396.95 $915.42

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KeyCare 25

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Settlement examples

*All disbursements made would be based upon contract terms.

*

Favorable Claims Year

Annual Claims Funding $200,000.00

Paid Claims $145,000.00

Potential Refund $55,000.00

Unfavorable Claims Year

Annual Claims Funding $200,000.00

Paid Claims $235,000.00

Potential Owed $0.00

In years with favorable claims

experience, you get money back.

In years with unfavorable claims

experience, your exposure is

capped under this funding

arrangement. So you can breathe

easier.

•AGGREGATE 110%

•SPECIFIC 25-50 $15,000

51-99 $25,000

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Specific and Aggregate Limits

• KEYCARE

• KEYCARE 10 PLUS 10/20/35 OR 20% DRUG CARD

• KEYCARE 20 PLUS 10/30/50 OR 20% DRUG CARD

• KEYCARE 10 10/20/35 OR 20% DRUG CARD



• KEYCARE 25/500 10/30/50 OR 20% DRUG CARD




•

• HEALTHKEEPERS

• HEALTHKEEPERS 20 OAPOS 10/30/50 OR 20% DRUG CARD

• HEALTHKEEPERS 25 OA POS 10/30/50 OR 20% DRUG CARD

• HEALTHKEEPERS 25/30 OAPOS 10/30/50 OR 20% DRUG CARD

• HEALTHKEEPERS 20/20/500 OA POS 10/30/50 OR 20% DRUG CARD

• VALUE ADVANTAGE 25/500 10/30/50 OR 20% DRUG CARD




•

• LUMENOS

• HSA 447 KEYCARE 10/30/50 OR 20% DRUG CARD



• HSA 576 HEALTHKEEPERS 10/30/50 OR 20% DRUG CARD



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Product Offering Dual & Triple Option Allowed

•DEMOGRAPHICS (CENSUS)

• INDUSTRY (SIC CODE)

•CLAIMS EXPERIENCE ADJUSTMENT IF KNOWN (MORE FOR EXISTING

ANTHEM GROUPS THAT WANT A QUOTE)

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Factors Impacting Rates

25-50

•YOUNG HEALTHY GROUP WANTING TO RETAIN LEGACY PRODUCTS

AND RATING PARAMETERS BEYOND 2014.

51-99

•GROUPS THAT BELIEVE CLAIMS EXPERIENCE WILL BE GOOD GIVING

THEM THE ABILITY TO SHARE IN THE SAVINGS

•GROUPS WANTING TO ELIMINATE/REDUCE TAXES/FEES

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Potential Candidates

•

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Administrative

Standard Broker commission schedules apply

One Solution Savings cannot be used

Request for quotes must be received by Underwriting 20

days prior to the requested effective date

The sold group paperwork(renewal paperwork) must be

received by Underwriting 5 days prior to the effective date

•A Business Associate Agreement will need to be signed by

the client upon sale in addition to the employer/employee

applications, VEC and check

The Stop Loss Application will need to be completed which

eliminates the need for an annual signature on the stop loss

contract

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PREDICTABILITY

SAVINGS POTENTIAL

FLEXIBILITY

PEACE OF MIND

COST TRANSPARENCY

That’s Anthem

Shared Funding.

Anthem SharedFunding PlansA new, more flexible andpredictable way to manage costs —and enjoy savings potential.

Anthem Shared Funding plans deliver the control, adaptability and insights you’re looking for, the confidence you need, with the solid coverage you demand for your employees. And they can take a lot off your worry list. This new, self-funded arrangement is for employers with 25–99 enrolled employees.

There are many health plans to choose from with the option to buy dental, vision, disability and life coverage on a fully insured basis.

Consider these important benefits:

}} The predictability of a Fully Insured plan

}} The savings potential and flexibility of a Self-Funded plan

}} The peace of mind of Stop Loss Coverage

}} Cost transparency and visibility through monthly accounting statements

}} Excellent health care plans for your employees

Now read the reverse and see what additional benefits Anthem Shared Funding brings.

Choose the plan that meets your needs:

KeyCarePLAN PRESCRIPTION COPAY

KeyCare 10 Plus 10/20/35 or 20% drug card

KeyCare 20 Plus 10/30/50 or 20% drug card

KeyCare 10 10/20/35 or 20% drug card



KeyCare 25/500 10/30/50 or 20% drug card




HealthKeepersPLAN PRESCRIPTION COPAY

HealthKeepers 20 OA POS 10/30/50 or 20% drug card

HealthKeepers 25 OA POS 10/30/50 or 20% drug card

HealthKeepers 25/30 OA POS 10/30/50 or 20% drug card

HealthKeepers 20/20/500 OA POS 10/30/50 or 20% drug card

Value Advantage 25/500 10/30/50 or 20% drug card




LumenosPLAN PRESCRIPTION COPAY

HSA 447 KeyCare 10/30/50 or 20% drug card*

HSA 448 KeyCare 10/30/50 or 20% drug card*

HSA 576 HealthKeepers 10/30/50 or 20% drug card*

HSA 573 HealthKeepers 10/30/50 or 20% drug card*

HSA 440 KeyCare 80% after deductible

HSA 579 HealthKeepers 80% after deductible

*After Deductible

Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. are independent licensees of the Blue Cross Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

Anthem Shared Funding offers the solid health care plans you’re looking for, plus an array of added services to help employees proactively pursue wellness – and keep health care costs down.

Take advantage of —

24/7 NurseLineSM

Alleviates unnecessary worries and expenses by offering quick answers andassessments through a round-the-clock, toll-free service.

Future MomsPromotes happier, healthier mothers and babies by providing helpful tools,periodicals, pre-natal insights and ready access to nurses.

ComplexCareOffers many effective go-to options for those with multiple health issues demandingfrequent or advanced levels of medical care.

Condition CareHelps those suffering from diabetes, congestive heart failure, COPD, coronary arterydisease and asthma better manage their condition.

MyHealth Advantage GoldSeeks better outcomes — and member cost savings — by taking a wide spectrum ofproactive steps to address potential health issues early.

MyHealth Coach (for HSA plans only)Connects coaches with members who may be at risk with their health.

Healthy Lifestyles (for HSA plans only)An online resource for members to assess their current level of health and to develop an online tracking program to improve their life.

Remember, with Anthem Shared Funding, when claims experience is betterthan expected, you can reduce your overall health care costs and you are protected when claims experience is higher than expected.

Make Anthem Shared Funding part of yourhealth care success plan.

Anthem Shared Funding:Predictable plans – with unexpected extras.

For more information:

Contact your Anthem Sales Representative or Anthem broker

Anthem Shared Funding – a more flexible and predictable ... · Anthem Shared Funding: PLAN...

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