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Anthem 2020 Small Group Updates

Anthem Balanced Funding (ABF)

Smart Shopper – NEW (embedded in ACA products)

Anthem Essential Dental – Enhanced

Anthem Vision – Enhanced

Anthem Life & Disability – Embedded Features

2020 SEP Broker Bonus Program

Anthem’s response to Covid 19

Anthem Balanced Funding (ABF) Alternative to ACA

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How Does it Work?

ABF feels like a fully insured plan

Built in ASO contract underneath allows data and dollars to be shared with the group

Every safeguard against large/high claims is built in

No terminal liability upon plan termination

Streamlined implementation

Invisible to employees; easy for employer to understand

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Individual Stop Loss

(aka Specific Stop Loss (SSL) or

Individual Pooling Level)

Aggregate Stop Loss

provides protection for aggregate

claims

(at the group level)

Runs the policy year and covers each

member, protecting against high

individual claims

Provides a limit on claim liability to

protect against overall high group

utilization

Provides monthly and annual protection Provides monthly and annual protection

Stop loss premiums, along with the administration fee and broker

commissions, make up the fixed costs in any ASO contract.

Stop Loss is insurance that mitigates the cost of catastrophic medical claims.

May be invisible but most FI contracts have this baked in (ISL)

How Does it Work?

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4-tier composite rates are set up front

Money is saved when claims run well

No deficit recovery if claims run poorly

No terminal liability when client leaves Anthem at

renewal

State taxes limited

Advantages for a Small Employer

How Does it Work?

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The employer is not responsible for the negative balance.

Unfavorable Claims Year

Annual fixed cost $150,000

Annual claims funding $380,000

Actual paid claims $400,000

Negative balance - $20,000

Deficit carried forward $0

Part of the rate

eligible for a refund

Net claims over the

stop loss

Year-end Settlement Examples

How Does it Work?

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The employer receives 50% of the surplus as a credit toward

future bills.

Favorable Claims Year

Annual fixed cost $150,000

Annual claims funding $380,000

Actual paid claims $290,000

Surplus $90,000

Part of the rate

eligible for a refund

Net claims below

claims funding

Year-end Settlement Examples

How Does it Work?

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Termination

How Does it Work?

Customer stays with Anthem, but switches from ABF to standard Fully Insured funding

• Eligible to receive credit in case of a surplus

Customer leaves Anthem

• Will not receive a refund if there is a surplus

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Why ABF?

ABF Will: ABF Will Not:

Protect the current “best risk”

clients

Put clients at risk for high claims

Give Employers an opportunity to

benefit from healthier risk

Lead to unpredictable monthly cost

Provide YOU the opportunity to add

value:

Offering an innovative solution

that lets the customer continue

to keep an Anthem plan

Added transparency with

reports, allowing you to work

consultatively with the

customer to address areas of

concern

Adversely affect members-they

won’t know the difference

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*Reports do not include PHI.

Fully

Insured

Self

Insured

Anthem

Balanced

Funding

Predictable, fixed monthly payments

Ability to save money if claims run well

Discounts for Dental/Vision and/or Life

Coverage for terminal built into the plan

Protection against large claims

Reporting* to give transparency and

better control

Savings on some taxes and ACA Insurer

fee

Simple to administer

Why ABF?

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Product Portfolio

26 Plan options are available with ABF; 13 Keycare

PPO plans and 13 Healthkeepers HMO POS plans

Effective July 1, 2020 – will add more plans with richer

prescription drug co-pays. (Key Accounts (51 to 99) will

begin offering ABF)

Groups can offer up to 3 plans

ABF – does not include Pediatric dental or vision

Specialty; if new vision, dental, life or DI is sold, a

discount will be applied to the ABF medical rate

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o Group Risk Questionnaire (GRQ) or Individual Health questionnaire.

o VA ABF Quote Census Template.

o Renewal rates from current carrier.

o If the group has a balanced funding-type product, they will need to submit claims experience.

For the most aggressive quote, the broker/group should submit IND Health Questionnaires rather than Group Risk.

Quoting ABF

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• Submit/Upload group sold paperwork 21 to 30 days prior to the groups requested effective date through the Anthem broker portal. Before submitting/uploading, you must have all of the sold group paperwork saved on your computer:

1. - ABF Group Application – please complete and submit using the enrollment tool for ABF.

2. - EFT Form

3. - Copy of voided check

4. - ABF NY HCRA form

5. - ABF enrollment spreadsheet

6. - ABF Checklist

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Enrolling in ABF

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Enroll in and save on your ABF medical payments1

ABF Medical + Dental 1.0%

ABF Medical + Vision 0.5%

ABF Medical + Life 0.5%

Total savings 2.0%

Discount to be applied to the ABF Administrative Services Fee only and will equal up to two (2) percent of the ABF medical payment. Discount only applies when new Anthem dental, vision and/or life coverage is purchased with an Anthem Balanced Funding medical plan.

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Specialty Discounts

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A doctor recommends a medical service.

Member goes online or talks with a SmartShopper Personal Assistant to find high-value locations. Personal Assistants can also help schedule appointments.

Member has the procedure at the location of their choice.

Once the member’s claim is paid, SmartShopper verifies that the location qualifies and sends the reward to the member.

SmartShopper - How it works

May 8, 2020 © 2018 Anthem Blue Cross Blue Shield. All

Rights Reserved. 4

ENHANCEMENTS TO 2020 DENTAL PLANS

More choices to meet customer needs

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• Unlimited Annual Maximum Classic and Enhanced plans take the worry out of planning treatment around annual maximum limits

• $2,000 Annual Maximum Classic plans for those that need just a little more coverage

• $1,500 Orthodontic Lifetime Maximum Classic plans that match the annual maximum of $1,500

• Other Carriers’ Buy-ups are Anthem’s Standard Benefits

Implants

Composite Fillings

4 Periodontal cleanings

Orthodontia down to 5 lives

MAXIMIZING

OUR MAXIMUMS

ENHANCEMENTS TO 2020 DENTAL PLANS

Enhanced preventive dental care for better overall health

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• New dental PPO plans include dental implants, tooth-colored fillings, accidental dental injury coverage and annual maximum carry over + network boost

• Extra cleanings, exams, fluorides and sealants for members with certain medical conditions

• Orthodontia for 5+ enrolled employees

• 36% average nationwide discount

• NO employer contribution required, however dental participation is required

OUR DENTAL PPO NETWORK:

Consider the facts

2nd largest in the nation

399K+ places to get care;

9,568 in VA

27% network growth over past

2 years

130K+ unique dentists;

4,363 in VA

ENHANCEMENTS TO 2020 DENTAL PLANS

Effective May 1, Anthem introduces TeleDentists & Ortho@Home

• In network dental providers offering online & mobile app, enabling teledentistry solutions for dental visits and dental emergencies

• Ortho@Home is embedded in Anthem Dental plans that offer orthodontia coverage. Ortho@Hom eoffers convenient at home clear aligner therapy option

ENHANCEMENTS TO 2020 VISION PLANS

New Blue View VisionSM improvements give clients more

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• $150 $180 and $200 materials allowance for frames

• Lower member costs on standard progressive lenses – $55 copay in 2020 vs. $65 in 2019

• No employer premium contribution requirements for voluntary and non-voluntary (employer-paid) plans

• New participation requirements

– Non-voluntary plans: 50% participation with minimum of two enrolled

– Voluntary plans: no participation rate requirement; a minimum of 5 must be enrolled

QUOTING BEGINS

October 2019

EFFECTIVE DATES

January 1, 2020 and later

NEW PLAN NAMES

Make it easier to tell if plan is full

service, exam only or material only

Blue View Vision: A clear choice for convenience and savings

Here’s why Blue View VisionSM is a great value for your clients

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• Leading member discounts, free scratch coating, tiered pricing on popular options, 40% off additional pairs of glasses and discounts on laser surgery

• Polycarbonate and Transitions lenses for kids at no extra cost

• Adult eye exam and full service pediatric vision care (exam and materials) embedded in Anthem medical plans – full-service and materials-only options available as standalone

• 63% average network savings*

* Based on the Blue View Vision plan with $10 lens copay and $130 frame allowance for glasses or $130 contact lens

allowance. Laws in some states may prohibit network providers from discounting products and services that are not

covered benefits under the plan.

INDUSTRY’S LARGEST

NETWORK of private eye

doctors, retail locations and

online stores

38K eye doctors in the plan;

1,037 in VA

97% in-network use

27K+ locations nationwide;

694 in VA

Life & Disability – Expanded SIC codes to include agricultural, trade & construction

• Expanded SIC codes to include agricultural, trade & construction industries (groups of 2+).

• Allows these industries to purchase STD & LTD.

• More small groups can offer a complete benefits package to include medical, dental, vision, life & DI.

Life & Disability 2 to 50

Benefits that HELP BUILD FINANCIAL WELLNESS

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• Robust portfolio of employer-paid and voluntary benefits (with contract flexibility to meet needs)

• Fast claims payment

• Claims calls answered by real people – not an interactive voice response system

• Value-adds give employees and beneficiaries the support they need, when they need it, at no added cost

– Resource Advisor provides support for legal, financial and emotional issues

– Members get 24/7 phone counseling, plus can schedule three face-to-face or LiveHealth Online counseling visits

– Travel assistance helps life members who are 100 miles or more away from home

– Beneficiary Companion helps life beneficiaries close accounts and settle estate details

– Perks at Work discounts give employees discounts on goods and services they use every day

– The Healing Book helps children affected by loss and is provided at no cost

Offering Anthem Specialty Products

What’s in it for the Employer?

• Employer/Member – benefits from whole health connection – our systems talk to each other

• Employer only has one invoice to review each month (all lines of coverage on one invoice) – making it easier for your client to reconcile

• Employee receives one ID card for all lines of business

• Bundled & Medical Lock Discounts - when Anthem Dental is sold with either vision or life, the group receives our bundled discount of 5%

SEP – Individual Business

Effective dates of April 1 through December 1, 2020.

Anthem will pay a one-time bonus of $150 for each member (no family max) enrolled in an individual ACA on or off exchange plan with an effective date between April 1 and December 1, 2020.

You must sell at least 10 members and those members must stay with

Anthem for at least 90 days for you to qualify for the bonus.

This SEP business will also qualify for a renewal commission effective January 1, 2021.

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COVID-19 Producer

Response Toolkit

COVID-19 FAQ