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2-50: More HCR Updates to PPO Products

Jan 20, 2011



Additional HCR Updates to Small Group PPO Products
Anthem Blue Cross recentily issued retroactive changes to a few of their Small Group plans. Clarification on the updates is provided below.

Effective November 1, 2010

As a result of Anthem's filing with the California Department of Insurance (CDI), additional benefit changes are required to a select number of their Small Group PPO Products.

The combination of a per day maximum and a limit on days or visits per year results in an annual benefit maximum that is prohibited by Health Care Reform. As a result, the following changes are being made to comply effective November 1, 2010.


Effective February 1, 2011

As a result of the limit combination stated above, the following changes are being made to comply effective February 1, 2011.

Clarification - There has been confusion on when the updated Mental Health benefits will go into effect. In addition to the mental health change, there is also an update to Skilled Nursing Facility/Home Health benefits (SNF/HH) for Elements and BeneFits on 2/1/11.   

Mental Health benefits effective: 11/1/10 for CDI plans; 2/1/11 for DMHC plans
Skilled Nursing Facility/Home Health benefits effective: 2/1/11 for Elements and BeneFits plans only (CDI plans)
November Change Example: If the group has a plan that is in the 11/1/10 folder (CDI plan), and they are a 10/1 group, they will not get that benefit update until 10/1/2011 (their next anniversary after 11/1/10).  11/1 groups and after will get that 11/1/10 plan benefit change on their anniversary. Any incorrectly processed claims will be adjusted. 
February Change Example: If the group has a plan that is in the 2/1/11 folder (DMHC plan), and they are a 1/1 group, they will not get that benefit update until 1/1/2012 (their next anniversary after 2/1/11).

Contact any member of your b&p Sales Team at 888.722.3373 for assistance with Small Group plan summaries and EOCs.
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