51-100: Anthem Renewal when Moving to Small Group

In an effort to help your clients make the transition from Key Accounts to Small Group, as mandated by the ACA (effective January  1, 2016 upon renewal), Anthem has developed some key highlights to help groups understand what to expect when transitioning to the Small Group segment.  

• Rating areas – in Small Group, there are 19 rating areas in CA, divided mainly by county.
• Small Group Rates

  • Rates are now filed and based on all groups in your rating area (community rated) instead of your specific group experience (composite rated), and based on Employer zip code (physical location).
  • Rates are issued quarterly but are locked in and guaranteed for 12 months.
  • 3:1 Rate Ratio (Highest cost point cannot be greater than 3x lowest cost point for members 21+)
  • Rates are based on exact age, and not age-banded rate increments.
  • Rates are calculated for a family based on the combined ages of the employee, spouse, all dependents 21 and older, and up to three dependents age 20 or younger.

• Products and networks

  • The Small Group portfolio offers different HMO & PPO networks, pharmacy, and specialty options that comply with ACA regulations.

• Benefit Changes

  • Mandated essential health benefits (EHB) as well as refreshed portfolio benefits based on updated actuarial value (AV) calculations each year could impact costs.

• Plan Choices (Mapping)

  • The Small Group renewal will include suggested Small Group plan options that are based on a similar plan design to what the group has now (Product, Network, Price). A group can discuss other options with you, their broker.