Anthem announced rate and plan updates for January 1, 2021 effective dates. Rates are available for quoting!
Average Medical Quarterly Rate Change:
- PPO: 3.7% decrease
- HMO: 2.7% decrease
Dental: No changes to rates or benefits.
Vision: New rates and benefits.
New Pharmacy Networks
Anthem is introducing a tiered pharmacy network called the "Rx Choice Tiered" network. This network is the same as the current National network except that pharmacies will be either Level 1 or Level 2 pharmacies. Member's will pay a lower cost share at Level 1 pharmacies than at Level 2 pharmacies. Some pharmacies in each level are:
- Level 1: 25,000 pharmacies like CVS, Target, WalMart, Sam's, Kroger, Costco
- Level 2: Walgreens, Rite Aid, Giant Eagle
The Rx Choice Tiered network will be part of all small group plans except the SHOP mirror plans which will use the "Standard" pharmacy network which includes most national chains but excludes Walgreens. The SHOP mirror plans that will use this Standard network include:
- Platinum Select PPO 15/10%
- Gold Select PPO 25/350/20%
- Silver Select PPO 50/2250/30%
- Bronze Select PPO 7000/0% w/HSA
Click here for a current listing for the Rx Choice Tiered network in California as of September 3, 2020.
Opt-out Home Delivery
Anthem is pairing convenience and savings with their Opt-out Home Delivery program. For medications taken regularly, members can choose, or opt out of, home delivery. Here's how it works:
- Member obtains medications taken regularly at retail pharmacy, up to three courtesy fills
- Messaging is provided at the retail pharmacy counter that they will be switched to home delivery unless they call to opt out (there is no penalty for opting out)
- Members can also choose to get a 90-day supply at any CVS pharmacy at the same cost as home delivery
- Member will receive a letter when their courtesy fells run out
Plans & Benefits
New Whole Health Plan Portfolio
Anthem is rolling out a new suite of their most popular medical plans with enhanced coverage for Pediatric dental, Adult dental, and Adult vision materials.
- This limited portfolio includes seven plans identified with "WH" at the end of the plan name
- This is a great option for groups not currently offering
Medical plans may experience some benefit and name changes. Anthem is adding two new plans, below are the plans along with a quick description with how they fit into the Anthem portfolio:
- Silver PPO 2500/35% w/HSA PrevRx & Silver Select PPO 2500/35% w/HSA PrevRx
- New HSA options that have "PrevRx" in the plan name, meaning they member pay a copay that's deductible waived for preventive drugs.
- Bronze PPO 75/6300/45% & Bronze Select PPO 75/6300/45%
- New Bronze options that offer unlimited office visits at a copay with deductible waived and deductible waived Tier 1 pharmacy benefits.
Underwriting Promotions Extended through 3/15/21!
- Relaxed Participation: 25% participation for groups of 5 or more enrolled subscribers! 65% participation required for 4 or fewer enrolled subscribers.
- DE9C: Not required with 6 or more subscribers enrolling! Groups with prior coverage must submit prior carrier bill. Excludes virgin groups.
- Valid Waivers: Individual coverage both on and off of the Exchange will be accepted as a valid waiver
- Network flexibility: Groups can offer any 2 HMO networks alongside 1 PPO network OR both PPO networks and any 1 HMO network for 10/1/20-3/15/21 effective dates!
- 10/19/20: 1/1/21 Renewals will be posted to Producer Toolbox (producer renewals are no longer mailed)
- 10/26/20: 1/1/21 Group renewals will be mailed
- 10/28/20: 1/1/21 Group renewals will be available on EmployerAccess
The Anthem 1/1/21 book rates will be posted to the B&P website when they are available.
Anthem has three bonus programs currently running, with the last two running through January 2021:
- 7% Commission for December 2020: Anthem is offering a 7% commission for the life of the case when you sell any new small group medical case with 10+ enrolled employees for July 2019 through January 2020 effective dates. See flyer for complete details. Bonus applies for business written through a General Agent.
- 6% Commission for July 2020 through January 2021: Anthem is offering a 6% commission for the life of the case when you sell any new small group medical case with 10+ enrolled employees for July 2020 through January 2020 effective dates. See our news post for complete details. Bonus applies for business written through a General Agent.
- Specialty "New" Broker Bonus: Anthem is offering a Specialty bonus program for new groups with 2-500 enrolled employees with July 2020 through January 2021 effective dates. See flyer for complete details. Bonus applies for business written through a General Agent.
For questions, please contact a member of your B&P Sales Team — 888.722.3373.