Anthem Rolls Back July 2012 Rate Increases

We have been notified by Anthem Blue Cross that they are choosing to withdraw the Medical rate increase they announced for third quarter on a limited number of Medical plans. The rate rollback will affect the following plans:

• Solution PPO Plans
• GenRx PPO Plans
• Lumenos HRA Plans
• Elements Hospital Plans
• BeneFits Hospital Plans   

Please note that this rating news does not affect the Anthem Blue Cross rates within the CaliforniaChoice portfolio.

What does this mean for new business?

• New groups sold for July, August and September effective dates and HAVE PAID THEIR INVOICES will see revised rates and a credit on their next billing statement.
• Groups impacted by this rate adjustment will receive a letter from Anthem Blue Cross within the next couple of weeks. 
• beere&purves will provide revised final rates for any sold groups with July, August or September effective dates. 
• Revised rates will be available for quoting on Friday, July 6th.   

What does this mean for renewing business?

• Groups that have received their July, August and September renewals packages will receive a revised rate comparison based on the group's current census. 
• Groups that renew July, August and September and HAVE PAID THEIR INVOICES will see revised rates and a credit on their next billing statement.
• Groups that renew July, August and September and HAVE NOT PAID THEIR INVOICES will receive a revised billing statement reflecting the lower premium amount.  
• If an employee changed Medical plans due to the expected rate increase for the plans listed above, they may switch back to their old plan with a written request to Anthem Blue Cross no later than July 31, 2012.
• Groups impacted by this rate adjustment will receive a letter from Anthem Blue Cross within the next couple of weeks. 

Medical rate increases previously announced for the Anthem plans listed below will not go into effect. Instead, all Anthem Medical plans will receive a RATE PASS for third quarter 2012.

Plans Receiving Rate Rollback

• Solution PPO Plans
• GenRx PPO Plans
• Lumenos HRA Plans
• Elements Hospital Plans
• BeneFits Hospital Plans 

MEDICAL BENEFIT CHANGES
Even though rate increases scheduled for July 2012 effective dates will not go into effect, ALL plans in ALL medical portfolios (EmployeeElect, EmployeeChoice and BeneFits) will experience benefit changes as originally announced.

• Expansion of Women's Preventive Care Mandates per PPACA
• Maternity Benefits added to Elements and BeneFits Hospital plans per CA AB210 Mandates 
• Autism Benefit added per CA SB946 Mandates 
• Remove Healthy Check
• Updates to the Solution 2500, 3500 and 5000 PPO plans 
• EOC Language Updates
• Click here to view before and after benefit grids. 

:::Expansion of Women's Preventive Care Mandates

Newly expanded benefits for women's preventive care through PPACA includes the following services, drugs and supplies paid at 100% in-network:

• Breastfeeding support, breast pumps, supplies and counseling
• Prescription contraceptives (birth control) and counseling for women
  • 100% coverage is limited to generic and/or single source brand contraceptives included in the plans applicable drug formulary
• Permanent surgical contraception (sterilization) for women
• Counseling for sexually transmitted infections
• Counseling and screening for HIV
• Counseling and screening for interpersonal and domestic violence
• Screening for gestational diabetes
• Human Papillomavirus (HPV) testing  

:::Maternity Benefits (California AB210) 

This bill requires that every group health insurance policy provide coverage for maternity services, including office visits. As a result, the Anthem Blue Cross Elements Hospital Basic and BeneFits Hospital Basic plans are being updated to comply with this legislation (also see Discontinued Plans).  

:::Autism Benefit (California SB946) 

This bill requires that all health plans and policies provide coverage for behavioral health treatment for pervasive developmental disorder or autism.

• Preservice review will no longer be required for behavioral health outpatient professional services following the 12th visit; however,
• Preservice review will be required for behavioral health treatment for pervasive development disorder or autism.
• Benefits are not required to exceed essential health benefits as defined by PPACA.

:::Solution PPO Plan Updates

The Solution 2500, 3500 and 5000 PPO plans will experience benefit changes. To view the current benefits alongside the July 1, 2012 benefits, click here.  

 

:::EOC Language Updates

Updates to EOC language includes:

• Change Mail Order references to Home Delivery Program
• Add Tier 4 copay and benefit maximum (for eligible drugs) under Home Delivery Program 

PLAN DISCONTINUATIONS
As planned, Anthem Blue Cross will eliminate two (2) medical plans from their portfolios for July 1, 2012 effective dates.  Unless the employer notifies Anthem Blue Cross of different plan elections, members will be migrated as listed below:

• Lumenos HIA Plus 500 will migrate to the PPO 1500/$35
• Lumenos HIA Plus 750 will migrate to the PPO 1000/$25  

Effective October 1, 2012, Anthem Blue Cross will eliminate the three (3) medical plans listed below. Due to legislated benefit changes, the Elements and BeneFits plan designs scheduled to be eliminated will closely mirror the Plus plans. As a result, members will be migrated to those plans.  

• EmployeeElect Portfolio: Elements Hospital Basic will migrate to Elements Hospital Plus 
• EmployeeElect & BeneFits Portfolios: BeneFits Hospital Basic will migrate to BeneFits Hospital Plus
• EmployeeChoice Portfolio Only: Premier PPO $20 Copay will migrate to the PPO $30 Copay 

A quick reminder that Anthem Blue Cross will require the revised Statement of Understanding for all new and renewing groups beginning with July 1, 2012 effective dates. The broker AND employer will be required to sign the Statement of Understanding.

• Statement of Understanding 

• Prime & Complete = 1.23% 
• All Other Dental PPO = Rate Pass
• All DHMO = Rate Pass
• No changes to benefits.

• Rate pass and no changes to benefits.