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HCR Update: Individual HCR Benefits Mailing

Oct 28, 2010

Health Care Reform Update

October 22, 2010

Individual  Member Health Care Reform Benefits Mailing

We are dedicated to helping your clients understand the Patient Protection and Affordable Care Act (PPACA) and how it will impact their health plan.  In the coming week, all Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company Individual members will receive mailings with information about upcoming changes to their benefits. These benefits will be effective December 1, 2010, ahead of the of the January 1, 2011 date communicated previously. Also included in the mailing is information regarding open enrollment opportunities coming in November 2010.  

Benefit Changes
All Anthem Blue Cross
and Anthem Blue Cross Life and Health Insurance Company Individual Members will see changes to their current benefits as a result of PPACA.  The extent of those changes will be based on their grandfathered or non-grandfathered status.

Non-grandfathered members receive full, mandated PPACA benefits...

...while grandfathered members receive a
subset of mandated benefits.

  • Expanded dependent coverage
  • Expanded dependent coverage
  • No annual dollar or lifetime limits
  • No lifetime limits
  • Expanded preventive care
  • New patient protections
  • No pre-existing condition waiting period for children under 19
  • New limitations on rescission
  • New patient protections


  • New limitations on rescission


There are some exceptions where grandfathered members will receive full PPACA benefits, but retain their grandfathered status.  These members are enrolled in a small number of plans with limited membership, like HIPAA plans.  As long as they do not change benefits or plans, they will maintain their grandfathered status and future PPACA changes will have a limited impact on their policy.
Click here
to view a complete list of plans with grandfathered or non-grandfathered status.  As a reminder, members who changed benefits on March 24, 2010 or after may have lost grandfathered status regardless of their current plan.  

Open Enrollment Period for Certain Eligible Members

Your Individual clients will also learn about a one-time open enrollment period from November 1, 2010 through November 30, 2010 for the following eligible family members:

  • Adult Dependents: Adult dependents from age 19 up to age 26 who are not currently enrolled on a member's policy or who were previously cancelled from a member's policy due to age, student or marital status are eligible for enrollment.  The member's policy to which the adult dependent will be added must have an effective date prior to September 23, 2010.

o    If an adult dependent is added to a family policy that is grandfathered, the adult dependent will also have grandfathered status under the policy.

  • Members who reached their Lifetime Maximum: A family member who previously reached his or her lifetime maximum can enroll for benefits on a member's existing policy during this special period.

Coverage for family members enrolled during this special open enrollment period will begin on January 1, 2011 and associated premium adjustments for adding dependents will be made, as appropriate. During this time, we're waiving the standard health review requirements for coverage qualification. Please note that health history will be reviewed to determine the rate level.

How Do Members Enroll?
Members will receive enrollment instructions in their mailing and will be referred to to obtain the necessary applications. The member should complete the application, then mail or fax it to the address or fax number listed on the form. All applications must be postmarked or faxed NO LATER THAN November 30, 2010.

Sample Communications

We have provided sample member letters and information inserts below for your reference.  Click on the links to view examples of what your clients will receive based on their grandfathered member status and plan type:


Grandfathered Members

Non-Grandfathered Members

Mandated GF PPACA Benefits

Full PPACA Benefits for GF members

Full PPACA Benefits for NGF member

We're Here to Help
Health Care Reform brings many changes, as well as a great deal of information for your clients to consider.  We value your partnership and willingness to help guide members through the facts, so they can make benefit choices with confidence.

Please contact your Regional Sales Manager or Regional Sales Representative with any questions. You can also contact the Individual Broker Services team at
[email protected] or 800-678-4466.


Updated appeals fact sheets include more process details.   

We have updated our fact sheets about the health care reform appeals provision. See this new version for additional details about our appeals processes, including the standard process for external appeals.


New fact sheets explain health care reform long-term care program 

Under the Patient Protection and Affordable Care Act (or health care reform law), the secretary of Health and Human Services will establish a voluntary long-term care insurance program called Community Living Assistance Services and Supports (CLASS) by January 1, 2011. The program will offer the CLASS Independence Benefit Plan, but the new law does not specify a date for enrollment. As this is a government program, we will not be involved in administering this insurance plan.

We've developed new fact sheets to explain what the program is, who can enroll and how premiums will be determined.

Health care reform new W-2 reporting requirements delayed   

The health care reform law requires employers to report the cost of employer-sponsored health benefits. This will be a new, separate entry on the W-2 form. The IRS also announced that it will defer the new requirement for employers to report the cost of coverage under an employer-sponsored group health plan, making that reporting by employers optional in 2011.This new fact sheet  gives you the lowdown on this requirement.

Getting to the bottom of your health care costs       

Did you know: Obesity's hidden job costs are $73 billion

Loss of productivity due to obesity costs as much as medical expenditures for the condition, according to a new study. The cost of obesity among full-time workers in the United States is $73.1 billion per year, according to a study published in the October 2010 issue of the Journal of Occupational and Environmental Medicine.

This content is provided solely for informational purposes: it is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers.

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