Updated Participation Guidelines Alongside Another Carrier’s HMO
Effective April 1, 2008 Aetna will accept the greater of 50% participation and a minimum of eight (8) enrollees for group's offering another carrier's HMO. All of Aetna's products are available for the reduced participation via Pick-A-Plan.   
 
The guidelines have not changed for groups that only offer Aetna:

• Employers with 2 - 3 eligible employees:  100% of eligible, excluding those with coverage through another employer's plan must participate
• Employers with 4 - 50 eligible employees:  75% of eligible (rounded), excluding those with coverage through another employer's plan must participate 

Aetna HealthFund HRA – Waiving Set Up Fees!!
Effective April 1, 2008 through July 15, 2008 effective dates, Aetna is waiving the employer set up fees for HRA administration. The monthly administration fee of $5 per participant will remain in tact.

Waiving the setup fee saves the employer:

• 2-25 members = $350
• 26-50 members = $450

Remember the Key Benefits of Aetna’s HealthFund HRA:

• Employer does not have to pre-fund the HRA account!
• Reimbursement for employees is streamlined. No need for employees to submit claims for reimbursement!

Aetna Dental PPO - Network Expansion
See the article in the Aetna Large Group section.

Aetna Broker Bonus Programs
Annual Broker Trip – St. Regis Resort in Aspen March 2009 -- Click here for details.

Broker Bucks – April 1, 2008 through July 15, 2008 effective dates

• 50 medical subscribers = $50 per subscriber (paid retroactive to 1st sale)
• 25 medical subscribers = $25 per subscriber (paid retroactive to 1st sale)

Program Guidelines:

• Broker sales will be calculated at the end of the contest period to determine bonus level.
• One-time lump sum payout will be made by October 15, 2008.
• Qualifying dates: January 1 through December 31, 2008 group effective dates.
• Accumulate 200 point by selling Aetna Small Group California products.
• 1 point per application for medical and dental subscribers.
• ½ point per application for life.

Rating Updates: April 1, 2008 - June 30, 2008
Aetna Small Group has announced plan, benefit, rate and underwriting changes for April 1, 2008 effective dates.

Employer Rating in effect April 1st for new & renewing business.
Composite Rating available for groups with 25 or more enrolling:

• 4 Plan maximum, and must have 1 member enrolled in the plan for it to be offered to new hires.
• Composite rates are based upon final enrollment in each plan platform (HMO, MC/PPO). If the quoted rates and the final rates vary less than 5%, Underwriting will honor the quoted rates.
• Inforce groups with 25 or more enrolled employees can move to composite rates at renewal.
  - Groups wishing to change plans at renewal, select the Pick A Plan option, or switch rating methodology (tabular to composite or composite to tabular) may be subject to underwriting.

Rate Adjustments by Region for 2nd Quarter 2008

Rating Area Changes Effective April 1, 2008

• Contra Costa and Alameda counties are moving from RA 7 to RA 5 – this results in a decrease on HMO of 5% and MC of 18%.
• Sacramento 956 is moving from RA 8 to RA 6 – this results in a decrease on HMO of 8% and MC of 16%.
• Tulare and Madera counties are moving from RA 9 to RA 7 – this results in a decrease on HMO & MC of 12%.
• Placer County is moving from RA 8 to RA5 - this results in a decrease on MC of 10%.

Aetna Network: Promise Hospital of East LA – Southern California
Effective April 25, 2008, Long Term Acute Care Hospitals located in Los Angeles, Paramount and San Diego are available for HMO, MC and PPO Members. They will be accessible via DocFind after the effective date.

Aetna Network: USC University Hospital – Southern California
Institutes of Excellence added USC University Hospital effective March 1, 2008. New programs added to this facility are Adult Heart, Lung, Heart-Lung, and Kidney transplants.

Aetna Dental® PPO II Offers Greater Network Access
The Aetna Dental PPO plan just got better! Aetna Dental has grown their PPO network to include over 6,000 more available dental practice locations. These additional dentists belong to what Aetna refers to as, Aetna Dental PPO II. Aetna Dental PPO II provides the member with more Aetna dentists to choose from. This means discounted rates are offered at more dental practice locations, which may help members lower the cost of their dental care.

How do you find an Aetna dentist?
Access Aetna’s online provider directory, DocFind, at http://www.aetna.com/docfind/home.do. Make sure to select Dental PPO/PDN with the PPO II network.

Consolidated Billing Now Available!
Single bill, single check simplifies billing.

Plan sponsors asked Aetna to simplify the billing process and Aetna responded with a consolidated bill solution called the Enterprise Billing System (EBS). Now your clients (51-3000 lives) can experience the benefits of integration from a billing perspective, in addition to the numerous advantages integrating benefits offers them and their employees.

What’s new?
EBS provides a consolidated HMO and Traditional (PPO) list bill that:

• Replaces multiple invoices with one statement that list all products.
• Accepts a single check payment for all products.
• Captures credits, debits accurately when calculating back adjustments.
• Reads easier, according to plan sponsor testing.
• Improves efficiency and accuracy of broker commission payments.

Availability
EBS supports Aetna fully insured list-billed only products for both HMO medical, Traditional medical, dental and life coverage. It is available to new customers beginning with an effective date of February 1, 2008, with plans to roll out to existing customers later in the year.

Want to know more?
For a detailed look at the Enterprise Billing System, the brochure describes the consolidated list invoice to plan sponsors.

Please contact B&P if you have any questions about this new feature!

No significant updates at this time.

New HIPAA Form Required
Anthem Blue Cross has revised their Small Group HIPAA Authorization Form. Please note that the old form will no longer be accepted. Please update your copy, click here.

Blue Cross Revises RAF Program
We are pleased to announce that Blue Cross has revised their RAF Program for May through August 2008 effective dates. The program now includes groups down to 10 enrolling employees!

May – August 2008 Effective Dates:
Guarantees for groups of 10-14 and 15-50 with no health questions required!

• Groups with 10-14 enrolling employees receive a maximum .95 RAF.
• Groups with 15-50 enrolling employees receive a maximum .90 RAF.

And remember:

• There are no health questions required.
• The lowest RAF available is .90 and the RAF is guaranteed for the initial 12 months from the Medical coverage effective date.
• This offer does not apply to association groups.
• Clients can save when bundling Life, Dental and Workers' Compensation.

For more information, contact your B&P Sales Team or click here for the New Business Deadlines & Offers from our Carriers.

Blue Cross Updates Pharmacy Benefit Specialty Drug List
For updates, reference the article located in Blue Cross Large Group.

The Agent Site Received a Makeover!
The Agent Site has been updated with the Anthem Blue Cross branding and a new look and feel, including separate buttons for Individual, Small Group and Senior. Functionality hasn’t changed, so you won’t have problems finding information. The change is mainly to reflect the new brand, to make Blue Cross of California consistent with other sites within their parent company and to give them a more stable platform moving forward.

Lumenos® Underwriting Requirement
Effective April 1, 2008, if a group currently offers a Single plan, Designated Plans or Mix-n-match option, the group will require full medical underwriting for the Lumenos plans. This is beginning with April Anniversary groups and Focal groups.

2008 Focal Renewal Details
Click here for access the Blue Cross 2008 Focal Renewal details and resources.

Blue Cross Network: Select HMO Network Expansion – Ventura County
Over the past year, Blue Cross has worked diligently to respond to broker, sales and member requests to expand the Select HMO Network. They are pleased to announce that they received DMHC approval to expand the Select HMO Network into Ventura County. The expansion was effective March 1, 2008.  Note: When Select HMO launched approximately four years ago, Ventura County was not part of the original network which included 22 counties across California.

BC PPO is the New Name for BlueCard PPO
To comply with the brand regulations of the Blue Cross and Blue Shield Association, Blue Cross of California (BCC) stopped using the words "BlueCard" in its PPO plan names as of March 31, 2008. The Association does not allow any licensees to use the term "BlueCard" in product names. "BlueCard" may only be used to refer to the program and the network. The new product name will be BC PPO; in some cases, BC PPO (non-California resident) will be used.

To date, the compliance modifications that have been completed include:

• California website references or links on member, provider and broker portals
• Benefit Summaries accessed via links on the websites
• California collateral (brochures, flyers, custom materials, proposals)

March 31, 2008 deliverables include (but may not be limited to) modifications to external messaging such as:

• Any remaining collateral (brochures, flyers, broker books, custom materials, proposals) that's been identified
• California contracts (EOCs and COIs)
• California forms (enrollment, group administrative agreements, vouchers)
• California materials included in Dynamic Kits (letters, plan overviews, single source summaries)

By March 31, 2008, please destroy any remaining collateral or broker books referring to BlueCard PPO plans that you may have or that are posted on your websites. Visit www.beerepurves.com to access plan summaries containing the BC PPO reference.

New EAP Plan Designs Effective April 1^st
An Employee Assistance Program (EAP) is now easier to sell and available for quoting! We are pleased to inform you that Blue Cross has announced their new EAP designs for new and renewing groups, beginning with April 1, 2008 effective dates.

The Basic EAP design offers three face-to-face clinical sessions per concern, while the Enhanced EAP design is available with either four or six face-to-face clinical sessions per concern. Groups of 1000+ may customize the number of sessions.

There are several advantages to the plans, including:

• The focus of the Basic EAP design is employee (member) services.
• Full work/life services are built into the Enhanced plans and do not have to be purchased separately.
• For the Enhanced designs, onsite service hours are now fixed.
• Rates for the EAP plans are less than the existing comparable EAP plans.
• Pricing is list priced.

For details on the EAP product designs and pricing, reference the Blue Cross Broker Guide.

All proposals will automatically include EAP plan options and rates based on the group size. If you have any additional questions regarding Blue Cross EAP options or would like to request a quote with these options, please contact your b&p Large Group Specialist.

Formulary update
The following grid lists the outcomes of the first quarter 2008 Anthem Blue Cross Pharmacy and Therapeutics Committee meetings held on March 5, 2008. Members should refer to their benefit agreement to understand how changes to non-Formulary status may affect them. For additional information regarding their benefits, members should contact Customer Service at the phone number on their ID card.

Access to Non-Formulary Medications
The Drug Utilization Review (DUR) exception process provides access to most non-formulary medications, multi source brands, therapeutic interchanges and step therapy procedures for select benefit plans. When the prescribing physician denotes "do not substitute" (DNS) or "dispense as written" (DAW) on the prescription, the pharmacist transmits the claim using the appropriate DUR code to allow adjudication of the claim. Select non-formulary medications are channeled through the Prior Authorization of Benefits process where an internal review is required before dispensing.

For a copy of the Formulary, please access the Anthem Blue Cross website at anthem.com/ca under Pharmacy Information, or call Customer Service at 800-700-2541. You may also contact your b&p sales team for with questions.

Early Bird from CaliforniaChoice®
Group numbers guaranteed on the effective date with CaliforniaChoice®.

When you submit your group through Beere & Purves by the 18th of April for a May 1, 2008 effective date, and all pending requirements are completed by the 24th of the same month, we will submit your case to CaliforniaChoice® as an Early Bird case. Cases meeting special receipt and pending item dates receive a group number on the requested effective date.

Early Bird Special Timeline:

If you have any questions, please contact one of the B&P Underwriters.

Update Your Employee Enrollment Applications
Please visit www.beerepurves.com or contact a member of your dedicated Sales Team, to obtain the new CaliforniaChoice® enrollment forms for your groups.

No significant updates at this time.

Double Your First Month Commission – Extended!
Double your first month commission for any CaliforniaChoice 51+ group NEW to Kaiser Permanente has been extended through June 1, 2008 effective dates (groups without current Kaiser Permanente membership).

Plus, for every Kaiser Permanente member you enroll, earn an additional $15/member.

EXAMPLE*:
You enroll a 150 member group in CaliforniaChoice 51+ and 75 members enroll in Kaiser Permanente; the others enroll into Health Net and Cigna.

*For illustration only. For more information on commission opportunities, please consult CaliforniaChoice 51+.

Please contact your Large Group Specialist for a CaliforniaChoice 51+ quote.

Update Your Employee Enrollment Applications
Please visit www.beerepurves.com or contact a member of your dedicated Sales Team, to obtain the new CaliforniaChoice 51+ enrollment forms for your groups.

Please see the CaliforniaChoice® -Small Network Updates.

Small Group Advertising Assistance Program for Brokers
Delta Dental’s Small Group (5-99) Advertising Assistance Program for preferred brokers provides you with direct mail postcards which can be sent directly to potential clients. You can choose from three different postcard campaigns. Each postcard includes postage and will be printed with your name and contact information.

With this program, Delta Dental shares in your overall costs. Your costs are as follows:

Click here for sample mailers or contact your B&P Group Sales Representative if you would like additional information.

Health Net Employer Satisfaction Survey
For more details, reference the article in Health Net Large Group.

Salud HMO y más is coming to the Inland Empire
Health Net is bringing Salud HMO y más to select areas of San Bernardino and Riverside counties, complete with all the great features that have made Health Net’s cross-border HMO health plan so popular:

Serves the unique needs of Latinos:

• A select network of doctors and office staff in California who speak both English and Spanish
• Cross-border access to care via the SIMNSA network of providers in Mexico
• Coverage to eligible dependents living in Mexico, within 50 miles of the California border, who may enroll and receive care exclusively from SIMNSA providers

Saves employers up to 20% over comparable full-network HMO plans

The Salud expansion is effective:

• April 1, 2008 for groups of 51 or more
• May 1, 2008 for Small Business Groups
• July 1, 2008 for Individual Family Plans

Service Areas
People who live or work in select zip codes in Riverside or San Bernardino are eligible to enroll in the Salud HMO y más plans. Click here for an updated plan service area list.

The Doctor Search at www.healthnet.com has already been updated to reflect the plan expansion; paper directories will be available in mid-April.

Rate Updates

• Rates are effective May 1, 2008, through July 1, 2008, effective dates.
• There will be a modest trend rate increase for Medical.
• There are no rate changes for Dental, Vision and Life.
• There are no rate changes for Chiropractic, Acupuncture, and Combo Rider.

Hⁿ Options with Silver
This new product offers the choice and flexibility of Hⁿ Options with Silver Network savings. It is a budget-friendly choice for employers, allowing them to offer their employees this portfolio alongside Health Net’s Silver Network, which is a select subset of their full network.

For more details, contact a member of your dedicated b&p Sales Team.

No significant updates at this time.

Employer Survey Update
Health Net of California will be conducting a 2-week, online Health Net Employer Satisfaction Survey starting on Wednesday, April 16, 2008.

What is the purpose of the survey?
Health Net will be asking their employer groups for their feedback on how well they are serving them and their employees. Understanding employer opinion of their current performance is a critical part of their ongoing efforts to improve service to their clients.

How will the survey be conducted?
On April 16th, an email invitation containing a link to the survey will be sent to Health Net’s California employer groups. Those employers who choose to participate will be asked to click on the link and be led to the survey site. The survey will take approximately 15 - 20 minutes to complete.

Survey responses will be anonymous and kept completely confidential.

New Pharmacy Benefit - PA Light
Health Net’s revised Starting Line-Up Phase II quote now includes a new pharmacy plan design called the PA Light that may be purchased with any of their PPO plans.
 
The PA Light plan options offer a standard 3-tier Rx (such as $10/25/40) benefit with a reduced Prior Authorization list for only a few dollars more per person. The standard Prior Authorization list contains approximately 90 drugs, whereas, the PA Light Prior Authorization list has been shortened to 37 drugs.
 
Click here for the PA Light Prior Authorization drug list.

Now Wrap with Kaiser Permanente Choice Solution
Kaiser Permanente Choice Solution can now be used as a wrap program. And, the minimum Kaiser Permanente Choice Solution participation requirement is only one life!

Your clients can choose from 5 great Kaiser Permanente Choice Solution benefit designs:

• HMO 10 • HMO 30 • HMO 20/1000
• HDHP 1400* • HDHP 2400* (*HSA-Qualified High Deductible Health Plan)

The POS, PPO and Indemnity benefit plan designs are not available when wrapped.

Please contact a member of your B&P Sales Team with any questions.

Please note: Ancillary participation guidelines will apply to those enrolled in Kaiser Permanente Choice Solution.

No significant updates at this time.