Anthem 2019 Q1 & Q2 Rate Actions, Relaxed Participation, Product and Program Updates!

Relaxed Participation Extended through 6/15/2019 Effective Dates

  • 25% participation for group of 5 or more enrolled subscribers – also applies to groups wrapping with another carrier HMO
  • 65% participation for groups with 4 or less subscribers enrolled
  • REMINDER – Anthem accepts individual coverage, both on and off the Exchange, as a valid waiver

2019 First Quarter Rate Action:

2019 Q1 Quarterly Statewide Averages:

  • HMO: 2.4%
  • PPO: 2.1%

2019 Q1 Annual/Renewal Statewide Averages:

  • HMO: -3.9%
  • PPO: 1.3%
  • Combined: 0.7%

    • 2019 Second Quarter Rate Action:

    2019 Q2 Quarterly Statewide Averages:

    • HMO: 4.8%
    • PPO: 4.5%

    2019 Q2 Annual/Renewal Statewide Averages:

    • HMO: 1.8%
    • PPO: 5.7%
    • Combined: 5.1%

    2019 Medical Program Enhancements

    • Available to all Small Group ACA business as of 1/1/2019
    • LiveHealth Online: NEW $0 copay for first 3 visits on non-HSA plans
    • Future Moms NEW Enhanced Breastfeeding Support includes visits through LiveHealth Online with a lactation consultant or registered dietician at no charge
    • NEW Anthem Health Guide, accessed by calling the number on the member ID card can educate and/or connect members to clinical support, education and online tools and resources
    • Expanded Customer Service Hours

    2019 Small Group Medical Product Updates

    New Streamlined Product Naming Conventions

    • Out of Pocket Maximum has been removed from all plan names
    • PCP Copay has been added
    • Only the PCP copay will be listed for HMO “no deductible” plans

    New Streamlined Product Naming Conventions

    • Out of Pocket Maximum has been removed from all plan names
    • PCP Copay has been added
    • Only the PCP copay will be listed for HMO “no deductible” plans

    NEW EPO Product!

    • Introduced for 2019 – new EPO product where member selects a PCP at enrollment, no referrals required for specialist visits
    • Offers In-Network Only coverage for both CA based and out-of-state employees using the full Prudent Buyer network in California and the BlueCard network out-of-state
    • Two Gold plan options ($500 and $1,700 deductible)
    • Benefit Summaries: Gold EPO 35/500/20% and Gold EPO 35/1700/20%

    NEW Silver HMO 55 Plan on Full and Select networks!

    • Silver tier “copay only” plan option with no medical deductible or coinsurance
    • Note, this plan is in addition to the Silver HMO 55/2250/40% plan design
    • Benefit Summaries: Silver HMO 55 and Silver Select HMO 55

    Discontinued Plans

    • Gold HMO 500/20%/5000
    • Gold HMO 1000/30%/4000
    • Silver HMO 1500/35%/7150
    • Gold PPO 2000/20%/4000
    • Bronze PPO 4500/45%/6550 w/HSA

    Talk to your RBG Representative about Anthem integration with EaseCentral for both new sales and ongoing maintenance!