Rate Action Q1 2018:

PPO Average decrease -0.4% and the HMO average increase +2.4%. No increase to dental and vision plans.

A Few Changes to Note for 2018:

Added two new plans:

  • – Anthem Gold Select HMO 1000/30%/4000
  • – Anthem Gold HMO 1000/30%/4000
  • – Anthem Bronze Select PPO4500/35%/6550 w/HSA
  • – Anthem Bronze PPO4500/35%/6550 w/HSA

Discontinued the following plans:

  • – Anthem Silver Select HMO1750/40%/7150
  • – Anthem Silver HMO 1750/40%/7150
  • – Updated the benefits to the PPO plans (office visit copays, out of pocket maximum and pharmacy) to achieve more affordable coverage options.

Underwriting Made Easy:

  • Only 30% participation required for groups of 5+ subscribers enrolled
  • DE9-C not required for groups of 6+ subscribers enrolled
  • Dual HMO Network option is available
  • Individual coverage both on and off Exchange will be considered a valid waiver
  • Same Day Turnaround for New Business Enrollment! If the new business submission is received by 8 AM Monday through Friday, Anthem will provide same day review and approval, subject to completeness of new business submission*. Case must use census Enrollment Tool for same day turnaround, excluding holidays. *same day review & approval does not include clarifications or missing information identified.

Age Band Rate Changes:

If you have clients who are covered by a Small Group health plan, new regulations take effect on January 1, 2018, that will impact how premiums for children up to age 20 years old are calculated.

The new rule: multiple age rating bands for children As a result of regulations issued by the Centers for Medicare and Medicaid Services (CMS), one age band for all children from 0 to 20 years of age will no longer be used. Instead, under the new rule, the following will be adopted:

  • A single age band for individuals age 0 through 14
  • One-year age bands for individuals ages 15 through 20.

This change will take effect for new, renewed, or amended small group plans effective on or after January 1, 2018.

Under the regulations, when determining the premium for family coverage under a per-member rating system, the total premium is determined by adding the premium cost for each family member. With respect to family members under the age of 21, the premiums for no more than the three oldest covered children must be taken into account in determining the total family premium.

For Small Group plans, the rate for the family is based on the combined ages of the employee, spouse, all dependents 21 and older, and up to the three oldest dependents 20 or younger. The premium is determined on the employer’s principal business zip code.

The new rule applies to Small Group health plans. As a reminder, in California, an employer with between 1 and 100 employees will be covered by a Small Group health plan as defined by SB125.

Disabled Social Security Registration Option:

During a recent upgrade, Anthem disabled the option for Social Security numbers to be used as a registration data point when members are setting up an online account on the secure member website, or when they’re recovering a forgotten password or username. This change went into effect on all of Anthem’s member websites on September 15. To register, members will enter their member identification number (found on their ID card.) For members who forget their username or password, they’ll need to use their email address or ID number to find their account. The member’s first name, last name and date of birth are still required for registration and for username or password account recovery.