Post on 30-Jun-2020
1
Anthem 2020 Small Group Updates
Anthem Balanced Funding (ABF)
Smart Shopper – NEW (embedded in ACA products)
Anthem Essential Dental – Enhanced
Anthem Vision – Enhanced
Anthem Life & Disability – Embedded Features
2020 SEP Broker Bonus Program
Anthem’s response to Covid 19
Anthem Balanced Funding (ABF) Alternative to ACA
2
3
How Does it Work?
ABF feels like a fully insured plan
Built in ASO contract underneath allows data and dollars to be shared with the group
Every safeguard against large/high claims is built in
No terminal liability upon plan termination
Streamlined implementation
Invisible to employees; easy for employer to understand
4
Individual Stop Loss
(aka Specific Stop Loss (SSL) or
Individual Pooling Level)
Aggregate Stop Loss
provides protection for aggregate
claims
(at the group level)
Runs the policy year and covers each
member, protecting against high
individual claims
Provides a limit on claim liability to
protect against overall high group
utilization
Provides monthly and annual protection Provides monthly and annual protection
Stop loss premiums, along with the administration fee and broker
commissions, make up the fixed costs in any ASO contract.
Stop Loss is insurance that mitigates the cost of catastrophic medical claims.
May be invisible but most FI contracts have this baked in (ISL)
How Does it Work?
5
4-tier composite rates are set up front
Money is saved when claims run well
No deficit recovery if claims run poorly
No terminal liability when client leaves Anthem at
renewal
State taxes limited
Advantages for a Small Employer
How Does it Work?
6
The employer is not responsible for the negative balance.
Unfavorable Claims Year
Annual fixed cost $150,000
Annual claims funding $380,000
Actual paid claims $400,000
Negative balance - $20,000
Deficit carried forward $0
Part of the rate
eligible for a refund
Net claims over the
stop loss
Year-end Settlement Examples
How Does it Work?
7
The employer receives 50% of the surplus as a credit toward
future bills.
Favorable Claims Year
Annual fixed cost $150,000
Annual claims funding $380,000
Actual paid claims $290,000
Surplus $90,000
Part of the rate
eligible for a refund
Net claims below
claims funding
Year-end Settlement Examples
How Does it Work?
8
Termination
How Does it Work?
Customer stays with Anthem, but switches from ABF to standard Fully Insured funding
• Eligible to receive credit in case of a surplus
Customer leaves Anthem
• Will not receive a refund if there is a surplus
9
Why ABF?
ABF Will: ABF Will Not:
Protect the current “best risk”
clients
Put clients at risk for high claims
Give Employers an opportunity to
benefit from healthier risk
Lead to unpredictable monthly cost
Provide YOU the opportunity to add
value:
Offering an innovative solution
that lets the customer continue
to keep an Anthem plan
Added transparency with
reports, allowing you to work
consultatively with the
customer to address areas of
concern
Adversely affect members-they
won’t know the difference
10
*Reports do not include PHI.
Fully
Insured
Self
Insured
Anthem
Balanced
Funding
Predictable, fixed monthly payments
Ability to save money if claims run well
Discounts for Dental/Vision and/or Life
Coverage for terminal built into the plan
Protection against large claims
Reporting* to give transparency and
better control
Savings on some taxes and ACA Insurer
fee
Simple to administer
Why ABF?
11
Product Portfolio
26 Plan options are available with ABF; 13 Keycare
PPO plans and 13 Healthkeepers HMO POS plans
Effective July 1, 2020 – will add more plans with richer
prescription drug co-pays. (Key Accounts (51 to 99) will
begin offering ABF)
Groups can offer up to 3 plans
ABF – does not include Pediatric dental or vision
Specialty; if new vision, dental, life or DI is sold, a
discount will be applied to the ABF medical rate
12
o Group Risk Questionnaire (GRQ) or Individual Health questionnaire.
o VA ABF Quote Census Template.
o Renewal rates from current carrier.
o If the group has a balanced funding-type product, they will need to submit claims experience.
For the most aggressive quote, the broker/group should submit IND Health Questionnaires rather than Group Risk.
Quoting ABF
13
• Submit/Upload group sold paperwork 21 to 30 days prior to the groups requested effective date through the Anthem broker portal. Before submitting/uploading, you must have all of the sold group paperwork saved on your computer:
1. - ABF Group Application – please complete and submit using the enrollment tool for ABF.
2. - EFT Form
3. - Copy of voided check
4. - ABF NY HCRA form
5. - ABF enrollment spreadsheet
6. - ABF Checklist
13
Enrolling in ABF
14
Enroll in and save on your ABF medical payments1
ABF Medical + Dental 1.0%
ABF Medical + Vision 0.5%
ABF Medical + Life 0.5%
Total savings 2.0%
Discount to be applied to the ABF Administrative Services Fee only and will equal up to two (2) percent of the ABF medical payment. Discount only applies when new Anthem dental, vision and/or life coverage is purchased with an Anthem Balanced Funding medical plan.
14
Specialty Discounts
1
A doctor recommends a medical service.
Member goes online or talks with a SmartShopper Personal Assistant to find high-value locations. Personal Assistants can also help schedule appointments.
Member has the procedure at the location of their choice.
Once the member’s claim is paid, SmartShopper verifies that the location qualifies and sends the reward to the member.
SmartShopper - How it works
May 8, 2020 © 2018 Anthem Blue Cross Blue Shield. All
Rights Reserved. 4
ENHANCEMENTS TO 2020 DENTAL PLANS
More choices to meet customer needs
6
• Unlimited Annual Maximum Classic and Enhanced plans take the worry out of planning treatment around annual maximum limits
• $2,000 Annual Maximum Classic plans for those that need just a little more coverage
• $1,500 Orthodontic Lifetime Maximum Classic plans that match the annual maximum of $1,500
• Other Carriers’ Buy-ups are Anthem’s Standard Benefits
Implants
Composite Fillings
4 Periodontal cleanings
Orthodontia down to 5 lives
MAXIMIZING
OUR MAXIMUMS
ENHANCEMENTS TO 2020 DENTAL PLANS
Enhanced preventive dental care for better overall health
7
• New dental PPO plans include dental implants, tooth-colored fillings, accidental dental injury coverage and annual maximum carry over + network boost
• Extra cleanings, exams, fluorides and sealants for members with certain medical conditions
• Orthodontia for 5+ enrolled employees
• 36% average nationwide discount
• NO employer contribution required, however dental participation is required
OUR DENTAL PPO NETWORK:
Consider the facts
2nd largest in the nation
399K+ places to get care;
9,568 in VA
27% network growth over past
2 years
130K+ unique dentists;
4,363 in VA
ENHANCEMENTS TO 2020 DENTAL PLANS
Effective May 1, Anthem introduces TeleDentists & Ortho@Home
• In network dental providers offering online & mobile app, enabling teledentistry solutions for dental visits and dental emergencies
• Ortho@Home is embedded in Anthem Dental plans that offer orthodontia coverage. Ortho@Hom eoffers convenient at home clear aligner therapy option
ENHANCEMENTS TO 2020 VISION PLANS
New Blue View VisionSM improvements give clients more
9
• $150 $180 and $200 materials allowance for frames
• Lower member costs on standard progressive lenses – $55 copay in 2020 vs. $65 in 2019
• No employer premium contribution requirements for voluntary and non-voluntary (employer-paid) plans
• New participation requirements
– Non-voluntary plans: 50% participation with minimum of two enrolled
– Voluntary plans: no participation rate requirement; a minimum of 5 must be enrolled
QUOTING BEGINS
October 2019
EFFECTIVE DATES
January 1, 2020 and later
NEW PLAN NAMES
Make it easier to tell if plan is full
service, exam only or material only
Blue View Vision: A clear choice for convenience and savings
Here’s why Blue View VisionSM is a great value for your clients
10
• Leading member discounts, free scratch coating, tiered pricing on popular options, 40% off additional pairs of glasses and discounts on laser surgery
• Polycarbonate and Transitions lenses for kids at no extra cost
• Adult eye exam and full service pediatric vision care (exam and materials) embedded in Anthem medical plans – full-service and materials-only options available as standalone
• 63% average network savings*
* Based on the Blue View Vision plan with $10 lens copay and $130 frame allowance for glasses or $130 contact lens
allowance. Laws in some states may prohibit network providers from discounting products and services that are not
covered benefits under the plan.
INDUSTRY’S LARGEST
NETWORK of private eye
doctors, retail locations and
online stores
38K eye doctors in the plan;
1,037 in VA
97% in-network use
27K+ locations nationwide;
694 in VA
Life & Disability – Expanded SIC codes to include agricultural, trade & construction
• Expanded SIC codes to include agricultural, trade & construction industries (groups of 2+).
• Allows these industries to purchase STD & LTD.
• More small groups can offer a complete benefits package to include medical, dental, vision, life & DI.
Life & Disability 2 to 50
Benefits that HELP BUILD FINANCIAL WELLNESS
12
• Robust portfolio of employer-paid and voluntary benefits (with contract flexibility to meet needs)
• Fast claims payment
• Claims calls answered by real people – not an interactive voice response system
• Value-adds give employees and beneficiaries the support they need, when they need it, at no added cost
– Resource Advisor provides support for legal, financial and emotional issues
– Members get 24/7 phone counseling, plus can schedule three face-to-face or LiveHealth Online counseling visits
– Travel assistance helps life members who are 100 miles or more away from home
– Beneficiary Companion helps life beneficiaries close accounts and settle estate details
– Perks at Work discounts give employees discounts on goods and services they use every day
– The Healing Book helps children affected by loss and is provided at no cost
Offering Anthem Specialty Products
What’s in it for the Employer?
• Employer/Member – benefits from whole health connection – our systems talk to each other
• Employer only has one invoice to review each month (all lines of coverage on one invoice) – making it easier for your client to reconcile
• Employee receives one ID card for all lines of business
• Bundled & Medical Lock Discounts - when Anthem Dental is sold with either vision or life, the group receives our bundled discount of 5%
SEP – Individual Business
Effective dates of April 1 through December 1, 2020.
Anthem will pay a one-time bonus of $150 for each member (no family max) enrolled in an individual ACA on or off exchange plan with an effective date between April 1 and December 1, 2020.
You must sell at least 10 members and those members must stay with
Anthem for at least 90 days for you to qualify for the bonus.
This SEP business will also qualify for a renewal commission effective January 1, 2021.
15
COVID-19 Producer
Response Toolkit
COVID-19 FAQ