Anthem Balanced Funding 54626CABENABC 07/15. A new solution for health care spending and saving

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1 Anthem Balanced Funding 54626CABENABC 07/15 A new solution for health care spending and saving

2 Protecting the health of your employees we re all about that. Now let s protect the health of your business. If you re looking for a new health care option with more savings potential, Anthem Balanced Funding could be right for you Your business is as unique as the employees that make it successful every day. So choosing how you fund your health plan is a big decision. It has to be the right fit, so you can keep your company s financial health strong and your employees feeling safe and valued. It s our job to help you find that balance. What do we mean by funding, in general? Funding is how you pay for your employees health benefits. In the past, there have usually been two choices fully insured or self-funded. Here s an example to help you understand the difference: Fully insured funding works like a cable TV bill. No matter how much TV you watch, you re charged a fixed monthly rate. For health coverage, there s no penalty if claims are higher than anticipated, but there s no reward if they are lower. Fully insured Balanced funding Self-funding works like your electric or gas bill. You pay a minimum administrative fee each month, but total charges are linked to actual usage, like how often you keep the lights on. For health coverage, if claims are low, you pay less; if claims are high, you pay more. Potential savings 1 Here s how it works with health insurance With a fully insured plan, you pay a set premium each month, which varies only by enrollment, and no matter how much or how little your employees use the plan, you pay the same amount. Balanced funding is a little like a self-funded plan, but with a lot less risk. With balanced funding, you can have the same fixed monthly payments, but, when your group s claims are better than expected meaning your employees have lower usage of benefits you could get a premium credit at the end of the benefit year. 100% nonrefundable premium Actual claims paid in a benefit year 1 Administrative fees, stop loss coverage and coverage for claims run-out. 1 This amount is variable, depending on your groups claim usgae in a year

3 Anthem Balanced Funding can give small group employers the best of both worlds It s a winning combination that can be perfect for your group. Here s what to consider: You can save money! With balanced funding, you can eliminate paying Affordable Care Act (ACA) premium taxes, your expenses may be lower, and at the end of your benefit year, depending on your claims, you may get a premium credit. You can get the same benefit package! Our plan designs are the same ones you re used to with predictable monthly payments. You can pick a plan and wellness options tailor-made for your business. You can rest easy! We ve built in a cap on your financial responsibility, so there s limited risk for you and your business. How does it work? Simple! You Members Claims make a fixed monthly payment that includes: Administrative fees. Specific and aggregate stop loss coverage. A paid claims fund. Coverage for claims run-out. use their benefits. are reconciled. If your claims are higher than projected, you re not liable for any additional costs because of the stop loss coverage. If your claims are lower than projected, you can share in the savings! 1

4 Let s take a closer look at the overall advantages Anthem Balanced Funding lets you enjoy greater cost control by providing dual financial benefits the potential for annual savings, with built-in safeguards to cap your expenditures. And if you re not a fan of paperwork, balanced funding is great because we ll take care of the administration. Here s what you get: Savings on premium and health care reform taxes. Prefunded claims run-out to help you avoid unpleasant surprises if you terminate the plan. Funds are collected to cover claims incurred prior to termination and submitted afterward. Fixed monthly payments so you have that predictability to simplify budgeting. No deficit carry forward built in with stop loss coverage, so if your group has a high claims year, you won t have to pay that money back at the start of the new contract year. Those claims are covered and paid for, so that deficit does not carry forward. End-of-year premium credit when claims are lower than expected. Stop loss coverage protects you from the risk of large claims: specific stop loss for high individual claims and aggregate stop loss for higher-than-expected overall claims costs for your group. You ll also get monthly reports To help you understand the relationship between benefits and costs, you ll get monthly reports that can identify opportunities where you can save money and make smarter health care decisions. These reports do not include protected health information. 2

5 How does it work at the end of the benefit year? It s easy to see how Anthem Balanced Funding provides a path to help keep your employees healthy and your health care costs in check. Favorable claims year A surplus can offer significant savings when you have a favorable claims year. Fixed cost $100,000 Annual Claims Funding $200,000 Actual Paid claims $150,000 Surplus $50,000 Employer receives a premium credit* Unfavorable claims year The deficit balance is covered by stop loss insurance. Net result? You can breathe a little easier. Fixed cost $100,000 Annual Claims Funding $200,000 Actual Paid claims $235,000 Deficit $35,000 Employer not responsible for deficit * A credit may be applied toward next year s premium, as long as the group remains with Anthem. Bottom line? Anthem Balanced Funding offers the potential to lower your overall health care costs. 3

6 \\\ What type of health plan goes with Anthem Balanced Funding? You choose! You have plenty of plan options from our broad portfolio. We ll help you find the health and prescription drug plan that s the perfect fit for your company and employees. You also can choose dental, vision, life and disability coverage as well, on a fully insured basis. And we don t stop there. You even get health and wellness programs to help employees get healthy and stay that way. Here s what s included: 24/7 NurseLine is staffed with registered nurses who are just a phone call away at any time. Nurses can answer questions about a medical concern or help members choose the right level of care. Members can call the same phone line and listen to hundreds of health topics in the AudioHealth Library. The recordings are available in English and Spanish. Future Moms helps moms-to-be have a healthy pregnancy. Experienced nurses provide individualized care for pregnant members to help ensure a full-term, healthy baby. The ConditionCare program teams up members with nurse coaches and other health professionals who give them holistic, integrated and seamless health management for chronic conditions including asthma, chronic obstructive pulmonary disease (COPD) and heart disease. MyHealth Advantage is an outreach program that helps members stay current with their health care and save money. By analyzing member health data and history, the program identifies possible health risks, care gaps and savings options. Members are contacted with MyHealth Notes that offer resources to help them make the best choices about their care. MyHealth Coach offers members one-on-one professional guidance from an experienced health coach for common health issues, such as weight management, tobacco use and managing stress. Healthy Lifestyles is an online health resource that helps members transform their behaviors and improve their health in a variety of areas including weight, nutrition, physical activity, tobacco use, stress and depression. Some plans may include incentives. LiveHealth Online gives members 24/7 access to doctors through a mobile device or a computer with a webcam. Board-certified doctors can evaluate nonemergency illnesses or conditions and prescribe basic medications, if needed, 1 for $49 or less, depending on health plan benefits. 2 Case Management nurses help members deal with complex health issues and navigate the health care system. Backed by a team of physicians, pharmacists, exercise physiologists and others our nurses have the latest information on treatment options. 1 Prescription availability is defined by physician judgment and state regulations. LiveHealth Online is available in most states and is expected to expand to more in the near future. Visit the home page of livehealthonline.com to view the service map by state. 2 Doctors using the LiveHealth Online tool charge an average fee of $49. 4

7 You can always count on Anthem If you re considering a balanced funding plan, you can rest easy knowing you still have the tried and true strength of an Anthem Blue Cross (Anthem) health plan: We ve been one of California s leading insurance companies for more than 75 years. Our BlueCard program includes 96% of hospitals and 91% of doctors nationwide. You can rely on our years of expertise in funding solutions. Beginning in 2016, employers can also buy an incentive package to motivate their employees to live healthier lives. Ask your broker or Anthem Sales rep! 5

8 For more information about Anthem Balanced Funding, call your broker or Anthem Sales representative. *Prescription availability is defined by physician judgment and state regulations. LiveHealth Online is available in most states and is expected to expand to more in the near future. Visit the home page of livehealthonline.com to view the service map by state. LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross. Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.