Health care reform benefit comparison guide How small group plans are changing as of September 23, 2010
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1 Health care reform benefit comparison guide How small group plans are changing as of September 23, CABENABC 9/10
2 September 23, 2010 marks an important day for the health care reform law. That s because many important provisions take effect on this day. These provisions will change your clients Anthem Blue Cross health care plans. Starting with October 1, 2010 renewals, you ll start seeing: lifetime benefit s Based on the interim final regulations, lifetime s are not permitted for essential health benefits. We will no longer include lifetime dollar s at the plan level for grandfathered or non-grandfathered plans. 100% coverage for in-network care Based on interim final regulations and our interpretation of these regulations, only non-grandfathered plans must meet the provision requirements. We have chosen to add this provision to all grandfathered California small group plans as well. This includes 100% in-network coverage for services (based on the recommendations of USPSTF, ACIP and HRSA) and no requirement to cover out-of-network care services. To learn more about the services that are covered at 100%, go to the agent site at anthem.com/ca. Dependent coverage for adult children up to age 26 Based on interim final regulations and interpretation of these regulations, although coverage must be offered for a subscriber s or participant s children or dependents who are under the age of 26. This requirement applies to grandfathered and non-grandfathered plans. Financial dependency on or residency with the subscriber or participant is not required. Also, there is no requirement for the dependent to be unmarried, a student, unemployed or any combination of these factors. annual s on certain types of benefits Based on the interim final regulations and our interpretation of these regulations, annual dollar s for essential health benefits are not allowed. } } under the age of 19 Based on interim final regulations and our interpretation of these regulations, this prohibits pre-existing s for members younger than 19 from plans in which such s existed.
3 Helping your clients make the best decisions We want your clients to get the most from these provisions. The following chart compares our plans before and after September 23, 2010, so they ll know what you can expect. As you review this information, keep in mind that your clients with EmployeeElect plans effective before March 23, 2010 may already be on a grandfathered plan. Your clients may lose grandfather status if their plan offerings: Eliminate all (or substantially all) benefits to diagnose or treat a particular. Increase (or another percentage cost-sharing requirement) above the level at which it was set on March 23, Increase fixed-amount cost-sharing requirements other than copays, such as a deductible or an out-ofpocket, by a total percentage (measured from March 23, 2010) that is more than the sum of medical inflation plus 15%. Increase copays above the level in effect on March 23, 2010, by an amount that exceeds the greater of (a) the sum of medical inflation plus 15% or (b) $5 increased by medical inflation. Reduce employer contributions (calculated by cost or formula, such as hours worked) toward any tier of group health insurance coverage or a group health plan by more than 5% below the contribution rate on March 23, Impose an annual on the dollar value of benefits if an annual or lifetime had not been previously imposed on all benefits or, for plans that previously imposed a lifetime on all benefits, impose an overall annual dollar that is lower than the lifetime, or, for plans that previously imposed an annual on all benefits, decrease the dollar value of the annual. Change from one insurer to another (insured plans only). To help you and your clients learn more about grandfathering, we are introducing our innovative Grandfathering Decision Tool. Available now, this tool is engaging, interactive and conversational. Users will learn more about grandfathering, while gaining a better understanding of how grandfathering may impact their unique situations. Check out the tool at As always, talk with your Regional Sales Manager if you have any questions. We re ready to help you and your clients make the best decision for their businesses.
4 Premier PPO plans $10, $20, $30 10%, 20%, 30% Uned cost share Up to 26 $50 lifetime payment of $2,000 per year lifetime Co-insurance with no annual PPO Copay plans $20, $30, $40 20%, 30%, 40% Uned cost share Up to 26 $50 lifetime payment of $2,000 per year Smoking Cessation Program: lifetime Durable Medical Equipment: Co-insurance with no annual PPO Gen Rx plans $25, $35, $45 25%, 35%, 45% Uned cost share Up to 26 $50 lifetime payment of $2,000 per year. lifetime Co-insurance with no annual
5 Solution plans 2500, 3500, %, 35%, 40% Uned cost share Up to 26 $50 lifetime payment of $2,000 per year. lifetime Co-insurance with no annual Elements plans Hospital, Plus, Preferred 20%, 30%, 30% Uned cost share Up to 26 and lab: 50% for first $1,500 $750 per year (non-ab88 ): $5,250 per year and lab: 50% (non-ab88 ): Maximum 30 days per cost share Lumenos HIA Plus 500, 750 Uned change Up to 26 change
6 cost share Lumenos HSA (100/70) 2000, 3000, 5000 Uned change Up to 26 change Lumenos HSA (80/50) 1500, 2500, 3500 cost share Uned change Up to 26 change High Deductible EPO 20% or $25/$75 copay for HealthyCheck (non-ab88 ): $5,250 per year Uned cost share Up to 26 (non-ab88 ): Maximum 30 days per
7 EmployeeElect HMO 100% $10, $25 lifetime change $10, $25 copay copay Up to 26 $50 lifetime Limited to our combined payment of $2,000 per year. lifetime Coinsurance with no annual n/a change Classic HMO $20, $30, $40 lifetime change $20, $30, $40 copay cost share Up to 26 $50 lifetime Limited to our combined payment of $2,000 per year. lifetime Coinsurance with no annual n/a change Saver HMO $20, $30, $40 lifetime change $20, $30, $40 copay change Up to 26 $50 lifetime Limited to our combined payment of $2,000 per year. lifetime Coinsurance with no annual n/a change Select HMO $25, $35 lifetime change $25, $35 copay change Up to 26 $50 lifetime Limited to our combined payment of $2,000 per year. lifetime Coinsurance with no annual n/a change
8 BeneFits Hospital BeneFits Preferred PPO 25%, 35%, 40% Uned cost share Up to 26 $50 lifetime Durable medical equipment : payment of $2,000 per year. copay Coinsurance with no annual Hospital BeneFits Plus PPO 20%, 30%, 30% Uned cost share Up to 26 and lab: 50% for first $1,500 $750 per year. (non-ab88 ): $5,250 per year and lab: 50% (non-ab88 ): 30 days per cost share Hospital BeneFits PPO Uned cost share Up to 26 change
9 BeneFits (Cont.) cost share PPO $35 Copay GenRx Uned change Up to 26 change cost share Lumenos HSA 3000 (100/70) Uned change Up to 26 change 20% or $25/$75 copay for HealthyCheck (non-ab88 ): $5,250 per year Select $25 HMO Uned cost share Up to 26 (non-ab88 ): Maximum 30 days per
10 EmployeeChoice Premier PPO $20 Copay 25%, 35%, 40% $50 lifetime payment of $2,000 per year. Uned cost share Up to 26 copay Coinsurance with no annual PPO $30 Copay 20%, 30%, 30% Uned cost share Up to 26 and lab: 50% for first $1,500 $750 per year. (non-ab88 ): $5,250 per year and lab: 50% (non-ab88 ): 30 days per cost share PPO $35 Copay GenRx Uned cost share Up to 26 change
11 EmployeeChoice (Cont.) cost share Lumenos HSA 3500 (80/50) Uned change Up to 26 change cost share Saver $20 HMO Uned change Up to 26 change Lumenos HSA 3500 (80/50) with MHP 20% or $25/$75 copay for HealthyCheck (non-ab88 ): $5,250 per year Uned cost share Up to 26 (non-ab88 ): Maximum 30 days per Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees 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. Additional information about Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company is available at
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