We conducted an analysis of the House Republican Platform released over the summer, which may serve as a starting point for legislative changes. The below chart shows how some of President-elect Trump’s campaign proposals line up with the House Republican Platform released earlier this year.
For 2017, Anthem Blue Cross will offer a new Silver Pathway HMO 2650 plan for Individual business. This plan meets Affordable Care Act (ACA) rules and will be sold off the exchange only. We also will expand our Pathway HMO network in Los Angeles County for members who buy plans on or off the exchange.
Anthem Blue Cross has made it easier for members with off-exchange plans to change plans without filling out a new application. Current off-exchange members who want to change from their 2016 ACA compliant Anthem plan (purchased off the exchange) to a different off-exchange plan for 2017 can use the appropriate new form instead of having to complete the full enrollment application.
The California Office of the Patient Advocate (OPA) has released their health plan quality report cards in time for the 2017 open enrollment period. Now in its 16th year, the 2016/2017 OPA Health Care Quality Report Cards are available online at www.opa.ca.gov. This timely release of the Report Cards is critical as consumers prepare in making the important decision of choosing a new health plan for themselves and their families during 2017 open enrollment. Quality matters when consumers choose a health plan or medical group, and this free tool helps ensure they have the information they need to make an educated decision.
There are errors on the Medicare Plan Finder website, Medicare.gov, and within the “2017 Medicare & You Handbook” regarding some Anthem Blue Cross Medicare Advantage plans. The errors are limited to the state of California (CA) and include the counties of Santa Clara, Kings, Tulare, Madera, Stanislaus, San Bernardino, Riverside and Fresno. The benefit information for Fresno MediBlue Plus (HMO) Plan is incorrect, and the service area information for Santa Clara, Kings, Tulare, Madera, Stanislaus, San Bernardino, and Riverside counties is also incorrect.
For 2017, we have adjusted our product portfolio to include an exclusive provider organization (EPO) in most rating regions. Rating Regions 10 – 14 (Southern San Joaquin Valley counties) will continue to be offered PPO plans. Members on some 2016 PPO plans and all Tiered PPO plans in these areas will be transitioned to EPO plans effective 1/1/17 (unless they choose a different plan). Members will have access to our Pathway network of doctors and hospitals, but their EPO plan will not cover out-of-network benefits.
Health care costs continue to rise, and specialty drugs are a big contributor. These prescription medicines are used to treat complicated and chronic conditions, such as hepatitis C, cancer and multiple sclerosis. As specialty drugs become more widely used, we’re looking for new ways to control costs while keeping members healthy. That’s why we created our Right Drug Right Channel (RDRC) program.
Starting October 1, 2016, American Specialty Health (ASH) will process all acupuncture claims, in and out of the network, for our California fully insured large and small group PPO (Preferred Provider Organization) plans. ASH also will review claims for acupuncture care to make sure the services members get are medically necessary.
Covered California has released their 2017 Regional Rate and Plan Information summary. This summary has a more in-depth focus specific consumer market information than does their 2017 Health Plan Booklet. While the target audience is Certified Application Counselors and Agents, there is also some very useful information for consumers.
The rule includes clarifications and requirements for covered entities (including Anthem) that impact how Anthem administers benefits related to transgender services, and requires Anthem to add statements on materials provided to members about nondiscrimination, as well as information about language assistance.