Anthem Blue Cross of California has released an infographic summarizing the factors which cause a grandmothered or legacy small group to realize a higher than expected increase in rates. In 2016 all small group plans must become ACA compliant. This means they must include certain new medical elements, but how the rates are determined are also affected.
Anthem Blue Cross drops SEP online applications
Anthem Blue Cross will accept only paper applications for special enrollment in individual plans sold off the exchange. Online applications for plans sold off the exchange during a special enrollment period (SEP) are no longer accepted.
Anthem Blue Cross California releases 2016 individual and family plan material
The exclusive provider organization (EPO) is now a tiered preferred provider organization (PPO) plan. Members on 2015 EPO plans will be transitioned to Tiered PPO plans effective 1/1/16 (unless they choose a different plan).
Anthem Blue Cross employer group reporting requirements
The Affordable Care Act (ACA or health care reform law) requires employers with at least 50 full-time workers (called Applicable Large Employers or ALEs) to offer their employees health care coverage (minimum essential coverage or MEC). Those who don’t comply may face penalties.
Anthem Blue Cross launches Cal INDEX connecting health records
California has a new, state-of-the-art system that gives your clients’ doctors a new way to exchange health information. It’s called Cal INDEX. It lets doctors, nurses and hospitals across California connect and see health records quickly and easily. It’s like sharing an index of each person’s health history. And by sharing records, doctors can offer better, safer, more efficient care.
Anthem Blue Cross emergency coverage during California wildfires
Emergency and urgent care services provided by doctors and hospitals out of our network will be paid at in-network coverage levels.
Anthem Blue Cross dropping coverage for certain prescription compounded drugs
Starting November 4, 2015, Anthem’s prescription drug plans will no longer pay for certain compound drugs that contain ingredients not approved by the Food and Drug Administration (FDA). A compound drug is a customized medication prepared by a pharmacist for a specific person. Some of your clients may be affected by this change, if they are taking one of these drugs, particularly ones containing:
Anthem Blue Cross announces new physical therapy collaboration
Starting November 1, 2015*, OrthoNet will handle the management of both in-network and out-of-network outpatient physical therapy and occupational therapy services [in California]. OrthoNet is a musculoskeletal management company that has ties to leading therapists in Anthem’s service areas. It also has created many best practices followed throughout the industry.
OTC Nexium prompts drug formulary changes
Anthem Blue Cross of California August 4, 2015 NEXIUM® 24HR (esomeprazole 20 mg) became available as an over-the-counter (OTC) 14-day treatment for frequent heartburn in May 2014. As a result, our drug formulary (list of covered drugs) will change, effective October 1, 2015, as follows: Nexium 40 mg moves from Tier 2 to Tier 3 and has […]
Anthem Blue Cross files report on MLR rebates for California: No rebates
Anthem Blue Cross of California August 4, 2015 The Affordable Care Act (ACA or health care reform law) requires health plans to meet a minimum medical loss ratio (MLR), which varies according to market. Health insurance issuers must meet a minimum MLR of 85% in the fully insured large group market and 80% in the […]
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