As previously communicated we’re discontinuing all 2017 non-grandfathered individual plans on December 31, 2017. For the 2018 benefit year, we will offer EPO Individual on and off exchange plans in rating regions 1, 7, and 10. The 2018 individual EPO plans will not have out of network benefits, except for urgent/emergency/pre-authorized care. We will not be offering non grandfathered individual health plans in any other regions areas in 2018.
How does this impact members with ongoing treatment?
Members who live in rating regions 1, 7, and 10 and who transition into a new Anthem EPO plan for 2018 can apply for Continuity of Care coverage if their current provider is no longer in network. They can call member services and ask for assistance with their ongoing treatment with their current providers.
Continuity Of Care Help
Members who will be discontinued (including HMO members in rating region 7) for 2018 have been notified by mail that their coverage is ending December 31, 2017. These members can work directly with you or select a new plan on Covered California’s website at CoveredCA.com and click “Find Help” for personalized assistance or call Covered California at 1-800-300-1506 (TTY: 1-888-889-4500). Once they’ve picked a new plan, they should notify their new carrier that they are formally requesting their care to be considered for “continuity of care” coverage.
Anthem adjusts Individual health plan offerings in California for 2018
August 1, 2017
For more than seven decades, Anthem Blue Cross has served consumers in the Individual market in California. Throughout that time our commitment remained the same: to provide access to affordable, quality health care. And since the inception of the exchanges, Anthem continued its commitment to serve consumers in all of the states where we provide fully insured individual health plans.
A stable insurance market is dependent on products that create value for consumers through the broad spreading of risk and a known set of conditions upon which rates can be developed. Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to shrinking individual market as well as continual changes in federal operations, rules and guidance.
Our goal is to offer attractive, affordable plans across California, and we are pleased that some steps have been taken to address the long term challenges all health plans serving the Individual market are facing, such as improving the eligibility requirements that allow consumers to purchase a plan outside of open enrollment and improved risk adjustment. However, the individual market remains volatile.
As a result, Anthem has made adjustments to our 2018 Individual plan offerings in California.
What this means in California
Next year, we will offer plans in three regions of Northern California only, which will include Redding, Santa Clara County, and Stockton/Modesto. The coverage options will include EPO plans available both on-exchange and off-exchange, and at all metal levels. Staying in these three key areas will help ensure Californians in those regions have access to health plans.
It’s important to note that these changes do not immediately impact the benefits of members currently enrolled in our Individual health plans. They can use their health benefits without interruption until the end of the year.
We’ll soon send members an email sharing this news (if they’ve chosen to receive email communications). Then, in September, we’ll send impacted members a formal notice that their plan will be discontinued at the end of the year, as well as information to help them understand how to pick a new plan for 2018 during this year’s open enrollment period.
This decision does not affect those who have employer-provided insurance, those with Medicare Advantage, Medicare Supplement, Medi-Cal or those enrolled in “grandfathered” plans (plans purchased before March 2010). Additional information and resources for members affected by changes to their 2018 health care coverage are available at Anthem.com/CaliforniaChanges.
Individual (under 65)