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.
Anthem Blue Cross of California is moving Small Groups in California to electronic billing and online payment, starting May 1, 2016. The new Anthem standard will be to issue bills (invoices) online and accept premium payments online through EmployerAccess, also known as the Employer Portal.
The Department of Managed Health Care (DMHC) invites you to a public meeting on the acquisition of Cigna by Anthem Blue Cross. Representatives from both plans will be present. The meeting will be held in Sacramento on March 4, 2016 from 1:30 p.m. to 3:30 p.m. The purpose of the meeting is to discuss DMHC’s jurisdiction and authority to oversee the transaction and to solicit public comment for DMHC’s consideration as it reviews the transaction. Public comment will be limited to 3 minutes. Comments may also be submitted to [email protected] until 5:00 p.m. on March 11, 2016.
Anthem Blue Cross Medicare members will have more provider choices. This is especially exciting as we introduce our NEW Anthem MediBlue Plus and Select plans [Medicare Advantage], which are available throughout AEP 2016.
Members will be allowed only 15 days per fill during the first 30 days, when starting on a select group of new specialty drugs. Copays are prorated during this time. The Split Fill program only applies to the first month of the drug fill at Accredo Specialty Pharmacy. After that, the prescription is filled as it is written by their doctor.
You may recall that in 2015, BlueCard was limited to hospital and urgent care only for Individual PPO members, while Small Group PPO members enjoyed full BlueCard access. But all that changes for 2016, when our Individual PPO members will also now have full access to BlueCard. So for example, if they want to go to a chiropractor while traveling, it’s a covered service under BlueCard.
Anthem Bronze PPO members with contract codes 1FZ3 and 1FZ4 received Benefit Comparison Charts in their 2016 Open Enrollment Kits that had incorrect coinsurance amounts listed for Tier 4 pharmacy benefits. The 2016 Tier 4 Retail Pharmacy benefits were listed as 0% coinsurance up to $500, and the Tier 4 Mail Order Pharmacy benefits were listed as 0% coinsurance up to $1,500. These amounts are not correct. The correct pharmacy benefits for 2016 are as follows:
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 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.
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).