Anthem Post 9/20 - More Benefits, No Rate Increases

dgoldenz

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Virginia
For more than 70 years, we've been providing our Virginia members with coverage they can count on. We're pleased to announce we are offering existing products with the provisions of the Patient Protection and Affordable Care Act (PPACA) for September 20, 2010 effective dates. As one of the largest individual health care plans in the state, we remain committed to providing individual consumers with choices to help meet their health care needs and budget.

These plans include the new health care reform mandated benefits at current rates.



• No pre-existing waiting period for children under age 19.
• Unlimited Lifetime max
• In- Network Preventive Care covered at 100% with no member cost share
• Removing $7500 annual Prescription Drug max
• Removing $5000 annual Durable Medical Equipment (DME) max
• Removing$3000 annual Ambulance max
• Replacing $500 annual Chiropractic Care max with 15 visits per member per calendar year
• Replacing $2000 annual Physical Therapy/Occupational Therapy max with 20 combined visits per member per calendar year
• Replacing $500 annual Speech Therapy max with 20 visits per member per calendar year
 
loosely translated:

We've been screwing our policyholders for years. Obama was on to us. Now you're gonna get a better bang for your buck because MLR is gonna make us pay out what used to be our "excess profits" one way or another.
 
Regarding the premiums, Anthem of Virginia is boldly lying without shame. They were just approved for a 10% price increase effective 10/1/2010.

"In Virginia, Anthem has been approved for a 10 percent increase in rates for individual plans as a result of the (health reform) legislation, according to documents obtained from the Virginia Bureau of Insurance."
Source: Health insurance to cost more across region | Washington Examiner

-AC
 
Regarding the premiums, Anthem of Virginia is boldly lying without shame. They were just approved for a 10% price increase effective 10/1/2010.

"In Virginia, Anthem has been approved for a 10 percent increase in rates for individual plans as a result of the (health reform) legislation, according to documents obtained from the Virginia Bureau of Insurance."
Source: Health insurance to cost more across region | Washington Examiner

-AC

Where does it say 10% as of 10/1? It just says 10% unless I missed something. That might happen on 1/1/11 when the preventative care 100% benefit has to go into effect for plans written between 3/23 and 9/20.
 
The devil is in the details.

BCBSGA has 2 plans approved for post 9/22.

Both are POS, not PPO.

POS plans have fewer par docs & hospitals. I am trying to get clarification on the Rx formulary but so far no response. Based on experiences with earlier POS plans there are a lot of meds that are not covered.

They are using hidden gotcha's to keep the premium down.
 
Somarco: Help us out here...I have sold a lot of the POS network, never a complaint on the Rx coverage. What you bring up on the difference on the Rx coverage with the PPO, are there really some major drugs NOT covered with the POS? I have never heard of this. If this is really true, this is important.
 
This is an issue in GA, which may or may not translate to other states.

I rewrote a BX policyholder a few months back when she signed up for the SmartSense POS with expanded Rx cover. When she went to fill her BP meds one (or both) were not on the formulary.

Instead of higher copays/OOP, Blue said they were not covered at all.

No discount.

No accrual toward the Rx deductible.

No Rx copay.

Nada.

Further exploration revealed the primary hospital in her area was non-par.

I moved her to Humana where her meds were covered and Phoebe Putney Hospital was a par provider.

When I asked about Rx coverage on the new POS plans at a meeting on Friday they looked at me like I had two heads. I told them when I tried to find out if certain meds were covered under the POS plan the only way to find out is to buy a policy and then call customer service.

They were unfazed by this revelation.

Finally, one of the coordinators of the meeting came back and asked to contact me later and get details. He did email me later that day and I not only provided info on that individual (without revealing PHI) I asked how one finds a list of Rx that is or is not on the formulary.

I also asked if there was ANY coverage at all for non-formulary meds.

So far, no response.

It is one thing to put out a plan with a limited network but another to play games with benefits such as Rx. I have never encountered a situation before with any carrier where "routine" drugs were not covered because they fell outside the formulary.
 
I don't know about other states, but SmartSense is a PPO plan here. They just introduced 3 new plans in April (Premier, SmartSense, and CoreShare) and along with the Lumenos HSA, are the only plans that are available after 9/20. No other changes as of now.
 

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