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

[somarco]

We had two versions here before 9/23 . . . PPO and POS. PPO was higher in price.

For now we only have SS POS and Premier POS (which is new). The PPO versions are supposed to be approved in a month or so. For now, all we have are SS POS, Premier POS and Tonik.

More plans, including an HSA compatible plan, are supposed to be introduced later in the year or early next year.

The SS POS has the same rates in the 4th quarter as they were in the 3rd quarter but include Obamacrap "upgrades".

Of course underwriting has changed on all plans and, for now at least, children with severe medical conditions can cause the entire family to be rated up or even declined.

 

[HealthGuy]

Thanks Somarco for the analysis. As always, very very helpful! Because of your post, I am going to my regional rep this week to as about the Rx coverage on the POS vs. the PPO.

 

[CHUMPS FROM OXFORD]

Coreshare. Uggh! Worthless. That reminds me to take it out of my quote engines.

 

[somarco]

Look at the brochure for the SmartSense plan. The wording on drug coverage is different from the Premier plan.

In the GA brochure (above) compare the following.

Premier Plus POS offers broad prescription drug coverage before the deductible, including benefits for generic,
brand name and specialty drugs.

Now look at SmartSense.

SmartSense Plus POS includes coverage for generic and
select brand name and specialty drugs.
For an additional cost, you can upgrade the SmartSense
Plus POS prescription benefi t to extend the coverage for
brand name and specialty drugs.

 

[HealthGuy]

Very interesting, however on the Smart Sense, if I quote it at all, I always recommend (insist they take) the Rx upgrade.

 

[dgoldenz]

Very interesting, however on the Smart Sense, if I quote it at all, I always recommend (insist they take) the Rx upgrade.

Same, I don't even quote the regular SmartSense since the difference is minimal. Here's what the Rx plan for SmartSense w/ Enhanced Drug says (Rx limit eliminated now though):

Upgrade Drug Coverage (deductible waived):
NETWORK:
• For Generic and Brand Name Drugs: $15 Copay or 40% Coinsurance, whichever is greater. $7,500 annual benefit maximum per member (not including
Specialty drugs), network and non-network combined.
• For Specialty Drugs: 40% Coinsurance up to a separate $10,000 annual Prescription Drug out-of-pocket maximum per member.
- - - - - - - - - - - - - - - - - -
More information from Anthem:

Child can still be declined on family apps. During annual open enrollment period of November 1-30, they can't be declined, but can be max-rated (HIPAA rates from what underwriting "thinks" is the answer). Since apparently this open enrollment period only applies to Virginia and Ohio, who knows what the deal is in other states....what a mess.

 

[somarco]

I always recommend (insist they take) the Rx upgrade.

What drugs does the upgrade cover? The same as Premier? Are there drugs that are not covered under either plan?

Literature in GA says "see Benefit Guide" for more details.

And the Benefit Guide is . . . nowhere to be found.

$7,500 annual benefit maximum per member (not including
Specialty drugs), network and non-network combined.

Obamacrap prohibits limits. So Anthem is selling a non-compliant plan? How do they get away with that?

During annual open enrollment period of November 1-30, they can't be declined, but can be max-rated (HIPAA rates from what underwriting "thinks" is the answer).

Does the max rate up apply only to that individual or is it spread over the rest of the family?

BCBSGA tells me they will apply it to the entire family. If that rate is insufficient, they will reject the entire application.

 

[dgoldenz]

Rx upgrade covers same as Premier plan. The limit on Rx is being eliminated as of 9/23, but the brochure hasn't been updated yet. This is from the old brochure. According to Anthem, children should be rated to Level 4 (HIPAA rates) during open enrollment if they can't pass underwriting. Underwritten levels are 1-3 and the rate jump to level 4 is pretty substantial. Rest of family is underwritten separately and they can all be on the same plan. Anthem is the only company here that will allow one family member at HIPAA rates and other family members underwritten on the same plan as far as I know.

What drugs does the upgrade cover? The same as Premier? Are there drugs that are not covered under either plan?

Literature in GA says "see Benefit Guide" for more details.

And the Benefit Guide is . . . nowhere to be found.



Obamacrap prohibits limits. So Anthem is selling a non-compliant plan? How do they get away with that?



Does the max rate up apply only to that individual or is it spread over the rest of the family?

BCBSGA tells me they will apply it to the entire family. If that rate is insufficient, they will reject the entire application.