Anthem – Susman

May 24, 2012

Track your health insurance

It is so hard to keep track of all of my health insurance bills, and options, what I have used, what my deductible IS, what I’ve filled and what I haven’t. I actually found a good way to do it, check out this video on a new free service called Simplee. I’m going to try it. It works with Aetna, Anthem, Blue Cross Blue Shield (BCBS) Blue Shield, Cigna, Dental Dental, Medica, MetLife, United Healthcare, Vision Service Place, VSP, WellPoint, Inc. (Empire BCBS) Here is a video and a link:

What do you think? Tell me below.

Dominique

December 3, 2010

Small Group and Large Group Definitions and Differences

The Patient Protection and Affordable Care Act (or health care reform law) established several new st andards for private health insurance coverage. As part of these st andards, the law established federal definitions of “small employer” and “large employer” for health insurance markets. Previously, states defined these markets.
From now until 2016, states can define the size of small groups:

Small employer can be either 50 and fewer or 100 and fewer. Beginning in 2016, the definitions in the federal health care reform law will apply:

Small employers are those who had, on average, 1-100 employees in the preceding calendar year and at least one employee on the first day of the plan year. (Note that this means sole proprietors could be considered part of the small group market.)

Large employers are those who had, on average, 101 or more employees in the preceding calendar year and at least one employee on the first day of the plan year.

These definitions are based on full-time equivalent calculation that accounts for both full-time and part-time employees. Full-time seasonal employees who work fewer than 120 days during the year are excluded. On the surface, the inclusion of group size definitions in the federal health care reform law appears to bring more uniformity to health insurance markets. However, the definitions aren’t applied consistently throughout the law. For example, the medical loss ratio provision of the health care reform law amended the Public Health Service Act – but it didn’t change the existing, conflicting group size definitions in the Public Health Service Act. In addition, some provisions that set different thresholds consider only full-time employees in the calculation rather than full-time equivalents.

Thanks to our friends at Anthem Blue Cross for this helpful information!

September 22, 2010

Anthem Blue Cross and Blue Shield Individual Business to Suspend Child-Only Coverage Effective 9/23/10

Anthem Blue Cross and Blue Shield is committed to offering a broad range of products and services that meet customer needs in the changing health insurance market, and to implementing the new health care reform legislation in a way that benefits our customers and members.

We have reviewed the rules regarding the provisions of the Patient Protection and Affordability Care Act (PPACA) limiting the application of pre-existing condition exclusions for children under 19. Unfortunately, there remains a great deal of uncertainty as to how the rules will be implemented and what the impacts might be on participating insurers.

While some carriers may continue to offer child-only policies, other carriers have dealt with this lack of clarity by choosing to discontinue new business sales of their child-only policies. Some have cited the lack of an effective m andate for individuals to obtain coverage, as well as ongoing market uncertainty. Unfortunately, this has created an unlevel competitive environment. As a result, Anthem has decided to suspend the sale of child-only policies indefinitely, beginning September 17, 2010.

We will continue to monitor the situation and provide additional details on any changes to our process and policies as they become available.

Please Note: This decision has no impact on any existing child-only policies. In addition, we will continue to accept children on family policies as long as the primary subscriber is 19 or older.

Why is Anthem suspending the sale of new child-only policies?

Anthem is committed to offering a broad range of products and services that meet customer needs in the changing health insurance market, and to implementing the new health care reform legislation in a way that benefits our customers and members.

When will Anthem stop selling these polices?

Due to ongoing uncertainty, Anthem has made the decision to suspend the sale of child-only policies and policies where the primary subscriber is under 19 years of age, for effective dates of 9/23 or later. Quoting capability for child-only policies will begin being removed on September 17, 2010.

Will Anthem’s family plans be offered to children 18 and under?

Anthem will continue to offer family policies that have dependent coverage to subscribers who are 19 years of age or older.

Will Anthem participate in an "open-enrollment period" for child only plans?

No, Anthem has made the decision to suspend the sale of child-only policies and policies where the primary subscriber is under 19 years of age, for effective dates of 9/23 or later.

Will this impact all states in which Anthem’s affiliated health plans are currently providing Individual Child-only plans?

The suspension of child-only plans will apply to all states unless a particular state requires the offering of child-only policies. Based on state specific requirements, we will continue to offer Child-only plans in Maine and New York, and in open enrollment periods in Ohio and Virginia. Child-only plans will also be offered in those states requiring such policies for conversion and HIPAA eligible individuals. Existing policyholders will not be impacted by this action and they may continue in their current coverage.

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