Individual & Family Medical, Dental & Life Plans March 2009.

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Presentation transcript:

Individual & Family Medical, Dental & Life Plans March 2009

2 PPO Plans  SmartSense  Lumenos CDHPs  PPO Share  RightPlan PPO 40  3500 Deductible PPO  PPO 3500 HSA-Compatible  Basic PPO (2500/1000) Benefits shown on slides that follow are in-network

3 PPO Plans  Reliable protection with some of our lowest rates  Choice of deductible  Choice of generic or comprehensive drug coverage  “Embedded” family deductible and out-of-pocket maximum  3 office visits before deductible  4 th quarter deductible carryover  $7 million lifetime benefits  No maternity coverage  Member-level-rated 2-year anniversary date rate guarantee on 5000 deductible plans SmartSense

4 Annual Out-of-Pocket Maximum Single/Family (in addition to deductible) $2,500/$5,000 (family out of pocket can be satisfied by 2 or more members) Annual Deductible $500, $1,500, $2,500 or $5,000 (single) $1,000, $3,000, $5,000 or $10,000 (family deductible can be satisfied by 2 or more members) Office Visits3 before deductible w/ $30 copay, then 30% after deductible Preventive Care 30% after deductible HealthyCheck Centers: $25/$75 copay for basic/ premium screenings, with deductible waived Hospital In/Outpatient30% after deductible Drug Benefits Generic plan Comprehensive plan Generic: $15 copay or 40%, whichever is greater Brand name: $500 annual brand deductible (2-member maximum), then $15 copay or 40%, whichever is greater (up to $500 maximum per prescription) — $4,500 maximum annual out-of-pocket in addition to brand deductible 4 th Quarter Deductible Carryover For last 3 months of calendar year for expenses incurred in the 4 th quarter that are less than the deductible MaternityNot covered SmartSense

5 PPO Plans Consumer-Driven Health Plans (CDHPs )  HSA-compatible, HIA and HIA Plus plans  Deductible waived in-network (no cost to member) for nationally recommended preventive care services  Choice of no maternity plans or one maternity plan  After deductible, member pays 0% or 30% co-insurance (depending on plan) for most covered services  Generic and brand drugs – member pays 0% or 30% after annual deductible (depending on plan)  $7 million lifetime maximum (no maternity plans), $5 million lifetime maximum (maternity plan)  Member-level-rated  Powerful online health management tools Lumenos ®

6 HSA Account  Funded by subscriber, up to maximum limit set by U.S. Treasury  Unused dollars rollover year-to-year  Subscriber “owns” HSA Annual Out-of-Pocket Maximum (in addition to deductible) Single: $3,500/$2,000/$0 Family: $7,000/$4,000/$0 (aggregate) Annual Deductible $1,500/$3,000/$5,000 (single) $3,000/$6,000/$10,000 (family maximum) Coinsurance after deductible 30%/30%/0% Office Visits30%/30%/0% after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient30%/30%/0% after deductible MaternityNot covered Drug Benefits30%/30%/0% after deductible Lumenos Health Savings Account (HSA)-Compatible Without Maternity

7 HSA Account  Funded by subscriber, up to maximum limit set by U.S. Treasury  Unused dollars rollover year-to-year  Subscriber “owns” HSA Annual Out-of-Pocket Maximum/Member (in addition to deductible) $0 Annual Deductible $5,000 (single) $10,000 (family maximum) Coinsurance after deductible 0% Office Visits$0 after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient$0 after deductible Maternity$0 after deductible Drug Benefits$0 after deductible Lumenos Health Savings Account (HSA)-Compatible With Maternity

8 HIA Account  Funded through financial incentives earned through Healthy Rewards  Must be actively enrolled in HIA plan to access HIA account funds Annual Out-of-Pocket Maximum/member (in addition to deductible) Single: $3,500/$2,000/$0 Family: $7,000/$4,000/$0 (aggregate) Annual Deductible $1,500/$3,000/$5,000 (single) $3,000/$6,000/$10,000 (family maximum) Coinsurance after deductible 30%/30%/0% Office Visits30%/30%/0% after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient30%/30%/0% after deductible MaternityNot covered Drug Benefits30%/30%/0% after deductible Lumenos Health Incentive Account (HIA) Without Maternity

9 HIA Account  Funded through financial incentives earned through Healthy Rewards  Must be actively enrolled in HIA plan to access HIA account funds Annual Out-of-Pocket Maximum (in addition to deductible) $0 Annual Deductible $5,000 (single) $10,000 (family maximum) Coinsurance after deductible 0% Office Visits$0 after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient$0 after deductible Maternity$0 after deductible Drug Benefits$0 after deductible Lumenos Health Incentive Account (HIA) With Maternity

10 HIA+ Account  Funded through health plan allocation of $500/$1000 per year single/family and financial incentives earned through Healthy Rewards  Must be actively enrolled in HIA plan to access HIA account funds Annual Out-of-Pocket Maximum/Member (in addition to deductible) Single: $3,500/$2,000/$0 Family: $7,000/$4,000/$0 (aggregate) Annual Deductible $1,500/$3,000/$5,000 (single) $3,000/$6,000/$10,000 (family maximum) Coinsurance after deductible 30%/30%/0% Office Visits30%/30%/0% after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient30%/30%/0% after deductible MaternityNot covered Drug Benefits30%/30%/0% after deductible Lumenos Health Incentive Account Plus (HIA+) Without Maternity

11 HIA+ Account  Funded through health plan allocation of $500/$1000 per year single/family and financial incentives earned through Healthy Rewards  Must be actively enrolled in HIA+ plan to access HIA+ account funds Annual Out-of-Pocket Maximum/Member (in addition to deductible) $0 Annual Deductible $5,000 (single) $10,000 (family maximum) Coinsurance after deductible 0% Office Visits$0 after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient$0 after deductible Maternity$0 after deductible Drug Benefits$0 after deductible Lumenos Health Incentive Account Plus (HIA+) With Maternity

12 PPO Plans Comprehensive PPO plans  Once deductible is met, member pays 30% co-insurance for most covered services  Deductible waived for office visits, annual physical exam and preventive care  Maternity coverage  $5 million lifetime maximum PPO Share (5000/2500/1500)

Annual Out-of-Pocket Maximum (in addition to deductible) (2-member maximum, par/non-par) $2,500 per member $5,000 per member $4,500 per member Annual Deductible (2-member maximum) $5,000 per member $2,500 per member $1,500 per member Office Visits $40 copay deductible waived $35 copay deductible waived 30% of negotiated fee, deductible waived Preventive Care (deductible waived) Annual physical exam:30% of negotiated fee, or HealthyCheck Centers: $25/$75 copay for basic/premium screenings Routine mammogram, Pap, PSA ordered by physician: 30% of negotiated fee Well Child: 40% of negotiated fee Hospital In/ Outpatient 30% of negotiated fee Maternity 30% of negotiated fee Drug Benefits (Anthem Blue Cross Formulary) (2-member maximum for brand deductible) $15 generic; $35 brand copay after $750 brand deductible $10 generic; $30 brand copay after $500 brand deductible $10 generic; $30 brand copay after $250 brand deductible PPO Share (5000/2500/1500)

14 PPO Plans Our no-deductible PPO plan  No deductible  $40 office visit copay, 40% share of costs  3 prescription drug options:  None  Generic only  Comprehensive (generic and brand)  Single policy coverage (each family member gets their own policy)  No maternity  $5 million lifetime maximum RightPlan PPO 40

15 Annual Out-of-Pocket Maximum (par/non-par) $7500/subscriber Annual DeductibleNo deductible Office Visits$40 copay Preventive Care HealthyCheck Centers: $25/$75 copay for basic/ premium screenings Routine mammogram, Pap, PSA ordered by a physician: $40 office visit plus 40% of negotiated fee Well Child: $40 office visit plus 40% of negotiated fee Hospital In/Outpatient Inpatient: 40% of negotiated fee plus $500 copay/day; 4-day maximum copay per admission Outpatient: 40% of negotiated fee plus $500 copay per outpatient surgery admission MaternityNot covered Drug Benefits (Anthem Blue Cross Formulary) No coverage (P958), or Generic coverage (PE48) - $15 generic, or Comprehensive coverage (PE49) - $15 generic, $35 brand copay after $500 brand deductible RightPlan PPO 40

16 PPO Plans HSA-Compatible plan  HSA-compatible  Most services covered at 100% after deductible is met ($100 copay for emergency services after deductible; waived if admitted)  Deductible waived for HealthyCheck screenings  No maternity  Generic and brand drug coverage after annual deductible is met  Member-level-rated  $5 million lifetime maximum 2-year anniversary date rate guarantee PPO 3500 (HSA-Compatible)

17 Annual Out-of-Pocket Maximum (in addition to deductible) (Medical/Pharmacy combined, par/non-par) $1500/member, $3,000/family (aggregate) Annual Deductible (Medical/Pharmacy combined, par/non-par) $3500/member, $7,000/family (aggregate) Office Visits$0 after deductible Preventive Care HealthyCheck Centers: $25/$75 copay for basic/ premium screenings, deductible waived Routine mammogram, Pap, PSA ordered by physician: $0 after deductible Well Child: $0 after deductible Hospital In/Outpatient$0 after deductible MaternityNot covered Drug Benefits (Anthem Blue Cross Formulary) $15 generic; $35 brand copay after Medical/Pharmacy deductible met PPO 3500 (HSA-Compatible)

18 PPO Plans Another affordable plan for individuals and families  Most services covered at 100% after deductible is met ($100 copay for emergency services after deductible; waived if admitted)  Out-of-pocket maximum met in-network when deductible is met  Deductible waived for HealthyCheck screenings  No maternity  Member-level-rated  Generic and brand drug coverage  $5 million lifetime maximum 2-year anniversary date rate guarantee 3500 Deductible PPO

19 Annual Out-of- Pocket Maximum (in addition to deductible) (2-member maximum, par/non-par) Satisfied in-network once annual deductible is met Annual Deductible (2-member maximum) $3500/member Office Visits$0 after deductible Preventive Care HealthyCheck Centers: $25/$75 copay for basic/premium screenings, deductible waived Routine mammogram, Pap, PSA ordered by physician: $0 after deductible Well Child: $0 after deductible Hospital In/Outpatient$0 after deductible MaternityNot covered Drug Benefits (Anthem Blue Cross Formulary) $15 generic; $35 brand copay after $500 brand deductible (2-member maximum) 3500 Deductible PPO

20 PPO Plans Our most basic and affordable plan  In-hospital coverage in the event of catastrophic illness or injury  Office visit only after out-of-pocket maximum is met  Prescription drugs in the hospital only  Available with or without $1,000 Term Life  No maternity  $5 million lifetime maximum Basic PPO (2500/1000)

21 Annual Out-of-Pocket Maximum (in addition to deductible) (2-member maximum, par/non-par) $2500 Annual Deductible (2-member maximum) $2500/member$1000/member Office Visits No office visit benefits until out-of-pocket maximum is met, then plan pays 100% of negotiated fee Preventive Care (deductible waived) HealthyCheck Centers: $25/$75 copay for basic/ premium screenings Routine mammogram, Pap, PSA ordered by physician: 20% of negotiated fee Hospital In/Outpatient20% of negotiated fee MaternityNot covered Drug BenefitsNot covered Basic PPO (2500/1000)

22 HMO Plans  HMO Saver  Individual HMO  Select HMO

23 HMO Plans  First dollar coverage on:  Office visits  Generic drugs  Preventive care  Unlimited office visits with set copays  Coverage for services from doctors and hospitals in HMO network  Comprehensive drug plan  Maternity coverage  Lifetime maximum - unlimited HMO Saver, Individual HMO, Select HMO

24 HMO Plans HMO SaverIndividual HMOSelect HMO Annual Out-of-Pocket Maximum (in addition to deductible) (2-member maximum) $1500/member$3,000 Annual Deductible$1,500/member for Inpatient, Outpatient and ASCs only No deductible Office Visits (unlimited) $10 copay/visit$25 copay/visit Preventive Care (specific services) $10 copay$25 copay Hospital In/Outpatient $1,500 deductible, then: Inpatient: 20% of negotiated fee Outpatient: 20% of negotiated fee (emergency & non-emergency services subject to deductible) Inpatient: 20% of negotiated fee Outpatient: 20% of negotiated fee Inpatient: $250 copay/day first 4 days; then covered at 100% Outpatient: 20% of negotiated fee, $250/surgery MaternitySee Office visits and In/Outpatient (subject to deductible) Office visits: $10 copay Inpatient: no charge Outpatient: 20% of negotiated fee See Office visits and In/Outpatient Drug Benefits (Anthem Blue Cross formulary) $10 generic; $30 brand copay after $250 brand deductible (2-member maximum)

25 Plan Options Based on Prospect’s Needs If Main Need Is:Recommended Plans: BudgetBasic PPO, SmartSense Immediate coverage for office visits before deductible PPO Share and HMO (unlimited) SmartSense (up to three) No deductible RightPlan PPO 40 Individual HMO or Select HMO 100% coverage of most services after deductible Lumenos HSA/HIA/HIA+ (0% coinsurance plans) 3500 Deductible PPO or PPO 3500 (HSA-Compatible) Control over finances, including health care expenses Lumenos PPO 3500 (HSA-Compatible) Maternity coverage Lumenos with maternity PPO Share HMO 2-year anniversary date rate lockSmartSense 5000, 3500 HSA, 3500 PPO

26 Rating Methodology Summary Plan Anniversary- Rated? Member- Level or Contract Rated? Gender-Rated? SmartSenseYESMEMBERYES LumenosYESMEMBERYES 3500 HSA, 3500 PPOYESMEMBERYES RightPlanYESMEMBERYES PPO ShareYESCONTRACTNO HMOYESCONTRACTNO Basic PPONOCONTRACTNO

27 Short-Term Plans  Coverage from 30 to 180 days  Choice of deductible level  $3 million lifetime maximum  Easy application process  Streamlined underwriting  No maternity  Member-level-rated Short-Term Plans

28 Out-of-Pocket Maximum$1,000 per member plus deductible Deductible$250, $500, $1,000, $2,000 Hospital In/Outpatient20% of negotiated fee Ambulatory Surgical Center and ER 20% of negotiated fee (Accidental injuries not subject to deductible) MaternityNot covered Drug Benefits (Anthem Blue Cross Formulary) $10 generic; $30 brand name Brand name maximum $500 Short-Term Plans

29 Dental Coverage Options  Our New Dental Blue ® PPO Plans  Dental SelectHMO Plans  SmileNet Dental Discount Program

30 Dental Coverage Options Dental Blue PPO Plans  Power to choose from:  Two networks (Dental Blue 100 or 200)  Can even go to a dentist in DB 300 network and still be “in-network”  Best to choose 200 Essential or 200 Plus plan if dentist is in DB 300 network  Four plans  Key benefits:  Negotiated discounts during waiting periods  One of the largest PPO dental network in CA  Negotiated discounts after exceeding the plan maximum  Discounts on non-covered dental work such as teeth whitening, implants and orthodontics

31 Individual Dental – Dental Blue 100 Basic200 Essential100 Plus200 Plus Deductible $25/person (no family maximum) $50 single/$150 family The deductible is waived for covered in-network Diagnostic & Preventive services Maximum Benefit$500/person/yr$1000/person/yr Waiting Periods (months) 0 Basic services: 3 Major services: 12 Basic services: 0 Major services: 6 Basic services: 3 Major services: 12 Diagnostic Care (cleanings, exams, X-rays) 100% in-network (fee schedule out-of-network) 100% in-network (80% out-of-network) Basic Services 80% fillings; 50% stainless steel crowns (fee schedule OON) Fee schedule (e.g., $42 for filling) 80% (60% OON) Major ServicesNot covered Fee schedule (e.g., $57 for stainless steel crown) 50% (in-network and OON) OrthodontiaNot covered

32 Individual Dental – DHMO, SmileNet (3) DHMO PlansSmileNet Dental Discount Program Deductible None Not an insurance plan; a very simple, low-priced discount dental program Maximum Benefit Unlimited Waiting Periods None for most services Office Visits $5 Routine Cleanings $0 Diagnostic Care (oral exams, X-rays) $0 Orthodontia Coverage Yes

33 Dental Coverage Options What About Our Other (Previous) Dental PPO Plan?  Sell Dental Blue 200 Essential Plan, which offers:  Identical benefits to previous Dental PPO plan  Access to much larger network  Discounts during waiting periods and after exceed plan maximum  Discounts on non-covered dental work such as teeth whitening, implants and orthodontics

34 Individual Life Insurance  Anyone who qualifies for one of our Level 1 or Level medical plans can purchase:  $15,000, $30,000, $50,000, $75,000 or $100,000 (if over age 19)  $15,000 or $30,000 (ages 1-19)  Basic PPO and PPO Saver plans include $1,000 of Term Life insurance for:  An additional $1 per month through age 49, or  An additional $2 per month for ages Term Life Insurance

35 Health Dental Life Thank You for Selling Anthem Blue Cross!