1. KPCA Fall Conference
2017 11

2. What’s new for 2018
QHPs
Open Enrollment started 11/01/2017 and will end on 12/15/2017.
All applicants that enroll after 12/15/2017 will be considered as a SEP (Special Enrollment Period) and will need to provide proof of a qualifying event to receive coverage. (QE examples – Loss of coverage, a move, or marriage)
All Anthem PPO plans will be discontinued as of 1/1/2018.
HMO product will be offered in 59 counties.
All QHP applicants will receive a 01/01/2018 effective date for Open Enrollment.
Anthem dental and vision plans can be sold on a stand alone basis in all counties.

3. Individual Plans Only
Blue counties represent the 59 counties that Anthem will Participate in for 2018.
Grey counties represent the 61 counties that Anthem will not participate in for 2018. 29

4. Discontinuance and Migration Process
Anthem PPO members in the 61 counties we are not participating in will get a discontinuance letter explaining that their plan will end as of 12/31/ They will be mapped to a CareSource plan to ensure coverage.
Anthem members who are currently on a PPO plan within the 59 counties Anthem will participate will get a letter informing them they will be mapped to a HMO plan with the new premium listed on the letter.
HMO members in the 59 counties Anthem is participating in will get a letter informing them they will be able to keep their plan for 2018 and will receive a new renewal rate.
Please Note : All on-exchange applicants are still required to confirm their subsidy on the FFM website for (Healthcare.gov) (income verification)

5. Individual Product Updates

6. 3D Mammogram Preventive Screening
Effective 6/6/2017, Preventive care benefit will include Digital Breast Tomosynthesis (DBT or 3D screening mammography) as HCR preventive for all ACA compliant plans.
o 3D mammography for screening purposes will be covered at 100% with no member cost share (copayments, percentage of cost or deductibles) when services are provided by a participating/preferred health care professional.

7. Urgent Care Changes
Urgent care will no longer be covered Out-of-Network. It will be covered Out-of-Area (outside KY) if they go to a BlueCard provider.
Where possible, many plans have had their urgent care cost share changed to a copay - deductible not applicable.

8. Individual Product Portfolio

9. 2018 Gold Plan (ON Exchange)
Product Name
Network
Metal
INN Ded Single
INN Ded Family
INN OOP
Single
Family
Coins
Anthem Gold Pathway X HMO 1350
Pathway X HMO
Gold
$1350
$2700
$5800
$11600
20%
Pathway X HMO network plans are available in the following counties only: Adair, Allen, Ballard, Barren, Bell, Breathitt, Breckinridge, Butler, Caldwell, Calloway, Carlisle, Christian, Clinton, Crittenden, Cumberland, Daviess, Edmonson, Fulton, Graves, Grayson, Green, Hancock, Hardin, Harlan, Hart, Henderson, Hickman, Hopkins, Johnson, Knott, Lawrence, Lee, Leslie, Letcher, Lewis, Livingston, Logan, Lyon, Magoffin, Marshall, Martin, McCracken, McCreary, McLean, Meade, Metcalfe, Monroe, Muhlenberg, Ohio, Owsley, Pike, Russell, Simpson, Todd, Trigg, Union, W arren, Wayne, and Webster.
Pathway Transition X HMO network plans are available in Hardin county.

10. 2018 Silver Plans (ON Exchange)
Product Name
Network
Metal
INN Ded Single
INN Ded Family
INN OOP
Single
Family
Coins
Anthem Silver Pathway X HMO 2000 (2VA1)
Pathway X HMO
Silver
$2000
$4000
$7350
$14700
20%
Anthem Silver Pathway X HMO 3000 for HSA (2V9V)
$3000
$6000
$5700
$11400
10%
Anthem Silver Pathway X HMO 3500 (1GHS)
$3500
$7000
$5850
$11700
25%
Anthem Silver Pathway X HMO 5300 (2EDB)
$5300
$10600
$14000
Anthem Silver Pathway X Transition HMO (2VAH)
Pathway X Transition HMO
$6350
$12700
Pathway X HMO network plans are available in the following counties only: Adair, Allen, Ballard, Barren, Bell, Breathitt, Breckinridge, Butler, Caldwell, Calloway, Carlisle, Christian, Clinton, Crittenden, Cumberland, Daviess, Edmonson, Fulton, Graves, Grayson, Green, Hancock, Hardin, Harlan, Hart, Henderson, Hickman, Hopkins, Johnson, Knott, Lawrence, Lee, Leslie, Letcher, Lewis, Livingston, Logan, Lyon, Magoffin, Marshall, Martin, McCracken, McCreary, McLean, Meade, Metcalfe, Monroe, Muhlenberg, Ohio, Owsley, Pike, Russell, Simpson, Todd, Trigg, Union, W arren, Wayne, and Webster.
Pathway Transition X HMO network plans are available in Hardin county.

11. 2018 Bronze Plans (ON Exchange)
Product Name
Network
Metal
INN DED
Single
Family
INN OOP
Coins
Anthem Bronze Pathway X HMO 6100 (1GG6)
Pathway X HMO
Bronze
$6100
$12200
$7350
$14700
40%
Anthem Bronze Pathway X HMO 6650 for HSA (2V9S)
$6650
$13300 0%
Anthem Bronze Pathway X Transition HMO (2VAD)
Pathway X Transition HMO
$6750
$13500
Pathway X HMO network plans are available in the following counties only: Adair, Allen, Ballard, Barren, Bell, Breathitt, Breckinridge, Butler, Caldwell, Calloway, Carlisle, Christian, Clinton, Crittenden, Cumberland, Daviess, Edmonson, Fulton, Graves, Grayson, Green, Hancock, Hardin, Harlan, Hart, Henderson, Hickman, Hopkins, Johnson, Knott, Lawrence, Lee, Leslie, Letcher, Lewis, Livingston, Logan, Lyon, Magoffin, Marshall, Martin, McCracken, McCreary, McLean, Meade, Metcalfe, Monroe, Muhlenberg, Ohio, Owsley, Pike, Russell, Simpson, Todd, Trigg, Union, W arren, Wayne, and Webster.
Pathway Transition X HMO network plans are available in Hardin county.

12. 2018 Catastrophic plan (ON Exchange)
Product Name
Network
Metal
INN DED
Single
Family
INN OOP
Coins
Anthem Catastrophic Pathway X HMO 7350 (2VAG)
Pathway X HMO
Cat
$7350
N/A 0%
Pathway X HMO network plans are available in the following counties only: Adair, Allen, Ballard, Barren, Bell, Breathitt, Breckinridge, Butler, Caldwell, Calloway, Carlisle, Christian, Clinton, Crittenden, Cumberland, Daviess, Edmonson, Fulton, Graves, Grayson, Green, Hancock, Hardin, Harlan, Hart, Henderson, Hickman, Hopkins, Johnson, Knott, Lawrence, Lee, Leslie, Letcher, Lewis, Livingston, Logan, Lyon, Magoffin, Marshall, Martin, McCracken, McCreary, McLean, Meade, Metcalfe, Monroe, Muhlenberg, Ohio, Owsley, Pike, Russell, Simpson, Todd, Trigg, Union, W arren, Wayne, and Webster.
Pathway Transition X HMO network plans are available in Hardin county.

13. Questions?