1. Available with Anthem in CA, ky, and nv
Innovative Plans
Available with Anthem in CA, ky, and nv

2. Overview of Innovative Plans
It is a competitively priced plan sold by Anthem in CA, KY and NV
It is generally $10 - $20 cheaper than standard plans
It contains some hearing and vision value added benefits (no dental)
Anthem offers dental riders at an additional cost – we will not be offering these at this time
Since CUL does not coordinate benefits you can carry both policies and use them together

3. Vision Benefits Innovative plan F, G, or N CUL (1000/1500 max)
Eye Exam (no waiting period)
In network: $25 copay then covered at 100%
Out of network: $35 allowance
Frames (no waiting period)
In network: $100 allowance
Out of network: $45 allowance
Lenses (no waiting period)
Out of network: $25 - $55 allowance
Contacts (no waiting period)
Out of network: $80 allowance
Eye Exam (no waiting period)
Covered at 60% year 1, 70% year 2, 80% year 3
Frames (6 month waiting period)
Lenses (6 month waiting period)
Contacts (6 month waiting period)

4. Vision Costs Example
Example eye exam costs $200 (How does CUL work with OUT of network Inn. F benefits?)
A CUL patient pays:
$80 year 1
$60 year 2
$40 year 3
An Innovative plan F patient pays:
In network: $25 copay
Out of network: patient gets $35 allowance so they pay $165
CUL with Innovative F (out of network)
Year 1: patient pays $80 + gets a $35 allowance so they pay $45
Year 2: patient pays $60 + gets $35 allowance so they pay $25
Year 3: patient pays $40 + gets $35 allowance so they pay $5
Network benefits favor Innovative plan F benefits over CUL. However, CUL could work in conjunction with the out of network benefits.
Since you can carry both policies, clients stand to MAKE money on in network benefits. Example: client goes for vision exam that totals $200 to an in network provider. They pay $25 and then the exam is covered. They can then submit the claim for the entire $200 amount to CUL and received $120 back. After the copay they paid, this would mean they MAKE $95 off that exam.

5. Hearing Benefits
Innovative plans – Administered through Hearing Care Solutions
CUL (1000/1500 max)
Hearing Exam (no waiting period)
Covered at 100%
Hearing aids (no waiting period)
In network: up to a $750 allowance per year
Hearing exam (no waiting period)
Covered at 60% year 1, 70% year 2, 80% year 3
Hearing aids (12 month waiting period)
Covered at 0% year 1, 70% year 2, 80% year 3

6. Hearing Costs Examples
General exam could cost $250 without insurance
Covered at 100% with Inn. F
File a claim with CUL and get reimbursed: $150 (in year 1)
Client makes $150 on this exam
Hearing aids can cost $1500 (on the low end)
Receive up to a $750 allowance from Inn. F.
If, after your CUL 12 month waiting period, you file a claim for $1500 you would be reimbursed $ (70%)
$750 allowance + $1050 reimbursement = $1800
Client stands to make $300

7. Dental plans cost anthem dental riders CUL
$500 max benefit AKA “Standard Plan”: $18.48/month
$1000 max benefit AKA “Premium Plan”: $31.48/month
$1250 max benefit AKA “Premium Plus”: $46.66/month
$1000 max benefit (65 – 74): $34.17
$1500 max benefit (65 – 74): $45.17
The dental riders cost as much as the full CUL plans.
Can use doc in and out of network; out of network docs can charge any fee amounts and may not be paid
As a company, we will not be offering the dental riders. We have no way of capturing this rider in MA for quoting/tracking/reporting.
If a client wants the rider over the CUL plan, they will need to sign up for this with Anthem directly after approval.

8. Dental Benefits (Called Dental Blue 100)
Anthem riders (additional cost – NOT included)
CUL (1000/1500 max)
Preventative (exam/x-rays)
No waiting period
$500 max – covered 100%
$1000 max – covered at 100%
$1250 max – covered at 100%
Basic services (fillings/simple extractions)
6 month waiting period
$500 max – not covered
$1000 max – covered at 80%
$1250 max – covered at 80%
Major services (root canals/oral surgery)
12 month waiting period
$1000 max – covered at 50%
$1250 max – covered at 50%
Preventative (exam/x-rays)
No waiting period
Covered at 60% year 1, 70% year 2, 80% year 3
Basic services (fillings/simple extractions)
Major services (root canals/oral surgery)
12 month waiting period
Covered at 0% year 1, 70% year 2, 80% year 3

9. Innovative Plans vs. CUL Talking Points
For preventative dental, Innovative F riders do have better coverage
For basic dental services, Innovative F riders have better coverage but they are subject to a 6 month waiting period
For major dental services, CUL has the better benefits
When it comes to vision/hearing – CUL works really well with Innovative F and ensures maximum benefits received
Part of the benefit of going with CUL will be an easy application process and our ability to help them service the policy whenever they need it. With a dental rider add on, they will have to go to company direct.
Benefit to CUL is no-network freedom

10. Network Info
Vision: Access to more than 4,400 providers in the Blue View Vision Network
Includes LensCrafters, Pearle Vision, JC Penny, Sears Optical, Contacts and more
Provider Search: tool to see if their doc is in network
Hearing: Access to more than 2,500 providers through Hearing Care Solution
$750 benefit is administered through Hearing Care Solutions. Locations for this provider can be found HERE
Dental: Access to thousands of providers statewide within the Dental Blue 100 Network
Check to see if your doctor is in network by using this LINK

11. FAQs Can you slide into this plan using CA birthday rule?
NO: if someone is on a plan F currently and wants an Innovative F, they must be underwritten into it.
Inn. F is considered “additional coverage” in comparison to standardized plans
Can they GI into this plan?
YES, if it is an Innovative F (cannot do for Innovative G or N)
How does Innovative plan F fit into the conversation of a plan F “phase out” by 2020?
Same rules apply to Innovative F as standard F: If you turn 65 on or before 12/31/2019, you will be eligible to buy and keep one of these plans indefinitely
If they are first eligible for Medicare part B on 1/1/2020 or later, they will not be eligible to pick up this plan.
Can they get both a dental rider and CUL?
Yes, but it would be expensive and might not be worth the premiums (approx. an additional $70-$80/month combined). Assess which one is the right fit and guide your client to go Anthem direct if necessary.
What are rate increases predicted to be like?
About 4% each year.
Are the vision/hearing benefits guaranteed for the life of the policy or are they subject to change?
The vision/hearing benefits are embedded in this policy and will never change.