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Anthems Lumenos Consumer-Driven Health Plans for 10/1/08 Effective Dates and Beyond Georgia Group Plans.

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Presentation on theme: "Anthems Lumenos Consumer-Driven Health Plans for 10/1/08 Effective Dates and Beyond Georgia Group Plans."— Presentation transcript:

1 Anthems Lumenos Consumer-Driven Health Plans for 10/1/08 Effective Dates and Beyond Georgia Group Plans

2 2 Agenda/ Course Objectives Consumerism and Why Employers Consider Consumer Driven Health Care Plans (CDHPs) Start with Sound Clinical Strategy Back It Up With Account-based CDHPs: Health Savings Account (HSA) Health Reimbursement Account (HRA) and Health Incentive Account Plus (HIA Plus) Health Incentive Account (HIA) Consumer Support Product Portfolio, Account Funding and Plan Considerations Consumer Communications Next Steps for Your Groups with BCBSGA

3 3 How Do We Define Consumerism? Consumerism is the process of engaging and enabling consumers to make better decisions about their health care. Consumerism can help individuals understand how to: Maintain their good health Improve their risk factors Find the highest quality health care solutions at the best price

4 4 An Engaged Consumer… 1.Understands his or her health status/medical conditions and demonstrates good health behaviors 2.Is a smart buyer of health care products and services because they are informed about the quality, value and cost of these products and services 3.Participates in a transformational consumer-focused health plan

5 5 How Do Consumers Use Health Care? Consumers today are passive. Theyre individuals who fall into the system. Theyre insulated from the real costs of health care (no price transparency) They typically dont question the recommendations of their primary care physician regarding: Prescriptions (brand vs. generic; cost) Procedures (alternatives) Specialists (competence/track record) Hospitals (price and quality transparency)

6 Why Employers Consider Consumer Driven Health Plans (CDHPs)

7 7 Why Are Employers Considering CDHPs? Introduce consumerism Want employees to have a better understanding of the cost of care Offer employees more choice Improve employee health Improve employee satisfaction Offer employees opportunity to lower tax burden Increase employee contribution levels Long-term and retirement savings Manage medical costs through better employee health

8 8 Rising Costs: The Big 4 Risk Factors 62% of the rise in private insurance costs from was due to population risk factors and their treatment Average 10% of total claims costs attributable to obesity 60% of Americans exceed ideal BMI (body mass index) Soon to become the leading cause of death Average 10% of total claims costs attributable to tobacco 21% of adult Americans smoke Remains leading cause of death 60% perform no substantial activity or exercise Two-thirds of all office visits to family physicians are due to stress-related symptoms More than one in four workers have taken a "mental health day" off from work to cope with stress Costs U.S. businesses $300 billion annually in direct & indirect costs Stress

9 9 CDHP As A Health Care Strategy Employers and Consumers: Are becoming more sophisticated purchasers of health care benefits Recognize that changing copays, deductibles and increasing employee contributions is not the solution Realize that they must identify and address the fundamental causes of increasing health care costs Are looking for new solutions Are looking for partners that can help them formulate and execute a long term strategy In this environment, a consultative and strategic approach is essential to sales success

10 10 With 66% of employers considering CDHP … … can you afford to be on the sidelines? Selling CDHP - Realities Employer Perspectives on CDHP Strategies Not considering Planning to offer CDHP as an option in the short-term then move to a full replacement in the next few years Planning to offer CDHP on a slice basis going forward, dont anticipate moving to full replacement Moving or looking to move to a full replacement CDHP option all at once Had CDH plans but reverted back to HMO/PPO plans Source : 2006 ChapterHouse/NAHU Survey Looking at it, not yet offering

11 Start with Sound Clinical Strategy Incentive-based Health Improvement

12 12 Provide rewards for updating or completing health risk assessment 80% completion goal Identify, improve risk and care Incentive-based Strategy Take optimal care of the sick Engage population to understand & reduce risks Provide incentives to complete risk reduction programs Maintain low risk group to a minimum of 70%

13 13 Source:D.W. Edington Research GM-UAW LifeSteps Health Promotion Program Risk Factors Reduction Risk factors include: Smoking Physical inactivity BMI Alcohol drug use Job/personal dissatisfaction

14 14 $50 reward* for online completion (limited to one reward per family each year) $200 reward* for graduating from a health coaching program (limited to one reward per family member each year) Goals achieved with knowledge, skills and functional provider-patient relationship $100 reward* for enrollment for each eligible family member Participation in health coaching programs Engaging with health coach to identify goals; and understand and manage their health condition Identify, improve risk and care Incentive-based Strategy Identify MyHealth Assessment Engage Health Coaching Participation Engage Health Coaching Completion *Rewards may be allocations to account or, for fully-insured HSA plans, credit dollars to redeem for gift cards to select health-focused retailers.

15 15 Reward Programs & Eligibility All GA Fully Insured plans with incentives use the following incentive amounts for activities that contribute to the better health and well-being $50 for completing MyHealth Assessment online health profile; one incentive per contract per contract year $100 for enrolling in a Health Coaching program; incentive offered once per contract year to all eligible members $200 for graduating from a Health Coaching program; incentive offered once per contract year to all eligible members $50 for completing the Tobacco-Free program; incentive offered once per lifetime to eligible members $50 for completing the Healthy Weight program; incentive offered once per lifetime to eligible members

16 16 Tobacco Free Program Counseling calls with tobacco treatment specialist Personalized plan, decision support for pharmacotherapy and nicotine replacement fulfillment at no cost to consumer Individualized participant and physician correspondence, unlimited access to toll-free support Program is designed to be delivered over a 6-9 month period to meet the formal program completion criteria Incentives available for this program, specific amount at employers discretion Smoking Cessation

17 17 Telephonic course sessions address diet and healthy eating, physical activity and exercise, stress management, maintenance and relapse prevention Phone counseling facilitated by a registered dietician or health educator Includes course manual containing educational lessons for additional phone counseling sessions Calls scheduled at 1-to-2 week intervals. Over the course of the program, participants receive an average of 6 to 8 outreach-advising calls from a trained health professional Incentives available for this program, specific amount at employers discretion Healthy Weight Program Weight Management

18 18 Anthems CDHP 360º Health Programs 360º Lumenos products 24/7 NurseLine ComplexCare Future Moms MyHealth web tools ConditionCare* MyHealth Coach Healthy Lifestyles Online & Telephonic Coaching Weight Management Smoking Cessation * Asthma, COPD, CAD, Diabetes, and Heart Failure

19 19 What programs are eligible for incentives? Arthritis Osteoarthritis Osteoporosis RA Asthma Adult and Pediatric Cardiology Cardiology, Abnormal Cardiac Rhythm Cardiology, Angina Cardiology, CAD Cardiology, Cardiomyopathy Cardiology, CHF Cardiology, Endocarditis Cardiology, Hyperlipidemia Cardiology, Hypertension Cardiology, MI Coronary Artery Bypass Cardiology, Pacemakers Cardiology, Post Cardiac Surgery COPD Diabetes Type I and Type ll Maternity Oncology Oncology, Breast Cancer Oncology, Colon Cancer Oncology, Lung Cancer Oncology, Prostate Cancer Oncology, Skin Cancer

20 20 Requesting a Health Coach Anthems Lumenos plans utilize the most current MyHealth Assessment tool. Members are presented with a page to request a health coach contact the member by phone upon completion of the assessment.

21 21 What does a member have to do to meet the Activity Achievement criteria? The member must demonstrate to the health coach that they possess: Knowledge of their condition Self-management skills Ability to comply with the treatment plan Achievement of an effective relationship with a primary care physician

22 Back It Up With Account-based CDHPs

23 23 Clinically Appropriate Plan Design Preventive care Coverage for nationally recommended preventive care services Health account Health account should be sufficient for many people Out-of-pocket responsibility The bridge to Traditional Health Coverage – the amount consumer pays to satisfy their remaining deductible after health account funds are exhausted Traditional health plan coverage Coinsurance and annual out-of-pocket protection Sample Plan Design Traditional Health Coverage Health Account and/or Rewards Preventive Care Out-of-Pocket bridge to Traditional Health Coverage

24 24 Types of Lumenos Plans Health Savings Account (HSA) Health Reimbursement Account (HRA) Health Incentive Account Plus (HIA Plus) Health Incentive Account (HIA)

25 Anthem's Lumenos HSA Plan

26 Million People Enrolled in HSA Plans HSA plans accounted for 17% of new policies in the small group market and 8% of new policies in the large group market (2007) Source: Americas Health Insurance Plans (AHIP) of U.S Growth of HSA/HDHP Enrollment from March 2005 to January 2007

27 27 Anthem's Lumenos HSA Plan Consumers can fund their HSA with pre-tax dollars and can use funds for health care expenses Employers can also contribute to employees HSAs Preventive services are covered at 100% In-Network Includes Traditional Health Coverage to cover expenses after the bridge HSA Funded by annual employee and/or employer contributions Preventive Care 100% In-Network Traditional Health Coverage Out-of-Pocket bridge to Traditional Health Coverage

28 28 HSA Plan Details At-a-Glance Lumenos HSA PlanSingle CoverageFamily Coverage Preventive Nationally recommended services No cost, no deduction from HSA with in-network providers HSA Annual HSA contribution maximum $2900 $5800 Traditional Health Coverage Bridge amount to satisfy deductible Your bridge amount is your annual deductible, but can be reduced by any dollars you first use from your HSA for covered services. $2000$4000 Then, you pay coinsurance for covered services 80%/80% for in-network services 60%/80% for out-of-network services Plan pays 100% after annual out- of-pocket maximum (includes HSA, bridge and coinsurance) In- Network Out of Network In- Network Out of Network $5000$10000 $20000

29 29 Sample HSA Consumer Experience Pharmacy Service 1) Consumer visits pharmacy to fill a prescription 2) Pharmacy connects to Anthem to determine consumers benefit 3) Anthem determines consumers benefits real-time and passes back to pharmacy the amount the consumer is responsible for paying 4) Pharmacy provides consumer with prescription and charges the appropriate amount 5) Consumer uses HSA checkbook or debit card to access HSA funds and pay pharmacy Rx $

30 30 1) Consumer visits physician 2) Physician submits claim to Anthem 3) Anthem applies benefits and notifies physician of the amount the consumer is responsible for paying 5) Physician sends bill to consumer 6) Consumer uses HSA checkbook or debit card to access HSA funds to pay physician 4) Anthem sends consumer Claims Recap record of benefit applied $ $ Sample HSA Consumer Experience Physician Service

31 31 HSA Integration Employer product set-up One combined health plan and HSA employer application Consumer enrollment One combined health plan and HSA consumer application Employer funding implementation Plan-based resources and partner bank resources that will support employers efforts to facilitate payroll-based funding Customer service Customer Service Advocate can assist with all benefit information, level 1 HSA account service, and warm-transfers to partner bank for level 2 support Consumer portal Consumers will come to anthem.com for both their benefit and HSA details HSA consumer communications Consumers will receive all of their benefit and banking enrollment materials from Anthem

32 32 BNY Mellon172 ACS423 Bank of New York Mellon and ACS The HSA product is administered by professionals in banking, employee benefits, insurance and administration. Market leader providing business process and IT outsourcing More than 63,000 employees Human resource consulting and deep insurance expertise Nations largest HSA administrator in partnership with BNY Mellon Extensive footprint in benefits consulting and outsourcing services

33 33 Interest Rates and Fee Overview For the period July 1, 2008, through December 31, 2008, the interest rate to be credited to the Health Savings Account will be %. (Rate fluctuates every 6 months) Fee Overview: One-time setup fee ($15) and monthly maintenance fees ($2.95) are paid by Employee (standard) groups have rider option for ER to pay above fees 100+ groups have 3 fee payment options: ER pays setup and monthly fees ER pays setup fee and EE pays monthly fees ER pays monthly fees and EE pays setup fee Account Closure = Free, if closed by check Checks No charge for initial checkbook(40); $10 for additional books No fees for writing checks; Replacement/ additional debit card $5

34 34 Consumer Experience After choosing Anthems Lumenos HSA plan, consumers will: Receive an HSA Welcome Kit from Anthem at their home address with their account number; kit to include: Cover Letter with Account Activation Instructions Consumer Signature Card (Master Signature document) Fee & Rate Schedule Deposit ticket HSA Combined Deposit Agreement and Disclosure Documents Return envelope for Master Signature document Complete paper signature card/eSignature to activate account Receive debit card and checkbook Receive monthly bank account statements and year end reports for tax purposes (include 1099-SA sent in January and 5498-SA sent in May)

35 35 Incentive Rewards Allocations to HSA for Self Insured Groups ONLY Reward dollars earned are deposited directly into the consumers HSA Reward allocations are tax-free to the employee, so amounts count toward the annual HSA contribution limit Use like any HSA funds -- tax-free if used for qualified medical expenses Credit Dollars to redeem for Gift Cards for Fully Insured Groups Provided through our partner, IncentOne When reward is earned, consumer receives notification by mail Consumer redeems reward dollars for a gift card, online or by phone, choosing from a select list of fitness and wellness- focused retailers like Foot Locker, Dicks Sporting Goods and the Sports Authority Rewards are taxable, and consumer will receive a 1099 form if they redeem rewards over $600 in a single year

36 Anthem's Lumenos HRA and HIA Plus Plans

37 37 Anthem's Lumenos HRA Plan Consumers use employer-funded HRA dollars to pay for covered expenses Earn more dollars for their HRA through rewards for healthy behaviors Preventive services are covered at 100% In-Network Unused HRA dollars roll over from year to year and can be used for future health care expenses; employer caps may apply Traditional Health Coverage covers expenses after the bridge HRA Funded by annual employer allocation Plus Additional reward dollars Preventive Care 100% In-Network Traditional Health Coverage Out-of-Pocket bridge to Traditional Health Coverage

38 38 HRA Plan Details At-a-Glance *Bridge = annual deductible minus annual HRA allocation Lumenos HRASingle CoverageFamily Coverage Preventive Nationally recommended services No cost, no deduction from HRA with in-network providers HRA Employers annual allocation $1000 $3000 rollover max $2000 $6000 rollover max Traditional Health Coverage Bridge* amount to satisfy deductible $1500$3000 Then, you pay coinsurance for covered services 100%/100% for in-network services 70%/100% for out-of-network services Plan pays 100% after annual out- of-pocket maximum (includes HRA, bridge and coinsurance) In- Network Out of Network In- Network Out of Network $2500$5000 $10000

39 39 Anthem's Lumenos HIA Plus Plan Works like an HRA, except the account allocations are provided by Anthem as a part of the health plan Consumers earn more dollars for their HIA through rewards for healthy behaviors Preventive services are covered at 100% In-Network Unused account dollars roll over from year to year; caps may apply. Traditional Health Coverage covers expenses after the bridge HIA Plus Funded by annual plan allocation Plus Additional reward dollars Preventive Care 100% In-Network Traditional Health Coverage Out-of-Pocket bridge to Traditional Health Coverage

40 40 HIA Plus Plan Details At-a-Glance *Bridge = annual deductible minus annual HIA allocation Lumenos HIA Plus PlanSingle CoverageFamily Coverage Preventive Nationally recommended services No cost, no deduction from HIA with in-network providers HIA Plus You receive an annual allocation$750$1500 Traditional Health Coverage Bridge* amount to satisfy deductible $2500$5000 Then, you pay coinsurance for covered services 80%/80% for in-network services 60%/80% for out-of-network services Plan pays 100% after annual out- of-pocket maximum (includes HIA, bridge and coinsurance) In- Network Out of Network In- Network Out of Network $5000$10000 $20000

41 41 Integrated Plans Employer product set-up: One combined health plan and HRA employer application (no additional paperwork) Consumer enrollment: One combined health plan and HRA member application (no additional paperwork) Direct payment from plan to providers and pharmacy Customer service: Customer Service Advocate can assist with all benefit information as well as health account service Consumer portal: Consumers go to anthem.com for both their benefit and plan details

42 42 Sample HRA/HIA Plus Consumer Experience Pharmacy Service 1) Consumer visits pharmacy to fill a prescription 2) Pharmacy connects to Anthem to determine consumers benefit and funds available 3) Anthem determines consumers benefits and HRA funds available real-time 4) Anthem debits consumers HRA and pays pharmacy for the prescription 5) Pharmacy provides consumer with prescription. Consumer pays nothing out of pocket. $ Rx

43 43 1) Consumer visits physician 2) Physician submits claim to Anthem 3) Anthem determines consumers benefits and HRA funds available 4) Anthem applies benefit and debits consumers HRA then pays physician for the services 5) Anthem sends consumer Claims Recap record of benefit applied and account funds used $ $ Sample HRA/HIA Plus Consumer Experience Physician Service

44 44 Account Proration 10/1, 11/1 and 12/1 Effective Dates Annual allocation is prorated based on the month the member joins the plan. (1/12 for each month in the plan) 10/1 Members will receive 3/12 th of full allocation 11/1 Members will receive 2/12 th of full allocation 12/1 Members will receive 1/12 th of full allocation Available in 2009 for Large Groups Only Calendar year groups with HRA and HIA Plus can choose monthly or quarterly allocation Plan year groups with HRA and HIA Plus will have monthly allocation

45 45 Monthly Proration Option for All 12/1/2008 Groups Monthly Proration Standard Member #1 enrolls in Lumenos plan on 1/1, member receives full HRA allocation Member #2 enrolls in Lumenos plan on 7/1, member receives 6/12ths the full HRA allocation Both Member #1 and Member #2 receive full allocation 1/1/2010 Group Effective Date 1/1/2009 January 2009 July 2009

46 46 Quarterly Proration Scenario Option for Large Groups Only: HRA and HIA Plus Quarterly Proration Standard Member #1 enrolls in Lumenos plan on 1/1, member receives full HRA allocation Member #2 enrolls in Lumenos plan on 11/1, member receives one quarter of the full HRA allocation Both Member #1 and Member #2 receive full allocation 1/1/2010 Group Effective Date 1/1/2009 January 2009 November 2009

47 Anthem's Lumenos HIA Plan

48 48 Anthem's Lumenos HIA Plan Companion product to introduce elements of consumerism Can replace an existing PPO offering with a similar PPO plan design Preventive services are covered at 100% In-Network Has the added benefit of financial rewards for healthy behaviors Includes Traditional Health Coverage to cover expenses after the bridge Also includes all of the tools, services and programs to encourage and reward positive consumer behavior Traditional Health Coverage HIA Funded by reward dollars Preventive Care 100% In-Network Out-of-Pocket bridge to Traditional Health Coverage

49 49 HIA Plan Details At-a-Glance Lumenos HIA PlanSingle CoverageFamily Coverage Preventive Nationally recommended services No cost, no deduction from HIA with in-network providers HIA Earn reward dollars Traditional Health Coverage Bridge amount to satisfy deductible Your bridge amount is your annual deductible, but will be reduced by any HIA dollars you have available. $750$1500 Then, you pay coinsurance for covered services 90%/80% for in-network services 70%/80% for out-of-network services Plan pays 100% after annual out- of-pocket maximum (includes HIA, bridge and coinsurance) In- Network Out of Network In- Network Out of Network $2750$5500 $11000

50 Consumer Support High-touch Service and High-tech Online Health Site

51 51 Help and Information When Members Need It Dedicated service centers Customer Service Advocates with in-depth Lumenos plan knowledge One single point of contact Plan and account information Monthly Health Statement and Claim Recap – combining benefits and account status information Online Health Site

52 52 Sample Monthly Health Statement and Claim Recap

53 53 Doctor Info Find a doctor by name, specialty or location See how much theyll charge for typical services and if they offer network discounts

54 Degree Health: Online Health Tools MyHealth Assessment Preventive Care Guides MyHealth Record Condition Centers Surgical Guides and Hospital Comparisons Traditional and Alternative Health Library And more

55 55 Health Assessment Features: Consumer connect to assessment via Health Assessment link Completes assessment Views results Is presented with option to sign up for Personal Health Coach Services 360 Degree Health: Health Assessment Screen

56 56 Prepare for Surgery Features: Search key phrases and view results View sample procedure, complete with audio Link to resources and FAQs to help prepare for the procedure 360 Degree Health: Prepare for Surgery Screen

57 57 Healthcare Advisor (Subimo): Accessed via Hospital Comparison link in the left hand navigation of the MyHealth landing page Option to search en Espanol returns Subimo results page in Spanish (left nav will be in English) Includes: –Hospital search options by: Procedure Name Geographical proximity 360 Degree Health: Subimo Content Screen

58 58 Label warnings Drug Interactions Side Effects Precautions Cost comparison: – Accessible via Drug Cost link in left hand navigation MyHealth landing page – Consumer enters geographic search criteria – Results are displayed per local pharmacy based on recent purchases of drug 360 Degree Health: Cost Comparison

59 59 Online Tools to Manage Health Care Dollars Account Analysis: Available via Account Analysis link from Account Activity page Results are displayed graphically by: –How expenses were paid (shown) –Type of service received –Date parameters selected by the Consumer

60 60 Monthly Health Statement and Claim Recap Claims Information: Available via View Claims button in Account Analysis screen, Claims link from left hand navigation or Claims tab in global header Displays: –Claim summary –Search options –Display of claim in scrollable/print friendly table format –Note - claim types (e.g., Rx, Medical) will not be integrated in a single screen as shown

61 Product Portfolio, Account Funding and Plan Considerations

62 62 Offerings and Product Approaches Full suite of CDHP options allows for personalized strategies for employers Single Lumenos CDHP offering Multiple CDHP pairings – for example, HRA or HSA paired with HIA to replace (transition from) existing PPO Lumenos CDHP offered alongside a non-CDHP

63 63 Anthems Lumenos Product Portfolio 19 HSA Plans: 7 core plan designs with varying deductibles, coinsurance, OOP maximum levels Plans can be sold with or without incentives Five incentive plans can be sold with embedded deductibles 26 HRA & 24 HIA Plus Plans 7 core plan designs with varying deductibles, coinsurance, OOP maximum levels Plans can be sold with either 3x maximum contribution rollover max or unlimited maximum rollover 6 HIA Plans All HIA plans have Unlimited Rollover Contribution Max All Products use the BCBSGA PPO Network

64 64 HSA Embedded Deductible Deductible amounts contributed by an individual family member will apply to the family deductible amount. An individual family member is not required to contribute more to the family deductible than their single deductible amount. Account funds are not embedded for individual family members, and can not be customized. HSA plans meet all IRS requirements. HSA Embedded Deductible has a higher premium than non- embedded HSA products.

65 65 Example HSA with embedded deductible: Family of three. Family deductible: $5,000. Embedded individual deductible: $2,500 (each person). Person 2 meets $800. Remaining unmet family deductible: $1700 ($5,000 – $3,300). The remaining $1700 can be fulfilled by any combination of Person 2 and Person 3. Person 1 meets $2,500. That persons individual deductible is now met. Future claims for that person are subject to coinsurance. Embedded Deductible Example #1

66 66 Example HSA with embedded deductible: Family of four. Family deductible: $6,000. Embedded individual deductible: $3,000 (each person). Person 2 meets $1,000. Remaining unmet family deductible: $1000 ($6,000 – $5,000). The remaining $1000 can be fulfilled by any combination between Person 2, Person 3 and Person 4. Person 1 meets $3,000. That persons individual deductible is now met. Future claims for that person are subject to coinsurance. Embedded Deductible Example #2 Person 3 meets $1,000.

67 67 Local CDH Plans vs Lumenos CDH Plans Benefit Description Current Benefit (Local GA CDHP) New Benefit (GA Lumenos) TMJ$5,000 lifetime maximum$15,000 lifetime maximum Hospice$10,000 lifetime maximumNo lifetime maximum PHPNot coveredPlan to cover with 10 visits/yr once DOI approval received IOPCovered unofficially using the visit limits under the regular MH outpatient benefit Plan to cover as a real benefit with separate visit limits (10/yr) once DOI approval received Mental HealthMental health services do not apply to the OOP max Mental health services will apply to the OOP max Urgent Care Center Covered unofficially using the current specialist office visit coinsurance amount Plan to cover using new UC benefit once DOI approval received Mail Order RxNot CoveredCovered through Next Rx

68 68 Account Funding Availability Medical Funding Account Funding Contribution DollarsIncentive Dollars HSA -ASO N/AEmployer Funded -Fully Insured N/AEmployer Funded HIA -ASO N/AEmployer Funded -Fully Insured N/APlan Funded HIA Plus ° -Fully Insured Plan Funded HRA -ASO Employer Funded -Fully Insured Employer Funded Blended Funding ° Not available for ASO

69 69 HRA Blended Funding Medical is fully insured Incentives and account are self-insured/ASO Employer groups will receive: Premium bill Bill for account dollars and incentive dollars used

70 70 Criteria for Qualifying Accounts for CDHP Employer Drivers for CDHP 1.Interested to cost containment solutions along with empowering employees to take charge of their health care 2.Interest in health/disease management 3.Innovative and/or wellness oriented 4.Employee self-service oriented 5.Has a broker or consultant who is a proponent of CDHP 6.Internal CDHP champion or management support/imperative

71 71 Plan Comparison FeatureHSAHRAHIA PlusHIA Who contributes? Employer and/or Employee Employer onlyHealth PlanEarned through incentives Account funded? YesNo Funds availability? When deposited in the account Immediate When incentives are complete Ownership balances at termination? Remain with consumer Return to employerReturn to healthcare insurance provider Return to employer Contributed maximums? Lesser of the annual deductible or IRS maximum Dictated by plan design Allowable medical expenses? 213(d) expenses – employee discretion Plan covered - employer discretion Account ownership? EmployeeEmployerHealth PlanEmployer Portability? Yes – completelyYes – employer discretion Yes - employer discretion Financial partner requirement? Bank or TrustN/A - Notional Account Investment options? YesNo

72 72 Criteria for CDHP Product Selection What is our optimal and/or desired product strategy? Where are we today and how much ground to cover? Short-term & long-term tactical options? Importance of plan choice Organization's tolerance for change Employee receptivity to change Employee communication Employee contribution Avg employee income Current plan design value Cost control/trend mitigation goal Employee turnover Account portability Not ImportantImportant ModerateAggressive HighLow High Low PassiveAggressive LowHigh LowHigh LowHigh Low HRA/HIA PlusHSA

73 73 CDHP Key Features Consumers have choices Different ways to fund deductible HSA, HRA, HIA Plus, HIA Expanded preventive care services Superior tools for consumer RX drug cost info Hospital quality ratings Health Assessment Enhanced Surgical Decision Support 360 Degree Health and Personalized Health Coach

74 Consumer Communications More than just an enrollment event!

75 75 Behavior change is more than an enrollment event Ongoing commitment by the organization to provide the catalyst and cultural support system to make these changes will impact both the short-term and long-term success Individuals need constant reinforcement and support to process the change : To changeNeed to change In change activities Maintenance of new healthy lifestyle Creating a Health Culture

76 76 Sample consumer communications MyHealth Assessment Health Coaching Prescription Drug Costs Condition-specific mailings: Asthma Fitness High Blood Pressure Lower Back Pain Hypertension & High Cholesterol Repetitive Education and Outreach

77 77 Sample Online Health Site

78 78 Sample Did You Know Poster/

79 79 Sample Pre-Enrollment Website

80 80 Sample Open Enrollment Packet

81 81 Sample Open Enrollment Packet (contd)

82 82 Sample Open Enrollment Packet (contd)

83 Next Steps for Your Groups with BCBSGA

84 84 Forms Needed – Small and Large Group HSA Agreement HSA Worksheet HRA – HIA Agreement Lumenos Blended Product Banking Form (HRA) Member Enrollment Forms All forms must be collected at front end of group set up process. For HSAs with Bank of New York Mellon, paperwork must be received 30 days before effective date.

85 85 Member Administrative Comparison Anthems Lumenos PlansPaired with a BCBSGa Product (PPO, HMO or POS) Member Customer Service Member Portalwww.anthem.comwww.bcbsga.com Member ID CardAnthem logoBCBSGa logo Medical Claims Processing/Payment PO Box 9907 Columbus, GA Pharmacy Claims Processing/Payment Next RX – PO BOX Fort Worth, TX PO BOX 9907 Columbus, GA Explanation of Benefits (EOB) Claim Recap with Anthem logo EOB with BCBSGa logo Health StatementMonthly HealthN/A

86 86 Employer Administrative Comparison Anthems Lumenos PlansPaired with a BCBSGa Product (PPO, HMO or POS) Employer Customer Service Employer Portalwww.bcbsga.com Employer AccessNot availableAvailable for non Lumenos plans Employer InvoiceAnthem logo invoiceSeparate BCBSGa invoice Purchased with Specialty Products (Dental, Life Disability, EAP, etc.) Same current processes exist Premium Payment by Phone (Groups only)

87 87 Broker Administrative Comparison Anthems Lumenos PlansPaired with a BCBSGa Product (PPO, HMO or POS) Broker Customer Service (non- commissions) , Option 2 (Post-Sale) Broker Customer Service (agent/broker commissions only) (Post-Sale) for BCBSGa for Lumenos Broker PortalSame Agent/Broker portal Same Agent/Broker portal Broker Commission RateSame Standard Commission Schedule Broker Bonus ProgramsAnthem Lumenos included Single Case Agreement FormSame existing BCBSGa form usedSame existing BCBSGa form used; can submit all on one form Broker Commission StatementSeparate Anthem Lumenos Logo and format Separate BCBSGa commission statement Broker Commission Payment Schedule First week of the month for the previous months earned/ paid/reconciled premiums. *. First week of the month for the previous months earned/ paid/reconciled premiums. Electronic Funds Transfer (EFT) Functionality available * No supplemental commission payments if the groups premium is paid/reconciled after the standard monthly schedule

88 88 Step 4 ACS/Bank of New York Mellon activates bank account and confirms Group Timeline for Lumenos HSA with Mellon Member activates account Welcome Kits mailed to members home address ~ 15 days Step 3 New group installed Step 2 Step 1 Employer and Member contribute to account Member receives HSA Debit Card

89 89 Renewing Groups 11/1 Renewing Groups: May stay on current HDHP plan Groups interested in changing HDHP plans are able to select a Lumenos plan 12/1 (and after) Renewing Groups: May stay on current HDHP plan Groups interested in changing HDHP plans must select a Lumenos plan

90 90 Launch Update & Resources Online quoting tool is updated (New Business 51-99) Side by side comparison grids are available on website Marketing Collateral available HSA Agreement is available if choosing ACS/Mellon

91 91 Five Ways Our CDH Plans Are the Best 1.Coherent clinical strategy with proactive health management 2.BCBS brand and BlueCard network 3.Innovation 4.Integrated product 5.Results

92 92

93 93 Legal Disclaimer The Anthem National Accounts business unit serves members of the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as Empire Blue Cross Blue Shield in 17 eastern and southeastern counties, including the 5 New York City counties, and as Empire Blue Cross in 11 upstate counties), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company in Ohio. In Virginia: Anthem Health Plans of Virginia, Inc. (serving Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123.) In most of Missouri: RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi) underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Blue Cross and Blue Shield of Georgia and Blue Cross Blue Shield Healthcare Plan of Georgia, Blue Cross of California and BC Life & Health Insurance Company, In New York: Empire Blue Cross Blue Shield is the trade name of Empire HealthChoice Assurance, Inc and Empire Blue Cross Blue Shield HMO is the trade name of Empire HealthChoice HMO, Inc. Independent licensees of the Blue Cross and Blue Shield Association. ® Anthem, Lumenos and 360°Health are registered trademarks. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.


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