Presentation on theme: "Anthem’s Lumenos Consumer-Driven Health Plans for 10/1/08 Effective Dates and Beyond Georgia Group Plans State: Thanks you for joining us. We are very."— Presentation transcript:
1 Anthem’s Lumenos Consumer-Driven Health Plans for 10/1/08 Effective Dates and Beyond Georgia Group PlansState: Thanks you for joining us. We are very excited to share Anthem’s Lumenos Consumer-Driven Health Plans with you. These plans are for effective dates 10/1/08 and beyond.
2 Agenda/ Course Objectives Consumerism and Why Employers Consider Consumer Driven Health Care Plans (CDHPs)Start with Sound Clinical StrategyBack 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 SupportProduct Portfolio, Account Funding and Plan ConsiderationsConsumer CommunicationsNext Steps for Your Groups with BCBSGAReview agenda:We will begin with the idea of consumerism so we can ensure everyone is on the same page and working from the same definition of consumerism. Then, we will take a look at Why Employers Consider Consumer Driven Health Care Plans (CDHPs).Our plans begin with a sound clinical strategy. This is a strategy, not just another product.We will then review the account based plans that back up the strategy: Back It Up With Account-based CDHPs: Health Savings Account (HSA); Health Reimbursement Account (HRA) and Health Incentive Account Plus (HIA Plus); and the Health Incentive Account (HIA)You can’t offer a consumer driven healthcare product without support and tools to help consumers make knowledgeable decisions about their health and heathcare. We will review the hi touch, hi tech tools available to consumers on these plans.At that time, we will more into more details about the specific plans available as part of the product portfolio, the account funding options and some considerations when aligning these products with your clients.Lastly, we will take a look at the Consumer Communications paired with these products and review the Next Steps for Your Groups with BCBSGA.
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 healthImprove their risk factorsFind the highest quality health care solutions at the best priceDescribe: It is important to set the stage with consumerism.If you’ve seen any consumer driven health care, you’ve only seen one.Anthem’s Lumenos plans are:Clinically soundInclude an integrated and incentivized health improvement programWhether you are sick or whether you are healthy, these plans are for everyoneAre plans that encourage consumers to be engaged in their own health
4 An Engaged Consumer…Understands his or her health status/medical conditions and demonstrates good health behaviorsIs a smart buyer of health care products and services because they are informed about the quality, value and cost of these products and servicesParticipates in a transformational consumer-focused health planState: Our goals with consumer driven health care is to engage consumers. We want to transform every group and individual into consumers of healthcare, educate them to be smart buyers of health care , and teach them how to use healthcare differently.We want consumers know their numbers. For example, to know their blood pressure, BMI, cholesterol counts, etc. Every single agent should know that, too. We want consumers to use quality and cost comparison tools and ask questions before they receive care. We want consumers to participate in a plan that enables them to be knowledgeable, confident, and informed. A few ways we do this is by offering:a Nurseline 24X7, 7 days a weekhealth coaches to consumers managing chronic conditionsprograms to help consumers identify risk factors, help them to lose weight, and to quit smokingIf more time, explain that this definition is overarching.For example, in the process of engaging and enabling consumers:There must be transparency of price and quality, so that they become informed and involved.We must provide choices, so they can exercise their knowledge and make sound decisions.We must offer consumers control and sufficient funds in their accounts, so they can effectively manage their health care costs.To help individuals understand and learn how to maintain their good health’ improve their risk factors; and find the highest quality health care solutions at the best price we MUST:Educate them; communicate with them openly and often.Provide tools that are rich with information and that are easy-to-use.
5 How Do Consumers Use Health Care? Consumers today are “passive.”They’re individuals who “fall into the system.”They’re insulated from the real costs of health care (no price transparency)They typically don’t 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)State: Our program is different because Anthem’s Lumenos plans are designed to transform passive patients into engaged consumers.Most consumers perceive the cost of healthcare as the cost of their co-pays. In the eyes of the consumer, it costs more to go to the movies than go to your doctor.There hasn’t been any motivation on the part of the consumer or the design of healthcare plans to educate consumers on the real price of healthcare. Nor have there been the tools to educate consumers on alternative procedures and to comparison shop for providers and facilities.Milton Friedman quote – no one spends someone else’s money as carefully as they spend their own. If we had passed out $100 bills to everybody today from the ATM, my bet is that you would spend that money all before the end of the day. Most people would. Where if you were pulling $100 out of your own pocket, it’s going to be different.So it’s the same concept with health care.
6 Why Employers Consider Consumer Driven Health Plans (CDHPs) State You may be wondering how this relates to your business and your customer.You have been living in a world where increases are going up every year. And you go to see that individual business owner. And the owner says ‘what have you done for me this year? And I don’t want to hear, not even about a 10% increase. Because that’s far more than any other item on the expense sheet. So what are you doing to help me to control and stabilize these costs over the next two or three years?’And these things, as you’ve now understood, are not the only things impacted. It’s their own employees, it’s the families that they have and we all have covered earlier that three basic behaviors are out of control – smoking, weight control and sedentary life style.One of the interesting stats from a productivity perspective to a business owner is losing 18 days a year for every person that smokes, because of smoke breaks. The smoke breaks total about 18 days a year, so share that with an agent or broker. And think about every single person that they have on their own staff. Our plan addresses that. It encourages people to get involved. Stopping smoking is hard. Losing a great deal of weight is hard. But our program not only includes the benefit but rewards people for doing it by paying them more. So again we’re really helping to be part of the solution. We are putting their money where their mouth is. We’re helping put these programs in place.Facilitator Note Additional information on drivers of healthcare costs:Several underlying drivers contribute to the growth in medical premiumsAge wave – Americans getting older and health status is declining (this one is beyond anyone’s control, of course)Increased treatment options with new, expensive technologyConsumer entitlement mindset & ease of access to careNew (expensive) pharmaceutical and biotech productsRegulations, mandates, & compliance adds to costs & administrative complexity in the system which drives sometimes unnecessary spending & wasteMedical error rates and malpractice litigation add to the costsIn short, premium growth is being driven by: growing demand, for more expensive services, in a wasteful medical environment, fueled by consumers’ belief that they need the latest greatest treatments regardless of cost or the individual’s role in causing the condition.
7 Why Are Employers Considering CDHPs? Introduce consumerismWant employees to have a better understanding of the cost of careOffer employees more choiceImprove employee healthImprove employee satisfactionOffer employees opportunity to lower tax burdenIncrease employee contribution levelsLong-term and retirement savingsManage medical costs through better employee healthDescribe: There are many reasons why employers are considering CDHPs, for example:Anthem Consumer-driven healthcare:Introduce consumerismWant employees to have a better understanding of the cost of careOffer employees more choiceImprove employee healthImprove employee satisfactionOffer employees opportunity to lower tax burdenIncrease employee contribution levelsLong-term and retirement savingsManage medical costs through better employee healthIn this environment a consultative and strategic approachis essential to sales success
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 treatmentAverage 10% of total claims costs attributable to obesity60% of Americans exceed ideal BMI (body mass index)Soon to become the leading cause of deathAverage 10% of total claims costs attributable to tobacco21% of adult Americans smokeRemains leading cause of death60% perform no substantial activity or exerciseDescribe the impact of consumer behavior on the cost of health care:Weight, smoking, inactivity, and stress are the types of behaviors that account for 50 to 70% of health care costs.These are sometimes referred to as the “Big 4” costly behaviors when discussing medical costs.An average of 10% of health care claims is attributed to obesity, which is fast becoming the leading cause of death in this country, and another 10% to smoking.66% of all office visits to family physicians are stress-related, and employee absenteeism, diminished productivity, employee turnover and medical, legal, and insurance fees cost US businesses $300 billion annually in direct and indirect costs.GA ranks number 42 on State Health rank, including a 22% smoking rate and a 27% obesity rate. GA’s smoking and obesity rate is higher than average among all states. Health rankings are based on access to health care, lifestyle, stroke, hypertension, cancer, and high blood cholesterol.State: By offering programs to make better healthy lifestyle choices and by providing coverage for lifestyle improvement programs such as tobacco cessation and weight management, we help consumers to become healthier.Transition: Anthem’s 360° Health program offers consumers support to manage these ‘Big Four’ Risks and more.Facilitator Note: The source of the slide content is Health Affairs The Policy Journal of the Health Sphere (home page )Two-thirds of all office visits to family physicians are due to stress-related symptomsMore than one in four workers have taken a "mental health day" off from work to cope with stressCosts U.S. businesses $300 billion annually in direct & indirect costsStress
9 CDHP As A Health Care Strategy Employers and Consumers:Are becoming more sophisticated purchasers of health care benefitsRecognize that changing copays, deductibles and increasing employee contributions is not the solutionRealize that they must identify and address the fundamental causes of increasing health care costsAre looking for new solutionsAre looking for partners that can help them formulate and execute a long term strategyIn this environment, a consultative and strategic approachis essential to sales successState: CDH is a strategy, not a product. We have a solution for those small business trying to get costs in control and for those individuals wanting plans that make sense.Are becoming more sophisticated purchasers of health care benefitsRecognize that changing copays, deductibles and increasing employee contributions is not the solutionRealize that they must identify and address the fundamental causes of increasing health care costsAre looking for new solutionsAre looking for partners that can help them formulate and execute a long term strategyFacilitator Notes:Lumenos plan’s book of business for 2005 showed that consumer-driven health care, coupled with the right clinical strategy, can positively impact health care costs, the use of preventive care and consumers’ health behaviors.2005 results found:A reduction of 15% in overall pharmacy costs;A generic drug substitution rate of 92%;Outpatient visits reduced by 18%;Increased spending on preventive care (5% of total medical expenses were spent by CDHP consumers on preventive care; the remainder of the market spent 2-3%);53% of consumers reported increased knowledge about managing their health care;36% reported that they were more actively involved in health-related behaviors; and20% said their health has improved since enrolling in a Lumenos plan.( National Employers with over 170,000 consumers. These clients run the gamut and represent widely divergent industries and employee populations: high tech and heavy manufacturing, white and blue collar, rural and urban. Client size ranges from 2 to 90,000 employees.)
10 Selling CDHP - Realities With 66% of employers considering CDHP …Employer Perspectives on CDHP StrategiesMoving or looking to move to a full replacement CDHP option all at onceHad CDH plans but reverted back to HMO/PPO plans… can you afford to be on the sidelines?Planning to offer CDHP on a slice basis going forward, don’t anticipate moving to full replacementNot consideringMany agents and brokers are already thinking about consumer driven health care. Health savings accounts are in the news and it is a golden opportunity to take advantage of new legislation. For the brokers that want to be a leader in CDHP, now is the time. Now the reality is that the groups that are in financial pain are looking for solutions.Explain:ChapterHouse (a health care industry consulting firm) conducts a survey annually of 20,000 insurance agents and brokers in conjunction with NAHU (National Association of Health Underwriters).Broker responses suggest that 66% of employers are currently considering CDH plans.As a result, even brokers who are skeptical of consumerism will be forced to get on board.The point is: With two thirds of the market considering CDH, neither sales reps nor brokers can afford to sit on the sidelines.Planning to offer CDHP as an option in the short-term then move to a full replacement in the next few yearsLooking at it, not yet offeringSource: ChapterHouse/NAHU Survey
11 Start with Sound Clinical Strategy Incentive-based Health ImprovementExplain: As I mentioned earlier, the Lumenos plans start with an integrated and incentivized health improvement strategy.
12 Incentive-based Strategy Identify, improve risk and careProvide rewards for updating or completing health risk assessment80% completion goalMaintain low risk group to a minimum of 70%Our plans are based on the foundation of incentives. We offer incentives, or rewards, for assessing health, maintaining health and reducing health risk factors.Take optimal care of the sickEngage population to understand & reduce risksProvide incentives to complete risk reduction programs
13 Risk Factors Reduction Risk factors include:SmokingPhysical inactivityBMIAlcohol drug useJob/personal dissatisfactionDescribe if you look at the typical employer group, about half of the employee based fall in a low risk category; however, we all know that the high risk population accounts for a majority of the healthcare costs. The goal is first to identify the risks, then try to move high risk individuals to medium risk, the medium risk individuals to low risk.Source: D.W. Edington Research GM-UAW LifeSteps Health Promotion Program
14 Identify, improve risk and care Incentive-based StrategyIdentify, improve risk and careIdentifyMyHealthAssessment$50 reward* for online completion (limited to one reward per family each year)$100 reward* for enrollment for each eligible family memberParticipation in health coaching programsEngaging with health coach to identify goals; and understand and manage their health conditionEngageHealth Coaching ParticipationOur plans are based on the foundation of incentives. We offer incentives, or rewards, for assessing health, maintaining health and reducing health risk factors.Review each section and the incentives tied to them.$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 relationshipEngageHealth 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 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 membersState: The fully insured plans with incentives use the following incentive amounts for engaging in the health assessment, health coaching, and smoking cessation and weight management programs. There are some HSA plans available without incentives.
16 Smoking Cessation Tobacco Free Program Counseling calls with tobacco treatment specialistPersonalized plan, decision support for pharmacotherapy and nicotine replacement fulfillment at no cost to consumerIndividualized participant and physician correspondence, unlimited access to toll-free supportProgram is designed to be delivered over a 6-9 month period to meet the formal program completion criteriaIncentives available for this program, specific amount at employers discretionSmoking Cessation Program Covers 100% of the cost of telephone counseling services and educational materials, and also covers nicotine replacement therapy (not prescription drugs).
17 Weight Management Healthy Weight Program Telephonic course sessions address diet and healthy eating, physical activity and exercise, stress management, maintenance and relapse preventionPhone counseling facilitated by a registered dietician or health educatorIncludes course manual containing educational lessons for additional phone counseling sessionsCalls 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 professionalIncentives available for this program, specific amount at employers discretionIn a study done last year by the United Health Foundation, almost a quarter (24%) of the U.S. population is classified as obese, equating to 53 million adults. This is double the rate found in 1990, meaning about 25 million more American adults are obese.The health risks associated with being overweight or obese are many, associated with an increased risk of more than 20 conditionsincluding premature death, Type II Diabetes, heart disease,GA ranks number 42 on State Health rank, including a 22% smoking rate and a 27% obesity rate. GA’s smoking and obesity rate is higher than average among all states. Health rankings are based on access to health care, lifestyle, stroke, hypertension, cancer, and high blood cholesterol.Source: America's Health - United Health Foundation 2006 State Health Rankings -
18 Anthem’s CDHP 360º Health Programs 360º Lumenos products24/7 NurseLineComplexCareFuture MomsMyHealth web toolsConditionCare*MyHealth CoachHealthy Lifestyles Online & Telephonic CoachingWeight ManagementSmoking Cessation* Asthma, COPD, CAD, Diabetes, and Heart FailureFuture Moms HMC’s Maternity Management program helps mothers-to-be to have healthier babies and controls related expenses by focusing on early prenatal interventions, risk assessments and education. It addresses the significant problems associated with high-risk pregnancies and premature births through a comprehensive strategy involving the following interventions, components and services:24x7 Nurseline. HMC’s URAC-accredited 24/7 NurseLine offers eligible members access to accurate information any time of the day or night. Through one-on-one counseling with experienced nurse care managers available 24 hours a day via a toll free number, members can make more informed decisions about the most appropriate and cost-effective use of health care services.ComplexCare Anthem’s ComplexCare program targets members identified as likely to incur significant medical expenses in the near future, but do not fall into established disease management programs. The ComplexCare program was founded on a proactive, collaborative, member-centric model of care management, in which chronic care management is emphasized for those members with chronic or multiple non-DM type of condition(s) at future high risk. For example, members with various forms of cancer or Multiple Sclerosis (MS) could be targeted for ComplexCare participation.ConditionCare ConditionCare is a voluntary program that provides services and support to positively impact the health and well-being of our members. The overall goals of the program are to: • Help promote and improve the overall health status; and quality of life of members; Help delay disease progression, and avoid and/or; delay the complications associated with the conditions. The conditions addressed by ConditionCare are: • Pediatric or adult asthma; • Chronic obstructive pulmonary disease; • Heart failure; • Coronary artery disease; • Pediatric or adult diabetes (types I and II)Explain that the Healthy Lifestyles and MyHealth Coach programs are modified for the Lumenos plans. Recommend they contact their sales rep or account manager for more info on 360 Degree Health
19 What programs are eligible for incentives? ArthritisOsteoarthritis Osteoporosis RAAsthma Adult and PediatricCardiologyCardiology, 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 SurgeryCOPDDiabetes Type I and Type llMaternityOncologyOncology, Breast Cancer Oncology, Colon Cancer Oncology, Lung Cancer Oncology, Prostate Cancer Oncology, Skin CancerThis is a list of the programs eligible for incentives.
20 Requesting a Health Coach Anthem’s 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.State: Requesting a health coach is easy.After completing the MyHealth Asessement tool and if the data suggests a member may be eligible for a coaching program, the member is presented with a page to request a health coach contact him/her.
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 conditionSelf-management skillsAbility to comply with the treatment planAchievement of an effective relationship with a primary care physicianYou may be wondering what members have to do in order to meet the activity achievement criteria. This is specific to the program, but overall, the consumer must:demonstrate to the health coach that they possess. For example:Knowledge of their conditionSelf-management skillsAbility to comply with the treatment planAchievement of an effective relationship with a primary care physician
22 Back It Up With Account-based CDHPs Now let’s take a look at the plan designs which support the integrated, incentvized health improvement strategy.
23 Clinically Appropriate Plan Design Preventive careCoverage for nationally recommended preventive care servicesHealth accountHealth account should be sufficient for many peopleOut-of-pocket responsibilityThe “bridge” to Traditional Health Coverage – the amount consumer pays to satisfy their remaining deductible after health account funds are exhaustedTraditional health plan coverageCoinsurance and annual out-of-pocket protectionSample Plan DesignPreventive CareHealth Accountand/orRewardsI said if you’ve seen one consumer driven plan, you’ve seen one. All of ours have clinically appropriate plan design. It’s is really important. And the reason is…One of the reasons CDH has gotten bad press is because a lot of employers have set up plans that are horrific, and that are just pure cost shift, and not given anyone any information or tools.Our plans, we basically refuse to do that. So all of the plans have preventive care at 100%. They also have an account, they all have the incentives included. And they have a fair and compassionate out of pocket responsibility. Some employers have set up CDH plans which are unfair and unbalanced. So you want to reassure your broker and agent that if they deal with us, they can automatically know they’re covered from a clinical perspective in something that’s fair.Out-of-Pocket “bridge” to Traditional Health CoverageTraditional Health Coverage
24 Types of Lumenos Plans Health Savings Account (HSA) Health Reimbursement Account (HRA)Health Incentive Account Plus (HIA Plus)Health Incentive Account (HIA)The four types of Lumenos plans are:Health Savings Account (HSA)Health Reimbursement Account (HRA)Health Incentive Account Plus (HIA Plus)Health Incentive Account (HIA)
25 Anthem's Lumenos HSA Plan We’ll start with the HSA
26 4.5 Million People Enrolled in HSA Plans Growth of HSA/HDHP Enrollment from March 2005 to January 2007I probably don’t need to tell you that HSAs have grown tremendously since their inception. If you take a look at the growth, then you’ll see the growth is happening now in the large group and small group markets.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: America’s Health Insurance Plans (AHIP) of U.S. 2007
27 Anthem's Lumenos HSA Plan Consumers can fund their HSA with pre-tax dollars and can use funds for health care expensesEmployers can also contribute to employees’ HSAsPreventive services are covered at 100% In-NetworkIncludes Traditional Health Coverage to cover expenses after the bridgePreventive Care100% In-NetworkHSAFunded by annual employee and/or employer contributionsYou probably have a fairly extensive base of knowledge around the HSA in the sense that consumers can fund their HSA with pre-tax dollars and can use funds for health care expenses and employers can also contribute to employees’ HSAsFor 2008, the deductible for self-only coverage must be at least $1,100 (with an annual out-of-pocket limit not exceeding $5,600);the deductible for family coverage must be at least $2,200 (with an annual out-of pocket limit not exceeding $11,200).The annual HSA contribution limit in 2008 for individuals with self-only coverage is $2,900; for family coverage, it is $5,800. Individuals who are at least 55years of age but not yet enrolled in Medicare may contribute an additional $900.Out-of-Pocket “bridge” to Traditional Health CoverageTraditional Health Coverage
28 HSA Plan Details At-a-Glance Lumenos HSA PlanSingle CoverageFamily CoveragePreventiveNationally recommended servicesNo cost, no deduction from HSA with in-network providersHSA<Employer’s annual allocation>Annual HSA contribution maximum<$xxx>$2900$5800Traditional Health CoverageBridge amount to satisfy deductibleYour bridge amount is your annual deductible, but can be reduced by any dollars you first use from your HSA for covered services.$2000$4000Then, you pay coinsurance for covered services80%/80% for in-network services60%/80% for out-of-network servicesPlan pays 100% after annual out-of-pocket maximum (includes HSA, bridge and coinsurance)In-NetworkOut ofNetwork$5000$10000$20000This illustrates the details at-a-glance for an HSA. Specific plan is: GHSA / /80 60/ / /20000In this plan, the emphasis lies in the preventive care, covered at 100% for in-network providers and the tax savings. Highlight the updated HSA allocation rules. Contribution maximums are no longer tied to deductible amounts. A consumer can go up to the full treasury max for individual coverage/family coverage.For calendar year 2008, the limitation on deductions under § 223(b)(2)(A) for an individual with self-only coverage under a highdeductible health plan is $2,900. For calendar year 2008, the limitation on deductions under § 223(b)(2)(B) for an individual with family coverage under a high deductiblehealth plan is $5,800.For 2009, the maximum annual HSA contribution for an eligible individual with self-only coverage is $3,000. For family coverage, the maximum annual HSA contribution is $5,950.Catch up contribution for individual who are 55 or older is increased by statute to $1,000 for 2009 and all years going forward. For 2009, the maximum annual HSA contribution for an eligible individual with self-only coverage is $3,000. For family coverage, the maximum annual HSA contribution is $5,950. Catch up contribution for individual who are 55 or older is increased by statute to $1,000 for 2009 and all years going forward.
29 Sample HSA Consumer Experience Pharmacy Service 1) Consumer visits pharmacy to fill a prescription2) Pharmacy connects to Anthem to determine consumer’s benefit5) Consumer uses HSA checkbook or debit card to access HSA funds and pay pharmacyRx4) Pharmacy provides consumer with prescription and charges the appropriate amount3) Anthem determines consumer’s benefits “real-time” and passes back to pharmacy the amount the consumer is responsible for paying$Describe how the HSA works for pharmacy coverage
30 Sample HSA Consumer Experience Physician Service 6) Consumer uses HSA checkbook or debit card to access HSA funds to pay physician1) Consumer visits physician2) Physician submits claim to Anthem$5) Physician sends bill to consumer3) Anthem applies benefits and notifies physician of the amount the consumer is responsible for paying$Describe how the HSA works for medical coverage4) Anthem sends consumer Claims Recap record of benefit applied
31 HSA Integration Employer product set-up Consumer enrollment One combined health plan and HSA employer applicationConsumer enrollmentOne combined health plan and HSA consumer applicationEmployer funding implementationPlan-based resources and partner bank resources that will support employers’ efforts to facilitate payroll-based fundingCustomer serviceCustomer Service Advocate can assist with all benefit information, level 1 HSA account service, and warm-transfers to partner bank for level 2 supportConsumer portalConsumers will come to anthem.com for both their benefit and HSA detailsHSA consumer communicationsConsumers will receive all of their benefit and banking enrollment materials from AnthemReview the HSA integration benefits
32 Bank of New York Mellon and ACS The HSA product is administered by professionals in banking, employee benefits, insurance and administration.Nation’s largest HSAadministrator inpartnership with BNY MellonExtensive footprint inbenefits consulting andoutsourcing servicesBNY Mellon 172ACS 423Market leader providingbusiness process and IToutsourcingMore than 63,000 employeesHuman resource consultingand deep insurance expertiseThe ACS|Mellon HSA begins with an FDIC insured, interest-bearing checking account where all HSA deposits are first credited. No minimum balance is required to open andmaintain the HSA checking account. Once account holders’ HSA checking account reaches $2,000, they can begin to diversify their accumulated savings into a wide selectionof mutual funds. An HSA Investment Account is easily established online through the HSA Web site. The HSA account holder creates an Investment Account by completing thestep-by-step online registration process (this process takes approximately five (5) minutes to complete). Immediately following the account registration process, the HSA account holder caninitiate investments online. Investing can be on-demand or established as an automatic, recurring transaction.The investment options include a variety of fund families CDHP H.S.A. The broker needs to submit the paperwork 4 weeks prior to the clients effective date.
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)51-99 groups have rider option for ER to pay above fees100+ groups have 3 fee payment options:ER pays setup and monthly feesER pays setup fee and EE pays monthly feesER pays monthly fees and EE pays setup feeAccount Closure = Free, if closed by checkChecksNo charge for initial checkbook(40); $10 for additional booksNo fees for writing checks; Replacement/ additional debit card $5State:The rate fluctuates every 6 months.Interest RateFor the period July 1, 2008, through December 31, 2008, the interest rate to be credited to the Health Savings Account will be %. Reference the interest rate document in the Mellon Information folder. For the period January 1, 2008 through June 30, 2008, the interest rate to be credited to Health Savings Accounts will be 3.0%. Reference Interest rate document in Mellon Information folder. There are a number of investment options, as shown on the slide.Change to Mellon HSA Interest Rate WellPoint’s current HSA administration agreement requires the interest rate credited to participants’ HSAs be adjusted effective each July 1 and January 1. The interest rate is to be set at 185 basis points less than the six-month LIBOR rate as of the immediately preceding May 1 or November 1.2008 Contribution Limits Set by IRS The Internal Revenue Service (IRS) sets the contribution limit amounts for Health Savings Accounts. The IRS recently announced the contribution limits for 2008, which are $2,900 for those with self-only coverage and $5,800 for those with family coverage.New Investment OptionsChoice of 20 funds, Ongoing contributions made to investment account in $1 increments above $2,000 balance in transaction accountNo Investment Minimums — once ACS|Mellon HSA account holders reach$2,000 in their checking account, they can begin investing with no minimuminvestment required—allowing account holders to take full advantage of periodicinvesting.
34 Consumer ExperienceAfter choosing Anthem’s 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 InstructionsConsumer Signature Card (Master Signature document)Fee & Rate ScheduleDeposit ticketHSA Combined Deposit Agreement and Disclosure DocumentsReturn envelope for Master Signature documentComplete paper signature card/eSignature to activate accountReceive debit card and checkbookReceive monthly bank account statements and year end reports for tax purposes (include 1099-SA sent in January and 5498-SA sent in May)State that this slide reiterates some of the key information about the HSA account owner receives from Mellon.The Signature Card/ Master Signature Document is personalized and bar coded to the consumer. It is important that the consumer use the Signature document that was supplied to them in their Welcome kit.Even when the consumer chooses to activate their account online, they must always send in the Master Signature document. It is the Master Signature document that generates sending the check book and additional deposit slips. Also, if a consumer supplied only their P.O. Box address on their member application, the member needs to include their street address on this form. An account cannot be set up with a P.O. Box address (Patriot Act).
35 Incentive Rewards Allocations to HSA for Self Insured Groups ONLY Reward dollars earned are deposited directly into the consumer’s HSAReward allocations are tax-free to the employee, so amounts count toward the annual HSA contribution limitUse like any HSA funds -- tax-free if used for qualified medical expensesCredit Dollars to redeem for Gift Cards for Fully Insured GroupsProvided through our partner, IncentOneWhen reward is earned, consumer receives notification by mailConsumer 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, Dick’s Sporting Goods and the Sports AuthorityRewards are taxable, and consumer will receive a 1099 form if they redeem rewards over $600 in a single yearHow incentives on the HSA plans work are driven by whether the plans are self funded or fully insured.For Self Insured groups:Reward dollars earned are deposited directly into the consumer’s HSAReward allocations are tax-free to the employee, so amounts count toward the annual HSA contribution limitUse like any HSA funds -- tax-free if used for qualified medical expensesNote: If annual contributions are maxed, consumers cannot accept reward amount that take them over the annual max.For fully insured groups:Credit Dollars to redeem for Gift Cards for Fully Insured GroupsProvided through our partner, IncentOneWhen reward is earned, consumer receives notification by mailConsumer 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, Dick’s Sporting Goods and the Sports AuthorityRewards are taxable, and consumer will receive a 1099 form if they redeem rewards over $600 in a single yearYou may want to include an example on how the reward dollars are earned; the next slide addresses that they are provided through IncentOne but attendees may want to know how they are earned.
37 Anthem's Lumenos HRA Plan Consumers use employer-funded HRA dollars to pay for covered expensesEarn more dollars for their HRA through rewards for healthy behaviorsPreventive services are covered at 100% In-NetworkUnused HRA dollars roll over from year to year and can be used for future health care expenses; employer caps may applyTraditional Health Coverage covers expenses after the bridgePreventive Care100% In-NetworkHRAFunded by annual employer allocationPlusAdditional reward dollarsDescribe the HRA Plan:Consumers use employer-funded HRA dollars to pay for covered expensesEarn more dollars for their HRA through rewards for healthy behaviorsPreventive services are covered at 100% In-NetworkUnused HRA dollars roll over from year to year and can be used for future health care expenses; employer caps may applyTraditional Health Coverage covers expenses after the bridgeOut-of-Pocket “bridge” to Traditional Health CoverageTraditional Health Coverage
38 HRA Plan Details At-a-Glance Lumenos HRASingle CoverageFamily CoveragePreventiveNationally recommended servicesNo cost, no deduction from HRA with in-network providersHRAEmployer’s annual allocation$1000$3000 rollover max$2000$6000 rollover maxTraditional Health CoverageBridge* amount to satisfy deductible$1500$3000Then, you pay coinsurance for covered services100%/100% for in-network services70%/100% for out-of-network servicesPlan pays 100% after annual out-of-pocket maximum (includes HRA, bridge and coinsurance)In-NetworkOut ofNetwork$2500$5000$10000The following illustrates an HRA planThe allocation is provided in full on a prorated basis based on the calendar year. If the group starts 1/1, they receive the full allocation. If they start on the plan March 1st, they receive 9/12 the yearly allocation on the plan effective date. For a 11/1 group, they receive 2/12 the allocation and then receive the yearly allocation on 1/1. The bridge/deductible is combined for in-network and out of network services. The allocation applies to this amount, too. As a reminder, if the consumer participates in incentive programs, the money is added to their account and also reduces their bridge amount.There is a separate co-insurance amount for in network and of network services, along with a separate coverage for medical and RX. OOP max for in and out-of-network services*Bridge = annual deductible minus annual HRA allocation
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 planConsumers earn more dollars for their HIA through rewards for healthy behaviorsPreventive services are covered at 100% In-NetworkUnused account dollars roll over from year to year; caps may apply.Traditional Health Coverage covers expenses after the bridgeHIA PlusFunded by annual plan allocationPlusAdditional reward dollarsPreventive Care100% In-NetworkTraditional Health CoverageOut-of-Pocket “bridge” to Traditional Health CoverageDescribe the HIA PlusWorks like an HRA, except the account allocations are provided by Anthem as a part of the health planConsumers earn more dollars for their HIA through rewards for healthy behaviorsPreventive services are covered at 100% In-NetworkUnused account dollars roll over from year to year; caps may apply.Traditional Health Coverage covers expenses after the bridge
40 HIA Plus Plan Details At-a-Glance Lumenos HIA Plus PlanSingle CoverageFamily CoveragePreventiveNationally recommended servicesNo cost, no deduction from HIA with in-network providersHIA PlusYou receive an annual allocation$750$1500Traditional Health CoverageBridge* amount to satisfy deductible$2500$5000Then, you pay coinsurance for covered services80%/80% for in-network services60%/80% for out-of-network servicesPlan pays 100% after annual out-of-pocket maximum (includes HIA, bridge and coinsurance)In-NetworkOut ofNetwork$10000$20000The following illustrates an HIA Plus planThe allocation is provided in full on a prorated basis based on the calendar year. If the group starts 1/1, they receive the full allocation. If they start on the plan March 1st, they receive 9/12 the yearly allocation on the plan effective date. For a 11/1 group, they receive 2/12 the allocation and then receive the yearly allocation on 1/1. The bridge/deductible is combined for in-network and out of network services. The allocation applies to this amount, too. As a reminder, if the consumer participates in incentive programs, the money is added to their account and also reduces their bridge amount.There is a separate co-insurance amount for in network and of network services, along with a separate coverage for medical and RX. OOP max for in and out-of-network services*Bridge = annual deductible minus annual HIA allocation
41 Integrated Plans Employer product set-up: Consumer enrollment: 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 pharmacyCustomer service:Customer Service Advocate can assist with all benefit information as well as health account serviceConsumer portal:Consumers go to anthem.com for both their benefit and plan detailsHighlight integration – no bank partner as HRA is a notional account
42 Sample HRA/HIA Plus Consumer Experience Pharmacy Service 2) Pharmacy connects to Anthem to determine consumer’s benefit and funds available1) Consumer visits pharmacy to fill a prescriptionRx3) Anthem determines consumer’s benefits and HRA funds available “real-time”5) Pharmacy provides consumer with prescription. Consumer pays nothing out of pocket.Review the direct payment from Account to Pharmacy.This is a really cool feature of the Lumenos HRA, HIA Plus, and HIA plans. The consumer goes to the pharmacy to get a prescription filled. The pharmacy system connects with us real time and determines the consumer’s benefits and HRA funds. If there is money in the account, Anthem debits the HRA and pays the pharmacy for the prescription. No exchange of money at all! The consumer walks out with their prescription and pays nothing out of pocket.$4) Anthem debits consumer’s HRA and pays pharmacy for the prescription
43 Sample HRA/HIA Plus Consumer Experience Physician Service 2) Physician submits claim to Anthem$1) Consumer visits physician3) Anthem determines consumer’s benefits and HRA funds available4) Anthem applies benefit and debits consumer’s HRA then pays physician for the servicesThe same happens at the physician’s office. The consumer goes to the doctor. The physician submits the claim to Anthem who determines the consumer’s benefits and HRA funds. If there is money in the account, Anthem debits the HRA and pays the pharmacy for the prescription. No exchange of money at all! The consumer walks out with their prescription and pays nothing out of pocket.5) Anthem sends consumer Claims Recap record of benefit applied and account funds used$
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 3/12th of full allocation11/1 Members will receive 2/12th of full allocation12/1 Members will receive 1/12th of full allocationAvailable in 2009 for Large Groups OnlyCalendar year groups with HRA and HIA Plus can choose monthly or quarterly allocationPlan year groups with HRA and HIA Plus will have monthly allocationReview the proration allocation rules for different effective dates.Large groups with HRA and HIA Plus can choose monthly or quarterly allocation for calendar year administrationLarge groups with HRA can is allowed monthly allocation for plan year administration
45 Monthly Proration Option for All 12/1/2008 Groups Group Effective Date 1/1/2009Monthly Proration StandardMember #1 enrolls in Lumenos plan on 1/1, member receives full HRA allocationMember #2 enrolls in Lumenos plan on 7/1, member receives 6/12ths the full HRA allocationBoth Member #1 and Member #2 receive full allocation 1/1/2010January 2009July 2009Monthly Proration of Account Allocation (current standard):Calendar Year Benefits: You receive the full annual allocation on January 1st of each year. If you join the plan or the group effective date starts in a month other than January, your annual allocation will be prorated based on the month you joined the plan. For example, if you join the plan in November, you will receive 2/12ths of the annual allocation for the two months of the calendar year you are participating in the plan and you will receive another full annual allocation in January.Plan/Benefit Year: You receive a full annual allocation at the benefit year (group effective/renewal date) of each year. If you join the plan after your benefit year has begun, your annual allocation will be prorated based on the month you joined the plan. For example, if you join the plan in the 11th month of the benefit year, you will receive 2/12ths of the annual allocation for the two months of the benefit year you are participating in the plan and you will receive another full annual allocation at the start of the next benefit year.
46 Quarterly Proration Scenario Option for Large Groups Only: HRA and HIA Plus Group Effective Date 1/1/2009Quarterly Proration StandardMember #1 enrolls in Lumenos plan on 1/1, member receives full HRA allocationMember #2 enrolls in Lumenos plan on 11/1, member receives one quarter of the full HRA allocationBoth Member #1 and Member #2 receive full allocation 1/1/2010January 2009November 2009Quarterly Proration of Account Allocation:Calendar Year Benefits (quarterly proration is available with calendar year administration only): You receive the full annual allocation on January 1st of each year. If you join the plan or the group effective date starts in a month other than the first quarter (January-March), your annual allocation will be prorated based on the quarter you join the plan. For example, if you join the plan in November, you will receive one quarter of the annual allocation for the last quarter of the calendar year you are participating in the plan, and you will receive another full annual allocation in January.
48 Anthem's Lumenos HIA Plan Companion product to introduce elements of consumerismCan replace an existing PPO offering with a similar PPO plan designPreventive services are covered at 100% In-NetworkHas the added benefit of financial rewards for healthy behaviorsIncludes Traditional Health Coverage to cover expenses after the bridgeAlso includes all of the tools, services and programs to encourage and reward positive consumer behaviorPreventive Care100% In-NetworkHIAFunded by reward dollarsCompanion product to introduce elements of consumerismCan replace an existing PPO offering with a similar PPO plan designPreventive services are covered at 100% In-NetworkHas the added benefit of financial rewards for healthy behaviorsIncludes Traditional Health Coverage to cover expenses after the bridgeAlso includes all of the tools, services and programs to encourage and reward positive consumer behaviorOut-of-Pocket “bridge” to Traditional Health CoverageTraditional Health Coverage
49 HIA Plan Details At-a-Glance Lumenos HIA PlanSingle CoverageFamily CoveragePreventiveNationally recommended servicesNo cost, no deduction from HIA with in-network providersHIAEarn reward dollarsTraditional Health CoverageBridge amount to satisfy deductibleYour bridge amount is your annual deductible, but will be reduced by any HIA dollars you have available.$750$1500Then, you pay coinsurance for covered services90%/80% for in-network services70%/80% for out-of-network servicesPlan pays 100% after annual out-of-pocket maximum (includes HIA, bridge and coinsurance)In-NetworkOut ofNetwork$2750$5500$11000HIA PLAN 750/ /80 70/ / /11000This illustrates the details at-a-glance for an HIA plan. Only difference here is that there is no account allocation.In this plan, the emphasis lies in the participation of the incentive programs. If the consumer participates, the money is added to their account and reduces their bridge or deductible amount.
50 High-touch Service and High-tech Online Health Site Consumer SupportHigh-touch Service andHigh-tech Online Health SiteNote: Avoid using the term “our website;” use “online health site” instead. All members use ANTHEM.COMOpen this section with the following remarks:Anthem is committed to empowering consumers to manage their own health, health care, and health care costs.Consumer empowerment is at the heart of our consumer driven health care philosophy and strategy for health improvement.By empowering consumers to better manage their health, health care, and health care spending, we are able to reduce costs for both consumers and their employers.Our consumer online health sites are a central component of our education and communications programs. They provide consumers with a wealth of information and tools to help them become proactive, empowered consumers of health care.
51 Help and Information When Members Need It Dedicated service centersCustomer Service Advocates with in-depth Lumenos plan knowledgeOne single point of contactPlan and account informationMonthly Health Statement and Claim Recap – combining benefits and account status informationOnline Health SiteOur customer service advocates have in-depth product knowledge and access to total transactions with each consumer. The customer service advocates can see whether the consumer is working with a personal health coach, provide education and recommend personal health coach in appropriate circumstances. They can also answer any questions about the plan and account, including the Lumenos HSA plan. This includes account statements, benefits, etc. They can also help consumers find information on the online health site and provide information to those without access to the internet.
52 Sample Monthly Health Statement and Claim Recap Sample and Monthly Health Statement and Claims RecapThis is an example of the Monthly Health Statement and Claim Recap.This is provided as a summary of your account on a monthly basis. It is designed to be easy to read and understand. It is also designed to show how you are spending your healthcare dollars.This information is useful to you in a number of ways. For example, you may elect to use the prescription drug cost estimator to identify generic drug alternatives that you can discuss with your doctor to reduce your healthcare expenses, if you note that a high percentage of your health care costs are related to brand name drugs.How much came out of the account?How much did the claims cost?How much do I have left in my bridge or deductible.Be sure to mention:Our Account Analysis tool gives you tips on how to make your health care dollars go further, based on your spending history.
53 Doctor Info Find a doctor by name, specialty or location See how much they’ll charge for typical services and if they offer network discountsThis is a Provider Finder screen, which can be used when you need to seek care. The provider finder enables you to:Find a doctor, by nameFind a doctor or other provider, by specialtyFind a provider, by locationSee what a provider typically charges for a service (not by each provider, but a cost range of 90+ services)
54 360 Degree Health: Online Health Tools MyHealth AssessmentPreventive Care GuidesMyHealth RecordCondition CentersSurgical Guides and Hospital ComparisonsTraditional and Alternative Health LibraryAnd moreOur online health site is designed to educate you about health issues, to make it easy for you to find the information you need. The site includes access to:The Health Assessment (easy to use, confidential, HIPAA Compliant)Your account and family health fileCondition centersPreventive care guides. Preventive care guides show you what’s recommended for people of your age and gender. You can print them and take them to your doctor.Surgical guidesHospital comparisonsA library of information about both traditional and alternative healthAnd much moreOur sites are also designed to inform the consumers about the Lumenos plan features and benefits, to provide transparency of information about doctors, medications, hospitals, and costs, and to provide you access to information and tools that will help you manage how you spend the funds in your health accounts.The information on our online health site is kept current.Our online health site pulls together in one convenient location both publicly-available data plus data from reliable third parties such as WebMD.
55 360 Degree Health: Health Assessment Screen Health Assessment Features:Consumer connect to assessment via Health Assessment linkCompletes assessmentViews resultsIs presented with option to sign up for Personal Health Coach ServicesAfter a consumer completes the health assessment, they can ask for a personal health coach to contact them.EasyOpt-in and opt-outIntegratedThis is an example of how the consumer online health site may be used to seek help. This screen shows the linkage to the personal health coach program. When you complete your health assessment, you will automatically see this screen asking whether you would like to be contacted by a personal health coach. This is a proactive way to engage you early in the plan year in programs that help you to:Better manage chronic and ongoing health conditions, such as diabetes, asthma, hypertension, etc.Reduce risk factors by enrolling in smoking cessation and weight management programs
56 360 Degree Health: Prepare for Surgery Screen Prepare for Surgery Features:Search key phrases and view resultsView sample procedure, complete with audioLink to resources and FAQ’s to help prepare for the procedureThe surgical support tool is an animated guide to surgical procedures.No bloodShows the full proceduresIntroduces AlternativesDescribes the recovery PeriodThis is great stuff. To be able to have a surgical support nurse be able to partner with them and see the surgery ahead of time. There’s no blood. But you actually go through the full procedure. You understand what’s going to happen. You understand where complications can occur. You understand alternatives, and even the recovery period. Powerful, powerful things. And again, not offered by our competitors. But no other competitor, even in large group, offers this technology, and this capability, to their CDH members.
57 360 Degree Health: Subimo Content Screen Healthcare Advisor (Subimo):Accessed via Hospital Comparison link in the left hand navigation of the MyHealth landing pageOption to search en Espanol returns Subimo results page in Spanish (left nav will be in English)Includes:Hospital search options by:ProcedureNameGeographical proximityState: This is a Hospital Comparisons screen. It enables you to:Find information about a specific hospitalCompare hospitalsYou will be able to use this tool to select the factors important to you and compare hospitals in their area on a specific procedure or medical condition.This example compares a number of factors at three hospitals. This is a valuable tool for consumers who need to have serious or potentially life threatening procedures. It enables you to see important information such as how many procedures are done at the hospital and whether complication rates are better than expected. This information is worth printing and taking to your health care provider when discussing where to have a medical procedure.In a consumer driven world, this tool becomes very useful.A lot of times, people don’t think about this. If you have someone that you love, it’s important to look into this tool. There are plenty of places that do heart surgery, but which hospitals do the most surgeries, the most success rates, the least complication rates, the least mortality rates, 24 hours intensive care units, etc.
58 360 Degree Health: Cost Comparison Label warningsDrug InteractionsSide EffectsPrecautionsCost comparison:Accessible via Drug Cost link in left hand navigation MyHealth landing pageConsumer enters geographic search criteriaResults are displayed per local pharmacy based on recent purchases of drugBe sure to mention:Once you enroll in the plan, you can also use a tool that lets you look up actual amounts people in your local area have paid for the same prescription – and where they bought it.The prescription drug cost tool provides you with information on medication alternatives, including generic and over-the-counter drugs. This is good information to print and take to your healthcare provider when discussing which medications are best for you.Once you enroll in the plan, you can also use a tool that lets you look up actual amounts people in your local area have paid for the same prescription – and where they bought it. This is a direct benefit to you by enabling you to comparison shop for the best prices on prescription drugs.Real live claim data that is populating the tool. As more and more people join the plans, more data will be available.
59 Online Tools to Manage Health Care Dollars Account Analysis:Available via Account Analysis link from Account Activity pageResults are displayed graphically by:How expenses were paid (shown)Type of service receivedDate parameters selected by the ConsumerNOTES:
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 headerDisplays:Claim summarySearch optionsDisplay of claim in scrollable/print friendly table formatNote - claim types (e.g., Rx, Medical) will not be integrated in a single screen as shownOur Account Analysis tool gives you tips on how to make your health care dollars go further, based on your spending history.You can look into more detail about a claim and what has been paid under the account, from the bridge and from traditional health coverage.Consumers can also view their claims history and get detailed information about each claim, how it was paid, and their responsibility.On the claims page, consumers can choose which family consumer’s claims to view and select a time period.They can also click on a specific claim number to see claim details.If a consumer does not have online capabilities, the consumer can get the same claim information by calling the 800 phone number on their Health ID card and speaking with a customer service advocate.
61 Product Portfolio, Account Funding and Plan Considerations
62 Offerings and Product Approaches Full suite of CDHP options allows for personalized strategies for employersSingle Lumenos CDHP offeringMultiple CDHP pairings – for example, HRA or HSA paired with HIA to replace (transition from) existing PPOLumenos CDHP offered alongside a non-CDHPFull suite of CDHP options allows for personalized strategies for employersSingle Lumenos CDHP offeringMultiple CDHP pairings – for example, HRA or HSA paired with HIA to replace (transition from) existing PPOLumenos CDHP offered alongside a non-CDHP
63 Anthem’s Lumenos Product Portfolio 19 HSA Plans:7 core plan designs with varying deductibles, coinsurance, OOP maximum levelsPlans can be sold with or without incentivesFive incentive plans can be sold with embedded deductibles26 HRA & 24 HIA Plus PlansPlans can be sold with either 3x maximum contribution rollover max or unlimited maximum rollover6 HIA PlansAll HIA plans have Unlimited Rollover Contribution MaxRefer to side-by-side gridAll Plans include:100% Preventive careAll HRA, HIA Plus, and HIA plans have incentivesOnly ½ of HSA plans have no incentivesPlans vary from:Ind/Fam deductibleIn Network coinsuranceIn Network Out of Pocket MaxOut of Network CoinsuranceOut of network out of pocket MaxContribution Rollover Max for HRA, HIA PlusAll Products use the BCBSGA PPO Network
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.“Per the IRS the individual deductible within a family embedded deductible plan can not be less than $2400 for calendar year 2008.”Next Slide: HSA Embedded Deductible Example #164
65 Embedded Deductible Example #1 Example HSA with embedded deductible:Family of three.Family deductible: $5,000.Embedded individual deductible: $2,500 (each person).Person 1 meets $2,500.That person’s individual deductible is now met. Future claims for that person are subject to coinsurance.Person 2 meets $800.Also Add after 4th text box:“The contributions of Person 2 and Person 3 that fulfill the family deductible can not be more than their own individual deductibles of $2500.”Next Slide: HSA Embedded Deductible Example #2Remaining unmet family deductible: $1700 ($5,000 – $3,300). The remaining $1700 can be fulfilled by any combination of Person 2 and Person 3.65
66 Embedded Deductible Example #2 Example HSA with embedded deductible:Family of four.Family deductible: $6,000.Embedded individual deductible: $3,000 (each person).Person 1 meets $3,000.That person’s individual deductible is now met. Future claims for that person are subject to coinsurance.Person 2 meets $1,000.Person 3 meets $1,000.Also Add after 5th text box:“The contributions of Person 2, Person 3 and Person 4 that fulfill the family deductible can not be more than their own individual deductibles of $3000.”Next Slide: HSA Embedded Deductible Example #3Remaining unmet family deductible: $1000 ($6,000 – $5,000). The remaining $1000 can be fulfilled by any combination between Person 2, Person 3 and Person 4.66
67 Local CDH Plans vs Lumenos CDH Plans Benefit DescriptionCurrent Benefit(Local GA CDHP)New Benefit(GA Lumenos)TMJ$5,000 lifetime maximum$15,000 lifetime maximumHospice$10,000 lifetime maximumNo lifetime maximumPHPNot coveredPlan to cover with 10 visits/yr once DOI approval receivedIOPCovered unofficially using the visit limits under the regular MH outpatient benefitPlan to cover as a real benefit with separate visit limits (10/yr) once DOI approval receivedMental HealthMental health services do not apply to the OOP maxMental health services will apply to the OOP maxUrgent Care CenterCovered unofficially using the current specialist office visit coinsurance amountPlan to cover using new UC benefit once DOI approval receivedMail Order RxNot CoveredCovered through Next RxReview the specific benefits that are different from the current benefits to the Lumenos CDH benefits.
68 Account Funding Availability Medical FundingAccount FundingContribution DollarsIncentive DollarsHSAASON/AEmployer FundedFully InsuredHIAPlan FundedHIA Plus °HRAReview the funding options available for each plan. Also review who funds the account and incentives.° Not available for ASOBlended Funding
69 HRA Blended Funding Medical is fully insured Incentives and account are self-insured/ASOEmployer groups will receive:Premium billBill for account dollars and incentive dollars usedMedical is fully insuredIncentives and account are self-insured/ASOEmployer groups will receive:Premium billBill for account dollars and incentive dollars used
70 Criteria for Qualifying Accounts for CDHP Employer Drivers for CDHPInterested to cost containment solutions along with empowering employees to take charge of their health careInterest in health/disease managementInnovative and/or wellness orientedEmployee self-service orientedHas a broker or consultant who is a proponent of CDHPInternal CDHP champion or management support/imperativeReview why some employers are good candidates for CDHP.
71 Plan Comparison Feature HSA HRA HIA Plus HIA Who contributes? Employer and/or EmployeeEmployer onlyHealth PlanEarned through incentivesAccount funded?YesNoFunds availability?When deposited in the accountImmediateWhen incentives are completeOwnership balances at termination?Remain with consumerReturn to employerReturn to healthcare insurance providerContributed maximums?Lesser of the annual deductible or IRS maximumDictated by plan designAllowable medical expenses?213(d) expenses – employee discretionPlan covered - employer discretionAccount ownership?EmployeeEmployerPortability?Yes – completelyYes – employer discretionYes - employer discretionFinancial partner requirement?Bank or TrustN/A - Notional AccountInvestment options?State The chart on this slide illustrates some differences between the plans.Highlight some of the features and how they differ from product to product (contributions, funding, portability, ownership, etc)
72 Criteria for CDHP Product Selection HRA/HIA PlusHSAHighLowImportance of plan choiceWhat is our optimal and/or desired product strategy?LowHighOrganization's tolerance for changeLowHighEmployee receptivity to changePassiveAggressiveEmployee communicationWhere are we today and how much ground to cover?LowHighEmployee contributionLowHighAvg employee incomeState You may be thinking how you will approach new employers and consult with them on the product most appropriate for their employees. You can use this chart as a discussion guide to look at certain aspects of the employer group. For example, the employees receptivity to change. If the employees is more reticent for change, it maybe better to suggest an HRA or HIA Plus plan over an HSA plan.Highlight some of the features and how they differ from product to product (contributions, funding, portability, ownership, etc)HighLowCurrent plan design valueShort-term & long-term tactical options?ModerateAggressiveCost control/trend mitigation goalHighLowEmployee turnoverNot ImportantImportantAccount portability
73 CDHP Key Features Consumers have choices Different ways to fund deductibleHSA, HRA, HIA Plus, HIAExpanded preventive care servicesSuperior tools for consumerRX drug cost infoHospital quality ratingsHealth AssessmentEnhanced Surgical Decision Support360 Degree Health and Personalized Health CoachReview the key points of the CDH plansConsumers have choicesDifferent ways to fund deductibleHSA, HRA, HIA Plus, HIAExpanded preventive care servicesSuperior tools for consumerRX drug cost infoHospital quality ratingsHealth AssessmentEnhanced Surgical Decision Support360 Degree Health and Personalized Health Coach
74 Consumer Communications More than just an enrollment event!Its critical to treat CDH differently than other products. Employers and employees will have more success on a CDH plan if the product is treated more than an enrollment event.
75 Creating a Health Culture Behavior change is more than an “enrollment” eventOngoing 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 successIndividuals need constant reinforcement and support to process the change:To changeNeed to changeIn change activitiesMaintenance of new healthy lifestyleOngoing communication will help employees become engaged and keep them engaged.
76 Repetitive Education and Outreach Sample consumer communicationsMyHealth AssessmentFitnessHealth CoachingHigh Blood PressurePrescription Drug CostsThese are samples of the monthly postcard sent out to each contract address.Lower Back PainCondition-specific mailings:AsthmaHypertension & High Cholesterol
84 Forms Needed – Small and Large Group HSA AgreementHSA WorksheetHRA – HIA AgreementLumenos Blended Product Banking Form (HRA)Member Enrollment FormsHighlighted integratedState that there are few differences with installing these products. 1/1/08 – EET - Electronic Enrollment on ASO for 1/1Takeaway: No Macro SpreadsheetPrint-on-demand is a new ordering system – very easy and training information coming soon from Keith McMullin.New! New Sale Notification Form (to get the Case Number)Account Structure Template = Group MatrixEnterprise ID NumberUnique product ID assigned to all GenC products based on product variablesA new enterprise ID number will need to be assigned if any customization to standard productsAlpha Prefix – 1 for GA - XKGAll forms must be collected at front end of group set up process. For HSA’s with Bank of New York Mellon, paperwork must be received 30 days before effective date.
85 Member Administrative Comparison Anthem’s Lumenos PlansPaired with a BCBSGa Product (PPO, HMO or POS)Member Customer ServiceMember PortalMember ID CardAnthem logoBCBSGa logoMedical Claims Processing/PaymentPO Box 9907 Columbus, GAPharmacy Claims Processing/PaymentNext RX – PO BOX Fort Worth, TXPO BOX 9907 Columbus, GAExplanation of Benefits (EOB)Claim Recap with Anthem logoEOB with BCBSGa logoHealth StatementMonthly HealthN/AMention: the grid provides a high level overview of comparing our administration of the Lumenos products compared to our current BCBSGa products for members, employers and brokers.Many processes will remain the same, while there are certain processes and telephone numbers unique to the Lumenos product. The document will be posted to the Agent/Broker portal for future reference.
86 Employer Administrative Comparison Anthem’s Lumenos PlansPaired with a BCBSGa Product (PPO, HMO or POS)Employer Customer ServiceEmployer PortalEmployer AccessNot availableAvailable for non Lumenos plansEmployer InvoiceAnthem logo invoiceSeparate BCBSGa invoicePurchased with Specialty Products (Dental, Life Disability, EAP, etc.)Same current processes existPremium Payment by Phone (Groups only)Mention: the grid provides a high level overview of comparing our administration of the Lumenos products compared to our current BCBSGa products for members, employers and brokers.Many processes will remain the same, while there are certain processes and telephone numbers unique to the Lumenos product. The document will be posted to the Agent/Broker portal for future reference.
87 Broker Administrative Comparison Anthem’s 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 BCBSGafor LumenosBroker PortalSame Agent/Broker portalBroker Commission RateSame Standard Commission ScheduleBroker Bonus ProgramsAnthem Lumenos includedSingle Case Agreement FormSame existing BCBSGa form usedSame existing BCBSGa form used; can submit all on one formBroker Commission StatementSeparate Anthem Lumenos Logo and formatSeparate BCBSGa commission statementBroker Commission Payment ScheduleFirst week of the month for the previous month’s earned/ paid/reconciled premiums. *.First week of the month for the previous month’s earned/ paid/reconciled premiums.Electronic Funds Transfer (EFT)Functionality availableMention: the grid provides a high level overview of comparing our administration of the Lumenos products compared to our current BCBSGa products for members, employers and brokers.Many processes will remain the same, while there are certain processes and telephone numbers unique to the Lumenos product. The document will be posted to the Agent/Broker portal for future reference.* No supplemental commission payments if the group’s premium is paid/reconciled after the standard monthly schedule
88 Group Timeline for Lumenos HSA with Mellon Step 1Step 2Step 3Step 4New group installedMember activates accountACS/Bank of New York Mellon activates bank account and confirmsEmployer and Member contribute to accountMember receives HSA Debit CardCDHP H.S.A. the broker needs to submit the paperwork 4 weeks prior to the clients effective date.Welcome Kits mailed to members’ home address~ 15 days
89 Renewing Groups 11/1 Renewing Groups: May stay on current HDHP planGroups interested in changing HDHP plans are able to select a Lumenos plan12/1 (and after) Renewing Groups:Groups interested in changing HDHP plans must select a Lumenos plan11/1 Renewing Groups:•May stay on current HDHP plan - (add HDHP)•Groups interested in changing HDHP plans are able to select a Lumenos plan (add HDHP)12/1 (and after) Renewing GroupsMay stay on current HDHP planGroups interested in changing current HDHP plans must select a Lumenos plan
90 Launch Update & Resources Online quoting tool is updated (New Business 51-99)Side by side comparison grids are available on websiteMarketing Collateral availableHSA Agreement is available if choosing ACS/Mellon
91 Five Ways Our CDH Plans Are the Best Coherent clinical strategy with proactive health managementBCBS brand and BlueCard networkInnovationIntegrated productResultsWhat distinguishes Lumenos plans are these five ways:Our plans are clinically sound, they have an integrated and incentivized health improvement strategy.BCBSGA has a broad network with deep discounts with the security of Blue Cross and Blue ShieldThe BlueCross BlueShield brand brings the broadest network of providers to our consumers, thus giving them choice and cost savings for using these providers. Competitors fall well short on a national basis of matching the Blue network both in terms of overall access and in access to the Best Hospitals in the country. The Anthem Lumenos plans are built on top of this leading network to ensure market superiority.Our CDHPs are innovative. If you’ve seen one CDHP, you’ve only seen one.The Lumenos plans were the first to introduce incentives, first to introduce integrated HSA, and continued to add high value clinical programs (Continually expanding HealthModels, tobacco cessation program, Enhanced Surgical Decision tools)Our plans are easier. One-stop shopping.Seamless consumer experience with one point of contact for all products (HIA, HIA+, HRA and HSA)Integrated “hi-tech and hi-touch” health improvement and care managementPoint of sale pharmacy experience (HIA, HIA+ and HRA)Fully integrated with Mellon on the HSA productAnd we have proven results.Achieve lasting employee behavior changeDrive customer satisfaction – for consumers and employersEmployers report greater satisfaction because they finally areempowered to take control of their health and they have the resources todo so.
93 Legal DisclaimerThe 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.