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Annual Benefit Changes (ABCs) Ohio. 22 Agenda 2  Back ground on changes  Review of portfolio changes  Selling Strategy  Communication dates  Consultative.

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Presentation on theme: "Annual Benefit Changes (ABCs) Ohio. 22 Agenda 2  Back ground on changes  Review of portfolio changes  Selling Strategy  Communication dates  Consultative."— Presentation transcript:

1 Annual Benefit Changes (ABCs) Ohio

2 22 Agenda 2  Back ground on changes  Review of portfolio changes  Selling Strategy  Communication dates  Consultative Selling  Questions

3 Background on Changes

4 44 Changes As a result of complying with healthcare reform – from an admin Lean but still attractive to groups and members – we made some reductions, we had some gaps – we created new plans to fill the gaps. Price points Added some additional plans to meet cost shares Stay competitive – managing portfolios = address gaps that were present – competitors – simplify portfolio Options that groups are going to have 4

5 Objectives of ABC Changes

6 66 ABC Objectives ABCs will focus more on portfolio management and less on benefit modifications  Simplified 2-99 portfolio with new cost share options to fill price point gaps and offering different Rx options special enhancements to 2-50  Pharmacy portfolio standardization and modification  Benefit enhancements for Lumenos

7 What are the changes?

8 88 Portfolio Changes 8 Product EliminationsRationale Blue Access PPO  Ohio has designed a new 2-99 portfolio  New portfolio preliminary design offers 18 PPO products verses 14 SG and 15 Key plans  Added additional RX options to the 100+ portfolio  Increase operational efficiencies  Create a more attractive portfolio  Close the pricing gaps  To address missing price points  Eliminated unattractive plans Lumenos  Ohio may reduce total number of plans while creating the new 2-99  portfolio  Consider elimination of richer 0% plans on 100+ portfolio  Increase operational efficiencies and  create a more attractive, profitable  portfolio New Product Introductions (2-99)Rationale Blue Access PPO  Ohio is developing a new 2-99 portfolio effective May – June 2012 with a recommended 3% price point spread between plans  This will address many of the gaps on  the current 6.0 portfolio and offer new  cost shares and designs to remain  competitive Lumenos  HRA first dollar Rx and Medical copays plus embedded deductible  HSA with copay after deductible enhancement  Placeholder for up to 10 additional plans to accommodate  enhancements  We are losing groups to UHC; This will  allow us to gain HRA market share  while still attracting good risk

9 99 Pharmacy Changes 9 Pharmacy Changes 2-99Rationale Pharmacy Core  Reduce to 3 options total on the new portfolio  Implement Pharmacy Strategy  Increase 4 th tier per script max copay from $150 to $200 on 2-99  Increase Home Delivery Generic copay to 2.5 times  Richness compared to competition  Consistency across all Rx options  Keep up with rising cost of Rx  Provide cost savings/premium relief  Richness or leanness of medical benefit  paired with equally rich or lean Rx benefit  decreases anti–selection issues Pharmacy – CDH  Introduce leaner CDH Rx Option by  increasing existing tier copays  Increase 4 th tier per script max copay  from $150 to $200  Increase Home Delivery Generic copay  to 2.5 times  Consistency across all Rx  options  Keep up with rising cost of Rx  Provide cost savings/premium  relief 100+  Eliminate Rx options on 100+ tab (richer  options and those with little or no  membership)  Increase administrative efficiencies

10 10 Health Care Reform 10 Anthem will comply with the HHS recommendations for Women’s Preventive effective 8/1/12. Several of these services will not require additional services, because the services are already covered based on other recommendations. The guidelines are listed below. Screening for gestational diabetes HPV testing Contraceptives Breastfeeding support and supplies Additional services according to Guidelines Well woman visits Counseling for sexually transmitted diseases Counseling and Screening for HIV Screening and counseling for interpersonal and domestic violence Counseling related to contraceptive use and breastfeeding Services already covered

11 11 Future Lumenos Enhancement List date TBD 11 EnhancementDescription HSA Copay After Deductible  Allow medical flat dollar copayments after deductible for the following:  Only allowed on Blue 6 product platform  Allowed after deductible has been met  Must apply to the medical out-of-pocket max  Different copays for PCP and specialist HRA First Dollar Copays  Pre-deductible office visits and pharmacy copayments only allowed on the Blue 6 product platform  PCP/SCP copayments will only be allowed on 0%, 10% or 20% coinsurance plans  Physician home and office  Specialist office  Urgent care  Emergency room  Rx

12 12 Future Lumenos Enhancement List date TBD 12 EnhancementDescription HRA First Dollar RX  Can only offer one pre-deductible pharmacy option per benefit plan  Pre-deductible pharmacy copays/coinsurance must maintain a 4 tier pharmacy structure  Pre-deductible pharmacy copays/coinsurance will not apply to the medical deductible or out-of-pocket max HRA Flex  Offers flexibility to choose allocation and rollover options without impacting standard product offerings  Groups will not be allowed to select a traditional HRA option and offer it along side an HRA Flex  Existing HRA proration options will continue to apply  Embedded deductible availability is based on existing options available

13 Selling Strategy, Competition and Processes

14 14 What is the competition doing? 14 Observations and Opportunities  We are leaner than UHC in portfolio size in the Key market. Humana is  larger due to 2-99 single portfolio  We offer fewer 0% plans than either competitor  Humana now offering plans with $300-$350 copays. UHC $250 ER on all.  We offer $250 ER on select plans  We are the richest with a $200 and $250 deductible (on Key portfolio) verses  $500 as the richest with top two competitors  We offer fewer HAS 100% plans than UHC who offers 10; Humana offers 3  UHC offers an HRA product with Rx copays day on and an embedded  deductible resulting in challenges and group loss for sales  We offer the richest 4 tier Rx option  Gaps identified on SG and Key that must be addressed with new portfolio

15 15 Selling Strategies 15 Market Segments: Funding Arrangements: New BusinessRenewals Well Quote System Quote Date Effective Date

16 16 Updated SQFs and SOBs 16

17 Important Dates

18 18


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