1. It’s a new world for health care Anthem is leading the way
New plans
New services
New opportunities
Change is coming. What does it mean, what do we do about it and when do we do it?
It’s been more than two years since the Patient Protection and Affordable Care Act (PPACA) was enacted, and collectively, the industry is still awaiting clarification from the federal and state governments on some 1,200 “undetermined” items.
While a lot of the specifics are still up in the air, we do know that come January 1, 2014, we’re going to see some big changes:
Changes in the kinds of health plans that are offered;
Changes in the way premiums are calculated; and
Changes to how groups are rated.

2. Small Group Market
Anthem is ready to help with a range of compliant solutions, plans, tools and communications for your customers. 2

3. Health care options for 1-50 employee groups
Offer a fully insured plan
Offer a fully insured plan through SHOP
Stop offering coverage, directing employees to individual market exchanges
Renew your health plan in December 2013
Small group employers, those with between two and 50 employees, have a number of health care options:
One, they can offer a fully insured plan directly through an insurer as most small employers do today. (Please keep in mind that some community rating requirements still impact the products offered through insurers (i.e. individual versus family coverage, geographic rating area, age and tobacco use). As a result, premiums and products will still be impacted in 2014.
Two, they can offer an ASO plan (for employers with 25 or more full-time employees) that does not meet minimum coverage level requirements (60 percent actuarial value), if allowed by state law.
Or three, they can stop offering coverage and direct employees to the individual market exchange.
Dental and vision options:
For companies with 2-50 employees, there are a few things you will want to consider regarding Dental and Vision coverage—and this will vary depending on your medical approach.
If you are offering a fully insured plan directly through an insurer, Pediatric dental and vision “essential coverage” is required. You may want to consider moving any current dental or vision plans to an adult-only plan.
If you are offering a fully insured plan through the small-business health program, pediatric dental and vision “essential coverage” is required. Continue offering adult-only coverage through an insurer. In the future, adult coverage will be available through the public exchange.
If you’re on an ASO plan, which is an option open to employers with 35 or more employees, state law permitting, you can continue fully insured purchase through an insurer—ASO dental and vision are not typically available to small-group employers. In the future, adult coverage will be available through the public exchange.
Another option for small employers is to stop offering coverage, directing your employees to exchanges. Pediatric coverage is available through public exchanges. Adult coverage will be available though the public exchange in the future. For now, it can be purchased through Anthem’s online dental store.
Regardless of the option your employer selects, or if you want to offer an individual product, Anthem has a solution for you. 3

4. A healthy dose of wellness for Small Group Retention
24/7 NurseLine
Utilization management
American Imaging Management (AIM)
Fully Integrated Case Management/ComplexCare
Quick Care Options
Disease Management (includes 5 conditions)
Future Moms (w/proactive ID mailings)
ESRD program
Healthy Lifestyles Online
MyHealth Advantage Gold
Behavioral Health UM/CM/DM
NH has decided to embed this clinical solution within its non-CDH retention plans off exchange.
2014 Enhancements:
Provide enhanced health and wellness portal and wellbeing assessment (health risk assessment) through Healthy Lifestyles (targets all small group products)
Offer Live Chat wellness coaching through Healthways (targets all small group products)
Offer fitness reimbursement and personal training options (targets consumer centric options)
Increase engagement in Future Moms program (targets all small group products)
Align the GenC and non-GenC Health & Wellness Products
General Program Descriptions:
24/7 NurseLine — Members can call anytime from anywhere in the U.S. and speak to a registered nurse trained to help them make more informed decisions about their health care options.
Utilization management — Includes pre-certification of medical procedures, imaging services and hospitalization to authorize care and align medical services with the member’s benefits.
American Imaging Management (AIM) — A member outreach program designed to lower the costs of expensive imaging procedures. If the member qualifies they are contacted about equal-quality, lower cost imaging alternatives in their area. The program is voluntary and available in larger metropolitan markets.
Case Management — Offers telephonic and video chat nursing support following a major hospitalization or procedure due to illness or injury. Cancer, NICU and transplant services included. Case Management helps members maximize medical benefits, arrange post-discharge care, and community health services.
ComplexCare — For those with multiple health issues or a condition that puts them at risk for frequent or high levels of medical care. Participants have access to ComplexCare nurses for individualized education as well as preventive care self-management tips.
Quick care options — Provides touchpoints to help members make better decisions and ultimately reduce non-emergent ER visits. Through education, we’re steering avoidable ER visits to settings that are far less costly and have shorter wait times, like urgent care centers, walk-in doctors’ offices and retail health clinics.
Disease management — Core Condition Care Provides members who have any one of the 5 core chronic diseases (diabetes, asthma, heart failure, coronary artery disease, and chronic obstructive pulmonary disease) with access to education and goal-oriented health coaching from registered nurses. Members learn self-management techniques that help to improve their quality of life, increase adherence to medical best practices, and avoid costly condition-related complications.
Future Moms (w/proactive ID mailings) — Moms-to-be can register for this program and speak to registered nurses about pregnancy issues.
ESRD — The ConditionCare End Stage Renal Disease (ESRD) program is designed to help members with ESRD manage their condition, and improve quality of life and clinical outcomes.
Healthy Lifestyles Online — Designed to change behaviors and improve lifestyles, Healthy Lifestyles Online provides members with a suite of integrated tools, including: health assessment, well-being plan, nutrition and exercise trackers, smoking cessation program, online coaching, tools and rewards. (Confirm with your account manager if rewards are included.)
MyHealth Advantage — Communicates gaps in care and health savings opportunities to targeted members (via mailed MyHealth Notes) and gaps in care to their treating providers (via mailed notices), ultimately reducing costs and improving member health.
Behavioral health UM/CM/DM — Offers immediate and longer-term mental health management and information to eligible members.

5. New Healthy Support packages for small groups
HSA Qualified Plans contain all of our standard programs plus…
Disease Management incentives ($300/year)
Future Moms incentives ($200/year)
Healthy Lifestyles Online incentives ($150/year)
Healthy Support Plans contain all of the standard programs plus…
Webinars
Tobacco Free Certification incentives ($50/year)
Fitness Reimbursement ($400/year)
Some Healthy Support Plans also contain all of the standard programs plus…
FitOrbit (online trainers w/ $99 cost share)
For those who are less likely to use insurance but still want coverage in case of emergency, we offer "Healthy Support" plans that have higher deductibles and copays, but also cover fitness reimbursement and incentives to award a healthy lifestyle. 
Wellness incentives are embedded within our CDH retention plans.
For those who are less likely to use insurance but still want coverage in case of emergency, we offer "Healthy Support" plans that have higher deductibles and copays, but also cover fitness reimbursement and incentives to award a healthy lifestyle. 
Additionally, Healthy Support Package A will be embedded in plans both on and off exchange and Package C will be embedded in some plans off exchange
2014 Enhancements:
Key Differences in the Future CDH package:
Solution no longer includes hybrid MHC (GenC)
Switch to HL-Online instead of Hybrid Healthy Lifestyles (GenC)
Incentives more closely link member actions to the specific products
Incentives
Future Moms (up to $200/year)
Condition Care (up to $300/year)
Healthy Lifestyles Online w/Incentives (up to $150/year)
Gift Cards and AHR Direct admin
Note: For Health reimbursement Accounts (off exchange) the incentives are account allocations not gift cards
This includes Healthy Support Package A, which provides healthy lifestyle online resources and webinars, plus an opportunity earn up to $600/year in health incentives and reimbursements. Components include:
Healthy Lifestyles Online with incentives ($150/yr.)
Utilization management
Fitness reimbursement ($400/yr.)
Tobacco-free certification with incentives ($50/yr.)
AIM
Disease management
Quick Care options
Case management/Complex Care
ESRD
Future Moms
Behavioral Health UM/CM/DM
MHA Gold
24/7 Nurseline
Wellness Webinars
Healthy Support Package B includes everything in Package A, plus:
Vision
FitOrbit (Online trainers and nutrition plans) with member cost share ($99/yr.)
And Healthy Support Package C offers all the components of Package B plus:
Dental (Adult and pediatric high with cosmetic ortho.)
Note: Each state will select a default package. The federal government is giving the states some leeway in how these exchanges work. States that want to operate their own exchange had to have submitted their intention to Health and Human Services by January 1, For states that didn’t meet that date, the federal government has set up an exchange in that state.
In Georgia, Colorado and California, these packages also include Pharmacy Care Pilot.

6. Anthem SHOP Exchange Options
HMO South (Androscoggin, Cumberland, Franklin, Kennebec, Knox, Lincoln, Oxford, Sagadahoc, Waldo, and York counties)
Metal Level
Bronze
Silver
Gold
Plan
Anthem Bronze Guided Access Plus (730003)
Anthem Silver Guided Access Plus – (730002)
Anthem Gold Guided Access Plus- (730001)
Medical Deductible
$4,500
$2,000
$500
Coinsurance
30%
40%
20%
Medical OOP Max
$6,350
$5,500
$5,000
Drug Deductible
$250
Combined w/ Medical
Drug OOP Max
$3,500
Pediatric Dental No
POS North (Aroostook, Hancock, Penobscot, Piscataquis, Somerset and Washington counties)
Anthem Bronze Guided Access Plus - (740003)
Anthem Silver Guided Access Plus – (740002)
Anthem Gold Guided Access Plus- (740001)

7. Anthem Small Group: Employee Elect
2 different suites of products giving small employers the product flexibility usually afforded much larger groups
Employee Elect 1…8 products for your employees to choose from
Employee Elect 2…10 products for your employees to choose from
Products include HMO or POS, PPO and HSA-qualified plans
Speak to an Anthem appointed broker to see which suite is right for you.

8. Anthem Small Group: Chamber BlueOptions
Anthem has partnered with the Maine State Chamber of Commerce purchasing collaborative since 2007
Suite of products exclusively packaged for Chamber members
7 plan designs include HMO or POS plans, PPOs and HSA-qualified plans
Wellness discount available for small businesses
For more information, contact your local Chamber
of Commerce, the State Chamber of Commerce
or speak to your Anthem appointed broker.

9. Anthem Guided Access HMO and POS Plans
Innovative relationship with MaineHealth, allowing Anthem to offer HMO plans in Southern Maine and POS plans in Northern Maine
Access to the following hospitals and their provider networks in the following counties:
Cumberland: Maine Medical Center, Mid-Coast Hospital
Androscoggin: St. Mary’s Hospital
Oxford: Stevens Memorial Hospital
Franklin: Franklin Memorial Hospital
Kennebec: Maine General Medical Center
Knox: Penobscot Bay Medical Center
Lincoln: Miles Memorial Hospital
Waldo: Waldo County Healthcare
York: Southern Maine Medical Center, Goodall Hospital
Also includes Intermed and Martin’s Point providers

10. Pediatric Dental Solutions for Small Employers
For Anthem small group business, we are offering a pediatric dental rider
Members will be auto-enrolled in pediatric dental unless they attest to having other coverage
We are also offering stand-alone pediatric and family dental plans on and off Exchange (benefits differ)

11. On Exchange Stand-Alone Dental Plans
Network: Complete Network
Anthem Dental Pediatric
(70 AV)
IN/OON
Anthem Dental Pediatric Enhanced (85 AV) IN/OON
Anthem Dental Family
All Ages; 0-18 get Ped benefit, 19+ get Adult benefit
Anthem Dental Family Enhanced
(85 AV) IN/OON
Benefit Categories
Diagnostic and preventive
90%/70%
100%/80%
100%/50%
Basic services
60%/50%
80%/60%
50%/25%
80%/40%
Endodontic/Periodontal/Oral Surgery
50%/50%
30%/15%
Major Services
Medically Necessary Ortho (12 month WP)
not covered
Medically Necessary Ortho LT Max for OON only
n/a/$1,000
Cosmetic Ortho Lifetime Max *
$1,000 *
Deductible (applies to all services)
$0 / $0
$50
Annual Maximum
n/a / $1,000
$750
Included**
Annual Out of Pocket Maximum **
$700 / n/a
n/a
*Cosmetic Ortho is covered for members through age 18 in the Family Enhanced Plan ONLY; at 50% / %50
**Annual OOP Max: $700 for one child / $1,400 for 2+ children.

12. Questions?
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc.  Independent licensee of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.