News from Anthem Blue Cross:

Who needs one more thing to sort, file and recycle?  No one we know.

Give your mailbox and your recycle bin a well-deserved break – get your medical claim summaries online at anthem.com/ca. 

Right now, you’re getting your medical claim summaries (also called Claim Recaps or Explanation of Benefits [EOBs]) in the mail. The claim summary tells you how your benefits were paid and if you owe any part of the bill.

Sign up for paperless claim summaries today!

• Log in to anthem.com/ca
• Click on “Profile”
• Scroll down and select “Go Paperless”

Note: Going paperless applies only to your medical claims. You’ll still get paper claims for other types or services, like dental or vision care.

Join us in thinking outside the mail box!

Once you go paperless, you’ll get an email each time you have a new claim summary that’s ready to view. We’re happy to offer one more way to help keep your life and our planet a little less cluttered.

You’ll need to be registered to go paperless

If you’re already registered but haven’t been to the site in awhile you may need to register again. If you’ve never registered, now’s the time!

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Fortunately for consumers, the cost of prescription drugs still accounts for only 10 percent of healthcare spending nationwide. This is only good news because increases in the cost of hospital care and physician services have grown even faster, exceeding 5 percent annually.

Generic Counterparts

Nevertheless, several important factors have helped keep prescription costs in check. First and foremost, has been the introduction of generic alternatives when brand-name pharmaceuticals lose patent protection.

A report by the Kaiser Family Foundation points out that, “almost 80 percent of FDA-approved drugs have generic counterparts,” and explains that when there are two generic alternatives on the market, the generic price is usually about half the original price of the brand name drug. Moreover, when several competing generics are available, prices often plummet to 20 percent or less of the original brand cost.

The Value of a Formulary

In conjunction with cost-sharing techniques such as deductibles, copayments and co-insurance, another tool used by health insurers to keep prescription expenses down is the use of a formulary. Comprising a list of approved prescription drugs, formularies encourage the use of generics and lower-priced alternatives among their subscribers by creating a differentiated copayment schedule. Under such an arrangement, if you elect a brand-name drug when a generic equivalent is available, you will be responsible for a greater share of the cost.

Formulary lists are typically assembled by teams of doctors and pharmacists who evaluate drugs on the basis of safety and effectiveness in the treatment of diseases. Lists are updated regularly and will usually contain both brand name and generic drugs. When a generic is available for a brand-name product, the brand-name product is generally considered non-formulary. Typically only the generic equivalent will be on the formulary list, a practice endorsed by the FDA. In this way a formulary decreases the total prescription costs for a medical plan by steering subscribers to lower cost alternatives that fully meet their needs.

Other “utilization management strategies,” as they are known in the healthcare industry, include the requirement for prior authorization in the case of certain drugs and/or greater patient cost-sharing for new, bio-tech, and specialty pharmaceuticals. Such measures aid in controlling the cost of premiums for all plan participants.

ProtectPlus Formulary

Beginning January 1, 2011, ProtectPlus adopted use of the same formulary utilized by the Anthem Blue Cross HMO plans. The formulary is updated quarterly and can be found online at the ProtectPlus website under “Anthem Blue Cross Formulary List.”

 The copayment structure for ProtectPlus copay plans and Anthem Blue Cross HMO plans is the same for a 30-day supply bought through an in-network retail pharmacy and a 60-day supply when ordered through Anthem’s Express Scripts mail order pharmacy.

• generics = $10 copayment              

• brand-name = $150 annual deductible per member

• brand-name/formulary = $25 copayment

• brand-name/non-formulary = $45 copayment

• self-injectables (excluding insulin) = 30 percent of prescription drug maximum amount

One way to keep your prescription drug costs down is to provide a copy of the Anthem formulary list to your doctor. He or she can then use it to help select the best medication for you while still being mindful of your out-of-pocket costs. Another good strategy is to let your pharmacist know that you prefer to use generics when possible. Many pharmacies will substitute a generic when available unless the prescribing physician specifies a brand-name with the phrase “dispense as written,” but you can’t assume it. Ultimately, what matters is taking the appropriate medication for your condition. However, if an equivalent drug is available that will safely and effectively treat the condition and save you money, where is the downside?

Anthem Blue Cross has announced the launch of a new California website designed to provide reliable information to women about health issues specific to them. It will save women time searching for health related answers since everything is in one place and is accessible at any time of the day or night, which is the convenience that women need with their busy schedules. 

“We recognize that the lives of today’s women are filled with work, friends and family. At Anthem, we wanted to develop a place that’s just for them,” said Pam Kehaly, president of Anthem Blue Cross. “This dynamic new site is all about women’s health, and it can help women in California feel, and become their healthy best.”

According to Anthem’s press release last week, they selected SmartNow to develop the content for the site. SmartNow works with the top two hundred women’s health experts across the country, so the content is relevant, reliable and current. In addition, the information is designed to meet women’s personal, professional and business needs.

Anthem’s press release states that the site will help women:

• Stay on track with a dining out and fast food guide;
• Get more nutrition for their money with a down-loadable grocery guide iPhone app for Anthem members;
• Learn about health conditions and diseases;
• See how improved health can help lower costs;
• Learn how to compare quality and costs for hospitals in their area.

“At home, the woman is most often the one who makes the health care decisions that will impact the health of their family,” Anthem leaders said. “At work too, women are often the ones to make the choices about health care coverage and wellness offerings for their employees. This new site is intended to help guide women in California toward the right choices both at work and at home.”  

This great site provides the tools and programs needed to help women make healthier decisions and help those around them to do so as well. To check out this new site from Anthem click here.

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You can access these new tools by logging onto the Anthem Blue Cross website directly (www.anthem.com) or you can click through from the ProtectPlus site (www.cpaprotectplus.com). If you take the latter route, choose “Plan Members” then go to “My Plans” and click on “ProtectPlus (Anthem Blue Cross).” Please note that Anthem recently completed a major re-design of its website and you will be instructed to register, or re-register if you had an account on the earlier website, before accessing your account information. Once on your Anthem personal Account Summary page you will find several icons that you can click and drag onto your personal menu to customize your page.

Click on the “Facility Cost and Quality” icon to open the Anthem Care Comparison page. Once there click on “find a facility for a procedure or condition.” A drop-down list provides categories of treatment (e.g. cancer, lungs, orthopedic, or pediatric conditions). When you have chosen a category you can then choose from another list of procedures and diagnoses. You then put in your city or zip and the distance you are willing to travel.

The site will return a list of facilities that provide the procedure in question, typical minimum costs, typical maximum costs, and the average number of times this particular service was provided by the facility in a year. You may be shocked to discover that the average fee at some facilities is several times higher than the average fee charged by others. You may also find that one facility performs the procedure on a regular basis and another conducts it rarely.

To illustrate how significantly the negotiated fee can impact out-of-pocket costs, we searched facilities that perform standard colonoscopy screenings within a 20 mile radius. The results were surprising. For the 16 facilities within the search area, the typical maximum cost ranged from $996 to $4,982 for the same procedure. If the medical plan pays 70% of the negotiated rate, the member’s out-of-pocket costs at 30% could be as little as $299, or as much as $1,495.

If you want still more information, the Facility Cost and Quality tool can also display a customized graphic comparison much like those featured in Consumer Reports with rankings on various scales for factors such as complications, average length of stay, hospital safety, and patient satisfaction ratings.

Another useful tool that you can add to your personal menu is the “Treatment Cost Advisor.” This tool graphically illustrates the cost difference between in-network and out-of-network service providers for specific services.

If you are one of those who tends to say, “wake me when it’s over,” these tools may not be for you. But for those who want to take an active role in their care, the ability to compare medical costs and outcomes represents a major advance.

CaliforniaHealthline.org  -  Friday, April 30, 2010

On Thursday, WellPoint officials announced that the company’s subsidiary, Anthem Blue Cross of California, has withdrawn its request to raise premium rates for individual policyholders by as much as 39%, the Los Angeles Times reports.

The increase would have taken effect on Saturday and affected as many as 800,000 of Anthem’s customers. California Insurance Commissioner Steve Poizner (R) confirmed the company’s decision (Helfand, Los Angeles Times, 4/30).

Background

In February, Poizner WellPoint to delay the rate hike, which originally would have taken effect on March 1.

Anthem officials later said they would delay the rate hike until May 1, pending the findings of an investigation by external actuaries hired by Poizner, the Sacramento Bee reports.

Report Pending

Although the complete report is expected to be released as soon as Tuesday, Poizner released a summary of the findings on Thursday (Caina Calvan, Sacramento Bee, 4/30).

Poizner said the actuarial firm had found “multiple, significant errors” with Anthem’s proposal, including its calculations of medical claims trends (Wilde Mathews, Wall Street Journal, 4/30).

The report — conducted by the actuarial consulting firm Axene Health Partners — found that among other errors, Anthem overstated medical costs by raising the effect of aging. The actuaries found that modifying those numbers could lower the average rate hike by 10.2% (Los Angeles Times, 4/30).

Those errors “would have led to massive and unjustified rate increases,” Poizner said, adding that Anthem was notified about the errors “and they admitted to the mistakes” (Sacramento Bee, 4/30).

Poizner said the actuaries’ report likely played a key role in Anthem’s decision to withdraw its request (Wall Street Journal, 4/30). However, Anthem did not make any reference to the report in its announcement (Los Angeles Times, 4/30).

Anthem Plans To File New Rate Proposal

On Thursday Anthem officials acknowledged that the company is considering filing a new rate proposal as early as next month, but no specific timeline was disclosed.

The new filing would reflect “updated and real-time medical utilization information and address inadvertent miscalculations related to the way in which we estimated our future medical costs in our initial filings,” the officials said (Sacramento Bee, 4/30).

The new rate request also would comply with the latest federal standards outlined in the new health reform law, Anthem officials said (Wall Street Journal, 4/30). One of those standards, set to take effect on Jan. 1, 2011, requires insurers to spend at least 80% of collected premiums on medical care (Sacramento Bee, 4/30).

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The federal health care reform law will have a substantial impact on employers. Here are the main issues  that employers will want to be aware of:  

 1. Keeping the same coverage  

Employers will be able to avoid some of the law’s requirements by keeping their coverage the same after the law’s effective date (March 23, 2010). Unfortunately, it is very unclear at this time what kinds of minor changes will alter coverage, or keep it the same; this will be clarified in later regulation.  

 Changes that must be made to all plans include:  

• waiting periods for coverage must be less than 90 days; 
• no lifetime benefit maximum limits;
• dependent coverage for adult children up to age 26; and
• no annual limits on certain types of benefits (unless permitted by later-issued regulation).

2. New benefit and other plan changes If an employer does not keep its coverage the same, employers will need to make additional changes such as:  

• extending 100 percent coverage for preventive care;
• removing any prior authorization requirement or increased cost-sharing for emergency
• services (regardless of whether the services are provided in or out of network);
• no pre-existing limitation for children under age 19; and
• coverage of routine patient costs in clinical trials for life-threatening diseases.

3. FSA/HRA/HSA changes The law also will require changes to these types of accounts. In 2011, employees will no longer be able to receive pre-tax reimbursements from their FSA, HRA or HSA for non-prescribed over-the-counter medications, and the excise tax for nonqualified HSA withdrawals will increase from 10 percent to 20 percent. In 2013, employee contributions to FSAs will be capped at $2,500 annually, with the cap adjusted annually to the Consumer Price Index.  

4. Employee notification of value of coverage and exchange information Effective in 2011, employers will need to start reporting the value of the employer-sponsored coverage to employees on their W-2s. And in March 2013, employers will need to begin notifying employees about state exchanges and the availability of premium subsidies and free choice vouchers, all of which will be available beginning in 2014.  

5. Fees and penalties imposed on employer plans   

Under the law, employers will be subject to a number of fees and exposed to penalties for certain behaviors. Among them are the following:    

• Effective in 2013, a fee will be assessed on employers with self-funded health plans to fund a comparative effectiveness research agency. (For employers with fully insured health plans, the health insurer will be assessed the fee.) In 2013, this fee will be $1 times the average number of lives covered under the plan; for 2014 to 2019, the fee will be $2 times the average number of covered lives. The fee will end on September 30, 2019.
• Effective in 2014, if an employer has 50 or more full-time employees, then the employer may be subject to penalties under the law if it provides either no health coverage to full-time employees, or provides coverage to full-time employees that is not affordable. Penalties vary from $2,000 to $3,000 per employee.
• Effective in 2018, a 40 percent excise tax on high-cost plans will be applied to plans costing more than $10,200 for individual coverage, or $27,500 for family coverage.

6. Employer administrative reporting duties    

The law will require employers to annually report to the IRS a number of pieces of data, including:  

• Whether the employer offers minimum essential coverage to full-time employees;
• Any waiting period for health coverage;
• The monthly premium for the lowest cost option in each enrollment category under the plan;
• The employer’s share of the total allowed cost of benefits provided under the plan;
• The number of full-time employees during each month;
• The name, address and taxpayer identification number (or Social Security number) of each full-time employee, and the months each employee was covered under the employer’s plan, and
• “Such other information as the [Health and Human Services (HHS)] Secretary may require.” This requirement will likely be further refined in later regulations.

7. Changes to employee wellness programs  

• Effective in 2010, wellness programs may not require disclosure or collection of any information relating to the presence of firearms, and may not base premiums, discounts, rebates or rewards on the basis of firearm or ammunition ownership.
• Effective in 2014, the law codifies the HIPAA nondiscrimination rules on wellness programs and increases the incentive cap of 20 percent of premium to 30 percent. The HHS Secretary has the discretion to increase the incentives cap to 50 percent.

 This document is issued for informational purposes and is not intended to constitute legal advice. Please consult your attorneys in connection with any fact-specific situation under federal, state or local laws that may impose additional obligations. The information is current as of the date on the first page of the document. 

Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.   

The following information if from Anthem Blue Cross and is quite helpful in guiding you to a healthier lifestyle.

Are you or a family member living with a chronic condition such as asthma, diabetes or heart disease? If so, we can help. 360˚ Health provides you with support to help you achieve your health goals. We’ll work with you, your doctor and other health care professionals to help you improve your health.

ConditionCare enhances your doctor’s plan of care through the use of a dedicated nurse plus a team of health professionals including dietitians, exercise physiologists, pharmacists and more. You can gain a better understanding of your health, receive help in following your doctor’s care plan and learn how to better manage your health. This program is designed to help members with chronic conditions such as asthma, diabetes, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD) and heart failure.

ConditionCare Support Programs complement our core ConditionCare programs. They assist members who are not managing a core chronic condition, such as asthma or diabetes, but need help with other conditions ranging from arthritis pain to high blood pressure. These programs include help with vascular at-risk conditions, low back pain, musculoskeletal conditions, and various types of cancer.

ConditionCare Kidney Disease is a program specifically designed to support members with chronic kidney disease. Nurses that specialize in renal care and the treatment of kidney disease provide education and support to help members manage their health.

ComplexCare provides help to those with multiple health concerns who may require high levels of collaborative care. Personalized nurses who specialize in treating multiple health conditions work with members to help improve their health.

Comprehensive Medical Management provides one-on-one expert assistance to help members find and receive the right services and care. The program includes a personal advocate to see that benefits are utilized effectively and that necessary medical interventions are appropriate and safe.

360° Health program offerings vary by state. Specific programs are included in your health plan and others are available for additional cost. Contact your human resources department or benefits administrator as appropriate for eligibility and further details.

Take your next step to better health. Choose a link:

• 360° Health Overview
• Improve Your Health
• Get Guidance

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Over the last few weeks the Group Insurance Trust has received a number of phone calls in response to headlines about significant premium increases recently proposed by Anthem Blue Cross. In fact, it turns out that Blue Cross is just one of many major insurers in California and throughout the nation who are contemplating big rate hikes. The good news, which Trust staff has repeated to these callers, is that ProtectPlus subscribers are not subject to the threatened rate increases that are so much in the news.

Since being licensed by the State of California as a Multiple Employer Welfare Arrangement (MEWA) in 1997, the Trust has acted as the insurer for the entire ProtectPlus medical, dental and vision plans, designing benefits to meet the needs of CalCPA members and setting its own rates.

The Trust’s executive director, Susan Young, notes, “The confusion may have arisen because the Trust contracts with Anthem Blue Cross for use of its Prudent Buyer Network and to adjudicate claims. The Trust has an administrative-services-only agreement for which it pays Anthem a negotiated fee per member, per month, for the services it provides.”  Young adds, “Although ProtectPlus members get the advantage of Anthem’s deep provider discounts, members should understand that it is the Trust that is responsible for setting ProtectPlus premium rates and benefits, which are based on our group’s claims experience. This is why the recent threatened increases by Anthem and others do not directly affect ProtectPlus members.”

For CalCPA members who are not yet taking advantage of the remarkable benefits found in the Trust program, this is an excellent time to see how their present plan stacks up against the ProtectPlus plans. Solo practitioners and members with small group plans who are facing big increases may well find that ProtectPlus offers them superior coverage at significantly lower rates.

While for many years premium rates for the ProtectPlus copay and HSA-eligible plans have been consistently competitive, now members can also appreciate the remarkable stability of these plans. Over the last six years, participating firms with two or more members have experienced an average annual premium increase of 7.42 percent, well below industry averages every year. The following chart tells the story.

Year Rate Action
2005        8.7 %
2006        6.3 %
2007        6.2 %
2008        6.9 %
2009        6.9 %
2010        9.5 %

For a quick look at the range of plans available to your firm, take a look at the CPA ProtectPlus web site (http://www.cpaprotectplus.com). For help in identifying plans that best suit your firm’s needs, try the new “Plan Selector” located on the home page (http://cpaprotectplus.com/main/plan_selector.php). Through a few simple questions, this tool can streamline your choices. You can also contact Tom Kowalski, sales manager for the Group Insurance Trust, who can answer your questions and walk you though the application process. You can call him at (650) 802-2406 or email tom.kowalski@calcpa.org.  Alternatively, you can use the “Ask Our Sales Manager” feature (http://cpaprotectplus.com/landing_pages/HomePage/index.html) from the Web site home page. Tom or another staff member will reply to your question personally.

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Many of us often have concerns about whether or not it is safe to take certain medications while taking other prescription or over-the-counter drugs. The effects of drug interactions may cause unexpected side effects such as allergies, heart palpitations or dizziness. It can make your other medication(s) less effective or it can also increase the effects of your medication(s) which can be harmful to your health – even life threatening.

You should make it a habit to read the label of prescription and over-the-counter medications – often times there are warnings of other medications that should not be taken at the same time. It is important that you learn about drug interactions which may be critical to your health and by having this knowledge you can reduce the risk of potentially harmful interactions and its side effects.

Anthem Blue Cross offers a great tool that allows you to search  for information on thousands of prescription and over-the-counter medications. [Click here to check it out.] Of course, this is an online tool that can help you get some general information - but you should always check with your doctor and pharmacist for detailed information and instructions. Make sure to them all of the medications you are taking – even vitamins and herbal supplements since those can interact with medications as well. Some people have more than one doctor, so remember to always inform them of what medications you are taking, or better yet, bring the bottle to the appointment. That way they can see the exact information including the dosage you are taking. These are very simple precautions that we can take to insure ourselves a healthier life!

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Via Anthem Blue Cross–If you have not yet received your permanent ID card and want to access health care services, you can print a temporary ID card online through anthem.com/ca.

It’s a simple four-step process:

1. Before starting, check with your employer to confirm your information has been added into Anthem’s system. Your name, date of birth and ZIP code must match exactly what is on file with Anthem.
2. Go to anthem.com/ca, click Members in the top-left corner and log in to the secure Member site. If you have not visited this site before, on “Register.” When you are asked for a member ID number during online registration, you may use your Social Security number if you do not yet have a member ID number.
3. Select the “Print Temporary ID Card” option under “Things You Can Do” and follow the instructions on how to create and print the temporary ID card.
4. You can print the ID card using your own printer and use the card at your next doctor’s appointment.

Your temporary ID card expires 30 days after its issue date and is not meant to replace your permanent ID card, which you will still receive. Take a look at a sample below.

Note: The temporary ID card may not include all of your benefit information. If you have any questions, a Customer Service number is on the temporary ID card.