Following is an outline of the most important plan modifications subscribers will see this year. Some are in response to health care reform but not all.

Health Care Reform Mandates

Beginning January 1, every health plan must comply with the following provisions:

• All dependents up to age 26 are eligible for coverage
• No cost-sharing for in-network preventive services
• No pre-existing limitations for children under 19
• Prior authorization or higher cost-sharing disallowed for out-of-network emergency services
• New rules for appeals process
• Removal of lifetime maximum limits (copay and HSA plans)
• Removal of lifetime limits for hospice care (copay and HSA plans)
• Removal of annual limits on durable medical equipment (HMO plans)

Premium Rates

Naturally, all these mandated changes come at a price. Over the past seven years, the Group Insurance Trust has delivered single digit increases that were well below national and regional trends. However, a thorough analysis of the costs associated with these mandated benefits, plus unusually high claims experience in 2009, resulted in an increase to CalCPA ProtectPlus medical plan rates that is significantly higher than that of previous years.

Because each firm’s rates are based on a combination of factors, each firm’s increase is unique. Renewal packets, including rate information specific to each firm, were mailed to participating firms on November 1. If you did not receive your renewal package please contact Banyan Administrators, LLC at (877) 480-7923 immediately.

Plan Design Changes

In addition to the mandated changes described above, for the 2011 calendar year the Trust is implementing changes specific to the ProtectPlus program. There are also changes specific to Anthem HMO plans.

Prescription Drug Formulary

A significant change to be implemented in the ProtectPlus copay and Anthem Blue Cross HMO plans in the coming year is the introduction of the Anthem Blue Cross formulary (preferred list of drugs). This list is updated quarterly by a committee of doctors and pharmacists who evaluate drugs on the basis of safety and effectiveness in the treatment of diseases. To view the list on www.cpaprotectplus.com, click on Forms/Prescription and select Anthem Blue Cross Formulary List.

The formulary list contains both brand name and generic drugs. In many cases when a generic is available for a brand name product, the brand name product will be considered non-formulary and only the generic equivalent will be on the formulary list, a practice endorsed by the FDA.

Beginning January 1, the copayment structure for ProtectPlus copay plans and Anthem Blue Cross HMO plans will be 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 co-payment
• brand-name = $150 deductible per member
• brand-name/formulary = $25 co-payment
• brand-name/non-formulary = $45 co-payment
• self-injectables (excluding insulin) = 30 percent of prescription drug maximum amount

Administrative Updates

In addition to these rather significant changes in Trust plans, there are a couple of administrative issues that are important to note.

Anthem will be issuing new ID cards for all subscribers, regardless of whether they make an open enrollment change. This change is required by the National Blue Cross and Blue Shield Association, which is trying to standardize ID cards across all Blue plans. Please alert your employees to watch for an envelope from Anthem.

The Anthem Blue Cross HMO customer service phone number is now (888) 209-7847. This is the same customer service number that PPO and HSA subscribers currently use.

Maintaining the longer open enrollment period adopted in 2007, the Group Insurance Trust has announced that open enrollment begins on November 2 and ends December 31.

CalCPA member firms that haven’t offered ProtectPlus plans to their employees can, of course, enroll in Group Insurance Trust plans at any time.

Firms can consider the full range of offerings for 2010 that include;

• 5 copay plans
• 3 HSA-eligible plans
• 2 Anthem Blue Cross HMO plans

This is also the time of year that the Trust announces plan changes and premium adjustments. As always, premium  increases are anticipated with concern, but the good news is:

The Trust has been able to maintain its single digit  premium increases for the seventh consecutive year.

This is a remarkable achievement when you consider that ProtectPlus also beat industry averages in each of these years.

Several benefit improvements will be implemented in 2010.

• All ProtectPlus copay plans will see a reduction in the copay amount for generic prescription drugs from $15 to $10.
• Improved coverage for mental health and substance abuse services on all copay, HSA-eligible, and Anthem Blue Cross HMO plans.
• Medical plans will now align all mental health and substance abuse member cost-sharing provisions with those offered for in-network and out-of-network medical services and remove any visit limitations (in accordance with the Mental Health Parity and Addiction Equity Act of 2008).

The Trust will also combine several copay plans for 2010.
Last year the Trust offered eight copay plans, including both regular and enhanced versions of:

• Protect 15
• Protect 25
• Protect 35

The enhanced versions of these plans—which waive the deductible for the first six in-network office visits—proved so popular that trustees were persuaded to include the enhanced benefits as standard features in the copay plans at these levels.

For 2010 the Protect 15, Protect 25 and Protect 35 plans will all feature the enhanced benefit of six office visits that are not subject to the plan’s deductible, while the Protect 10 and Protect 45 plans will retain their original structure.

Vision Service Plan and Delta Dental rates will be restructured for 2010.
Going forward, rates for both plans will be based on firm size in much the same way the medical plan rates are structured.

• Effective January 1, 2010, firms with two or more participants will see a reduction in VSP and Delta Dental rates while others will note a small increase.

Changes in Premiums
Some ProtectPlus members will see changes in their premiums next year that reflect altered geographical rate bands. Anthem Blue Cross has re-aligned several zip codes in rate areas one, two, and three, and the Trust has followed its lead in order stay consistent. For some, these changes will mean lower than average premium increases, while for others, unfortunately, it may mean an increase in excess of the average overall premium increase.

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