Currently three of the major medical carriers are offering an opportunity for employers to either buy-down their current option(s) or to add additional lower priced options to their current benefit offering. Please pay special attention to the details and deadlines per carrier as they do differ. In all cases, the employer would simply refer to last year’s renewal or the recent proposal options from a 2020 sale and select the buy-down plan and pricing accordingly. The new plan(s) chosen would remain in effect until the groups’ next renewal.
Employers will have until July 31st to add a lean (lower cost) benefit plan. Groups will remain in the new plan option until their next renewal.
- A group may make a prospective plan change, such as a benefit buy down to a less costly plan.
- A group with a dual option could buy down to one option and all employees would then move into the single option or buy down both options and employees would be mapped accordingly to the appropriate plan. The employees would not be given an open enrollment option to switch between plans.
For the immediate future we are going to allow the following:
- Small Group ACA and MEWA groups can buy down to one new plan design off-cycle as long as the new plan is less expensive. Employers must notify Anthem by May 31, 2020 for a future off-cycle buy down effective date that is no later than July 1, 2020. Anthem will implement the off-cycle buy down within a minimum of 10 business days. The group will keep their current renewal date.
- Large Group ASO and Fully Insured accounts can potentially add a new plan design off-cycle, but these are subject to approval by the state Underwriting RVP.
- Small Group legacy (non-ACA) groups cannot add a new plan design off-cycle due to concerns with piercing grand mothered status.
In all situations:
- No retrospective plan changes will be allowed
- The amount of the deductible and out of pocket max that has already been met will accumulate towards the deductible and out of pocket maximum in the less expensive plan design that the employees switch to. Note that for groups undergoing a system migration it may take longer than ten days to implement the accumulators.
- Will allow existing groups to make a buy down change, to move to a lower cost plan, for 5/1/2020 and 6/1/2020 effective dates (for groups that are not in renewal). This applies to Non-community rated, fully insured, and Level Funded groups. They can make a plan change to a lower cost plan while waiving the standard advance notice requirements.
- Community Rated groups may request a plan change off or on renewal if the group’s renewal has already been released, so this is applicable for 1/1/2020-6/1/2020 renewal dates.
- A group can change from a non-HDHP plan to a HDHP or EHDHP plan.
- Plan adds ARE available as long as it is a lower cost plan add. Membership changes between plans ARE allowed as long as members are moving to a lower cost plan option. The group will not be able to add membership as this is not an open enrollment. The employers’ renewal date will not change with any plan change.
- Grandfathered groups are not in the scope of this option as they can only make a plan change at renewal time.
- If the employer does not want to make any plan changes, but subscribers want to move to a lower cost plan that is already offered, they can do this. This is for 5/1/2020 and 6/1/2020 effective dates for fully insured and level funded groups.
Employers will have until May 31st to add a lean (lower cost) benefit plan. Existing members can move to the new leaner plan design. No other benefit changes are permitted meaning new enrollees previously waiving coverage would not be eligible.
- A group may add an additional plan that is less expensive than their current option and keep their current plan, thus leaving them with a dual option.