Important Information About Anthem’s 2020 MLR Rebates

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Anthem groups and Individual members in 10 states will receive 2020 medical loss ratio (MLR) rebates this year. Anthem will begin mailing the rebates by the end of August. This is the second year in a row Anthem mailed rebates a month earlier than the September 30 deadline.

The MLR provision of the Affordable Care Act (ACA) encourages health plans to spend most of the premium dollars they collect on healthcare costs rather than overhead. MLR is a ratio of insurance premiums to claims costs, usually expressed as a percentage.

In the Fully Insured Small Group and Individual markets, the MLR provision requires plans to spend at least 80% of premium income on healthcare claims and quality improvement. In the Fully Insured Large Group market, it requires plans to spend at least 85%. In markets where Anthem does not meet the minimum ratio, they are required to issue rebates to employer groups and Individual members. ASO plans and stop-loss insurance are excluded from the rebates.

Along with the rebate checks, Anthem will send employer groups and Individual members a federally mandated notice that explains MLR and how it is calculated.

Anthem is also required to notify employees of the groups that receive rebate checks.

ACA rules require that employers either distribute the rebate among their employees covered by the rebated plan or use it to lower premiums in the next plan year. Policyholders must distribute the rebates within three months of receiving them. Group plans that are subject to Employee Retirement Income Security Act (ERISA) laws may also use the rebate funds to pay current plan premiums.

View this FAQ for more details on the rebates.

Contact your Cornerstone representative with any questions.

Anthem Reaches Agreement with Trinity Health System

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Anthem has reached a new agreement with Trinity Health System that will assure continued access to affordable healthcare at Trinity Health hospitals, physicians, and affiliated care providers through 2025. Their previous agreement with them ended August 1. See the announcement they posted on Friday, August 20, on the Broker Plus mobile app, in Producer Toolbox, or on Producer News on anthem.com.

Here are a few other Anthem highlights from last week:

  • The Consolidated Appropriations Act will impact information on member ID cards as well as when they’re reissued.
  • Sydney Preferred, a new premium version of Sydney Health, offers Large Group employers a fully integrated benefit engagement solution delivering a single, trusted digital experience.

Finally, just a reminder that all Anthem news sites are keyword searchable and have helpful filters so you can find news most relevant to you. Plus, in Producer Toolbox and the Broker Plus app, you can bookmark articles so you can quickly find them again.

Contact your Cornerstone representatives with any questions.

Send Membership Updates to Anthem’s New Email

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You can now send your large group, 51+ membership updates to Anthem’s new enrollment email box.

This shared mailbox is for membership changes/corrections or new enrollments, including Anthem enrollment forms, change forms, COBRA elections, and member termination forms.

  • All emails should contain the WGS group number and group name in the SUBJECT line.
  • All emails should contain the member id number, member name, and date of birth in the body of the message and on any attachments.
  • Recommended email file size should be limited to 10 MB in order to accommodate for file space.
  • Urgent access to care enrollments, MUST state “Urgent Access to Care” in the SUBJECT Line, the WGS group number, and group name.

Status of the enrollment will need to be checked online through EmployerAccess or by calling Billing and Enrollment. Anthem does not provide confirmations of completion via email.

The email address is:  AnthemWGSLargeGrpEnrollment@anthem.com

Contact your Cornerstone representative with any questions.

Anthem Launches Broker Resource Hub

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Anthem’s new Broker Resource Hub has launched and is now live! It has the resources you need to sell individual, small group, and large group business all in one place, making doing business with Anthem quicker and easier. Get all the details about the new Broker Resource Hub on the Broker Plus mobile app, in Producer Toolbox, and on Producer News on anthem.com. And while you’re there, be sure not to miss these other posts from last week:

  • CII Discover now provides consistent reporting for Self-Insured and some Fully Insured group accounts. (LG)
  • Starting September 1, 2021, we’re adding a non-binary birth-sex selection to our electronic membership and enrollment process. (SG, LG)

Contact your Cornerstone representative for more information.

Anthem’s COVID-19 Health Pass is Now Available

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Anthem has integrated the new COVID-19 Health Pass with the Sydney Health app for small and large fully insured groups. This new feature went live on July 19, 2021. If members provide their insurance information when vaccinated, they can access their COVID-19 vaccine record on our digital platform.

Contact your Cornerstone representative for more information.

Anthem Launches Sales and Marketing Broker Hub

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Anthem recently launched their Broker Hub, which makes it easier for brokers to find sales and marketing resources.

Additionally, Anthem has released a number of other updates including…

  • A network agreement with Hendricks County Hospital to add the Brownsburg location to their networks (large group).
  • Clients that combine coverage with standalone dental, vision, life, disability, or supplemental health plans can save on medical (large group).
  • Beginning with September renewals, Anthem will automatically give ACA groups without a vision plan quotes for adding vision coverage (small group).
  • Anthem just released a case study on IngenioRx as a new model of pharmacy care (individual, large group, small group).
  • The Federal Health Insurance Marketplace will automatically apply any additional Advanced Premium Tax Credits for eligible enrollees who haven’t updated their application by August 2021 (individual).

Contact your Cornerstone representative with any questions.

Anthem Indiana Broker News Recap

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Below are some recent updates from Anthem Indiana:

  • OrthoIndy joined the HealthSync network. The group has 10 locations in the Indianapolis area, as well as clinics in Greencastle and Lafayette (large group).
  • A new premium tax credit is available for anyone who receives at least one week of unemployment insurance compensation in 2021. Anthem has created an email template to help you share this news with your current and potential clients (individual).
  • Anthem’s clinical site-of-care review program expands starting August 1, 2021, to include physical therapy, occupational therapy, and speech therapy services (small group/large group).

Get the full stories in the Broker Plus mobile app, Producer Toolbox, and Producer News on anthem.com.

Contact your Cornerstone representative with any questions.

Anthem ARPA State Continuation Notification Update

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You may have received an email from Anthem recently to let you know about requirements involving individuals who are on state health continuation because they lost group health coverage because of termination of employment or reduction in hours. The American Rescue Plan provides these individuals with a 100 percent premium subsidy for continuation from April 1 through September 30, 2021.

Some details about these requirements for groups with less than 20 employees have changed since they contacted you.

You must send the alternative model notice and summary to each Assistance Eligible Individual (AEI).

Continue notifying AEIs as soon as they become eligible.

The employee must complete and sign the the Request for Treatment as an Assistance Eligible Individual form included in the notification and return it to you.

You will need to complete the employer portion of the form and add the group name and number to the top. When you have completed the form, send a copy to SmallGroupE&BSupport@Anthem.com. You do not need to submit an Employee Change Form for Small Groups as they originally told you.

Anthem is working to update our billing processes. They will stop billing for members who’ve submitted their Request for Treatment form as soon as they have a process in place. Continue to pay for any other employees listed on your invoice.

Anthem is responsible for filing the subsidy. As they solidify their billing details, they will credit your account for any premiums paid for eligible employees.

You must also send the Subsidy Expiration Notice to the eligible employees 15 to 45 days before their subsidy expires.

Contact your Cornerstone representative with any questions.

Anthem OFB Benefit Plan & Mewa.io: Frequently Asked Questions

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Introducing mewa.io

Walkthrough Video

What is the benefit of using mewa.io?

Mewa.io provides many benefits including:

  • Ensuring plan members are offered the appropriate continuation of coverage options, as required by ERISA.
  • Providing a single place to manage the above requests as well as any signed documents. This helps keep the plan compliant and ensures employers don’t have to go searching for important documents.
  • Mewa.io offers a wide range of employer services, as highlighted in the videos. While services may expand in the future, mewa.io will only be used for continuation coverage verification at this time.

For more detailed information, Anthem recommends visiting mewa.io and watching the introduction and walkthrough videos.

Is there a cost to use mewa.io?

Mewa.io is provided at no cost by the Anthem OFB Benefit Plan to plan members and brokers.

Is training required to use mewa.io?

As you’ve seen from the videos, mewa.io is incredibly simple to use for employers. Also, as the process is managed automatically, no action is required on your part. That means no logins or passwords to manage and no training required.

How do I know when my employers need to perform an action?

Mewa.io uses email to notify employers when they need to verify termination information. Every week, you’ll receive a summary email indicating which of your employers are affected, if any.

How will brokers process terminations?

No additional action is required on your part to process terminations. You will continue to fill the Anthem termination form with the required termination information. If there is a case where the termination data needs to be verified, mewa.io will notify you and the affected employer.

How soon does MyCOBRA Plan send notices to eligible employees?

The COBRA Administrator, MyCOBRA Plan, will process the file within one business day after receipt of the weekly file. COBRA or State Continuation letters will mail out the next business day. However, if there are errors in the data on the
file, additional time to research and resolve the errors may be needed.

Can I add additional representatives from my agency to the summary email distribution list?

Yes. At the end of the broker communications, you’ll find a link that allows you to add additional agency contacts to the email notification list. Simply click on the link and add or delete agency contacts.

What if the group contact is not receiving the notices?

If notices are going to the wrong group contact or the group contact has changed,
please send a letter on company letterhead to mewamembermaintenance@anthem.com to notify them of the change.

What happens if an employer does not respond to a notification?

Employer reminders are sent to employers at 3, 5, and 9 business days. Unanswered requests will automatically close at 10 business days. A non-response report is sent to Consoliplex for groups that don’t submit a response and the termination code will default to loss of eligibility. A letter will be mailed to the group contact stating that no response has been submitted and asks them to respond if
this is in error.

How will this program be introduced to employers?

Employers will receive an introductory email explaining the program along with the first notification they receive from mewa.io. Included in that email will be the Employer Walkthrough video Anthem previously shared. Each request from mewa.io will also contain any relevant information and instructions specific to that request.

 

Contact your Cornerstone representative with any questions.

Anthem Small Group Updates for June 2021

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ARP COBRA rules require SGs with less than 20 employees to take action

The American Rescue Plan (ARP) provides premium subsidies to qualifying individuals with federal COBRA coverage and state health continuation coverage. The legislation provides a 100 percent subsidy of premiums from April 1 through September 30, 2021. Small group employees who have lost coverage due to involuntary termination or reduced hours qualify if they have COBRA coverage or a qualifying enrollment event during the subsidy period, these individuals are referred to as Assistance Eligible Individuals (AEIs).

What action is required of Employers?

By May 31, 2021, and for each month during the eligible period, small group employers in all markets (except CA, IN, KY, NH, and NV) must notify eligible individuals that subsidies are available. IN and NV small group employers are excluded from this requirement and will not receive any communication and no action is necessary for those employers or sales teams. Please see FAQ and webinar deck to address questions you may have on this.

Important Cost Share Waiver Update

Anthem has made the decision to extend cost share waivers for audio-only, in-network provider telephone-only visits for fully-insured, individual, Medicare, and Medicaid plans through July 31, 2021.

Broker Service Team Anthem Account Inquiries update:

Effective immediately, when reaching out to your customer service representative, the below information is required with every inquiry. These items are required as part of the HIPAA Verification Process. Please provide the following:

  • Group Name
  • Group #
  • Member Name
  • Member ID # or SSN
  • Member Date of Birth

If specific claims need to be reviewed, please also provide:

  • Date of Service(s)
  • Name of Provider
  • Total Charge

If the above information is not provided, your email will be returned thus causing delays in service and resolution.

SOCA Employer Access

The EmployerAccess Administration Guide has been discontinued. In lieu of that, employers are directed to use the interactive chat bot and/or FAQs available in EmployerAccess. To alert MEWA employers to these resources, here is an updated EmployerAccess Registration flyer you can provide to your groups to show that these tools are available.

October 2021 Formulary Changes:

There are upcoming changes to the formulary effective October, 1 2021. Additionally as a reminder, Anthem’s drug list changes are available on their public site under “see our latest drug list changes”. For your convenience, here is a list of the changes.

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