new anthem small group portfolio for 2014!forms.warnerpacific.com/shared/anthemcoemployee... ·...
TRANSCRIPT
Design a health benefits package that meets the needs of your small business.
The health care landscape may be changing, but one thing is clear: We are still here for you. You still can enjoy the great features of the EmployeeElect portfolio that you’ve come to trust.
With an Anthem customized health benefits package, you can meet your small business needs and the requirements of the Affordable Care Act.
}} Choose one, two or any combination of 31 plans with a wide range of benefits and price points.*
}} Offer plans that give your employees the ability to pick the right plan for their budget and health care needs.
}} Gain more financial control through employer contributions as low as 50% or $125 per employee.
}} All plans cover in-network preventive care at no extra cost to our members and also include additional benefits for chiropractic, acupuncture and massage therapy.
}} Enjoy easy administration and online tools.
Also, our new plans are now offered across three networks along with our new Pathway Enhanced network. You have even more choices to balance affordability and value.
Let us work with you to build a benefits package that makes sense for you and your business.
*Groups with four or more enrolling employees may offer multi-option plan offerings.
New Anthem Small Group portfolio for 2014!
Get the detAils
Call your Anthem authorized agent
or 866-287-1351 to learn more.
40216COBENABS Rev. 02/14
employeeelect product suite for small businesses Per-member in-network costs are shown here
What Are Your Priorities?
PlansMetal level
NetworkAnnual
deductibleAnnual Out-of-Pocket
Maximum1
Office Visits PCP/sP
Prescription drugs
select drug list
inpatient hospital
healthy support
Relative Price
elem
ents
O
ur m
ost
affo
rdab
le p
lans
pro
vide
solid
cov
erag
e at
bud
get
frie
ndly
pric
es
Anthem Core DirectAccess Plus grdf Bronze PPO $5,900 $6,350
Separate Rx OOP $6,350$35 (3 visits before
deductible/coinsurance)$450 Deductible Tiers 2-4
$15/$35/ $70/30%2 0% A
Anthem Core DirectAccess Plus gtpa Bronze PPO $4,000 $6,350
Separate Rx OOP $6,350$35 (3 visits before
deductible/coinsurance)$250 Deductible Tiers 2-4
$15/$35/$70/30%2 30% A
Anthem Essential DirectAccess Plus gjpa Silver PPO $3,000 $5,500 $35 (3 visits before
deductible/coinsurance)$500 Deductible Tiers 2-4
$15/ $35/ $70/30%2 30% A
Anthem Essential DirectAccess Plus ggqa Silver PPO $2,000 $5,000 $50 (3 visits before
deductible/coinsurance)$250 Deductible Tiers 2-4
$15/$35/$70/30%2 $500 +30% A
Anthem Essential DirectAccess Plus gcqa Silver PPO $1,500 $4,250 $35 (3 visits before
deductible/coinsurance)$250 Deductible Tiers 2-4
$15/ $35/ $70/30%2 $500+ 30% A
Anthem Essential DirectAccess Plus w/ Dental3 ggqa Silver PPO $2,000 $5,000 $50 (3 visits before
deductible/coinsurance)$250 Deductible Tiers 2-4
$15/$35/$70/30%2 $500 +30% C
Cla
ssic
sol
utio
ns
Mid
-ran
ge P
PO p
lans
off
er a
n id
eal b
alan
ce b
etw
een
cost
and
com
preh
ensi
ve b
enefi
ts.
Anthem Essential DirectAccess gyia Silver PPO $2,000 $6,350 $50/$75$250 Deductible Tiers 2-4
$15/$35/$70/25%4 50%
Anthem Preferred DirectAccess gjha Gold PPO $2,000 $4,000 $20/$40 $15/$35/$70/25%4 40%
Anthem Preferred DirectAccess Plus gzpa Gold PPO $500 $3,000 $20 (3 visits before
deductible/coinsurance) $15/$35/$70/30%2 $500+20% A
Anthem Preferred DirectAccess gfha Gold PPO $1,500 $4,000 $25/$50 $15/$35/$70/25%4 20%
Anthem Preferred DirectAccess Plus w/ Dental3 gzpa Gold PPO $500 $3,000 $20 (3 visits before
deductible/coinsurance) $15/$35/$70/30%2 $500+20% C
Anthem Preferred DirectAccess ghla Gold PPO $750 $4,500 $20/$40$250 Deductible Tiers 2-4
$15/$35/$70/25%4 20%
Anthem Preferred DirectAccess gfga Gold PPO $1,000 $3,500 $25/$50 $15/$35/$70/25%4 20%
Anthem Preferred DirectAccess gpka Gold PPO $500 $4,500 $25/$50 $15/$35/$70/25%4 20%
Con
sum
er-d
rive
n Pl
ans
Thes
e co
mpr
ehen
sive
pla
ns
expa
nd m
embe
r co
ntro
l and
finan
cial
opp
ortu
niti
es
Anthem Core DirectAccess Plus w/ HSA ghhb Bronze PPO $4,500 $6,350 $50/$75 $15/$35/$70/30% 30% A
Anthem Core DirectAccess Plus w/ HSA gpdb Bronze PPO $2,500 $6,350 50% 50% 50% A
Anthem Core DirectAccess w/ HSA gmua Bronze PPO $5,500 $5,500 0% 0% 0%
Anthem Essential DirectAccess w/ HSA gpsa Silver PPO $2,500 $4,500 20% 20% 20%
Anthem Essential DirectAccess w/ HSA gdsa Silver PPO $3,500 $3,500 0% 0% 0%
hig
h Pe
rfor
man
ce
Thes
e pl
ans
offe
r a
smal
ler
netw
ork
wit
h bi
g re
sult
s in
clud
ing
a m
ix o
f HM
O
and
PPO
opt
ions
Anthem Core Guided Access Plus gjqa Bronze Blue Priority5 $5,000 $6,350
Separate Rx OOP $6,350$35 (3 visits before
deductible/coinsurance)$15/$35/$70/30%2 $500+30% A
Anthem Core Guided Access Plus w/ Dental3 gjqa Bronze Blue Priority5 $5,000 $6,350
Separate Rx OOP $6,350$35 (3 visits before
deductible/coinsurance)$15/$35/$70/30%2 $500 + 30% C
Anthem Essential Guided Access gpja Silver Blue Priority5 $1,750 $6,350 $50/$75$250 Deductible
$15/$35/$70/25%4 $1000+40%
Anthem Essential Guided Access Plus gcda Silver Blue Priority5 $2,500 $6,000 $25/$50$250 Deductible Tiers 2-4
$15/$35/$70/30%2 $500+20% A
Anthem Essential DirectAccess Plus gnea Silver Blue Priority PPO6 $2,500 $6,000 Designated: $30/$60
Participating: $60/$100$500 Deductible Tiers 2-4
$15/$35/$70/30%2 20% A
Anthem Preferred Guided Access Plus gmca Gold Blue Priority5 $1,000 $4,500 $20/$40$250 Deductible Tiers 2-4
$15/$35/$70/ 30%2 20% A
Focu
sed
Our
new
est
port
folio
of H
MO
pla
ns
that
allo
ws
refe
rral
-fre
e ac
cess
to
spec
ialis
ts a
nd h
ospi
tals
sta
tew
ide Anthem Essential DirectAccess Plus ghpa Silver Pathway7 $4,000 $4,500
$30 (3 visits before deductible/coinsurance)
$500 Deductible Tiers 2-4 $15/$35/$70/30%2 0% A
Anthem Essential DirectAccess Plus gzca Silver Pathway7 $3,000 $6,000 $25/$50$500 Deductible Tiers 2-4
$15/$35/$70/30%2 $500+20% A
Anthem Essential DirectAccess gzia Silver Pathway7 $4,000 $6,350 $50/$75$250 Deductible Tiers 2-4
$15/$35/$70/25%4 20%
Anthem Essential DirectAccess ggja Silver Pathway7 $2,500 $6,350 $30/$60$250 Deductible Tiers 2-4
$15/$35/$70/25%4 20%
Anthem Preferred DirectAccess Plus gfda Gold Pathway7 $1,500 $4,000 $10/$35 $15/$35/$70/30%2 20% A
Anthem Preferred DirectAccess Plus gmpa Gold Pathway7 $500 $5,000 $20 (3 visits before
deductible/coinsurance)$15/$35/$70/30%2 20% A
EmployeeElect Quick Reference Guide
employeeelect product suite for small businesses Per-member in-network costs are shown here
What Are Your Priorities?
PlansMetal level
NetworkAnnual
deductibleAnnual Out-of-Pocket
Maximum1
Office Visits PCP/sP
Prescription drugs
select drug list
inpatient hospital
healthy support
Relative Price
elem
ents
O
ur m
ost
affo
rdab
le p
lans
pro
vide
solid
cov
erag
e at
bud
get
frie
ndly
pric
es
Anthem Core DirectAccess Plus grdf Bronze PPO $5,900 $6,350
Separate Rx OOP $6,350$35 (3 visits before
deductible/coinsurance)$450 Deductible Tiers 2-4
$15/$35/ $70/30%2 0% A
Anthem Core DirectAccess Plus gtpa Bronze PPO $4,000 $6,350
Separate Rx OOP $6,350$35 (3 visits before
deductible/coinsurance)$250 Deductible Tiers 2-4
$15/$35/$70/30%2 30% A
Anthem Essential DirectAccess Plus gjpa Silver PPO $3,000 $5,500 $35 (3 visits before
deductible/coinsurance)$500 Deductible Tiers 2-4
$15/ $35/ $70/30%2 30% A
Anthem Essential DirectAccess Plus ggqa Silver PPO $2,000 $5,000 $50 (3 visits before
deductible/coinsurance)$250 Deductible Tiers 2-4
$15/$35/$70/30%2 $500 +30% A
Anthem Essential DirectAccess Plus gcqa Silver PPO $1,500 $4,250 $35 (3 visits before
deductible/coinsurance)$250 Deductible Tiers 2-4
$15/ $35/ $70/30%2 $500+ 30% A
Anthem Essential DirectAccess Plus w/ Dental3 ggqa Silver PPO $2,000 $5,000 $50 (3 visits before
deductible/coinsurance)$250 Deductible Tiers 2-4
$15/$35/$70/30%2 $500 +30% C
Cla
ssic
sol
utio
ns
Mid
-ran
ge P
PO p
lans
off
er a
n id
eal b
alan
ce b
etw
een
cost
and
com
preh
ensi
ve b
enefi
ts.
Anthem Essential DirectAccess gyia Silver PPO $2,000 $6,350 $50/$75$250 Deductible Tiers 2-4
$15/$35/$70/25%4 50%
Anthem Preferred DirectAccess gjha Gold PPO $2,000 $4,000 $20/$40 $15/$35/$70/25%4 40%
Anthem Preferred DirectAccess Plus gzpa Gold PPO $500 $3,000 $20 (3 visits before
deductible/coinsurance) $15/$35/$70/30%2 $500+20% A
Anthem Preferred DirectAccess gfha Gold PPO $1,500 $4,000 $25/$50 $15/$35/$70/25%4 20%
Anthem Preferred DirectAccess Plus w/ Dental3 gzpa Gold PPO $500 $3,000 $20 (3 visits before
deductible/coinsurance) $15/$35/$70/30%2 $500+20% C
Anthem Preferred DirectAccess ghla Gold PPO $750 $4,500 $20/$40$250 Deductible Tiers 2-4
$15/$35/$70/25%4 20%
Anthem Preferred DirectAccess gfga Gold PPO $1,000 $3,500 $25/$50 $15/$35/$70/25%4 20%
Anthem Preferred DirectAccess gpka Gold PPO $500 $4,500 $25/$50 $15/$35/$70/25%4 20%
Con
sum
er-d
rive
n Pl
ans
Thes
e co
mpr
ehen
sive
pla
ns
expa
nd m
embe
r co
ntro
l and
finan
cial
opp
ortu
niti
es
Anthem Core DirectAccess Plus w/ HSA ghhb Bronze PPO $4,500 $6,350 $50/$75 $15/$35/$70/30% 30% A
Anthem Core DirectAccess Plus w/ HSA gpdb Bronze PPO $2,500 $6,350 50% 50% 50% A
Anthem Core DirectAccess w/ HSA gmua Bronze PPO $5,500 $5,500 0% 0% 0%
Anthem Essential DirectAccess w/ HSA gpsa Silver PPO $2,500 $4,500 20% 20% 20%
Anthem Essential DirectAccess w/ HSA gdsa Silver PPO $3,500 $3,500 0% 0% 0%
hig
h Pe
rfor
man
ce
Thes
e pl
ans
offe
r a
smal
ler
netw
ork
wit
h bi
g re
sult
s in
clud
ing
a m
ix o
f HM
O
and
PPO
opt
ions
Anthem Core Guided Access Plus gjqa Bronze Blue Priority5 $5,000 $6,350
Separate Rx OOP $6,350$35 (3 visits before
deductible/coinsurance)$15/$35/$70/30%2 $500+30% A
Anthem Core Guided Access Plus w/ Dental3 gjqa Bronze Blue Priority5 $5,000 $6,350
Separate Rx OOP $6,350$35 (3 visits before
deductible/coinsurance)$15/$35/$70/30%2 $500 + 30% C
Anthem Essential Guided Access gpja Silver Blue Priority5 $1,750 $6,350 $50/$75$250 Deductible
$15/$35/$70/25%4 $1000+40%
Anthem Essential Guided Access Plus gcda Silver Blue Priority5 $2,500 $6,000 $25/$50$250 Deductible Tiers 2-4
$15/$35/$70/30%2 $500+20% A
Anthem Essential DirectAccess Plus gnea Silver Blue Priority PPO6 $2,500 $6,000 Designated: $30/$60
Participating: $60/$100$500 Deductible Tiers 2-4
$15/$35/$70/30%2 20% A
Anthem Preferred Guided Access Plus gmca Gold Blue Priority5 $1,000 $4,500 $20/$40$250 Deductible Tiers 2-4
$15/$35/$70/ 30%2 20% A
Focu
sed
Our
new
est
port
folio
of H
MO
pla
ns
that
allo
ws
refe
rral
-fre
e ac
cess
to
spec
ialis
ts a
nd h
ospi
tals
sta
tew
ide Anthem Essential DirectAccess Plus ghpa Silver Pathway7 $4,000 $4,500
$30 (3 visits before deductible/coinsurance)
$500 Deductible Tiers 2-4 $15/$35/$70/30%2 0% A
Anthem Essential DirectAccess Plus gzca Silver Pathway7 $3,000 $6,000 $25/$50$500 Deductible Tiers 2-4
$15/$35/$70/30%2 $500+20% A
Anthem Essential DirectAccess gzia Silver Pathway7 $4,000 $6,350 $50/$75$250 Deductible Tiers 2-4
$15/$35/$70/25%4 20%
Anthem Essential DirectAccess ggja Silver Pathway7 $2,500 $6,350 $30/$60$250 Deductible Tiers 2-4
$15/$35/$70/25%4 20%
Anthem Preferred DirectAccess Plus gfda Gold Pathway7 $1,500 $4,000 $10/$35 $15/$35/$70/30%2 20% A
Anthem Preferred DirectAccess Plus gmpa Gold Pathway7 $500 $5,000 $20 (3 visits before
deductible/coinsurance)$15/$35/$70/30%2 20% A
low high
1 Out-of-Pocket maximum includes deductible, coinsurance, and copayments, except adult vision and adult dental, where applicable. 2 30% to a maximum member copay of $500 per prescription. 3 This dental plan includes pediatric dental coverage. 4 25% to a maximum member copay of $250 per prescription 5 This is a HMO plan which provides in-network benefits from a high performance network composed of providers who commit to a patient centered model of care in the seven-county Denver metro area, Elbert, El Paso and Teller counties. 6 This is a high performance network composed of designated providers who commit to a patient centered model. 7 This is a HMO plan which provides in-network benefits from a highly-aligned network in the front range with a statewide wraparound.
Important: This chart is designed to help employers begin the selection process. It does not contain adequate information to make a final decision. Do not submit an application until you review each plan’s Summary of Benefits and Coverage. The relativity scale is based on pricing in the Denver MSA.
This summary of benefits has been updated to comply with federal and state requirements, including applicable provisions of the recently enacted federal health care reform laws. As we receive additional guidance and clarification on the new health care reform laws from the U.S. Department of Health and Human Services, Department of Labor and Internal Revenue Service, we may be required to make additional changes to this summary of benefits.
Not all of these policies include coverage of pediatric dental services as required under The Patient Protection and Affordable Care Act, Pub, L. 111-148 and the Health Care and Education Reconciliation Act of 2010, Pub, L. 111-152. Coverage of pediatric dental services is available for purchase in the State of Colorado, and can be purchased as a stand-alone plan. Please contact your insurance carrier, agent, or Connect for Health Colorado to purchase either a plan that includes pediatric dental coverage, or an Exchange-certified stand-alone dental plan that includes pediatric dental coverage.
Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Independent licensees 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.
Package A:Healthy Lifestyles online with incentivesTobacco-free certification with incentivesFitness reimbursementUtilization management (UM)Imaging cost and qualityCase management (CM)/ComplexCareQuick Care OptionsDisease management (DM)Future MomsEnd Stage Renal Disease24/7 NurseLineMyHealth AdvantageBehavioral Health UM/CM/DMWellness webinars
Package C – everything in A, plus:FitOrbitVisionDental (pediatric included)
New Healthy Support packages for small groupsWe offer Healthy Support plans that cover fitness reimbursement and incentives to award a healthy lifestyle.