Sep 14, 2023
Anthem has issued a small group medical rate update for Q1 2024, and plan benefits have been updated to meet actuarial value changes. Quoting is now available.
The statewide average change for the quarter shows the following increases:
| PLAN TYPE | QUARTERLY CHANGE | ANNUAL CHANGE |
|---|---|---|
| HMO | 0.8% | 9.2% |
| PPO | 2.0% | 8.4% |
In addition, the current underwriting promotions have been extended through first quarter.
Portfolio Updates
There are no new or discontinued plans for 2024. Plans were updated for actuarial value as well as the following changes:
| PLAN / PRODUCT | 2023 BENEFIT | 2024 BENEFIT |
|---|---|---|
| Lower Mail Order Copayments Tiers 2 and 3 remain unchanged at 2.5x retail |
Tier 1: 2.5x Retail | Tier 1: 2x Retail |
| Mail Order Home Delivery Members will no longer have a higher cost for failing to opt-out |
Opt-Out Home Delivery | Optional Home Delivery |
| Cellular and Gene Therapy (CAR-T) PPO plans will utilize Centers of Excellence and Blue Distinction centers to promote high qualify care and management costs |
Covered | Covered at Centers of Excellence |
| Vivity Coinsurance Benefits Wigs, DME, Home Dialysis, Home Infusion, and Diabetic Equipment & Supplies |
Coinsurance | Copayment |
| Preventive Rx Benefit Drug List Update Included on HSA plans and waives the deductible on drugs from the Preventive Rx Plus drug list |
Preventive Rx Plus | Preventive Rx Plus w/drug class modifications |
| HMO Urgent Care Benefits OON Covers urgent care out of network the same as in network (Vivity plans already covered the same IN and OON) |
Not covered | Same as in network |
| Rx Infusion Drugs - HMO Now covered at a copayment |
0% coinsurance | $125 copay |
| Lower Specialist Benefit & Tier 1 Rx on Silver HMO plans with Deductible Rx change is not applicable to Silver Vivity plan |
$110 copay specialist $15 copay Tier 1 Rx |
$95 copay specialist $10 copay Tier 1 Rx |
| Pediatric Dental Enhanced the pediatric dental plans (non-WH) to pay benefits without being subject to the medical deductible |
Medical Deductible applies to Pediatric Dental | Medical Deductible does NOT apply applies to Pediatric Dental |
| Outpatient Surgery OP surgery benefits have the same cost share types; lower copays on AM/surgical vs OP facility |
Ambulatory/Surgical = Coinsurance | Ambulatory/Surgical = Copay + Coinsurance |
| Hybrid HSA plans Renamed Plans with different deductible based on enrollment (EE vs EE+FAM) are now clearly identified |
Only individual deductible displayed in the plan name | Include "HSA/H" and display all 3 deductible values in the plan name |
CarelonRx and BioPlus
CarelonRx and BioPlus will provide an unparalleled level of service that's easy and focused on whole health. New business starting January 1, 2024 will take advantage of this program. Existing business will transition at their 2024 renewal date. This digital-first experience delivers:
Accessibility
- 24/7 text or chat directly with pharmacists
- Maintenance medications delivered directly to the patient's door
- Status updated from prescription order to delivery
Affordability
- Cost-saving opportunities: accepting coupons and recommendations on lower-cost alternatives
- Clear understanding of medicines' costs, benefits before the prescription fill
Simplicity and Personalization
- Refill reminders, automatic refills, drug interaction alerts
- Self-serve digital tools and updates to help patients make informed decisions about their health
Anthem will reach out to members that are impacted by this transition.
Specialty Updates
New dental enhancements coming January 1, 2024:
- New Dentures@Home program offers custom-fit, replacement dentures, shipped directly to the member's home
- New Ortho@Home provides teeth straightening with clear aligners at home. Dental@Home offers teledentistry services including problem focused exams and referrals or virtual care for dental emergencies
- Reminder: Effective July 1, 2023, New vision discount prescription eye drop program for myopia and dry eyes
Q1 Renewal Release Dates
- Available on Producer Toolbox on 10/24/23
- Mailed to employers on 10/30/23
- Available on EmployerAccess on 11/03/23
