Grandfathered plans are not affected by the 2018 withdrawal from 16 CA Regions

April 1, 2017 rate action for California Individual Grandfathered plans

Beginning April 1, 2017, Anthem will adjust the base rates for existing business on all CDI grandfathered medical plans with an April 1, 2017 effective date. Members will also receive an adjustment for age changes. The base rates for members on DMHC grandfathered medical plans, that were effective April 1, 2016, are not scheduled to change in 2017. DMHC members will receive an adjustment for age changes. Click here for a copy of the updated Grandfathered Rate Sheet. It includes the plan names, contract codes and base rates effective April 1, 2017 for CDI plans and effective April 1, 2016 for DMHC plans.

• CDI Member Letter    2.2017 Version
• DMHC Member Letter (sent 60-days prior to their age change increase)
• Dental Member Letter
  • Dental Insert
• Centers for Medicare and Medicaid Services (CMS) Notice: This notice of renewal is required by the Department of Health and Human Services.
  • CMS Member Letter
• CA DOI says rates are not reasonable, but Blue Cross will use them anyway – Sample Letter
• SB 908 Premium Rate Notice attached to change application

• Downgrading to another Grandfathered Anthem Individual Health Plan if available
• Choosing a New Non-Grandfathered ACA compliant Individual Health Plan during the Open Enrollment or a Special Enrollment Period (SEP)
  • Learn more about the difference between ACA-ObamaCare Plans and Grand Fathered Plans
    • Chart
• Grandfathered members (CDI and DMHC) qualify for a SEP on their 2017 renewal. If they wish to change to an ACAplan due to this qualifying event:
  • They should select the “non-calendar renewal” qualifying event on the 2017 application
  • They may apply up to 60-days before or 60-days after the effective date of their rate change
  • And they need to submit a copy of their grandfathered rate action/renewal notice as documentation of their qualifying event

Cheat Sheet

File Directory

Blue Cross has made the difficult decision to reduce the number of Individual health plans they will offer in California for 2018.

It’s important to note that through December- your coverage stays the same, all you need to do is keep paying their premiums.

If you pick a plan from a different insurance company, you  must enroll by December 15, 2019 for an effective date of January 1, 2020 Important dates and deadlines can be found in the sample member letter below.

To reduce the administrative burden of maintaining multiple products/contracts, they  will be discontinuing about 200 grandfathered plans/contracts, many of which only have a few members. This change will impact around 14,000 members and some of these members may have other Anthem options to replace their plans.

Blue Cross advised us on 12.4.2017 that they are working on a process to allow agents to know which clients are affected.  They should have it done by Wednesday or Thursday.  ^{Email dated 12.4.2017 8:45 AM}

Get Competitive quotes for new plans.

In order to give grandfathered members impacted by this change plenty of time to plan for their coverage needs in 2018, they are notifying affected members over the next few days that their current plan will be discontinued on February 28, 2018. This includes some grandfathered plans in all regions of California.

We do have Affordable Care Act (ACA) EPO plan options available for members in Regions 1, 7 and 10 if they would like to continue with Anthem. It’s important to note that through February 28^th, their coverage stays the same, all they need to do is keep paying their premiums.

• If they pick another Anthem plan in 2018, their cost sharing payments for 2018 will roll-over to that new Anthem plan.
• If they pick a plan from a different insurance company, they must enroll by December 15, 2017 for an effective date of January 1, 2018 for all of their 2018 cost sharing payments [not csr – enhanced silver, as the plans are grandfathered, not Covered CA] [OOP Out of Pocket Maximum – Deductibles – % of claim]   to apply to their new plan. Otherwise, if they change health insurance companies after 2018 begins, the 2018 cost shares they have with Anthem will not carry over to their new health insurance company.
• Some of these members may have a grandfathered downgrade option, please check the downgrade matrix or contact us or your agent.
  • This matrix might not be accurate.  We are checking with broker support, right now.  12.6.2017 3:30 PM

Here are sample copies of letters these members will receive. The letters will vary slightly based on the members’ location and plan.

Cover letters for discontinuations Regions 1, 7 and 10

• Letter 1
• Letter 2

Cover letters for discontinuations for all other Regions

• Letter 3
• Letter 4

These plans appear to be the ones being cancelled
Based on my interpretation of the downgrade matrix

These appear to be the ones that will remain.  If you have one being cancelled, you can switch over.

Child Pages

• Grandfathered April 2016 Rate Increase
  • Grandfathered Plan vs 2017 Offerings?