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.

Later this month, we will begin notifying  impacted grandfathered clients of their new rate and the date it will go into effect (the effective date will be April 1, 2017 for the majority of these clients). This mailing will provide the required 60-day advance notification to your clients.
In addition, any of your Dental clients entering a new age category will also be notified of their dental rate change.
Sample Communications
Please remember, because this notification overlaps the current Open Enrollment and as outlined in the letters, any of your grandfathered clients have the option to change their coverage by:
  • 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)
  • 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 28th, 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

Cover letters for discontinuations for all other Regions

 

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

 

Contract Code

 

Offered By

 

Plan  Name

 

Current Medical

Deductible

7900,  1518,  PE25,  PE26 ABCL&H Basic  PPO  1000 1000
01CE ABCL&H CoreGuard 7500 7500
01CD ABCL&H CoreGuard 5,000 5000
01CC ABCL&H CoreGuard 3500 3500
01CB ABCL&H CoreGuard 2500 2500
01CA ABCL&H CoreGuard 1500 1500
01C9 ABCL&H CoreGuard 750 750
00RP ABCL&H Clear  Protection 3300 3300
00RN ABCL&H Clear  Protection 1000 1000
H062 ABCL&H PPO  Share 5900
00Y3 ABC PPO  Share 4100
7891,  1871 ABC PPO  Share 2950
7889,  7890 ABC PPO  Share 1750
1393,  1503,  7878,  Z828 ABC PPO  Share 1150
1930,  Z830 ABCL&H PPO  Share 1150
1929,  Z829 ABCL&H PPO  Share 550
7895,  1501,  1575,  1920,  7888,  7904 ABC PPO  Share 550
7898,  7906,  7897,  NM02,  1913,  Z831 ABC Individual HMO 0
PE48 ABCL&H RightPlan PPO  (Generic Rx) 0
PE49 ABCL&H RightPlan PPO  (Rx) 0
DN13 ABCL&H Tonik 1750
DN14 ABCL&H Tonik 3500
Z126,  Z127,  Z128 ABCL&H Lumenos HSA 1750/3500
Z132,  Z133,  Z134 ABCL&H Lumenos HSA 3500/7000
Z135,  Z136,  Z137 ABCL&H Lumenos HIA Plus 1750/3500
Z141,  Z142,  Z143 ABCL&H Lumenos HIA Plus 3500/7000
Z144,  Z145,  Z146 ABCL&H Lumenos HIA 1750/3500
Z150,  Z151,  Z152 ABCL&H Lumenos HIA 3500/7000
DX26,  DX27,  DX28 ABCL&H Lumenos HSA 1750/3500
DX32,  DX33,  DX324 ABCL&H Lumenos HSA 2950/5900
DX38,  DX39,  DX40 ABCL&H Lumenos HSA 3500/7000
DX47,  DX48,  DX49 ABCL&H Lumenos HIA Plus 2950/5900
DX53,  DX54,  DX55 ABCL&H Lumenos HIA Plus 3500/7000
DX62,  DX63,  DX64 ABCL&H Lumenos HIA 1750/3500
DX68,  DX69,  DX70 ABCL&H Lumenos HIA 2950/5900
DX74,  DX75,  DX76 ABCL&H Lumenos HIA 3500/7000
Z153,  Z154 ABCL&H SmartSense (Standard Rx) 550/1100
Z155,  Z156 ABCL&H SmartSense (Standard Rx) 1750/3500
Z157,  Z158 ABCL&H SmartSense (Standard Rx) 2950/5900
Z161,  Z162 ABCL&H SmartSense (Upgrade Rx) 550/1100
Z163,  Z164 ABCL&H SmartSense (Upgrade Rx) 1750/3500
Z165,  Z166 ABCL&H SmartSense (Upgrade Rx) 2950/5900
Z167,  Z168 ABCL&H SmartSense (Upgrade Rx) 5900/11800

 

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

 

Contract Code

 

Offered By

 

Plan Name

Current Medical

Deductible

R418 ABCL&H Basic  PPO  2500 2500
01CF ABCL&H CoreGuard 10,000 10000
01CE ABCL&H CoreGuard 7500 7500
01CD ABCL&H CoreGuard 5000 5000
01CC ABCL&H CoreGuard 3500 3500
01CB ABCL&H CoreGuard 2500 2500
01CA ABCL&H CoreGuard 1500 1500
00RR ABCL&H Clear  Protection PPO  5000 5000
00RP ABCL&H Clear  Protection PPO  3300 3300
00Y4 ABC PPO  Share 8850
01LB ABCL&H PPO  Share 5900
01LC ABC PPO  Share 5900
H062 ABCL&H PPO  Share 5900
01LA ABC PPO  Share 4100
00Y3 ABC PPO  Share 4100
7891 ABC PPO  Share 2950
7889 ABC PPO  Share 1750
1930 ABCL&H PPO  Share 1150
1393 ABC PPO  Share 1150
PE43 ABC Select  HMO 0
7896 ABC HMO  Saver 1750
P958 ABCL&H RightPlan PPO  (no Rx) 0
PE48 ABCL&H RightPlan PPO  (Generic Rx) 0
01LE ABCL&H RightPlan (Generic Rx) 550
01LD ABCL&H RightPlan (Rx) 550
DN14 ABCL&H Tonik 3500
DN15 ABCL&H Tonik 5900
Z126,  Z127, Z128 ABCL&H Lumenos HSA 1750/3500
Z132,  Z133, Z134 ABCL&H Lumenos HSA 3500/7000
Z129,  Z130, Z131 ABCL&H Lumenos HSA 5900/11800
Z135,  Z136, Z137 ABCL&H Lumenos HIA Plus 1750/3500
Z141,  Z142, Z143 ABCL&H Lumenos HIA Plus 3500/7000
Z138,  Z139, Z140 ABCL&H Lumenos HIA Plus 5900/11800
Z144,  Z145, Z146 ABCL&H Lumenos HIA 1750/3500
Z150,  Z151, Z152 ABCL&H Lumenos HIA 3500/7000
Z147,  Z148, Z149 ABCL&H Lumenos HIA 5900/11800
DX44,  DX45, DX46 ABCL&H Lumenos HSA 5900/11800
DX59,  DX60, DX61 ABCL&H Lumenos HIA Plus 5900/11800
DX80,  DX81, DX82 ABCL&H Lumenos HIA 5900/11800
Z153,  Z154 ABCL&H SmartSense (Standard Rx) 550/1100
Z155,  Z156 ABCL&H SmartSense (Standard Rx) 1750/3500
Z157,  Z158 ABCL&H SmartSense (Standard Rx) 2950/5900
Z159,  Z160 ABCL&H SmartSense (Standard Rx) 5900/11800
Z163,  Z164 ABCL&H SmartSense (Upgrade Rx) 1750/3500
Z165,  Z166 ABCL&H SmartSense (Upgrade Rx) 2950/5900
Z167,  Z168 ABCL&H SmartSense (Upgrade Rx) 5900/11800

 

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