Below are the Anthem of KY 2017 Individual Member Brochures for On Exchange (Health Insurance Marketplace) and Off Exchange. There are no 2017 Individual Broker Guides at this time.
You will find the most important changes for 2017 below. The 2017 Individual Application will be available on 11/1/17 on the Producer Toolbox.
- Open Enrollment is from 11/01/2016 to 01/31/2017
- January 1, 2017 plans and rates are now available on the Producer Toolbox. Log in, then click on the Incoming Business tab/Individual tab and click Create New/Quote Comparison
- Anthem will be offering one Catastrophic plan on and off exchange, 2 Gold plans on and off exchange, 6 Silver plans On exchange, 8 Silver plans off exchange, 5 Bronze on exchange and 6 Bronze off exchange.
- New Silver HMO plan with $5300 Deductible and 25% coinsurance
- Anthem has eliminated several plans that did not have any membership
- Anthem will be offering plans in all 120 Counties on and off exchange: 74 of those counties will only be offered HMOs, while the other 46 counties will only be offered PPOs due to the fact that there is not an HMO available. (See Individual 2017 PPO and HMO Map & Competitive Info for further clarification). Baptist has pulled out of the Individual Market and Humana is in limited areas only, using the Norton network for their HMO. Caresource will be Anthem’s biggest competitor – their prices are low and they do not use agents. However, they only offer HMOs, and Anthem’s HMO network outperforms theirs.
- Anthem will be adding St. Elizabeth’s Hospital in the Northern KY area to their HMO network in 2017. They will also have all the major hospitals – Baptist, Norton’s, KY One and Kosair – in their HMO network. They ask members to choose a PCP but they are not required to get a referral to see a Specialist.
- Anthem’s Pathway PPO/Pathway PPO X plans will no longer have out of state coverage. They will only pay in network for out of state providers if it is an Emergency or Urgency.
- All Individual Members on exchange will have to Actively enroll like a new member thru the Federal Exchange. The best way to do this is to start with Anthem’s Producer Toolbox. Simply log in, click on Incoming tab at the top of the screen, make sure you are on the Individual tab and then click “create an Individual quote” button to the right of the screen. Once you pick an on-exchange plan and click enroll, it will take you to the Federal Exchange (FFM) to enroll then back to the Anthem site to make payment. SEE INSTRUCTIONAL SCREENSHOT HERE
- If you have a member that is off-exchange, that is in a county that is only offering an HMO plan and they are currently on a PPO, they will also have to actively enroll at open enrollment either thru the Producer Toolbox or with a paper application.
- Habilitative and Rehabilitative must have separate limits per CMS. You can’t have greater limits for rehabilitative services than you have for habilitative services, so those limits have to mirror each other. This applies to Physical Therapy, Occupational Therapy and Speech Therapy. There will be 25 visit limits each.
- Spinal Manipulation limit is 20 visits per member per calendar year (changed from 12 visits)
- Autism limits are removed, so no hour or age limit (changed from 20 hour limit and age limit)
- Post-Cochlear implant aural therapy limited to 30 visits
- Cognitive rehabilitation therapy limited to 20 visits.
- Pulmonary rehabilitation is limited to a maximum of 25 visits per member per calendar year
- Added advanced imaging copay and/or increased coinsurance up to 50%
- Gold plans modified to have embedded deductible up to 3X Single deductible
- Increased Out of network cost shares to 3X In Network deductible and Out of Pocket Maximum (PPO)
- Increased inpatient facility coinsurance up to 50%
- Retail Health Clinic is the same as PCP office visit cost shares
- For plans with all-inclusive PCP copays, all services done during visit covered under copay.
- Limited copay plans: retail clinic goes towards the number of office visits at copay, once visit limit is met, subject to deductible and coinsurance (Same as PCP)
RXChoice Tiered network: NEW
The new RX Choice Tiered pharmacy network will be applied to all Kentucky plans in 2017. With the RXChoice tiered network, the member has a reduced cost share if they go to a level one pharmacy.
Level one of this network consists of approximately 18,500 locations. Health Mart Pharmacies and other independents are being contracted to fill in the gaps of access for level one of the network. The total network, Level 1 and Level 2, provides the same access as National Plus, and includes approximately 70,000 pharmacies.
Level one includes the following pharmacies:
CVS, Target, Walmart, Kroger, Safeway, Meijer, Food City, K-Mart, Riley White Drugs, Danhauer Drug, Nations Medicines, The Prescription Pad Pharmacy
Members who fill their prescription at level two pharmacies are charged $10 or 10% more than level one cost share.
Anthem is still using the Select RX Drug List for all Individual plans
Home Delivery Choice is used on all Individual plans. Home Delivery Choice is a mandatory mail order program with an opt-out option. Members have the option of filling at mail or retail. The first two fills are covered at retail, but they must notify Express Scripts of their choice before their 3rd fill.
Mail Order Copays:
In 2017, the copay amounts for 90-day supplies are increasing to the following:
- Tier 1: 2.5 retail copay
- Tier 2: 3X retail copay
Pediatric Dental and Pediatric Vision are still embedded into the medical plan. Diagnostic and Preventive services for Dental are now paid at 100% in-network versus 90% in 2016.
Anthem offers LiveHealth Online on all Individual plans. In 2016, LiveHealth Online expanded to include Behavioral Health Professionals. The Cost share for behavioral health visits through LiveHealth Online matches the cost share for a mental health visit. Effective July 1, 2016: Anthem has lowered the age for dependents to access LiveHealth Online Psychology to ages 10 to 17.
Anthem will continue to offer LiveHealth Online (LHO), giving their members the option of visiting a board-certified doctor or licensed therapist virtually on a smartphone, tablet or computer. If needed, doctors can prescribe certain medications and send the script to the member’s pharmacy of choice.
Advantages to members include:
- All Doctors that you would talk to via LiveHealth Online would be considered in-network regardless of what plan you have with Anthem, so if you have a student that lives in another state or you are traveling and have a non-emergency, this would be an in network benefit.
- Resolution: nearly 90% of those who used the service say their issue was completely resolved
- Time Savings: most saved two hours or more
- Choice: members select the doctor from provided options
If you are a member, you would pay whatever your cost share is for in network, depending on if you are talking to a Physician (which would be an Office Visit charge) or a Psychologist. If you are not an Anthem member, it is typically a $49 charge for a Physician, slightly more for a Psychologist.
To enroll in LiveHealth Online, go to LiveHealthOnline.com
Anthem also offers Individual Dental and Vision products!
Questions? Email Bwalcott@agent-link.net