Dickerson Update, August 6 – Oscar’s big expansion plans, Anthem’s network flexibility promotion, and Blue Shield’s bonus program

Anthem offering network flexibility promotion and issuing MLR rebates ahead of schedule

Small Group Network Flexibility Promotion

To help employers, Anthem is offering a promotion for multiple network offerings for new sales with effective dates of 10/1/20 – 3/15/21! The group must meet the definition of a Small Group (1-100 employees).

During this promotional period, an employer group may select from the following network combination offerings:

  • Any 2 HMO combo options that are available in the region (Full HMO, Select HMO, or Priority Select HMO) and 1 PPO option (Full PPO or Select PPO)
    OR
  • 2 PPO options (Full PPO and Select PPO) and any 1 HMO option that is available in the region (Full HMO or Select HMO or Priority Select HMO)

Eligibility Requirements:

  • Meet the definition of a Small Group 1-100
  • New Small Group Business (effective date 10/1/20 to 3/15/21)

Here is how to request this promotion:

  • If you utilize Anthem’s Quote to Enroll tool, add comments in the comments field and mark “Make Public.” Upload the original Employer Application in the legal documents section, as you do today, with the requested network options checked. Also add this note on the application: Network Promotion
  • If you don’t utilize Quote to Enroll, select your requested network options in the application and add this note: Network Promotion

MLR Rebates

Anthem understands that COVID-19 has placed huge financial burdens on many employers and members. This is why they’re offering flexible, affordable coverage options for Small Group employers and fast-tracking the annual medical loss ratio (MLR) rebates.

Groups and Individual members typically receive MLR rebates in late September, but this year Anthem will issue these rebates in early to mid-August.

The MLR provision of the Affordable Care Act (ACA) encourages health plans to spend most of the premium dollars they collect on health care costs rather than overhead. It’s a ratio of insurance claims costs to insurance premiums, and is expressed as a percentage. 

Anthem groups and individuals in 8 states will receive rebates this year. Anthem will send rebate checks to employer groups and Individual members along with a federally mandated notice that explains MLR and how it is calculated. Anthem is also mandated to notify employees of the groups that receive rebate checks

For additional details on what MLR is and who is eligible to receive it, click here.

Please contact your Dickerson Account Executive for more information.

Blue Shield extends relaxed participation requirements through January 2021 effective dates

Get ready for Q4 with Blue Shield. They’re extending relaxed participation requirements for small business, and also offering a Medical Incentive Bonus Program.

Extension of relaxed participation requirements

Blue Shield extended relaxed participation requirements for small business through 1/31/21. 

Here are the details:

  • Groups with 5+ enrolled employees
    • 25% participation for medical, dental, vision, and life insurance plans
  • Trio HMO and Tandem PPO plans: enroll as few as one member
    • Blue Shield is waiving participation requirements for groups of 1 to 100 eligible employees that offer only Trio HMO or Tandem PPO medical plans
    • As of 10/1/20, Tandem-only participation is being added to the relaxed participation program for new sales 
    • Select Trio or Tandem plans only on the Master Group Application, and a new group can enroll with Blue Shield without needing to meet standard minimum participation requirements
    • This promotion allows clients to purchase a medical plan or specialty benefits from Blue Shield alongside another carrier with more lenient underwriting participation rule

For full details on this promotion, click here.

Medical Incentive Program

Boost your sales this Q4 with Blue Shield’s Medical Incentive Program! Bonuses apply to groups beginning with September 2020 effective or renewal dates through January 2021 effective or renewal rates. 

Here’s how the bonus program will work:

  • $50 per enrolled member on all medical plans
  • $100 for each member who enrolls in a Trio HMO or Tandem PPO plan as part of the initial sale or during renewal

Business sold through a GA is eligible for this bonus!

For all the particulars of this program, please refer to this flyer.

Please reach out to your Dickerson Account Executive for more information.

Health Net Large Group: product portfolio update and underwriting promotion

Health Net Large Group unveiled their product portfolios for groups of 101+ product portfolios as well as underwriting deals to help boost sales opportunities.

Health Net’s 2021 Enhanced Choice and Starting Line-Up portfolios deliver strong mixes of whole-health benefits and extra-value programs. Their underwriting promotion allows groups to offer Salud HMO y Mas on a standalone basis alongside Kaiser-only groups. Health Net’s multiproduct bundling discount program also helps large groups save up to 3% on their medical premiums.

To read more about Health Net’s updates, click here

Contact your Dickerson Account Executive for more information.

Big news from Oscar: 2021 expansion to four new states, 19 new markets, and new $0 Virtual Primary Care offering

Hot off the press: Oscar announced plans for a big expansion of Individual and Family plans in 2021. Next year, Oscar will be in 4 new states and 19 new markers, and also launch a new $0 Virtual Primary Care offering in nine markets in 2021, pending regulatory approval. This is the fourth consecutive year that Oscar is expanding their national footprint, as well as the second year that they’re almost doubling their total number of markets. 

Individual and Family Plan Market Expansion

In 2021, Oscar will offer Individual & Family plans in 19 total states and 47 total markets.

For the first time, Oscar will offer Individual and Family plans in the following states:

  • Arkansas (Little Rock and Fayetteville)
  • North Carolina (Asheville)
  • Oklahoma (Oklahoma City
  • Iowa (five markets)

Oscar is also expanding the following existing state footprints:

  • Colorado (Boulder)
  • Northeast Pennsylvania (three markets)
  • Florida (multiple markets including Jacksonville, Sarasota, and Tallahassee)

Additionally, Oscar is also expanding the following service areas:

  • Phoenix, Arizona
  • San Francisco, California
  • Columbus, Ohio

$0 Virtual Primary Care

Oscar is also very excited to announce their $0 Virtual Primary Care offering for Open Enrollment 2021 (pending regulatory approval). Virtual Primary Care plans will include $0, unlimited virtual visits with a dedicated team of Oscar primary care providers. Any tier 1 prescriptions, DME, labs, imaging orders, and initial specialist referrals prescribed by an Oscar primary care provider are also $0, even before deductible is met. 

Virtual Primary Care plans will be available to individuals & families in 10 markets: Miami, FL, Ft. Lauderdale, FL, Palm Beach, FL, Houston, TX, Dallas, TX, Austin, TX, Los Angeles, CA, Orange County, CA, Denver, CO, and New York, NY. 

Click here to read the full press release.

For more information, please contact your Dickerson Account Executive.

Ease and Dickerson partner to obtain insights on Open Enrollment readiness

Open Enrollment is right around the corner, which is why Ease and Dickerson want to learn a little bit more about whether or not you feel prepared for this busy time of year. We’ve put together a research survey, and we’d love to hear from you!

Hundreds of agencies are participating in this survey, and the responses we receive will help us, carriers, enrollers, and payroll providers better understand the challenges you’re facing so we can best serve brokers, especially in the face of a global pandemic. Brokers have the option to receive a copy of the report once the information has been gathered.

Click here to participate in the survey. 

Alera legal alert: IRS issues Affordability Percentage Adjustment for 2021

The IRS released Rev. Proc. 2020-36, which contains the inflation adjusted amounts for 2021 used to determine whether employer-sponsored coverage is “affordable” for purposes of the ACA employer shared responsibility provisions and premium tax credit program. Alera put together a chart for plan years beginning in 2021 that shows the affordability percentage for employer mandate purposes indexed to 9.83%. Employer shared responsibility payments are also indexed.

Applicable large employers should be aware of the updated affordability percentage for plan years beginning in 2021. Although the affordability percentage has not increased significantly from 9.78% to 9.83%, employers should consider it along with all other relevant factors when setting contributions.

Click here to learn more about the IRS’ Affordability Percentage Adjustment for 2021.

Alera legal alert: President Trump issues Executive Orders intending to lower the cost of prescription drugs

On July 24, 2020, President Trump issued several Executive Orders intending to lower prescription drug costs by (1) modifying anti-kickback laws to lower drug prices, (2) reducing trade barriers to increase importation of drugs and lower prices, and (3) improving access to insulin and epinephrine for individuals with diabetes or severe allergies.

Click here to read Alera’s legal alert for detailed explanations on how these Executive Orders might impact group health plans.