Anthem Small Group Network Promotion Update, HealthNet Finalizes Off Cycle MLR, Updates, News & More

DICKERSON WEEKLY UPDATE

We’re Here to Help with Your Renewals!

Q4 is around the corner, and Dickerson is ready to help with your renewal business! We want you to close out the year on a high note. Dickerson has everything you need to succeed. Plan ahead, and we can start quoting Q4 rates for new and renewing groups!

Contact your Dickerson Sales Rep for help with rates and quoting!

Anthem Small Group Network Promotion Update

Anthem is adding additional network flexibility to make it easier to move groups to Anthem when the prior carrier offers multiple PPO options! Anthem is starting new Network Flexibility Promotions for 8/1/2022-12/15/2022 effective dates. The second and third options in the table below show groups can now offer both PPO networks alongside the different HMO combinations.

Current Promotion New Promotion
2 PPO alongside any 1 HMO including Vivity 2 PPO alongside any 1 HMO including Vivity
2 HMO networks (including Vivity) alongside 1 PPO 2 HMO networks (including Vivity) alongside both PPO networks
Select HMO, Priority Select HMO, and Vivity HMO alongside 1 PPO network (excluding CaliforniaCare HMO) Select HMO, Priority Select HMO, and Vivity HMO alongside 2 PPO networks (excluding CaliforniaCare HMO)

Contact your Dickerson Sales Rep for more information!

Health Net Finalizes Off Cycle MLR Results

The Affordable Care Act (ACA) requires health carriers to maintain an MLR of at least 80 percent for Individual and Small Group Plans and 85 percent for Large Group Plans. The MLR is the percentage of premium dollars a health plan spends on physicians, hospitals, and other medical services.

The Health Plan/Insurance Carrier must refund part of the premium if the requirement is not met. This standard was created to provide transparency and accountability around health care costs.

As a result of a review of 2017, 2018, 2019, and 2020 MLR Annual Reporting Forms of Health Net of California, Inc., Health Net of California, Inc. is providing affected groups with a premium rebate.

Your Small Group Clients who had Health Net of California, Inc. HMO plans in 2018, 2019, and/or 2020 will receive a rebate of a portion of the premium as required under the ACA.

What This Means to Your Clients

Active or canceled groups in 2018, 2019, and/ or 2020 subject to ERISA will have the MLR refund checks issued to the employer.

Active or canceled groups in 2018, 2019, and/ or 2020 that are NOT subject to ERISA but sign an attestation confirming that the group will follow ACA guidelines regarding the handling of rebates, will have the checks issued to the employer.

Active or canceled groups in 2018, 2019, and/ or 2020 are NOT subject to ERISA AND not signing attestation confirmation that the group will follow ACA guidelines regarding the handling of rebates, and will have the checks issued directly to the employee enrollees. 

There aren’t any changes to the current premium, deductible, or copay amounts due to the rebate. Broker commissions are also not affected by this rebate transaction. ​

DICKERSON INDUSTRY NEWS

Amazon To Buy One Medical As It Expands Healthcare Footprint

Amazon announced that it has entered an agreement to acquire primary healthcare company One Medical in an all-cash deal valued at $3.9 billion. One Medical is a membership-based primary care service that promises customers “24/7 access to virtual care.” Click here to read the full story.

 

No-Bid Medicaid Contract for Kaiser Permanente Is Now California Law

California lawmakers have approved a controversial no-bid statewide Medi-Cal contract for HMO giant Kaiser Permanente over the objection of county governments and competing health plans. But key details — including how many new patients KP will enroll — are still unclear. Click here to read the full story.