Anthem Updates, Blue Shield Updates, Health Net Contract Updates, Counting Employees Guide, Updates, News & More


Anthem Q2 Updates

  • Rates:
    • Quarterly Rate Change Average: PPO 1.7% and HMO 3.0%
    • Annual/Renewal Rate Change Average: PPO 5% and HMO 4.2%
  • Selling Highlights:
    • DE9C not required for 3 or more subscribers enrolling! Also DE9C is not required for Specialty. This excludes virgin groups and a prior carrier bill is required if a DE9C is not provided.
    • Relaxed Participation! 25% for groups of 5 + enrolled subscribers. 65% participation is required for 4 or less subscribers enrolled.
  • Strong HMO Network Options! CaliforniaCare HMO, SelectHMO, Priority SelectHMO and Vivity HMO.
  • Additional Network Flexibility! Now employers can select one of the following pairings:
    • Both PPO Networks alongside any 2 HMO networks (including Vivity)
    • Both PPO Networks alongside Select HMO, Priority Select HMO and Vivity HMO (Excluding CaliforniaCare HMO)
  • Simplified Referrals with Vivity: Vivity makes access to care simpler, faster and more efficient. Click here to learn more about simplified referrals with Vivity.

Contact your Dickerson Sales Rep for help quoting Anthem plans!

Blue Shield Q2 Updates

  • Rates: Q2 rate action is a statewide average of 1.9%
  • Renewals: Groups renewing April, May, and June are now available to brokers through Shield renewals.
  • Virtual BlueSM: Virtual Blue plans feature $0 unlimited virtual care visits. In-person care cost shares vary by plan, and in-person access to care is available through the Tandem PPO network in California and via BlueCard when outside of the state.

Contact your Dickerson Sales Rep for help quoting Blue Shield plans!

Riverside Medical Clinic Termination Rescinded

Great news! Effective April 1, 2023, Riverside Medical Clinic (PPG # 2946) will continue to be contracted with Health Net Commercial Capitated Lines of Business (POS, WholeCare, Blue & Gold, HMO, ExcelCare, Medicare COB). “Good News” letters are being sent next week advising affected members that their PCP will continue to be available through Riverside Medical Clinic.


Health Net Update on Prime Care Chino Valley Provider Contract

Effective May 1, 2023, Prime Care Medical Group of Chino Valley PPG will no longer be a part of the following Health Net networks across our Commercial lines of business:

  • WholeCare
  • UC Blue & Gold HMO
  • ExcelCare
  • POS
  • Full Network HMO
  • SmartCare HMO
  • Ambetter HMO

Health Net will notify impacted members via mail on 3/1/2023 advising them that effective 5/1/2023, their medical group will no longer participate as a Health Net network provider.

Counting Employees For Federal Employee Benefit Laws

Federal Employee Benefit Laws frequently apply to employers that have a certain number of employees, but these laws use different methods to count employees. This is a brief outline of some of the key Employee Benefit laws, what size employers they apply to, how to count employees, any exceptions when the law applies as employers change size, and any poster/notice requirements.

Click here to view the Counting Employees For Federal Employee Benefit Laws Guide


Humana Plans to Exit Employer-Based Insurance Market

Humana Inc will exit the employer-based insurance business over the next 18 to 24 months, it said, to focus primarily on government-backed programs such as Medicare and its specialty businesses. Click here to read the full article.

Is California Breaking Its Promise To Cut Health Care Costs?

California set up a fund to cut out-of-pocket costs for those enrolled in Covered California. Healthcare advocates say Newsom’s latest budget proposal follows a pattern of missed opportunities to make insurance more affordable under Covered California. Click here to read the full article.