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Anthem has released their Q3 2017 rate action for small group plans as follows:

Rate Changes
  • HMO: 2.8% increase
  • PPO: 3.2% increase
  • CDHP:  2.9% increase

There are no benefit or plan changes.

Network Updates

The remaining 6 Sutter Medical Groups that were available in the Anthem Large Network are now going to be included in Small Group Network as well.  Those Sutter Medical Groups are effective 7/1 and are as listed:

  • SEBMF – Diablo Division in Contra Costa
  • Sutter Independent Physicians – Sacramento
  • Sutter Medical Group – Sacramento/Placer Division
  • Sutter Medical Group – Solano Division
  • Sutter Pacific Medical Foundation in Sonoma
  • Sutter Medical Group – Yolo Division
Online Enrollment

Effective 7/1, online enrollment will be the new Anthem standard for new enrollments, changes and terminations, through EmployerAccess, the Anthem Employer Portal.  Groups will have the opportunity to opt out of this new standard, and can do so via email, by sending an email to mailto:employeraccesssupport@anthem.com.  Anthem will continue to process paper enrollments requests as well for the time being.  Groups will be notified about this change via email from Anthem over the next few weeks.

Underwriting Guidelines Extended

Each of the below guidelines have been extended through the end of Q3 effective dates.

Relaxed Participation Guideline

The Anthem Reduced Participation Guideline has been extended again for Q3 effective dates. Groups will need to meet 30% participation, with a minimum of 5 enrolled in order to meet participation guidelines.  This applies to medical and specialty lines of coverage.

DE9C not required for new group submission with 6 or more enrolled

Anthem is making it easier for you to do business with them, by continuing to simplify enrollment for small groups. You will no longer be required to submit a Quarterly State Tax Withholding Report (DE9C)* for groups with 6 or more enrolled employees, through Q3 effective dates.

New business submissions will need to include an agent quote, employer application, employee applications, and waivers from all employees not electing coverage, legal documentation, Statement of Understanding, Electronic Debit Payment Form, and a copy of last month’s prior carrier group premium statement for all products elected.

  • If employees are not listed on the prior carrier bill, the group will need to submit payroll records
  • If the group is a startup company, they will need to submit a Conditions Enrollment/Start-up Companies form
  •  If a new group does not have prior coverage, they will need to submit a DE9C or payroll records

*Please note, while DE9C’s are not required for groups of 6 or more enrolled through this promotion, Anthem does reserve the right to request a DE9C to validate eligibility upon their discretion (e.g. variations in prior carrier bill and actual enrollment, future audits, etc.)

Dual Network HMO Plans

Anthem will allow clients to offer all HMO plans for groups, removing the limitation of only one HMO network per group.  Groups will still be limited to just one PPO network.

  • For new groups, simply indicate network option on the existing Employer Application.
  •  For groups that have already renewed, your clients can submit an Anniversary Month Change Form.

Please note: any applicable rate changes will be applied to their request to change their anniversary month. (i.e. age rated for birthday, any address changes, etc.).

Valid Waivers

Individual coverage both on and off the Exchange is accepted as a valid waiver has been extended through Q3 effective dates.

General Information & Reminders

Q3 Renewals:

Renewals for 7/1 groups will start appearing in the Producer Toolbox on 4/18, with renewals for 8/1  and 9/1 groups available shortly after.  Group renewals for 7/1 groups will be mailed to the groups the week of 4/24 and will be available on the Employer Access portal on 4/27.

Please contact your LISI Sales Representative for further information.