OH 2019 SG Guide

OH_2019_SG_Guide

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YOUR TIME MATTERS.

So we’re making everything work harder for you.

�

New, more affordable plan designs for your clients

�

Simpliﬁed electronic process, from quoting through enrollment, for you

Small Group product guide I Effective January 1, 2019

This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of coverage, contact your Anthem representative.

* Non-ACA compliant plans may may not qualify for single bill when combined with other coverages.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies,

Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and

HMO Missouri, Inc. RIT and certain afﬁliates administer non-HMO beneﬁts underwritten by HALIC and HMO beneﬁts underwritten by HMO Missouri, Inc. RIT and certain afﬁliates only provide administrative services for self-funded plans and do not underwrite

beneﬁts. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans

of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of

Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network beneﬁts

in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or

POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.

107469MUBENABS 05/18

HELPING CHOOSE THE RIGHT PLAN FOR YOUR CLIENTS SHOULDN’T KEEP YOU UP AT NIGHT

Your clients want their employees to have the right plan for their needs, while balancing the cost. We get it. We created a wider range of plan

options with everything your clients and their employees need to make smarter health care choices, save time and manage costs. And our plans

work together – medical, pharmacy, dental, vision, life, disability and behavioral health. You and your clients should feel good with that choice.

� More plan choices to meet more budgets

� A lower cost of care because of the strength and quality of our

networks, so members can see doctors who deliver the most

effective, efﬁcient care

� Expanded medical and pharmacy portfolios:

—ACA-compliant medical and pharmacy plans offering

a wide range of member cost share options

—Integrated Act Wise consumer-driven health plans

that manage the medical beneﬁts and the

spending accounts

� A 5% discount on specialty premiums (dental, vision, life and

disability) when clients purchase dental for the ﬁrst time along

with vision, life and/or disability

—Members get whole-person coverage. Because our products

are connected, doctors can work together behind the scenes

to see a person’s overall health, leading to earlier detection of

possible health issues

� Better health and engagement for members – our digital health

care platform integrates beneﬁt information, clinical and claims

data, and other digital tools to create a more personalized

member experience

MAKING IT ALL EASIER. YOU SPOKE, WE LISTENED.

We know it hasn’t always been easy to work with us. From complicated and inconsistent processes to long implementation times, you’re

frustrated and we hear you. We’ve been working hard to invest in, and develop, market-leading tools and technology with one goal in mind:

to streamline, so you can save time and worry. The changes you’ll see:

� Reimagined Producer Tool-box where you can do it all—in one

place, no more going back and forth between portals

� Simpliﬁed quoting so you can easily show your clients the cost

of any combination of our medical, dental, vision, life and

disability coverage

� Online enrollment submission for your clients and their

employees that drastically reduces implementation times; no

more paperwork

� Full transparency on your clients’ status in the implementation

process – no more guessing games

� Integrated EmployerAccess makes it easier for you to perform

maintenance on all of your clients with a single sign-on

But we didn’t change everything. You will continue to enjoy the support from the service teams you know and trust. And we’ve made their jobs

easier with streamlined processes that are consistent across our company and technology that’s ﬂexible so they can quickly answer your

questions. It’s the best of both worlds so you can rest easy.

PharmacyMedical Dental DisabilityLifeVision Behavioral Health

MAKING IT EASIER

FOR YOU AND YOUR CLIENTS

Your time should be focused on supporting your clients, consulting with them on the right health plan

for their unique needs. What if it could be easier? Instead of paperwork, what if you could focus on

building your business?

WELCOME TO A BETTER WAY.

Act Wise consumer-driven health plans

These plans make it easier for employers to administer their health savings account because Anthem manages both the medical

benef ts and spending accounts. Act Wise is streamlining everything – for you, employers and our members. It’s easy to get startedi

and get one-stop support from a dedicated team at one customer service number. And members have one web site and mobile app

to review claims in real time and access their benef ts and account information from the same place. i

Anthem Health Guide

This combination of customer service and health support offers members access to highly trained professionals (health guides) who

consult with them and provide comprehensive help. Backed by smart technology and analytics, guides are closely linked to health

professionals, such as nurses, health coaches, educators and social workers. Together, they can help members stay on top of their

heath, get more value from their benef ts and navigate the health care system more eff ciently. Members can call, request a scheduledii

call back, email or have an online chat on a computer or through our app.

New “Balance” plans from Independence Holding Company (IHC

These are complementary products designed to help members pay for high out-of-pocket costs due to accidents or critical illnesses.

Balance plans can be paired with any major medical Small Group Affordable Care Act (ACA) or transitional relief health plan, or

purchased as a stand-alone plan. Members pay a f xed amount for coverage and can use benef ts to pay for medical and non-medicalii

costs like living expenses or replacing lost wages.

Care and Cost Finder online tool

Members can use this easy online tool to make smart health care choices. Once they register at anthem.com they can compare

provider costs and look up quality ratings — all in one place. The tools lets them search for doctors, facilities and pharmacies, and

then gives cost estimates for more than 400 common medical procedures (based on their health plan) for those providers. They can

also rate a provider’s service and review ratings from other members.

LiveHealth Online

Through LiveHealth Online, members can have video visits 24/7 with board-certif ed doctors using a mobile device or computer withi

a webcam. Doctors can assess common health issues like f u or allergies. They provide a treatment plan and send prescriptions to al

pharmacy, if needed.1 Members can also talk with licensed therapists and psychiatrists. Therapists are usually available in four days or

less.2 And, Spanish-speaking doctors take appointments 7 a.m. to 11 p.m., seven days a week using Cuidado Médico.

1 Prescription availability is def ned by physician judgment. i

2 Appointments subject to availability of a therapist.

Streamlined Prescription Drug Benef ts i

Prescription drug benef ts have been streamlined under our 2019 PPO and HMO plans. Under the Specialty Rx cost share we’vei

removed the f fth cost sharing tier so that all plans now have just four cost sharing tiers under the Select formulary. As usual,i

members save money by using Level 1 pharmacies and generic drugs whenever possible.

For more details, contact your Anthem

representative or see anthem.com.

For employer groups with 2-50 employees

Ohio

2019 HIGHLIGHTS

Act Wise offers:

One-stop support from one implementation

team and one customer service number.

Easy set-up - whether it’s a new plan or a

renewal from another consumer-driven health

plan, it’s never been easier.

ACT WISE

CONSUMER-DRIVEN

HEALTH PLANS

Welcome to Anthem’s one team, one solution

consumer-driven health plan!

Act Wise makes it easier for your clients to administer

their health savings account because now Anthem

manages both the medical benef ts and the spendingi

accounts. We’re streamlining everything – for you, your

clients and even their employees.

One website and mobile app for members to

review claims in real time and access benef ti

and account information.

Simple tools and messaging to help both

employers and members understand their

coverage and manage their health benef tsi

and spending.

Working together to make health care easier for

everyone, everywhere

ANTHEM AND YOU

1 in 3 Americans are covered by a Blue

Cross and Blue Shield plan1

 More than 106 million members

 96% of hospitals in the U.S. are in

our plans

 95% of providers in the U.S. are in

our plans

Local focus in 14 states

 When using network doctors members

save big! And we reward our doctors for

the quality of care they give not the

number of patients they see. So members

get more attention and better care.

Benef ts that travel i

With the BlueCard® and Blue Cross Blue Shield Global

Core program members have access to care medically

necessary emergency and urgetn across the country

and around the world.

1 Blue Cross and Blue Shield Association website: About Blue Cross and Blue Shield Association

(accessed May 2018): bcbs.com.

1 Not available on all plans.

2 Available for iOs 9 and above and for Android versions 6 and above.

Access at-a-glance account information through

My Summary1.

touch authentication2.

Quickly ﬁnd providers or

urgent care centers.

Save their ID card to their phone or share, fax or

email an ID card directly to their provider.

Chat conﬁdentially with our Member

Services team.

Receive push alerts when there are changes to

claims or other updates.

MOBILE ANTHEM

ANYWHERE APP

The Anthem Anywhere app is better and faster than

ever, making it easy for members to manage their care

and coverage right from their smartphone.

With a quick tap, members can:

Within the United States

 No claims forms to complete.

 No payment upfront for medical services,

except for the usual out-of-pocket

expenses.



Outside of the United States

Our PPO plans also include coverage for

nonemergency care across the U.S. and while

traveling abroad.

BLUECARD® MAKES

GETTING CARE EASY

ALMOST ANYWHERE

Members take health care benef ts with them across thei

country and around the world.

The BlueCard® Program program gives members access

to doctors and hospitals almost everywhere, giving them

peace of mind that they can f nd the health care provideri

they need no matter where they are in the world.

Members are covered for medically

necessary emergency and urgent care in all

50 states, whether care is needed in a rural

or urban area.

Explanation of benef ts received from i

the members’ plan.

Members have coverage for medically

necessary emergency and urgent care with

access to doctors and hospitals worldwide

through the Blue Cross Blue Shield

Global Core program.

When a member sees a network provider

there are:

Search for doctors, specialists, hospitals,

urgent care centers and other providers in

their plan.

Rate a doctor’s service and review ratings from

other members.

CARE & COST FINDER:

BETTER CARE AT A

BETTER COST

Anthem’s Care & Cost Finder tool gives members what

they need to make smart health care choices.

And it’s easy! They can f nd a doctor, compare costs andi

look up quality ratings — all in one place. This online tool

lets them:

Use it anywhere!

Members can register or log in at anthem.com or use

our Anthem Anywhere app to start using the Care &

Cost Finder tool.

Search for pharmacies or link to Anthem

pharmacy benef ts information. i

See cost estimates for over 400 common

medical procedures (based on their health

plan) to know how much they may pay.

VISION AND DENTAL

BENEFITS FOR WHOLE-

PERSON HEALTH

Anthem Blue View VisionSM offers members access to

one of the largest networks in the nation — along with

signif cant savings. i

1 Except when discounting of non-covered services is prohibited by state law.

2 Based on the Blue View Vision plan with $10 lens copay and $130 frame allowance for glasses, or

$130 contact lens allowance.

3 AApplies to Anthem Dental Essential Choice members who are actively engaged in an Anthem Care

Management program for the following conditions: cancer, pregnancy, diabetes, certain heart

conditions, organ or bone marrow transplants, stroke, end stage renal disease (kidney disease), and

suppressed immune systems (HIV/AIDS).

38,000 doctors and 27,000 locations

40% off an additional pair of glasses from

providers in the plan1

63% average retail savings for Blue View

VisionSM members using network providers 2

Our Dental benef ts i offer members easy access to a

large number of dentists. That includes discounts and

services to help them keep up their dental health and

prevent long-term problems.

127,000 dentists and 385,000 places to

get care

35% average discount on covered dental

services when using a dentist in the plan

Extra cleaning or periodontal maintenance for

members in one of our medical care

management programs for certain conditions3

Retail and online partners

HEALTHY WAYS TO

EARN REWARDS

Our plans offer lots of ways to support members at

every stage and some provide incentives for taking

steps to stay healthy. Members can earn up to $700 a

year in rewards with these programs available on

some plans. 1, 2, 3

1 Must be 18 years of age or older to qualify.

2 A member and their covered spouse or partner can each earn up to $700 in rewards a year.

3 An employee’s child or children ages 18-26 who are covered as part of their parent’s plan are only eligible

for the gym reimbursement and may earn up to $400.

* Health Rewards card = A reloadable debit Mastercard® that's automaticaly credited when members earn

rewards. Rewards can be earned by a member and their covered spouse or partner. Must be 18 or older

to earn rewards.

Preventive Care Incentives + Fitness

 Get a preventive wellness exam and f u shot,l

get $100 on their Health Rewards Card*

 Complete tobacco-free certif cation, get $50i

on their Health Rewards Card*

 Exercise at a qualifying f tness center, geti

reimbursed up to $400 in cash*

 Use the Online Wellness Toolkit and get up to

$150 on their Health Rewards Card*

An easier approach to care

Expanded access



 24-hour phone support, seven days a week

Conﬁdential guidance

 Face-to-face counseling

 Legal and ﬁnancial consultations

 Identity monitoring

 Referrals for child and elder care

Mobile resources



Easy to implement

EMPLOYEE ASSISTANCE

PROGRAM (EAP)

Supporting members.

Building stronger companies.

Visits with a psychologist or therapist

through LiveHealth Online with an Anthem

health plan



Improves morale and productivity



Reduces risk

EAP website

Key EAP benef ts for employers i

Check eligibility.

Request ID cards.

View Summary of Beneﬁts.

View, pay and download bills.

View transaction history.

EMPLOYERACCESS

MANAGING BENEFITS

HAS NEVER BEEN EASIER

EmployerAccess is a simple and secure tool on

anthem.com that gives your clients everything they need

to manage benef ts easily and quickly - 24/7. i

They can:

Enroll and cancel members

and dependents.

Change member personal information.

To get started today, clients can sign

up at employer.anthem.com.

Improving care while keeping costs down

Enhanced Personal Health Care (EPHC) holds providers

accountable for cost and quality outcomes. This

patient-centered approach:

Rewards doctors for managing and improving

overall patient health, meeting quality

standards and lowering costs

Improves patient experience with 24/7

access to care, extended ofﬁce hours,

same-day and weekend appointments, better

phone and email access to doctors

Why EPHC matters

}

}Better disease management and care coordination that

can reduce hospitalizations and unnecessary tests

ENHANCED PERSONAL

HEALTH CARE

* Cost and utilization metrics based on a difference in difference analysis of members with a relationship

to an EPHC provider compared to a matched sample control group. Data range from 4/1/13 - 9/30/16.

1 Per attributed member per month. Gross medical savings. Net savings is $10.39 after provider gain

share and clinical coordination payments. Excludes RX.

Gives providers support, data and incentives to

help them deliver improved care coordination

that’s more eff cient and effective i

The results*

$15.42 (4.1%) savings per member per month1

1.9% savings on ER visits

8.9% savings on inpatient care

5.8% savings in outpatient surgery costs

7.6% decrease in inpatient admissions

Better health outcomes for

and lower costs for your clients

Personalized customer service and care support

Our guides work closely with health care professionals

and offer support needed like:

Reminders for preventive and

follow-up care

Resources for comparing costs, ﬁnding

in-network doctors and more

Clinical alerts for care gaps and savings on

services and medications.

MEET ANTHEM

HEALTH GUIDE

With Anthem Health Guide, members have access to

highly-trained professionals, backed by smart

technology and analytics. This helps them stay involved

in their health, get more value from their benef ts andi

navigate the health care system more eff ciently.i

Members can call, request a scheduled call back, email

or have an online chat on a computer or through our

app.

Cancer support for members, family

members and caregivers through treatment

Behavioral health support for members or

family members with mental health, drug and

alcohol abuse or other personal issues

HELP MEMBERS BE

THEIR HEALTHY BEST

These resources help members get support for every

life stage.

24/7 NurseLine

 Round-the-clock answers to health questions

 Help deciding where to go for care

Future Moms

 Education and support during pregnancy

 Assessments to help f nd risks i

 Nurses on call for questions and follow-up

throughout pregnancy

 Breastfeeding support through

LiveHealth Online

MyHealth Advantage

 Claims reviewed for gaps in care and

health risks

 Conf dential MyHealth Note sent toi

members offering suggestions to

improve health

Condition Care

 Support for members with a

chronic condition

 Personalized plan from a nurse coach and

team of specialists

Case Management

 Proactive outreach to members who are

hospitalized or have a serious illness

 Support from a nurse care manager and

other health professionals

Here’s how it works:

Balance plans can be paired with any

major medical Small Group Affordable Care

Act (ACA) or transitional relief health plan, or

purchased as a stand-alone plan.

Beneﬁts can be used to pay for medical and

nonmedical costs like living expenses or

replacing lost wages.

NEW BALANCE PLANS —

MORE COVERAGE FOR

UNEXPECTED COSTS

Anthem has arranged with the IHC Group

(Independence Holding Company) to offer Balance -

complementary products designed to help members

pay for high out-of-pocket costs due to accidents and

critical illnesses.

Members pay a f xed amount for coverage. i

For additional details please contact

your Anthem broker or visit

anthem.com.

ADDED PROTECTION FOR

MEMBERS

Dedicated team of disability case managers,

nurses and health coaches.

Personalized claim support and stay-at-work

programs help those with disability claims get

back to work quickly and safely.

Resource Advisor offers counseling on

emotional, f nancial and legal concerns, andi

identity theft recovery.

Travel assistance with emergency medical

assistance covers members when traveling more

than 100 miles from home.1

Benef ciary Companioni offers support for

handling estate details.

Disability claims processing time is 7.3 days

or less with 99.8% accuracy.

These benef ts can be offered on a voluntary basis toi

help your clients save on premium costs

Your clients can offer 100% employee-paid voluntary

dental, vision, life and disability plans. They pick the

plan design and their employees pay premiums at

affordable group rates.2

Life and disability benef ts are easy to add, easy toi

manage. Here's a sample of what's included:

1 Travel assistance available to clients with life benef ts. i

2 Minimum voluntary participation requirements: dental/vision = 5 enrollees, life/disability =

10 enrollees.

Why LiveHealth Online?

LIVEHEALTH ONLINE:

ACCESS TO CARE

ANYTIME, ANYWHERE

 Convenience. Access to care right from

the home or off ce. i

 Choice. Members can select from a range

of doctors and therapists.

 Cost. Depending on the health plan,

members pay $49 or less per visit1 to see a

doctor, and visits with a therapist or

psychiatrist cost about the same as an

off ce therapy visit. i

Members can use LiveHealth Online to have video visits

with board-certif ed doctors from a computer with ai

webcam or mobile device. In minutes, doctors can

address common health issues such as colds, allergies

and headaches. They’ll then assess conditions, provide a

treatment plan and send prescriptions to a pharmacy, if

needed. Spanish-speaking doctors are available by

appointment from 7 a.m. to 11 p.m., 7 days a week using

Cuidado Médico.

LiveHealth Online also has professionals available to

address mental health, allergies, wellness, and some

that specialize in kids’ health. Members can see a

licensed therapist or board certif ed psychiatrist in justi

a few days.1

Members can register at

livehealthonline.com or download the

free mobile app.

1 Appointments subject to availabiity of the mental health professional.

Vision and hearing

Fitness and health

Family and home

Medicine and treatment

*All discounts are subject to change without notice.

SPECIALOFFERS@

ANTHEMSM FOR

HEALTHY SAVINGS*

With SpecialOffers@AnthemSM, members get discounts on

products and services that promote better health and

well-being. Here’s a peek at the perks:

See the discounts

Members can log in to anthem.com and select

Discounts.

 Jenny Craig®

 GlobalFit™

 FitBit

 SelfHelp Works

 1-800 CONTACTS®

 Premier LASIK

 Puritan’s Pride

 Allergy Control products

 WINFertility®

 Safe Beginnings®

 ASPCA Pet Health Insurance

LET’S DO THIS, TOGETHER

Choosing a health plan isn’t easy, but we want it to be. The plans you’re about to see have been

created to be easy for you to quote and administer and easy for your clients and their employees

to use.

Select the links below to view Anthem’s products for 2019.

As you view our portfolio, you’ll see all types of plan designs that are as unique and different as

your clients.

Medical plan grid

Dental plan grid

Vision plan grid

Life & Disability plan grid