Anthem Extras Packages for Seniors Talking Points and Frequently Asked Questions FOR OHIO Background Anthem is proud to announce the availability Anthem Extras Packages for Seniors, providing coverage for dental, vision and other valuable benefits in one convenient package! Packages will be available in Ohio for effective dates of 4/1/11 and later. The market need Health and related insurance coverage is confusing to most consumers, and offering a streamlined package makes purchasing dental, vision and other benefits simpler There is a consumer desire for vision insurance, but it is not widely available in the marketplace today Package rationale Provides savings and convenience of one point of contact for the consumer By offering three levels of packaging, we ensure that there are choices to fit each member s budget and their product needs Increases earning potential for agents, as they can sell multiple products with one transaction. * Launch date pending regulatory approval. What is included in the packages? There will be a choice of three packages available: Standard our basic package, includes: Preventive dental Standard vision plan Premium our medium package, includes: Preventive dental, coverage for fillings, periodontal services, root canals and extractions Standard vision plan Premium Plus our most robust package, includes: Comprehensive dental More robust vision In addition, the dental portion of Premium Plus package can be purchased on a stand-alone basis!
How much do the packages cost? The following rates are effective 2/1/16, and are subject to change: State Standard Package Premium Package Premium Plus Premium Plus Package Dental Ohio $22 $31 $45 $40 About the dental benefits: Dental Benefits range from basic to more comprehensive. All plans utilize the Dental Blue 200 network and have in-network and out-of-network benefits at the same level (though there could be balance billing with out-of-network providers). Additional benefits for diabetic members Research has shown that there is an association between periodontal diseases and other chronic inflammatory conditions, such as diabetes, cardiovascular disease and Alzheimer s disease. 1 People with diabetes are more likely to get infections, which makes them more likely to get gum disease. 2 That is why third cleaning or periodontal maintenance procedures are covered for diabetic members on all of our Anthem Extras Packages plans. 1-www.perio.org, May 2010 2-National Institute of Dental and Craniofacial Research Website, May 2010. 2
All packages include emergency dental treatment for the international traveler All Anthem dental members and their eligible dependents have access to comprehensive emergency dental benefits while working or traveling nearly anywhere in the world. Participating dentists are credentialed, speak English and meet the requirements to practice dentistry in their home countries. Emergency dental care received from an International Emergency Dental Program dentist is reimbursed in full and does not count against the member s annual plan maximum. Claims are paid directly to the member in U.S. currency, since the patient pays the bill at the time services are rendered. The International Emergency Dental Program is administered by DeCare Dental. DeCare Dental is an independent company offering dental administrative services to Anthem Blue Cross and Blue Shield. About the vision benefits: Vision is covered in all three packages. About the lens benefit: Standard plastic single vision, bifocal or trifocal included Factory scratch coating included Transitions lenses available for adults for a fixed fee of $75 Standard Progressives available for an add-on fee to the bifocal of $65 Other lens upgrades available for negotiated rates Additional Savings Program: Through our Additional Savings program, members save 15% to 40% on non-covered materials such as extra pairs of eyewear, a number of non-prescription sunglasses, and other popular accessories. About the vision network: The Blue View Vision network offers access to more than 50,000 providers and provider locations nationwide including independent optometrists and opthalmologists, as well as popular retailers: 3
Frequently Asked Questions Q. Can Anthem Extras Packages be sold with Medicare Advantage plans? A. Anthem Extras Packages were designed to complement our Medicare Supplement plans. For Medicare Advantage customers, we have Optional Supplemental Benefit packages. Q. Do brokers need a scope of appointment to sell Anthem Extras Packages? A. No. However, if the customer would like to learn about Medicare Advantage or Medicare Part D, this discussion will need a scope of appointment, and the broker and the prospect will need to wait the required 48 hours to have the discussion. Q. Who can brokers call to check the status of an enrollment, verify coverage, or for other assistance? A. Brokers can call (877) 391-3897 for more information on Anthem Extras Packages and our Premium Plus Dental plans. Q. How do I find a participating dental provider? A. To see if your dentist is in our current network, visit our website, www.anthem.com. When prompted, choose the Dental Blue 200 dental network. If you prefer, you can contact our customer service center at 877-391-3897 for assistance. Q. Can members receive services from out-of-network dentists? If so, is there a difference in cost? A. Yes, members can receive dental services from dentists that are not in our network. However, there may be additional costs. The amounts we pay for dental services are based on a fee schedule (for example, the fee schedule shows that we will pay no more than $50 per filling or $25 for an office visit). The fee that Anthem pays for each out-of-network service is called the maximum allowed amount for that service. The maximum allowed amount is determined in one of the following ways: Out-of-network dental fee schedule/rate developed by Anthem, which may be updated based on things like reimbursement amounts accepted by dentists contracted with our dental plans, or other industry cost, reimbursement and utilization data Information provided by a third-party vendor that gathers similar costs for dental services In-network dentist fee schedule Here is an example of how the math would work for a Premium Plus member who receives a crown from an out-of-network dentist. Ted gets a crown from an out-of-network dentist, who charges $1,200 for the service and bills Anthem for that amount. Anthem pays $800 as the maximum allowed amount for this dental service. That means there will be a $400 difference, which the dentist can balance bill Ted. Since Ted will also need to pay $400 coinsurance, the total he ll pay the out-of-network dentist is $800. 4
Here s the math: Participating Dentist Non-Participating Dentist Dentist s charge $1,200 $1,200 Anthem s maximum allowed amount Anthem pay s 50% of maximum allowed amount Member pays 50% coinsurance Balance the member owes the provider $800 $800 $400 $400 $400 $400 $0 $1,200 - $800 = $400 Member s total cost $400 $800 In this case, if the member had seen an in-network provider, their cost would have only been $400 since they would not have been balanced billed the additional $400. This is an example only. The member s experience may be different, depending on their insurance plan, the services they receive and who provides the services. Q. How do I learn more about the International Emergency Dental Program? A. Members can download our International Emergency Dental Program flyer from the Anthem Extras Packages microsite: www.anthem.com/anthemextraspackages. The flyer includes a cut-out card they can take along with them on their trip. Q. What services are reimbursable under the International Emergency Dental Program? A. Only emergency treatments are covered under this plan. Emergency treatment is defined as dental services to: Treat or control acute infections Treat injuries to, or trauma of the teeth and/or supporting structures. Examples of dental injuries include enamel fracture, crown fracture and root fracture Relieve acute pain (not chronic pain or continuing undiagnosed pain) with palliative measures Identify the source of pain, the extent of trauma or the source of infection (diagnostic services) Determine the extent of a dental emergency via examination 5
Q. How do diabetic members access their third cleaning or periodontal maintenance procedure? A. Diabetic members can download a sign-up form from the Anthem Extras Packages microsite: www.anthem.com/anthemextraspackages. The form includes instructions on what to do. Q. How do I find a participating vision provider? A. To see if your vision provider is in our current network, visit our website, www.anthem.com. Click on Find a Doctor and choose your state. When prompted, choose the Blue View Vision network and complete your search. Q. Can I use my vision benefits at an out-of-network provider? A. Anthem Extras Packages members can see any vision provider. For out-of-network claims, members pay the provider at the time of service, and then submit a claim form for reimbursement to: Vision Claims PO Box 8504 Mason, OH 45040-7111 Q. How do I apply for membership in an Anthem Extras Package? A. To apply for membership in an Anthem Extras Package or a stand-alone dental plan, complete the Anthem Extras Packages application and send it back to us with payment for the first month s premium at: Anthem Blue Cross and Blue Shield P.O. Box 5028 Denver, CO 80217-5028 Applications can also be faxed to (877) 238-1107. Q. Do I have to include my first month s payment with the application? A. Yes. Applications received without payment will not be processed until payment is received. If you are faxing an application, please include a copy of the check. 6
Q. Is underwriting approval needed to purchase an Anthem Extras Package or a Premium Plus Dental Plan? A. There is no underwriting for these products. Q. If a medical member wants to add an Anthem Extras Package or Premium Plus Dental, can they do it at any time or do they have to do it within 30 days of their effective date with medical? Is there a separate application for this that they have to complete? A. Members can purchase Anthem Extras Packages or Premium Plus Dental at any time, regardless of their medical effective date. They will need to complete an application for the new products. Q. If an Anthem Extras Package member drops their plan during the year, do they have to wait till the next enrollment to sign back up? A. Members who drop their plan and then change their mind, can re-enroll at any time in any of the products. However, they may need to satisfy waiting periods again. Q. How do brokers receive credit for a sale? A. To receive credit for a sale, licensed brokers will need to sign, date, and include their agency s information in the Agent Certification section of the Anthem Extras Packages application: Q. Do brokers receive commission based on the total premium for the package? A. Yes, however, broker commissions for Anthem Extras Packages are broken into three components dental, vision and medical. All non-dental and non-vision package features are grouped into the medical category. Q. My prospect has questions about the Anthem Extras Packages who can they call? A. Non-members can call (877) 391-3897 for more information on Anthem Extras Packages and our Premium Plus Dental plans. 7
Q. My member has a customer service issue who can they call? A. Members can contact customer service at the numbers/urls listed below: Dental customer service (866) 589-0578 Vision customer service: (866) 723-0515 Q. Will members with both an Anthem Extras Package and a Medicare Supplement plan receive separate bills for these products? A. Yes, Anthem Extras Packages and Premium Plus Dental will be billed separately from our medical plans. Q. Can members combine payment for both their Anthem Extras Package and Medicare Supplement plan on one check? A. No, payment for Anthem Extras Packages and Medicare Supplement plans must be made separately. Q. Will members with both an Anthem Extras Package and a Medicare Supplement plan receive separate ID cards for these products? A. Yes, Anthem Extras Packages and Premium Plus Dental will be have separate ID cards from our medical plans. Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are the registered marks of the Blue Cross and Blue Shield Association. 8