Anthem Extras s for Seniors Talking Points and Frequently Asked Questions FOR CALIFORNIA Background Anthem is proud to announce the availability of Anthem Extras s for Seniors, providing coverage for dental, vision and other valuable benefits in one convenient package! 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 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 What s included in the packages? There will be a choice of three packages available: Standard our basic package, includes: Preventive dental Standard vision plan Premium (with or without ) our medium package, includes: Preventive dental, coverage for fillings, periodontal services, root canals and extractions Standard vision plan Available with or without (with or without ) our most robust package, includes: Comprehensive dental More robust vision Available with or without may be included in our Anthem Medicare Supplement plans. Both our Premium and packages are available with or without this added benefit. In addition, the dental portion of the Standard, Premium and packages can be purchased on a stand-alone basis! 1
How much do the packages cost? The following rates for California plans are effective 1/1/18, and are subject to change: Standard Premium with Premium without with without Senior Standard Dental Senior Premium Dental Senior Dental $25 $43 $38 $61 $56 $18.48 $31.48 $46.66 About the dental benefits: Dental benefits range from basic to more comprehensive. All plans utilize the Dental Blue 100 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). DENTAL Standard Premium Annual Maximum $500 $1,000 $1,250 Deductible Diagnostic and preventive care 2 exams, 2 cleanings, 1 set of X-rays per year Fillings Periodontal Services, root canals (endodontics) and extractions (oral surgery) No Deductible $50, waived for exams, cleanings and X-rays $50, waived for exams, cleanings and X-rays 100% 100% 100% Not covered Not covered 80% (6-month waiting period) 50% (12-month waiting period) Crowns, denture and bridges (prosthodontics) Not covered Not covered Out-of-network reimbursement Paid based on a Maximum Allowable Amount fee schedule 80% (6-month waiting period) 50% (12-month waiting period) 50% (12-month waiting period) Senior Standard Dental, Senior Premium Dental and Senior Dental have the same dental benefits (except vision) and can be purchased separately from the Standard, Premium and packages, if desired. 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 make 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 s 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. About the vision benefits: Vision is covered in all three packages. VISION Routine exams Frames Lenses Elective contact lenses (in lieu of eyeglasses lenses) Standard Premium Once every 12 months $20 copay $100 allowance $20 copay $80 allowance Once every 12 months $20 copay $100 allowance $20 copay $80 allowance Once every 12 months $10 copay $130 allowance $10 copay $80 allowance 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 ophthalmologists, as well as popular retailers: 3
About the extras: Other services vary by package. Standard Premium with Premium w/o wtih w/o OTHER Travel Assistance Not included Access to all equipment/amenities in a basic fitness membership at over 11,000 locations Not included Not included Not included Not included Access to all equipment/amenities in a basic fitness membership at over 11,000 locations Pre-departure info, emergency medical evacuations and other valuable services when traveling Not included Pre-departure info, emergency medical evacuations and other valuable services when traveling Frequently Asked Questions Q. Can Anthem Extras s be sold with Medicare Advantage plans? A. Anthem Extras s 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 s? 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 s and our Senior Standard Dental, Senior Premium Dental and Senior 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/ca. When prompted, choose the Dental Blue 100 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. 4
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 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. IN-NETWORK DENTIST OUT-OF-NETWORK DENTIST HERE S THE MATH Dentist s charge $1,200 $1,200 Anthem s maximum allowed amount $800 $800 Anthem pays 50% of maximum allowed amount $400 $400 Member pays 50% coinsurance $400 $400 Balance the member owes the provider $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. 5
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association. 12225CAMENABC Rev. 5/10 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* 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 * The following are considered dental injuries or trauma: enamel fracture; crown fracture; root fracture; crown-root fracture; luxation; avulsion; or fracture of the alveolar process (mandibleor maxilla). *Academy of General Dentistry, www.knowyourteeth.com, September 16, 2009 11396CAMENABC Rev. 6/10 The following are not considered emergency treatment services: Periodic examinations Preventive dental services (dental prophylaxis, topical fluoride treatment, sealants, space maintenance) Basic restorative dental services in the absence of pain, trauma, or acute infection Major restorative dental services in the absence of pain, trauma, or acute infection Periodontics Prosthodontics Implants Orthodontics 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 s microsite: www.anthem.com/ca/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 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 s microsite: www.anthem.com/ca/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/ca. 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 s 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 Emergency dental treatment for the international traveler Whether you re on that long-awaited vacation or just working abroad, the last thing you need to wonder about is where to go for emergency dental treatment. With dental coverage from Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company you don t have to worry. As an Anthem dental member, you and your eligible, covered dependents automatically have access to the International Emergency Dental Program administered by DeCare Dental, a separate company that administers dental benefits for Anthem members. With this program, you may receive emergency dental care from our listing of credentialed, English-speaking dentists while traveling or working abroad. Dental emergencies usually include the unexpected onset of a tooth injury or tooth pain. See the covered services listed on the wallet card below. Here s how your coverage works. If you need emergency dental care while traveling internationally, call our international service center right away. (The attached card gives complete details on how to make that call.) Our Englishspeaking customer service representatives can help you find a dentist. And they can even assist with translation services when contacting the dentist s office. COVERED SERVICES Only emergency treatment is a covered service under this plan. Visit our website for a list of participating dentists. For a complete listing of participating dentists, visit www.decare.com. Under the drop-down menu on the left, select DeCare Dental Products, then International Dental Program. From there you can review our list of participating dentists in the International Emergency Dental Program section. Payment of care Please pay the dentist directly and ask for a receipt. Then, print a claim form from our website (www.decare.com) and submit the completed form along with the receipt to the address listed on the claim form. Claims are paid directly to members in U.S. currency, since the patient pays the bill at the time services are rendered. Please note that emergency dental care received from an International Emergency Dental Program dentist is reimbursed in full and is not calculated into your annual plan maximum. Your claim will be paid at an out-of-network level if you: } Receive emergency dental care out of the country from a dentist who is not in the International Emergency Dental Program } Receive non-emergency dental care from any dentist outside of the United States Emergency dental care is available 24-hours a day, 365-days a year. For easy access to the International Emergency Dental Program cut out the card below, fold it in half and carry it with you while traveling outside of the United States. The International Emergency Dental Program is administered by DeCare Dental. No such relationship other than that of independent parties under an arrangement with each other solely for the purposes of providing dental care to Anthem Blue Cross/Anthem Blue Cross Life and Health Insurance Company members may be deemed to exist between DeCare Dental and participating dentists. DeCare Dental is an independent company offering dental administrative services to Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company plans. DeCare Dental does not offer Blue Cross products or services. DeCare Dental is solely responsible for its products and services. Diabetics should take special care of their teeth and gums. Find out why and then sign up for extra dental benefits at no extra cost using the form below. LOCATE AN INTERNATIONAL DENTIST Please note: This number is NOT toll-free. If you are using an international calling card, please follow the card s specific instructions first. STEP 1: Are you in a hotel, office building or other location that requires you to dial a specific number to dial out? If so, do this first. STEP 2: To find a dentist for emergency dental treatment, dial the outbound calling code for the country where you are located. (For example, Switzerland is 00) plus 353-94-9372257 If calling from Ireland, dial 0-94-9372257 (24-hours a day) CLAIm INquIRIES ONLy (IN ThE usa) 1-800-371-6561 Diabetes and your dental health If you have diabetes, you already know how important it is to take care of your body and monitor sugar levels. But there s more to it than just watching what you put in your mouth. You need to take special care of your mouth itself which includes your teeth and gums. Here s why. People with diabetes are more likely to get infections, which makes them more likely to get gum disease.* Diabetics with gum disease have a harder time controlling their sugar levels because infection can cause high blood sugar levels.* Your Anthem Blue Cross dental plan helps you take extra good care of your mouth. Taking care of your teeth and gums is easy and can help keep your mouth free from infection. You should brush and floss daily, and see your dentist regularly. And while your dental plan most likely provides coverage for preventive care services, by completing the form below, you can get coverage for an extra dental cleaning (to help keep your teeth healthy) or an extra periodontal maintenance procedure (to help keep your gums healthy) each year. For a healthy smile, sign up here. Simply complete the information below and mail, e-mail or fax it to us whichever is easiest for you. Mail: Anthem Blue Cross, 233 S. Wacker Drive, Suite 3700, Chicago, Illinois 60606 Attention: Clinical Integration Coordinator E-mail: YourOralHealth@anthem.com Fax: 877-261-2131 Dental enrollment form The extra dental benefit for diabetic members does not apply to all dental plans. Call the customer service number on the back of your identification card or check your benefits contract to determine if this benefit applies to your dental plan. Member name: Member address: Member phone number: (h) (w) Subscriber name: Subscriber ID number: Group (plan) number: Group name: Member signature: Today s date: I hereby certify that I am being treated for diabetes and will provide proof of such condition if requested by Anthem Blue Cross. Additionally, upon request, I will provide a written authorization to Anthem Blue Cross to obtain medical records from my provider(s). If such condition cannot be verified, I will not be eligible for coverage for the additional dental procedures available under this program. Name of primary doctor: Doctor s phone number: Questions? Just contact the phone number on the back of your Anthem ID card. Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association. 6
Q. What services are included in the Program? A. The program provides members with: Access to all equipment/amenities in a basic membership at participating facilities classes taught by certified instructors Health education seminars Social activities senior prom, potlucks, birthday parties Q. How do I find a participating location? A. There are more than 11,000 locations across the nation that offer the Fitness Program. To find one near you, visit www.silversneakers.com. Q. What if there are no participating locations near me? A. Members who live more than 15 miles away from a participating fitness facility can sign up for the Steps program. Steps program members receive: A pedometer Exercise bands DVD Enhanced walking program Access to Fitness Program website with online tools Q. What services are included in the Travel Assistance program? A. Members who have an emergency medical situation while traveling abroad can receive assistance with a host of services, including: Coordinating and paying for medical evacuation to the nearest appropriate treatment facility or back home when medically necessary Scheduling a bedside visit for a family member or friend if the member is hospitalized for more than seven days, or if he/she is in critical condition Receiving assistance in replacing lost prescription medications or contact lenses while traveling Q. How do members access the Travel Assistance program? A. Members who need assistance can call our assistance coordination line 24 hours a day, 7 days a week. Members simply call the number listed on their ID card if their plan includes Travel Assistance. Q. How do I apply for membership in an Anthem Extras? A. To apply for membership in an Anthem Extras or a stand-alone dental plan, complete the Anthem Extras s application and send it back to us with payment for the first month s premium at: Anthem Blue Cross P.O. Box 5028 Denver, CO 80217-5028 Applications can also be faxed to (877) 238-1107. 7
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. Q. Is underwriting approval needed to purchase an Anthem Extras or a Senior Standard Dental, Senior Premium Dental or Senior Dental plan? A. There is no underwriting for these products. Q. Do brokers receive commission based on the total premium for the package? A. Yes, however, broker commissions for Anthem Extras s 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 s who can they call? A. Non-members can call (877) 391-3897 for more information on Anthem Extras s and our Senior Standard Dental, Senior Premium Dental and Senior Dental plans. 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: (888) 209-7852 Vision customer service: (866) 723-0515 : (888) 423-4632 www.silversneakers.com Travel Assistance: (800) 698-5741 Q. Will members with both an Anthem Extras and a Medicare Supplement plan receive separate bills for these products? A. Yes, Anthem Extras s and Senior Standard Dental, Senior Premium Dental and Senior Dental plans will be billed separately from our medical plans. Q. Can members combine payment for both their Anthem Extras and Medicare Supplement plan on one check? A. No, payment for Anthem Extras s and Medicare Supplement plans must be made separately. Q. Will members with both an Anthem Extras and a Medicare Supplement plan receive separate ID cards for these products? A. Yes, Anthem Extras s and Dental will have separate ID cards from our medical plans. The International Emergency Dental Program is administered by DeCare Dental. DeCare Dental is an independent company offering dental administrative services to Anthem Blue Cross. Travel Assistance is provided by HTH Worldwide, and The Fitness Program is provided by Healthways, Inc. Both HTH Worldwide and Healthways, Inc. are independent companies not affiliated with Anthem Blue Cross, and the services provided are not part of the insurance coverage provided by Anthem Blue Cross. Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 09/17 8