Anthem Extras Packages for Seniors Talking Points and Frequently Asked Questions FOR VIRGINIA Background Anthem is proud to announce the availability of Anthem Extras Packages for Seniors, providing coverage for dental and vision 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 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 What s included in the packages? There will be a choice of three packages available: Senior Standard Dental our basic package includes: Preventive dental Standard vision plan Senior Premium Dental our medium package, includes: Preventive dental, coverage for fillings, periodontal services, root canals and extractions Standard vision plan Senior Premium Plus Dental our most robust package, includes: Comprehensive dental More robust vision In addition, the dental portion of the Senior Premium Plus Dental package can be purchased on a stand-alone basis! 1
How much do the packages cost? The following rates for Virginia plans are effective 10/1/17 and are subject to change: Senior Standard Dental Senior Premium Dental Senior Premium Plus Dental Senior Premium Plus Dental Only $19 $32.55 $47.05 $41 About the dental benefits: Dental benefits range from basic to comprehensive. The 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). DENTAL Senior Standard Dental Senior Premium Dental Senior Premium Plus Dental 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 Premium Plus Dental Only can be purchased separately from the Senior Premium Plus Dental package, if desired. 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. 2
About the vision benefits: VISION Routine exams Frames Lenses Elective contact lenses (in lieu of eyeglasses lenses) Senior Standard Dental Once every 12 months $100 allowance $80 allowance Senior Premium Dental Once every 12 months $100 allowance $80 allowance About the lens benefit: Factory scratch coating included on all covered lens purchases Transitions lenses available for adults for a fixed fee of $75 Senior Premium Plus Dental Once every 12 months $10 copay $130 allowance $10 copay $80 allowance 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
Frequently Asked Questions Q. Can Anthem Extras Packages be sold with Medicare Advantage plans? A. No. Anthem Extras Packages can only be purchased by Medicare Supplement and/or Medicare Part D customers on a stand-alone basis. They cannot be combined with Medicare Advantage Plans. 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 Senior Premium Plus Dental Only 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 Senior Premium Plus Dental 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 Dentist s charge: $1,200 Anthem s maximum allowed amount: $800 Anthem pays 50%: $400 You pay 50% (coinsurance): $400 Balance you owe the provider: $1,200 - $800 = $400 Your total cost: $400 coinsurance + $400 provider balance = $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 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. No. Simply indicate on the application how often you would like to be billed (monthly, quarterly, semi-annually, annually) or if you would like to have payments automatically drafted from your checking account. Q. Is underwriting approval needed to purchase an Anthem Extras Package or a Senior Premium Plus Dental Only plan? A. There is no underwriting for these products. 5
Q. If a medical member wants to add an Anthem Extras Package or a Senior Premium Plus Dental Only plan, 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 a Senior Premium Plus Dental Only plan 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 until 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 Senior Premium Plus Dental Only plans. Q. My member has a customer service issue who can they call? A. Members can contact customer service at the numbers listed below: Dental customer service: (877) 391-3897 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 Senior Premium Plus Dental Only plans will be billed separately from our medical plans. 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 Senior Premium Plus Dental Only plans will have separate ID cards from our medical plans. 6
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 plans. 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. 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 registered marks of the Blue Cross and Blue Shield Association. 09/17 7