Anthem Extras Packages for Seniors

Transcription

1 Anthem Extras s for Seniors Talking Points and Frequently Asked Questions FOR MISSOURI AND WISCONSIN 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! s will be available in Missouri and Wisconsin for effective dates of 3/1/11 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 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 SilverSneakers ) our medium package, includes: Preventive dental, coverage for fillings, periodontal services, root canals and extractions Standard vision plan Older Adult Care Support Resources and Member Assistance Program Available with or without SilverSneakers (with or without SilverSneakers) our most robust package, includes: Comprehensive dental More robust vision Older Adult Care Support Resources, Member Assistance Program and Travel Assistance Available with or without SilverSneakers SilverSneakers 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 package can be purchased on a stand-alone basis! 1

2 How much do the packages cost? The following rates for Missouri plans are effective 9/1/16, and are subject to change: Standard Premium Premium without SilverSneakers without SilverSneakers Dental Only $22 $42 $37 $53 $48 $36 The following rates for Wisconsin plans are effective 9/1/16, and are subject to change: Standard Premium Premium without SilverSneakers without SilverSneakers Dental Only $24 $43 $38 $57 $52 $42 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). 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 Dental Only can be purchased separately from the package, if desired. 80% (6-month waiting period) 50% (12-month waiting period) 50% (12-month waiting period) 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 May National Institute of Dental and Craniofacial Research Website, May

3 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

4 About the extras: Other services vary by package. OTHER SilverSneakers Older adult care Member Assistance Program services Travel Assistance Standard Not included Not included Not included Premium Access to all equipment/amenities in a basic fitness membership at over 11,000 locations Premium w/o SilverSneakers Not included Access to all equipment/amenities in a basic fitness membership at over 11,000 locations w/o SilverSneakers Not included Comprehensive and personalized senior care plans delivered telephonically Emotional and behavioral health consultations, financial and legal consultations and more Not included Not included Not included Pre-departure info, emergency medical evacuations and other valuable services when traveling 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) for more information on Anthem Extras s 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, When prompted, choose the Dental Blue 200 dental network. If you prefer, you can contact our customer service center at (877) for assistance. 4

5 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 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 pay s 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

6 * 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 and Blue Shield 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 Blue Shield plans. DeCare Dental is solely responsible for its products and services. 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. 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), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees 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 ANMENABS Rev. 10/11 *Academy of General Dentistry, September 16, 2009 Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, 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. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (serving Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ( BCBSWi ) underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ( Compcare ) underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees 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 ANMENABS Rev. 6/10 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/anthemextraspackages. The flyer includes a cutout 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 Emergency dental care for the world traveler Whether you re on a vacation or just working abroad, the last thing you need to worry about is where to go for emergency dental care. With dental coverage from Anthem Blue Cross and Blue Shield (Anthem), you don t have to worry. As an Anthem dental member, you and your family have access to the International Emergency Dental Program.* Anthem offers you this program through DeCare Dental. With this program, you may get emergency dental care from our list of credentialed, English-speaking dentists while traveling or working abroad. Program services are listed on the wallet card below. Here s how it works. If you need emergency dental care while traveling abroad, call us right away. (The attached card gives details on how to make that call.) Our English-speaking customer service reps can help you find a dentist. And they can even help with translation services when you call the dentist s office. Visit our website for a list of participating dentists. For a list of participating dentists, visit Under the drop-down menu on the left, choose DeCare Dental Products, then International Dental Program. From there you can check our list of participating dentists in the International Emergency Dental Program section. Payment for care. Please pay the dentist and ask for a receipt. Then, print a claim form from our website at and send the filled out form with the receipt to the address listed on the claim form. Claims are paid to members in U.S. funds. Please note that emergency dental care received from a dentist in this program is paid back in full and is not part of your yearly plan limit. Your claim will be paid at an out-of-network level if you: Get emergency dental care out of the country from a dentist who is not in this program Get dental care that is not an emergency from any dentist outside of the U.S. Emergency dental care is offered 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 you travel outside of the U.S. Program services Only emergency care is provided by this program. Emergency care means dental services to: How to find a dentist in the country you are visiting Please note: This number is NOT toll-free. If you are using an international calling card, please follow the steps on the card first. Step 1: If you are in a hotel, office building or other place where you need to first press a number to make a call, do this first. Step 2: Then press the outbound calling code for the country you are calling from. (For instance, Switzerland is 00) plus If calling from Ireland, press (24-hours a day) Claim questions only (in the U.S.) *Dental injuries or trauma include: These are not emergency care services: 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: 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, 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 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. 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 and Blue Shield 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, or fax it to us whichever is easiest for you. Mail: Anthem Blue Cross and Blue Shield, 233 S. Wacker Drive, Suite 3700, Chicago, Illinois Attention: Clinical Integration Coordinator YourOralHealth@anthem.com Fax: 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 and Blue Shield. Additionally, upon request, I will provide a written authorization to Anthem Blue Cross and Blue Shield 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. 6

7 Q. What services are included in the Member Assistance Program? A. Through our Member Assistance Program, members can receive telephonic or in-person consultations on emotional and behavioral health issues, financial and legal consultations, eldercare support and mediation services. We also offer a robust website with a whole host of resources. More information on these services are listed below: Emotional and Behavioral Health Telephone consultations 24/7 toll-free telephone access to licensed mental health professionals. Clinical consultations Up to three face-to-face or telephonic consultations per incident with mental health professionals for life management concerns. Financial and Legal Support Financial consultation One minute telephonic consultation with a financial counselor per separate financial issue such as credit issues, bankruptcy and investment planning. Legal consultation One 30-minute telephone consultation per separate legal matter for issues including divorce, wills, advance directives, estate issues, real estate, bankruptcy, identity theft, etc. Continued services are offered at a discounted rate. Older Adult Care Support Resources Older adult care resource and referral Online referrals, tips and brochures on a variety of elder care topics including Elder Care Safety, Nursing Home Alternatives and Geriatric Illnesses. Care coaching Telephonic assessment of elder care needs, care plan and follow-up. Discounted fee for ongoing follow-up/management. Additional Resources Mediation services One 30-minute personal mediation session, per separate issue (e.g., consumer issues, divorce/custody, landlord/tenant disputes). Discounted rates on continued services. Resource finder Online convenience services and education options, volunteer opportunities and a library of information on topics such as consumer resources, relocation, and health and wellness. Additional online resources, including: Legal and financial tools and calculators State-specific forms including wills, power of attorney, advance directives, etc. Links and resources for retirement, grand parenting, Medicare/Medicaid information, senior well-being and safety and housing and community resources Provider databases for dependent care Q. How do members access the Member Assistance Program benefits? A. To access the Member Assistance Program, members simply call (800) , or log on to 7

8 Q. What services are included in the SilverSneakers Program? A. The SilverSneakers program provides members with: Access to all equipment/amenities in a basic membership at participating facilities SilverSneakers classes taught by certified instructors Health education seminars Social activities senior prom, potlucks, birthday parties Q. How do I find a participating SilverSneakers location? A. There are more than 11,000 locations across the nation that offer the SilverSneakers Fitness Program. To find one near you, visit Q. What if there are no participating SilverSneakers 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 SilverSneakers Fitness Program Web site 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 and Blue Shield P.O. Box 5028 Denver, CO Applications can also be faxed to (877) 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. 8

9 Q. Is underwriting approval needed to purchase an Anthem Extras or a Dental Plan? A. There is no underwriting for these products. Q. If a medical member wants to add an Anthem Extras or a Dental 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 s or Dental Plans 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 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 s application: 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) for more information on Anthem Extras s and our 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: (866) Vision customer service: (866) Member Assistance Program: (800) SilverSneakers: (888) Travel Assistance: (800)

10 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 Dental 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 and Blue Shield plans. Travel Assistance is provided by HTH Worldwide, and The SilverSneakers Fitness Program is provided by Healthways, Inc. Both HTH Worldwide and Healthways, Inc. are independent companies not affiliated with Anthem Blue Cross and Blue Shield, and the services provided are not part of the insurance coverage provided by Anthem Blue Cross and Blue Shield. In Missouri, (excluding 30 counties in the Kansas City area) Anthem Blue Cross and Blue Shield is the trade name of 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. Independent licensees 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. Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWi), Compcare Health Services Insurance Corporation (Compcare) and Wisconsin Collaborative Insurance Company (WCIC). BCBSWi underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or 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. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 10/16 10