VIRGINIA PRODUCER MANUAL. Individual Market Under Age 65

Transcription

1 VIRGINIA PRODUCER MANUAL Individual Market Under Age 65 October 2013

2 Table of Contents Introduction Why sell Anthem Tools and Resources New Producer Toolbox, Producer Online News, Technical Support Enrollment periods Open enrollment period, Outside open enrollment period, Qualifying events for plans on and off the exchange Effective date assignment Open enrollment period, Outside open enrollment period with and without a qualifying event Selling on the exchange Certification requirements, Eligibility and qualifying for a subsidy or tax credit, Tools to assist your clients and more Selling off the exchange Tools to assist your clients, Eligibility, Application process, Premium payments and more Additional coverage available Dental coverage Servicing your clients on non-aca (Affordable Care Act) compliant plans (Grandfathered and non-grandfathered plans) Membership changes, Plan changes, Ongoing premium payment options, Plan materials and Member Services Servicing your clients on ACA compliant plans Membership changes, Plan changes, Ongoing premium payment options, Plan materials and Member Services Important phone numbers and addresses Stay informed about all the latest news that impact your new sales and existing business by frequently visiting 2

3 Introduction Navigating the new world of health care coverage is full of opportunities and challenges. Consumers need to understand all their options so they can choose the coverage that best meets their needs. Now, more than ever, your clients will depend on you for your experience and knowledge to help guide them through the process. This Producer Manual has the information you need to write new Individual business with Anthem effective on or after January 1, 2014 and continue servicing your existing clients. We re committed to helping you grow your book of business and maximize retention of your clients. Why sell Anthem Below are just a few of the many reasons why selling Anthem makes sense for your business: Easy to quote and sell Online quoting tools let you easily create and deliver quotes to your prospects Online applications streamline the process for you and your clients Online Producer Toolbox an enhanced secure producer site with all the information you need at your fingertips Experienced sales teams Local sales leadership Local Regional Sales Managers to support your selling efforts Experienced Broker Services team to answer your questions by or phone Support in retaining your clients We have an experienced team dedicated to helping you retain your clients. If your clients contact our Member Services team with a request to change or cancel their plan, we can help them evaluate all their options. We re here to support the trusted relationship you ve developed with your clients. Large portfolio of plans and coverage A variety of Individual medical plans designed to fit a wide range of budgets Dental to enhance the health of your clients and their families Emergency or Urgent care services are covered at the network level regardless of your location or the provider you see. A range of health programs when you need them. Note: The term producer in this Producer Manual refers to agents and brokers, as well as producers. This guide is an overview of current procedures and producers are expressly NOT authorized to make any promises or representations about whether, or what type of, coverage or outcome may be offered. The information contained in this manual is intended for use by authorized producers only and may not be copied or distributed for any other purpose. Any benefit descriptions are intended to be a brief overview of some benefits available to our members. 3

4 Tools and Resources You now have convenient single sign on access to our new Producer Toolbox and Producer Online News. New Producer Toolbox Our new Producer Toolbox at is available 24/7 to provide you with helpful resources, up-to-date information and custom sales tools to help your business succeed. It includes many of the same functions as our current secure producer site, plus enhancements to help you sell new Affordable Care Act (ACA) compliant plans, both on and off the exchange. You can also manage your book of business enrolled in these plans. With our new Producer Toolbox you can: Create a customized AgentConnect link to place on your website or send your clients to get a quote and apply online. This will ensure you get credit for your sales. Create and view quotes and comparisons for ACA-compliant plans for your new prospects and current clients Start online applications for off exchange plans on behalf of your clients View status of your clients applications, both online and paper View your book of business for clients on ACA-compliant plans to view their policy, order your clients ID cards and check their billing status View a list of your clients with delinquent payments Download client reports for your book of business View your commission statements (applies to Agency Heads only. Targeted for 2014) View sales and educational materials View and order sales brochures and applications Easily access our current producer website to continue selling non-aca compliant plans (through December 2013) and servicing your clients on these plans (grandfathered and nongrandfathered) Producer Online News You can access our Producer Online News directly from our new online Producer Toolbox to stay informed about the latest news and changes that impact your new sales and existing business. If you re not already registered, go to Technical Support Trained Technical Support Specialists are standing by to help you put all our Anthem technical tools to work. If you need help using Anthem technology, call them at 888-ANTHEM-1. 4

5 Enrollment periods The following information applies to enrollment in plans both on and off the exchange, unless otherwise noted. Open enrollment period The open enrollment period begins October 1, 2013 and ends on March 31, Outside open enrollment period Individuals who experience a qualifying event will be able to enroll in a plan on or off the exchange outside the open enrollment period. These individuals will have a special enrollment period and, unless stated otherwise, they will have 60 calendar days from the date of a qualifying event to select a plan. Documentation/proof of Qualifying Events is required prior to enrollment. If it is not received, the individual(s) may not be enrolled. Qualifying events for plans on the exchange An individual loses Minimum Essential Coverage*, which includes a loss of eligibility for coverage as a result of: Legal separation or divorce Cessation of dependent status, such as attaining the maximum age Death of an employee Termination of employment Reduction in the number of hours of employment Any loss of eligibility for coverage for any of the following: o An individual no longer resides, lives or works in the Plan s Service Area o Termination of employer contributions o Exhaustion of COBRA benefits An Individual gains a dependent or becomes a dependent through marriage, birth, adoption or placement for adoption An individual, not previously a citizen, national, or lawfully present gains such status An Individual s enrollment or non-enrollment in a qualified health plan is unintentional, inadvertent, or erroneous and is the result of an error of the Exchange or Health and Human Services Qualifying events for plans off the exchange Involuntary loss of Minimum Essential Coverage for any reason other than fraud, intentional misrepresentation of a material fact or failure to pay premium Loss of Minimum Essential Coverage due to dissolution of a marriage Marriage Adoption or placement for adoption Birth 5

6 *Minimum Essential Coverage refers to plans that must include essential health benefits as defined by the Affordable Care Act (ACA). Specifically, the plans must include items and services from at least these 10 categories of care: 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Preventive and wellness service and chronic disease management 10. Pediatric services, including oral and vision care 6

7 Effective Date Assignment The following information applies to enrollment in plans both on and off the exchange, with effective dates on or after January 1, 2014, unless otherwise noted. Open enrollment period During the open enrollment period of October 1, 2013 through March 31, 2014, there will be two phases: Phase 1: If an application and full initial premium payment are received during the period of October 1, 2013 through December 15, 2013, coverage will be effective on January 1, Phase 2: If an application and full initial premium payment are received during the period of December 16, 2013 through March 31, 2014: Between the 1 st and 15 th of the month, coverage will be effective date on the first day of the following month. Between the 16 th and the last day of the month, coverage will be on the first day of the second following month Exception: Newborns and adopted children can be added to their parent s existing coverage or enrolled in a separate plan as of the date of birth or placement. Outside open enrollment period with a qualifying event If an applicant applies outside the annual open enrollment period due to a qualifying event and their application is approved and full initial month s premium is received, their effective date will be as follows: In the case of birth, adoption or placement for adoption, coverage is effective on the date of the birth, adoption, or placement for adoption; or In the case of all other qualifying events, coverage is effective on the first day of the following month after the application is received For a complete list of qualifying events for both on and off the exchange, refer to the qualifying events section under Enrollment Periods. 7

8 Selling on the Exchange Certification requirements Producers must be certified in order to sell plans on the exchange and training is provided by the exchange. Producers who register with the federally facilitated marketplaces do not receive a registration number. The producers will self-select a user ID during Part II of the registration process, but they will not receive a registration number. Typically, only producers who service the individual market will establish a federally facilitated marketplace user ID. What is the exchange? The exchange is an online marketplace where individuals and some small businesses can shop for insurance and compare health plans, get answers to questions, find out if they are eligible for tax credits for health insurance, and enroll in a health plan that meets their needs. Exchanges will begin to offer products in October, 2013 for effective dates beginning January 1, Important: The exchanges do not replace private health insurance. They are simply a new place for qualified individuals to shop for and buy it. How will individuals get health insurance in 2014? Most Americans will have to make a decision about health insurance in 2014 and they ll have the following options: Continue to get coverage through their employer if available Buy an Individual plan through the exchange or the traditional Individual market Enroll in a government sponsored plan, if eligible Go uninsured and pay a penalty (unless they qualify for an exemption) Who is eligible for a subsidy or tax credit? In 2014, individuals who qualify may be able to get a tax credit from the government to help them buy health coverage and pay their premiums if they buy health insurance on the exchange.. And they don t have to wait until tax time to get it. The tax credit can be used for any individual plan sold on the exchange, or marketplace. They may also qualify for cost share subsidies from the government to help them pay for their out-of-pocket health care costs if they buy health insurance at the silver level on the exchange Who may qualify for a cost share subsidy? Individuals with incomes up to 250% of the federal poverty level may also get an extra subsidy when they buy a silver level plan. These subsidies lower member cost shares for services covered by the silver plan. The federal government subsidizes the higher benefits provided by the insurer. Who may qualify for a tax credit? Individuals who are U.S. citizens or legally live in the U.S. Individuals earning between 100% and 400% of the federal poverty level if they are not eligible for other sources of minimum essential coverage, including government-sponsored programs such as Medicare and Medicaid Single individuals with household modified adjusted gross incomes from 100% to 400% of the federal poverty level would earn from $11,490 to $45,960 each year A family of four with household modified adjusted gross income from 100% to 400% of the federal poverty level would earn from $23,550 to $94,200 each year 8

9 Who may not qualify for a subsidy or tax credit? Individuals who may be eligible for government sponsored programs such as Medicare and Medicaid Individuals who can get a plan of a minimum value through an employer with premiums that cost less than 9.5% of the employee s earnings for employee only coverage. Penalties for going uninsured If an individual doesn t buy a health plan in 2014, they will pay a penalty unless they qualify for an individual exemption. The penalty amount will start at $95 or 1% of taxable income (whichever is greater), and increases over the years with annual adjustments through 2017 and beyond. Tools to assess the best plan options on the exchange for your new and existing clients: Subsidy Estimator This helps you and your clients check if they may be eligible for a subsidy or a tax credit. Individual Online Store This online store is available for you and your clients to shop for ACA compliant plans and submit applications. This tool is available in English and Spanish and allows shoppers to compare plans side-by-side. Find a Doctor This valuable tool is easily accessible on both the Plan Comparison and the Plan Details pages so your clients can view and search for doctors in each plan s network. Changemycoverage This convenient tool lets you and your Individual clients view their current coverage, compare it with other ACA compliant plans and easily make changes if needed. Eligibility Each exchange is responsible for determining the eligibility of each applicant. All applicants deemed eligible and selecting a HealthKeepers, Inc. plan will be sent to us for enrollment. Premium payments for on exchange plans The exchange will not collect initial premium payment with the application submission. Once the exchange approves the applicant, they will electronically transfer the applicant to our payment page where they can submit electronic payment or receive instructions for submitting paper payments. Premium payment options The applicant has the following options for paying their premiums: Monthly Automatic Premium Payment: If this option is selected, we will automatically debit the applicant s initial premium amount and subsequent premiums on the debit date selected. Paper or electronic check: If the initial premium is submitted via paper check, we will convert that check to a one-time bank draft/electronic transaction and destroy the original check. Subsequent bills will be by mail or made available online if the member selects paperless billing. Money order: The initial premium can also be submitted with a money order. Subsequent bills will be by mail or made available online if the members selects paperless billing. Credit card: For payments by credit card, we will submit the charge for one month s premium. We accept Visa and Mastercard but this option is not available for subsequent recurring monthly premium payments. 9

10 The first month s premium payment will not be processed unless and until the application is approved. If the application cannot be approved, the applicant will be notified. If the initial payment is returned, the policy will be terminated back to the effective date of coverage. 10

11 Selling off the Exchange Tools to assess the best plan options off the exchange for your new and existing clients: Individual Online Store This online store is available for you and your clients to shop for ACA compliant plans and submit applications. This tool is available in English and Spanish and allows shoppers to compare plans side-by-side. Find a Doctor This valuable tool is easily accessible on both the Plan Comparison and the Plan Details pages so your clients can view and search for doctors in each plan s network. Changemycoverage ` ` This convenient tool lets you and your Individual clients view their current coverage, compare it with other ACA compliant plans and easily make changes if needed. This tool is available for reviewing options and submitting Change of Coverage Applications. Eligibility To be eligible to enroll for coverage all applicants must:. 1. Be a United States citizen or national or be a lawfully present non-citizen for the entire period for which coverage is sought; and 2. Be a legal resident of the state in which they are applying; 3. Be under age 65; 4. Submit proof satisfactory to Anthem to confirm dependent eligibility, if requested; 5. Agree to pay for the cost of Premium that Anthem requires; 6. Reveal any coordination of benefits arrangements or other health benefit arrangements for the applicant or Dependents as they become effective; 7. Not be incarcerated (except pending disposition of charges); 8. Not be entitled to or enrolled in Medicare Parts A/B and or D; 9. Not be covered by any other group or individual health benefit plan. 10. Applicants are eligible if they reside in our designated service area. Note: Designated service are is defined as the state of Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123. Dependent coverage Eligible dependents of the policyholder or spouse/domestic partner include married or unmarried children up to the end of the calendar month in which they turn 26 years of age, regardless of student or tax status. Domestic partners Please refer to the domestic partner language under the section for Servicing your clients on ACA compliant plans. Military service An applicant or dependent is not eligible to apply for an Individual health care plan/policy if they are on active duty with any branch of the Armed Services. 11

12 Application process You can send your clients a Quotes and Comparisons for up to five plans. Once your client selects a plan and is ready to apply, he or she can click the Apply Now button to start the application process. You can also start an application on behalf of your client and transfer it to them at any point during the process for your client to submit. You can also submit your client s application by using voice signature. Or you can direct your client to your AgentConnect link to get a quote and apply online. Application submission Initial Premium Payment is required and must accompany the application. We accept application submission through any of the following methods: Online: Applications and initial premium payment can be submitted online 24 hours a day, 7 days a week on our website Fax: Completed applications can also be faxed to the phone number indicated on the application Mail: Completed applications may be mailed to us at the address indicated on the application. Completed applications may be ed at the address indicated on the application. If the initial payment is returned, the policy will be terminated back to the effective date of coverage. Application tracking and status After your clients submit their paper or online applications, you can view status of their applications on the new Producer Toobox site. Premium payments The first month s full premium payment must accompany the application. Once the applicant is approved for an off exchange plan, their first month s full premium payment must be received before they can be enrolled. If the application cannot be approved, the applicant will be notified. Premium payment options Applicants have the following payment options: Monthly Automatic Premium Payment: If this option is selected, we will automatically debit the applicant s initial premium amount and subsequent premiums on the debit date selected. Paper or electronic check: If the initial premium is submitted via paper check, we will convert that check to a one-time bank draft/electronic transaction and destroy the original check. Subsequent bills will be by mail or made available online if the member selects paperless billing. Money order: The initial premium can also be submitted with a money order. Subsequent bills will be by mail or made available online if the members selects paperless billing. Credit card: For payments by credit card, we will submit the charge for one month s premium. We accept Visa and Mastercard but this option is not available for recurring monthly premium payments. Enrollee review period An enrollee has 10 days from the date of receipt to examine the Application Conditions and Agreement, in which he/she can decide to cancel for a full refund of premium paid. Cancellations will need to be submitted in writing. Members need to send in a written request to cancel the policy as never effective. 12

13 Entry age determination Entry Age is based on each applicant s age as of the assigned effective date of coverage. If the actual effective date of the policy is different from the requested effective date on the application, the final premium may be different from the rate shown in on the quote. We reserve the right to change this methodology in the future. Signature requirements The subscriber (and spouse/domestic partner, if applying) must sign and date the application. All applicants age 18 and over also need to sign and date the application. The parent/legal guardian of a dependent child applying must sign and date the application. Applications without the above signatures will be returned to the applicant. Additional coverage available Dental coverage We will offer new ACA compliant dental plans effective on or after January 1, These dental plans will be available in combination with medical coverage or as a standalone product. Members who cancel their medical coverage will be able to keep their dental coverage active. 13

14 Servicing your clients on non-aca plans (Grandfathered and non-grandfathered) Membership changes after January 1, 2014 Adding dependents An Addition of Dependent application must be completed. Effective date for additional dependents is determined as follows: If the dependent has current coverage, they will be effective the day after the application is received. If the dependent did not have coverage, there is a 10 day rule that would apply. Effective dates must be within 75 days of the signature date. If the dependent is denied an underwritten policy due to health or lifestyle status, there may be other ACA-compliant plan options available during the annual open enrollment period or during a special enrollment period triggered by a qualifying event. Dependents who reach age limitation (Overage dependents) For dependent children on existing policies, once they reach the State specific attained age of 26 years of age (also called Overage dependents), we will automatically cancel them off their parent s policy on the 1st of the following month in which they reach age 26. We will send notification to the parent that this will occur, up to 90 days in advance. We will also provide the overage dependent with information about plans available and how they can enroll on their own policy. For Overage dependents who are disabled and incapable of self-sustaining employment by reason of a physically or mentally disabling injury, illness or condition, and are chiefly dependent upon the subscriber for support and maintenance, there will be a form attached to the letter sent up to 90 days in advance. The parent should complete this form and submit all requested documentation so the dependent can remain on the parent s policy. Newborns and adopted child coverage We automatically cover the primary policyholders newborn 31 days from the date of birth. When we say newborn we are including adopted children. We cover adopted children for 31 days from the date of placement with the primary policyholder. We may charge premium for the 31 days of coverage. Please note: The health policy must be in effect prior to the child s date of birth. Also, when adding a newborn, the newborn s policy must be effective as of his/her date of birth in order for there to be no underwriting required. If your clients want to continue the newborn s or adopted child s coverage under the policy, he/she must: Tell us in writing; and Pay the required additional premium (if any). Important: The policyholder must tell us in writing and pay any additional premium within 31 days of the birth or legal placement of the child. Domestic partners Our general definition for a domestic partnership is each party is the sole domestic partner of the other, one person is at least 19 years of age, must have lived together for the previous six months, are financially inter-dependent, are not married to anyone else, and are not related by blood in a way that would prohibit marriage. 14

15 Divorce Coverage under this policy ends automatically for the divorced spouse of the policyholder on the last day of the month in which the appropriate court grants the final divorce decree. We must receive written notification in order to remove the ex-spouse from the plan. This triggers a qualifying event for a special enrollment period in which the ex-spouse could apply for an ACA-compliant plan. Refer to the Qualifying Event section of this manual for more details. Plan changes after January 1, 2014 Members on grandfathered and non-grandfathered plans who want to change to an ACA plan on or off the exchange during Open Enrollment or following a qualifying event can use ChangemyCoverage (Targeted for November 2013). Plan transfers (for moves out of state) If a current member moves outside their state of residence in which the policy is held, the member may be required to transfer to a local plan in the new state of residence. It is the policyholder s responsibility to notify us of such a move. The member will need to complete a transfer form and application for the new state. Cancellation of coverage A member may cancel their plan/policy at any time. Individual policies are not automatically canceled when transferring to an Anthem Group plan or Senior plan. In these cases, the member must request cancellation of the Individual coverage in writing. Members with multiple policies (i.e., medical and dental) must specify which policies are to be canceled. If the member does not specify which policies should be canceled, all active coverage will be canceled. When premiums are not paid, plans/policies will terminate due to non-payment according to the contract. Members may request reinstatement either in writing or by calling Member Services. Full premium will be required before the policy can be reinstated. Death of a member or policyholder/certificate holder Upon the death of a member or policyholder/certificate holder, we can be notified of the death by phone as long as it is within 12 months of the death. Beyond 12 months, we require written notification for the death of any member on a policy to process the cancellation. Cancellations for that member will be effective the date after death to ensure eligible benefits are paid up to that date. Any unused premiums will be refunded. A Death Certificate is not required as long as we are notified within one year of the date of death. Unless otherwise specified, only the deceased member will be canceled. If the deceased member is the policyholder, all other members will be transferred to their own policy(s) (same benefits as prior plan) effective the date the deceased member is canceled. Ongoing premium payment options Payment options for ongoing premium payment Members can select any of the following methods for paying their ongoing monthly premiums. Monthly Automatic Premium Payment Members can choose debit dates of the 1st and 5th of the month Premiums can be deducted from the member s checking or savings account The Automatic Premium Payment for Individual Plans form must be completed by the member This form is available at the online Producer Toolbox and member website. The form can also be requested from Member Services. 15

16 Check or Money Order Paper payments should be sent with the identification number written on the check or money order and accompanied with the monthly bill Payments must be submitted to the address provided on the bill Payments online Members can register at our member website and make their payments online Payments can be made by electronic check Payments over the phone Payments can be made through one of our Member Services representatives We can accept check payments via phone Reinstatements If a current member allows his/her contract to terminate and wishes reinstatement, he/she will automatically be eligible if they do the following: Written or telephone requests for reinstatement and full premium owed is received within 60 days of the due date Member sends in full premium owed with their bill or cancellation letter within 60 days of the due date If a member does not fall within the above guidelines, a new application for coverage must be completed for an ACA compliant plan during the open enrollment period. Plan materials and Member Services Member Self-Service Members have the ability to manage their health benefits any time, day or night, through our website. Members under the age of 18 cannot be viewed or registered in Member Self Serve. Members should select the member tab, and enter their home state. Members who log in will be able to: Find a doctor or hospital Order a new ID card View their benefits View status of their claims View their plan s prescription formulary Pay their premiums online 16

17 Address changes Members may make address changes by contacting Member Services. Members can also change their address by submitting a written request to Member Services or by contacting their producer. If you submit the address change on your client s behalf, please submit the change in writing, by fax or to Broker Services. Note: If your client moves from one geographical rating area to another, their rates may be subject to change. Translations for non-english speaking applicants We offer assistance for translations in Spanish. 17

18 Servicing your clients on ACA compliant plans Membership changes Adding dependents to ACA plans Dependents can only be added to ACA compliant plans during the open enrollment period or if there is a qualifying event. Members adding a dependent to plans off the exchange can use the same application used for new business. Members adding a dependent to plans on the exchange must notify the local exchange. Dependents who reach age limitation (Overage dependents) For dependent children on existing policies, once they reach the State specific attained age of 26 years of age (also called Overage dependents), we will automatically cancel them off their parent s policy on the 1st of the following month in which they reach age 26. We will send notification to the parent that this will occur, up to 90 days in advance. We will also provide the overage dependent with information about plans available and how they can enroll on their own policy. For Overage dependents who are disabled and incapable of self-sustaining employment by reason of a physically or mentally disabling injury, illness or condition, and are chiefly dependent upon the subscriber for support and maintenance, there will be a form attached to the letter sent up to 90 days in advance. The parent should complete this form and submit all requested documentation so the dependent can remain on the parent s policy. Newborns and adopted child coverage The birth or adoption of a child is a qualifying event. For plans both on and off the exchange, newborn children of the subscriber or the subscriber s spouse or Domestic Partner will be covered for an initial period of 31 days from the date of birth, including 5 days of nursery care for a well newborn. Coverage for newborns will continue beyond the 31 days, provided the subscriber submits an Individual application to request coverage for the child under the subscriber s contract. The application must be submitted along with the additional premium, if applicable, within 60 days after the birth or adoption. A child will be considered adopted from the earlier of: (1) the moment of placement for adoption; or (2) the date of an entry of an order granting custody of the child. The child will continue to be considered adopted unless the child is removed from the subscriber s home prior to issuance of a legal decree of adoption. Members adding a newborn or adopted child to a plan on the exchange must notify the local exchange. Marriage Marriage is considered a qualifying event. Current members who wish to add a spouse due to marriage must submit their request within 60 calendar days of the marriage date. Members adding a spouse to plans off the exchange can use the same application used for new business. Members adding a spouse to plans on the exchange must contact the exchange directly. Domestic Partners For plans both on and off the exchange Domestic Partner or Domestic Partnership means a person of the same or opposite sex for whom all of the following are true: he or she is the subscriber s sole Domestic Partner and has been for twelve (12) months or more; he or she is mentally competent; neither the subscriber nor the Domestic Partner is related in any way (including by adoption or blood) that would prohibit him or her from being married under state law; he or she is not married to or separated from anyone else; and he or she is financially interdependent with the subscriber. 18

19 Divorce When a covered person loses coverage due to divorce, we require written notification from the policyholder to remove the former spouse from the current coverage. If a policyholder wants to remove the former spouse from current coverage on the exchange, the policyholder must contact the exchange directly. If divorce results in the loss of Minimum Essential Coverage, which is considered a qualifying event, an individual is eligible to enroll in a new plan within 60 calendar days from the date of the event. The individual will need to complete a new Individual Application and include documentation of coverage termination from the prior carrier. Plan changes Changes in coverage Use ChangeMyCoverage located on the online Producer Toolbox to view your client s current plan and available options both on and off the exchange. Plan transfers (for moves out of state) If a current member moves outside their state of residence in which the policy is held, the member may be required to transfer to a local plan in the new state of residence. It is the policyholder s responsibility to notify us of such a move. The member will need to complete a transfer form and application for the new state. Cancellation of coverage A member may cancel their off exchange plan/policy at any time. Individual policies are not automatically canceled when transferring to an Anthem Group plan or Senior plan. In these cases, the member must request cancellation of the Individual coverage in writing. Members with multiple policies (i.e., medical and dental) must specify which policies are to be canceled. If the member does not specify which policies should be canceled, all active coverage will be canceled. When premiums are not paid, plans/policies will terminate due to non-payment according to the contract. A new member may cancel their coverage back to the original effective date as never effective. This must be within 10 days after a new member receives the contract or certificate. If no claims have been submitted, Anthem will refund all premiums to the member. For on exchange plans, cancellation requests must be handled directly with the exchange. Note: See Death of a Member for plans/policies related to death cancellations. Death of a member or policyholder/certificate holder For plans off the exchange, upon the death of a member or policyholder/certificate holder, we can be notified of the death by phone as long as it is within 12 months of the death. Beyond 12 months, we require written notification for the death of any member on a policy to process the cancellation. A cancellation for that member will be effective the date after death to ensure eligible benefits are paid up to that date. Any unused premiums will be refunded. A Death Certificate is not required as long as we are notified within one year of the date of death. Unless otherwise specified, only the deceased member will be canceled. If the deceased member is the policyholder, all other members will be transferred to their own policy(s) (same benefits as prior plan) effective the date the deceased member is canceled. For plans on the exchange, notification must be sent directly to the exchange 19

20 Ongoing premium payment options Payment options for ongoing premium payment Current members can select any of the following methods for paying their ongoing monthly premiums Monthly Automatic Premium Payment Members can choose debit dates of the 1st to 6th of the month Premiums can be deducted from the member s checking or savings account The Automatic Premium Payment for Individual Plans form must be completed by the member This form is available at the online Producer Toolbox and member website and can also be requested from Member Services. Check or Money Order Paper payments should be sent with the identification number written on the check or money order and accompanied with the monthly bill Payments must be submitted to the address provided on the bill Payments online Members can register at our member website and make their payments online Payments can be made by electronic check Members can opt to turn off their paper bills and receive electronic reminders Payments over the phone Payments can be made through our Automated IVR Payment system Payments can be made through one of our Member Services representatives We can accept check or credit card payments via phone Plan materials and Member Services ID Cards and Certificate of Coverage or Evidence of Coverage (EOC) booklet Once approved, your client will receive their ID cards with the toll-free phone number for Member Services. Under separate cover they will receive their Welcome letter and plan booklet. Member Self-Service Members have the ability to manage their health benefits any time, day or night, through our website at Members under the age of 18 cannot be viewed or registered in Member Self Serve. Members should select the member tab, and enter their home state. Members who log in will be able to: Find a doctor or hospital Order a new ID card View their benefits View status of their claims View their plan s prescription formulary Pay their premiums online 20

21 Address changes Members enrolled in off exchange plans can make address changes by contacting Member Services. Members can also change their address by submitting a written request to Member Services or by contacting their producer. If you submit the address change on your client s behalf, please submit the change in writing, by fax or to Broker Services. Members enrolled in plans on the exchange need to contact the exchange directly for address changes. Note: For both on and off exchange plans, if your client moves from one geographical rating area to another, their rates may be subject to change. 21

22 Important Phone Numbers and Addresses Anthem ACA Broker Services Broker Services - non-aca <65 Business or ACAbroker@wellpoint.com or EastBrokerServices@wellpoint.com (Medical, Dental and Life Inquires) For Dental and Life Claim contacts see below. Anthem Individual Underwriting P.O. Box Roanoke, VA Underwriting Fax: Senior (>65) Broker Services Agent.services@anthem.com Licensing and Credentialing Virginia Avenue Indianapolis, IN Fax LicensingandCredentialing@Wellpoint.com Commissions and AOR questions Fax VaBrokerCommissions@Anthem.com Anthem Dental Claims/Providers Anthem Life Claims

23 Technical Support 1 st contact Broker Services ( ) 2 nd Contact Broker Portal Anthem1 ( ) Contact Numbers for Members: Individual Customer Service (Lumenos Only) Underwriting

24 The information in this Producer Manual is subject to change without notice. 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 VABENAHK 10/13 24