CALIFORNIA Y0071_14_18056_I 09/05/2013 WPNSF494M(13)-CA

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1 CALIFORNIA 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 name and symbol are registered marks of the Blue Cross Association. Y0071_14_18056_I 09/05/2013 WPNSF494M(13)-CA

2 Background CALIFORNIA Anthem Blue Cross (Anthem) serves nearly 76,000 Medicare Advantage (MA) members in 10 California counties. Impacted counties include the following: Kern, Los Angeles, Orange, Riverside, Sacramento, San Diego and San Mateo. Additionally, Anthem is expanding to Madera and Ventura counties. Two counties will not have another Anthem MA plan option. They are Sacramento and San Mateo counties. Members can purchase an Anthem Medicare Supplement plan (with more robust coverage at a higher cost) or seek a MA plan from an Anthem competitor. It s important to note that members may have a different network of providers and/or different benefit structure when switching from previous plans. It s important to note that marketing to members impacted by service area reductions or non-renewals cannot begin until 10/2/13. *(Note: Membership data is from July 2013). 2

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4 Contract Plan Legal Entity 2014 Overview Anthem will expand the HMO offering to Ventura County, which will improve member access to medical services. The product will be withdrawn from San Diego County due to high cost medical contracts. Competing MAOs have exclusive arrangements with the two largest health systems, which prevents Anthem from obtaining cost competitive contracts with high quality health systems. Increases to some member cost shares were made but will continue to offer strong value by maintaining a $0 premium with $0 preventive services and low generic prescription drug copays. Use of a preferred/non-preferred pharmacy network will ensure members will have access to the drugs they need at the lowest cost possible; the preferred pharmacy network will include Walmart, Kroger (local brands), and Rite-Aid pharmacies. Changes to the formulary will encourage generic utilization particularly among higher cost drugs. H0564 CA-HMO BLUE CROSS OF CALIFORNIA Optional Supplemental Packages provide members with choice and flexibility in selecting supplemental benefits that meet their individual needs. This product is offered through a capitated network of physicians and providers. The product will be marketed and sold through employed field and telephone agents, as well as certified brokers. H Blue Cross Senior Secure Plan I (HMO) MAPD HMO $0 Prem, $5000 INN MOOP, $20 INN Pharm, $0 Part D Ded. Counties Available: Los Angeles, Orange. H Blue Cross Senior Secure Plan I (HMO) MAPD HMO $0 Prem, $6700 INN MOOP, $20 INN PCP, $50 INN Spec, $5 Pref Gen Copay Pharm, $0 Part D Ded. Counties Available: Riverside, San Bernardino. H Blue Cross Senior Secure Plan II (HMO) MAPD HMO $0 Prem, $4000 INN MOOP, $0 INN PCP, $20 INN Spec, $5 Pref Gen Copay Pref Pharm, $35 Pref Brand Copay Pref Pharm, $120 Part D Ded. (Tiers 2, 3 & 4) Counties Available: Kern. 4

5 Contract Plan Legal Entity 2014 Overview H Blue Cross Senior Secure Plan II (HMO) MAPD HMO $0 Prem, $6700 INN MOOP, $20 INN PCP, $50 INN Spec, $5 Pref Gen Copay Pharm, $0 Part D Ded. Counties Available: Ventura. Anthem will offer market competitive mid to high premium LPPO options that increase member access to care by providing an out of network benefit. Anthem will continue to be one of two major carriers to offer a competitive PPO option in CA. Plan premiums and maximum out of pocket cost shares were adjusted in order to maintain competitive innetwork benefits and maintaining the value proposition of out of network coverage. Anthem s LPPO offering will be expanded to Madera County. The product will be withdrawn from Sacramento and San Mateo Counties. H8552 CA-LPPO ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE CO. Use of a preferred/non-preferred pharmacy network will ensure members will have access to the drugs they need at the lowest cost possible; the preferred pharmacy network will include Walmart, Kroger (local brands), and Rite-Aid pharmacies. Optional Supplemental Packages provide members with choice and flexibility in selecting supplemental benefits that meet their individual needs. This product is offered through a network of physicians and providers. The product will be marketed and sold through employed field and telephone agents, as well as certified brokers. H Anthem Medicare Preferred Standard (PPO) MAPD LPPO $80 Prem, $4500 INN MOOP, $6700 Combined MOOP, $15 INN PCP, $50 INN Spec, $5 Pref Gen Copay Pharm, $149 Part D Ded. (Tiers 2, 3 & 4) Counties Available: Los Angeles. H Anthem Medicare Preferred Standard (PPO) MAPD LPPO $100 Prem, $4500 INN MOOP, $6700 Combined MOOP, $15 INN Pref Pharm, $40 Pref Brand Copay Pref Pharm, $135 Part D Ded. (Tiers 2, 3 & 4) Counties Available: Orange. 5

6 Contract Plan Legal Entity 2014 Overview H Anthem Medicare Preferred Standard (PPO) MAPD LPPO $127 Prem, $4500 INN MOOP, $15 INN Pref Pharm, $30 Pref Brand Copay Pref Pharm, $179 Part D Ded. (Tiers 2, 3 & 4) Counties Available: Riverside. H Anthem Medicare Preferred Standard (PPO) MAPD LPPO $106 Prem, $4500 INN MOOP, $15 INN Pref Pharm, $36 Pref Brand Copay Pref Pharm, $173 Part D Ded. (Tiers 2, 3 & 4) Counties Available: San Diego. H Anthem Medicare Preferred Standard (PPO) MAPD LPPO $68 Prem, $4500 INN MOOP, $15 INN Pharm, $145 Part D Ded. (Tiers 2, 3 & 4) Counties Available: Ventura. H Anthem Medicare Preferred Standard (PPO) MAPD LPPO $100 Prem, $3800 INN MOOP, $15 INN PCP, $45 INN Spec, $4 Pref Gen Copay Pref Pharm, $37 Pref Brand Copay Pref Pharm, $120 Part D Ded. (Tiers 2, 3 & 4) Counties Available: San Francisco. H Anthem Medicare Preferred Standard (PPO) MAPD LPPO $110 Prem, $4400 INN MOOP, $15 INN Pref Pharm, $39 Pref Brand Copay Pref Pharm, $149 Part D Ded. (Tiers 2, 3 & 4) Counties Available: Sonoma. H Anthem Medicare Preferred Standard (PPO) MAPD LPPO $81 Prem, $4500 INN MOOP, $15 INN Pharm, $115 Part D Ded. (Tiers 2, 3 & 4) Counties Available: Fresno. H Anthem Medicare Preferred Standard (PPO) MAPD LPPO $97 Prem, $4500 INN MOOP, $15 INN Pref Pharm, $36 Pref Brand Copay Pref Pharm, $125 Part D Ded. (Tiers 2, 3 & 4) Counties Available: Tulare. H Anthem Medicare Preferred Standard (PPO) MAPD LPPO $60 Prem, $4500 INN MOOP, $10 INN Pharm, $146 Part D Ded. (Tiers 2, 3 & 4) Counties Available: Madera. 6

7 The following tables are a way to quickly find the 2013 plans that are no longer being offered or have service area reductions for Tables may include a full county exit with no MA plan available, non-renewal of a 2013 plan with another MA plan available or Service Area Reductions where another MA plan is available. Service Area Expansion State Counties Impacted Product New CMS Contract Type of Action CA Ventura HMO CA Madera LPPO H Secure Plan II) H Service Area Expansion Service Area Expansion Non renewals or service area reductions which are county exits where Anthem will no longer offer a MA product State County Product CMS Contract Impacted Type of Action CA Sacramento, San Mateo LPPO LPPO H County Exit Non Renewals of a plan where another MA Product is available State Counties Impacted Product CMS Contract Impacted Type of Action CA Los Angeles, Orange, Riverside HMO HMO H Los Angeles, HMO H Orange, HMO H Riverside Secure Plan II) Non Renewal 7

8 Service Area Reduction in counties where another MA Product is available State Counties Impacted Product CMS Contract Impacted Type of Action CA Kern, San Diego HMO H Service Area Reduction 8

9 State County Impacted Plans Exit or Service Area Reduction Expansion Plan Migration Plan/Lead Plan CA Fresno LPPO H Migration/Lead Plan Description $81 Prem, $4500 INN MOOP, $15 INN Pharm, $115 Part D Ded. (Tiers 2, 3 & 4) Other MA Options (Prioritized Plan- PBP) OSB/AE Packages CA Kern SAR HMO H HMO H Secure Plan II) $0 Prem, $4000 INN MOOP, $0 INN PCP, $20 INN Spec, $5 Pref Gen Copay Pref Pharm, $35 Pref Brand Copay Pref Pharm, $120 Part D Ded. (Tiers 2, 3 & 4) CA Los Angeles Exit HMO H Secure Plan II) HMO H $0 Prem, $5000 INN MOOP, $20 INN Pharm, $0 Part D Ded. LPPO H CA Madera LPPO H Preferred Standard) LPPO H $60 Prem, $4500 INN MOOP, $10 INN Pharm, $146 Part D Ded. (Tiers 2, 3 & 4) CA Orange Exit HMO H Secure Plan II) HMO H $0 Prem, $5000 INN MOOP, $20 INN Pharm, $0 Part D Ded. LPPO H CA Riverside Exit HMO H Secure Plan II) HMO H $0 Prem, $6700 INN MOOP, $20 INN PCP, $50 INN Spec, $5 Pref Gen Copay Pharm, $0 Part D Ded. LPPO H

10 State County Impacted Plans Exit or Service Area Reduction Expansion Plan Migration Plan/Lead Plan Migration/Lead Plan Description Other MA Options (Prioritized Plan- PBP) OSB/AE Packages CA Sacramento Exit LPPO H Medicare Supplement CA San Bernardino HMO H $0 Prem, $6700 INN MOOP, $20 INN PCP, $50 INN Spec, $5 Pref Gen Copay Pharm, $0 Part D Ded. CA San Diego SAR HMO H LPPO H $106 Prem, $4500 INN MOOP, $15 INN PCP, $45 INN Spec, $5 Pref Gen Copay Pref Pharm, $36 Pref Brand Copay Pref Pharm, $173 Part D Ded. (Tiers 2, 3 & 4) CA San Francisco LPPO H CA San Mateo LPPO H Medicare Supplement CA Sonoma LPPO H $100 Prem, $3800 INN MOOP, $15 INN PCP, $45 INN Spec, $4 Pref Gen Copay Pref Pharm, $37 Pref Brand Copay Pref Pharm, $120 Part D Ded. (Tiers 2, 3 & 4) $110 Prem, $4400 INN MOOP, $15 INN PCP, $45 INN Spec, $5 Pref Gen Copay Pref Pharm, $39 Pref Brand Copay Pref Pharm, $149 Part D Ded. (Tiers 2, 3 & 4) 10

11 State County Impacted Plans Exit or Service Area Reduction Expansion Plan Migration Plan/Lead Plan CA Tulare LPPO H Migration/Lead Plan Description $97 Prem, $4500 INN MOOP, $15 INN Pref Pharm, $36 Pref Brand Copay Pref Pharm, $125 Part D Ded. (Tiers 2, 3 & 4) Other MA Options (Prioritized Plan- PBP) OSB/AE Packages CA Ventura HMO H (Blue Cross Senior Secure Plan II) LPPO H $68 Prem, $4500 INN MOOP, $15 INN Pharm, $145 Part D Ded. (Tiers 2, 3 & 4) HMO H Secure Plan II) 11