Category News

Anthem Blue Cross and Blue Shield Individual Business to Suspend Child-Only Coverage Effective 9/23/10

Anthem Blue Cross and Blue Shield is committed to offering a broad range of products and services that meet customer needs in the changing health insurance market, and to implementing the new health care reform legislation in a way that benefits our customers and members.

We have reviewed the rules regarding the provisions of the Patient Protection and Affordability Care Act (PPACA) limiting the application of pre-existing condition exclusions for children under 19. Unfortunately, there remains a great deal of uncertainty as to how the rules will be implemented and what the impacts might be on participating insurers. 

While some carriers may continue to offer child-only policies, other carriers have dealt with this lack of clarity by choosing to discontinue new business sales of their child-only policies.  Some have cited the lack of an effective mandate for individuals to obtain coverage, as well as ongoing market uncertainty.  Unfortunately,  this has created an unlevel competitive environment.  As a result, Anthem has decided to suspend the sale of child-only policies indefinitely, beginning  September 17, 2010.

We will continue to monitor the situation and provide additional details on any changes to our process and policies as they become available.

Please Note: This decision has no impact on any existing child-only policies.  In addition, we will continue to accept children on family policies as long as the primary subscriber is 19 or older.

Why is Anthem suspending the sale of new child-only policies?

Anthem is committed to offering a broad range of products and services that meet customer needs in the changing health insurance market, and to implementing the new health care reform legislation in a way that benefits our customers and members.

We have reviewed the rules regarding the provisions of the Patient Protection and Affordability Care Act (PPACA) limiting the application of pre-existing condition exclusions for children under 19. Unfortunately, there remains a great deal of uncertainty as to how the rules will be implemented and what the impacts might be on participating insurers. 

While some carriers may continue to offer child-only policies, other carriers have dealt with this lack of clarity by choosing to discontinue new business sales of their child-only policies.  Some have cited the lack of an effective mandate for individuals to obtain coverage, as well as ongoing market uncertainty.  Unfortunately,  this has created an unlevel competitive environment.  As a result, Anthem has decided to suspend the sale of child-only policies indefinitely, beginning  September 17, 2010.

When will Anthem stop selling these polices?

Due to ongoing uncertainty, Anthem  has made the decision to suspend the sale of child-only policies and policies where the primary subscriber is under 19 years of age, for effective dates of 9/23 or later. Quoting capability for child-only policies will begin being removed on September 17, 2010.

Will Anthem’s family plans be offered to children 18 and under?

Anthem will continue to offer family policies that have dependent coverage to subscribers who are 19 years of age or older. 

Will Anthem participate in an “open-enrollment period” for child only plans? 

No, Anthem has made the decision to suspend the sale of child-only policies and policies where the primary subscriber is under 19 years of age, for effective dates of 9/23 or later.

Will this impact all states in which Anthem’s affiliated health plans are currently providing Individual Child-only plans?

The suspension of child-only plans will apply to all states unless a particular state requires the offering of child-only policies.  Based on state specific requirements, we will continue to offer Child-only plans in Maine and New York, and in open enrollment periods in Ohio and Virginia. Child-only plans will also be offered in those states requiring such policies for conversion and HIPAA eligible individuals.  Existing policyholders will not be impacted by this action and they may continue in their current coverage.

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The Census Bureau reported  “the number of people with health insurance fell to 253.6 million in 2009 from 255.1 million in 2008, the first year that the number of people with health insurance has decreased since 1987, when the government started collecting comparable data. The number of uninsured rose to 50.7 million from 46.3 million

The percentage of people without health insurance increased to 16.7 percent, or 50.7 million in 2009 from 46.3 million in 2008. Between 2008 and 2009, the number of people covered by private health insurance decreased to 194.5 million from 201.0 million. The number covered by employment-based health insurance also declined to 169.7 million from 176.3 million.  Also, the number of Americans with government coverage such as Medicare and Medicaid “climbed to 93.2 million from from 87.4 million.

The increase in people without insurance is mostly attributed to the loss of employer-provided insurance during the recession.

Click here to read the Census Bureau’s summary of key findings or to access the full report.

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Mississippi Rep. Gene Taylor on Wednesday became the first Democratic House member to join 171 House Republicans in signing a petition to repeal the recently passed health care reform act. Petition No. 11 needs 218 signatures and then Republican House leaders could force a full vote to repeal the entire law.

This is the start of the health care reform repeal process. As more of the negative aspects of the health care reform become available there could be stronger demand  to repeal the bill.

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In a 46-52 vote, lawmakers killed an amendment sponsored by Sen. Mike Johanns (R-Neb.) that would have saved businesses and nonprofit groups from having to report an array of small and medium-sized purchases to the IRS.
Deep in the  health law is a requirement that businesses file tax forms called 1099s with the Internal Revenue Service for every vendor that sells them more than $600 in goods. Business groups say it would create a paperwork nightmare for more than 40 million companies as they struggle to keep going in a weak economy.

The White House is backing a proposal by Sen. Bill Nelson, D-Fla., to exempt firms with 25 or fewer workers and raise the reporting threshold to $5,000 for the rest. But Nelson’s amendment failed a 60-vote procedural test 56-42.  Another vote did not pass at 46-52, an amendment by Sen. Mike Johanns, R-Neb., that would have repealed the reporting requirement.

Although majorities in both the House and Senate are now on record opposing the current 1099 reporting requirement, lawmakers disagree over whether to repeal or merely modify it, and how to plug a revenue gap that could be as large as $19 billion over ten years, depending on the approach Congress chooses.

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Anthem recently launched Wellness 360. This site is to help members control and better understand their health care. There are a multiple of programs that can help with lifestyle changes and disease management. By using these programs you could reduce your health care spending by half and have a much clearer picture of your health. Listed are a few of the programs that are available for members.

Get Guidance

360° Health offers guidance


Anthem experts provide the right guidance, so members get the help they need, whenever they need it. Whether they’re looking for quick information, a weight loss program, a live nurse on the phone or even a personal health coach, with 360° Health, our members have access, 24/7.

The 24/7 NurseLine provides members with anytime, toll-free access to nurses for answers to general health questions and guidance with critical health concerns. Callers can also access the Audio Health Library for confidential recorded messages about hundreds of health topics.


MyHealth Coach teams members with a health coach or a personal nurse that acts as a health and lifestyle resource. Health coaches also help members understand how to best use their health benefits.


Healthy Lifestyles is a wellness program that includes online and coaching support from health professionals to help members take steps toward improving their health. Key areas include weight management, stress management, physical activity, diet and nutrition, and smoking cessation.


Future Moms provides moms-to-be with telephone access to nurses to discuss pregnancy-related concerns. This program provides an educational packet, which includes a book about pregnancy, a questionnaire to evaluate risk for preterm delivery and other tools to help track pregnancy week-by-week.


NICUis a neonatal-intensive-care-unit program providing support for high-risk newborns with nurses who help coordinate NICU care between parents and medical professionals. Onsite support is available in select states.


MyHealth Advantage provides timely alerts in the mail, called MyHealth Notes, which notify members of possible health opportunities, gaps in medical care, medication alerts or possible ways to save money. Early detection of potential health issues may lead to decreased health care costs.


Employee Assistance Program (EAP) is a confidential, information, support, and referral service that offers tools and resources designed to help maximize employee productivity and meet the challenges of modern life. As an employer-sponsored program, EAP services are available to employees and their household members at no additional cost. Areas addressed by the EAP include child care and parenting, life events, financial issues, addiction and recovery and much more. Learn more about EAP

Improve Your Health

360° Health can help improve our members’ health


Members and their families, who are looking to make better health care decisions and live healthier lives, can find tools and resources they can trust when they go to MyHealth@Anthem at Whether a member is living with a chronic condition, ready to start a weight loss program or needs information on caring for an aging loved one, MyHealth@Anthem can help. Once they log on, they can access all kinds of health and wellness tools and resources like the following:

MyHealth Assessmentis the doorway to many 360° Health programs. By taking the MyHealth Assessment (available in English and Spanish), members can better understand their current health status and identify what positive changes they can make to improve their health.


The Personal Health Record lets members access and manage their medical records, privately and securely over the Internet. All information is stored in a central location that can be accessed anytime. Information can be shared with doctors to help ensure they know important details such as history of vaccinations, medications and test results.


The Childhood Immunization Scheduler projects children’s immunization schedules based on current clinical guidelines and their dates of birth. If a child has missed immunizations, the Catch-up Immunization scheduler can help identify which immunizations are needed.


Conditions Centers contain a wealth of information about managing a medical condition. Hundreds of articles and informational resources are available for download.


Anthem Care Comparison offers a side-by-side comparison of the costs for medical procedures at hospitals and other medical facilities. Additionally, Anthem Care Comparison can help members choose the right hospital by giving them access to scores about a hospital’s overall quality, including the number of patients treated in a year, complication rates for a particular procedure, if the hospital is a teaching hospital and more. Please note: This program is only available in certain areas.


Online Communities are a powerful way for members to find support from others going through similar experiences. This is an opportunity for members to relate to others to discuss health-related issues such as smoking, pregnancy, diabetes, depression, diet and nutrition and much more.


Health Videos feature current, trustworthy health information in a convenient and engaging video format. You can send members links to the videos or download them for podcast today.


WedMD Lifestyle Improvement Programsprovide a personalized, engaging and highly interactive way for members to address their risk factors like exercise, nutrition, smoking cessation, emotional health, stress management, or weight management. Each Lifestyle Improvement Program includes educational readings and journaling, planners and trackers that help drive steady improvement, and other tools to help members achieve their health goals.


The Symptom Checker can help members identify what type of ailments might be causing a particular pain or discomfort.


SpecialOffers@Anthem provides discounts directly from participating providers of alternative medicine such as chiropractors and acupuncturists, wellness products, laser vision correction and vision care, fitness club memberships and weight-loss programs.


Staying Healthy Reminders keeps members informed of the timing and frequency of important screenings, immunizations and other important health exams. Messages are targeted to certain age segments.


Worksite Wellnessprovides members with ways to get a jump start on improving their health right where they work. Our onsite programs help promote better health and cover topics such as flu shots and health screenings to wellness seminars and therapeutic massages.
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Governor Tim Pawlenty gave an  executive order barring state agencies from participation in the health reform law.
The executive order directs state agencies to decline all discretionary participation in the new law. As a result, none of Minnesota’s executive branch departments and agencies can submit applications for grants or demonstration projects unless required by the new law or approved by the governor’s office.

“Obamacare is an intrusion by the federal government into personal healthcare matters and it’s an explosion of federal spending that does nothing to make healthcare more affordable,” Pawlenty said in a statement. “To the fullest extent possible, we need to keep Obamacare out of Minnesota. This executive order will stop Minnesota’s participation in projects that are laying the groundwork for a federally-controlled healthcare system.”

The Kaiser Family Foundation has calculated that about 250,000 Minnesotans would join the Medicaid rolls under the expansion. Pawlenty has said it would cost the state $430 million in the first three years.

Pawlenty turned down an $850,000 sex-education grant on Monday, and Minnesota was one of five states — along with Alaska, Georgia, Iowa and Wyoming — not to apply for a $1 million healthcare reform grant to strengthen its health insurance rate review process. But the state already has one of the strictest rate review requirements in the country and may not have seen a need for the grants

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The think tanks have already started to come up with strategies to stop Obamacare. With Sept 23rd just a few weeks a way we are already seeing issues with health care reform that are leading people to think repeal.  Below are a few ways for the Republicans to fight the health care reform.

Here are six key strategies that a Republican Congress could employ to either repeal health care reform or delay it.

1.  Defund it. House Republican Leader John Boehner of Ohio has vowed to choke off funding for implementation of the legislation, starting with parts that are especially egregious such as the “army of new IRS agents” needed to police compliance.

While Republicans could target the most damaging provisions of the legislation and tie their defunding measures to appropriations legislation that the president wants and needs to sign, they’d better be ready for battles. When former House Speaker Newt Gingrich lost a stand-down with President Clinton over closing down the government in 1996, it was widely seen as a setback for GOP efforts to scale back big government.

2.  Dismantle it. To focus committee action and floor votes, Republicans can look for provisions in the law that Democrats are on record as opposing. For example, Senate Budget Committee Chairman Kent Conrad (D., N.D.) has said that the new federal program to fund long-term care—the Community Living Assistance Services and Supports Act, or CLASS Act—is “a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of.” Mr. Conrad and five of his Democratic colleagues sent a letter to Senate Majority Leader Harry Reid (D., Nev.) before the legislation passed opposing the program and expressing “grave concerns” about its fiscal sustainability.

Other highly unpopular provisions include the requirement that all businesses must file 1099 forms with the IRS to report any purchases totaling more than $600 in a year. This is designed to raise about $17 billion over 10 years from tax cheats. Rep. Dan Lungren (R., Calif.) was the first to introduce legislation to repeal this gigantic paperwork burden. Many Democrats in vulnerable districts who voted for the health law are also anxious to repeal this provision, which the National Federation of Independent Business says will impact 40 million businesses.

3.  Delay it. Republicans can also vote to postpone cuts to the popular Medicare Advantage program, postpone mandates requiring that individuals and businesses purchase and provide health insurance, and delay imposition of the $500 billion in taxes required by the law. Mr. Obama wouldn’t likely sign such legislation, but the debate would shine a light on problems that haven’t received nearly enough attention.

4. Disapprove regulations. The Congressional Review Act of 1996 (CRA) gives Congress the authority to overturn regulations issued by federal agencies if both houses approve, with a two-thirds majority needed to override a presidential veto. This would be difficult to pull off. But proposing a resolution of disapproval under the CRA gives Republicans a platform to express strong disagreement and bring attention to especially egregious rules.

The current congressional majority wants to gut the CRA, and the House passed a bill that would eliminate the requirement that federal agencies submit their rules to Congress before they can take effect. The Senate has not yet acted, but this measure should be on the Republicans’ watch list for the rest of the year.

5. Direct oversight and investigation. Other aspects of ObamaCare are ripe for public hearings. For example, rules dictating how much insurance companies must spend on direct medical benefits are already hugely controversial—even before they have been issued. Businesses are also aghast at the narrow openings they have to protect their current health plans from onerous federal regulation. Republicans could summon many witnesses to testify about the impact of this regulatory straightjacket.

Congress also must keep a careful eye on the evolving cost estimates and deficits. Former Congressional Budget Office Director Douglas Holtz-Eakin estimates that the cost of the subsidies for private insurance could rise to $1.4 trillion —triple the $450 billion assumed by the current CBO. This is because the legislation creates strong incentives for businesses to drop coverage and dump their employees into federally subsidized insurance. Congress has a responsibility to protect taxpayers from what surely will be exploding costs.

Republicans also will want to call Donald Berwick, head of the powerful Centers for Medicare and Medicaid Services, to testify before Congress and detail his regulatory agenda for implementing the health-care law. He escaped that duty earlier this year when the White House avoided his Senate confirmation by giving him a controversial recess appointment.

6. Delegate to the states. Congress should encourage states to press forward with their own innovative programs. For example, Gov. Mitch Daniels’s popular and fiscally responsible Healthy Indianapolis Plan expands coverage to the uninsured using a health savings account model. And the lightly regulated Utah Health Exchange provides a marketplace for individuals and small businesses to purchase affordable, portable health insurance. Both are threatened by ObamaCare. The more that states are marching forward with reform that suits the needs and pocketbooks of their citizens, the easier it will be for Congress to repeal ObamaCare and start over.

Americans intuitively understand that government can’t pay for huge new entitlement programs and the expansion of Medicaid with imagined cuts to Medicare, while still improving Medicare’s long-term solvency. They also know that job creation is flat and that employers’ fear of ever-rising health benefit costs is part of the problem. They need to hear the evidence that their fears are valid.

The real wallop of ObamaCare will come in 2014, when most of the spending begins and businesses and individuals are hit with intrusive and expensive mandates. The main job of Republicans, should they capture Congress, will be to slow down implementation of the law and explain to the American people the damage it will do—and already is doing—to our economy. If the White House changes hands in 2012, they can be ready to start with a clean slate and begin a step-by-step approach to sensible reform.

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I just spent 10 days in Canada and had the opportunity to listen to stories from multiple Canadians about there health care experiences.

I was able to speak to 3 different people about their health conditions and what kind of treatment they received. It was very interesting because as they told me their stories I thought how those conditions would have been treated here in United States.

The first situation was a gentlemen that need a double knee surgery. He needed both knees to be essential rebuilt. He had multiple tears in both knees and really had problems walking. When he would walk down the stairs he had to walk step side ways.  He has been on a waiting list for over 5 years. He lived in Toronto which is a major metropolitan city. I was amazed that it had really been 5 years.  Here in the US he might have waited 5 weeks. Now if was on a private health plan here he might have had to pay his out of pocket max for that surgery. If he was on a subsidized plan like Medicaid he would have paid very little out of pocket.

The next case was a women that suffered from Gall Stones. She had been in extreme pain and unable to eat.  It took the Canadian health care system well over a year to figure out what was wrong with her.  The big problem they had was access to diagnostic imaging to detect the stones.  She started the treatment in a rural hospital that had very little resources. They decided to move her treatment to Toronto. At that point she had no relationship with any of the doctors. She stated to me that in the Canadian system its very important to have your primary car physicianact as a gate keeper to all of your care. Once she lost that gate keeper none of the health care providers really show any case of urgency even though she was losing weight. After 8 months she was finally able to get diagnostic services to detect the stone.  Once the stone was it took about 6 months and 3 outpatient surgeries to remove it. There was problems removing the stones because of a lack of having the correct instruments for the surgery.  On the 3rd procedure they were finally able to remove the stones. It was indicated to the patient that the gall bladder was close to dieing because of a lack of blood.  The patient lost almost 50 lbs and was on her death bed. Her husband though that she had a couple of weeks left had the 3rd surgery not worked.  Here in the US this condition could have been corrected in just a couple of months tops.  There would have been immediate access to diagnostic imagining. With our technology the removal of the gall stone would have had a much higher probability of being success on the 1st surgery.  There is absolutely no reason a person should come close to death because of a gall stone.

The 3rd person had a much different story. She was diagnosed with a very rare kind of cancer. So rare that her life expectancy was months if not treated.  She was treated and the cancer went into remission in just a couple of months. When she told me this I asked how she was able to get such fast treatment. She told me that it was her doctor that saved her. The doctor put her on a list of need treatment immediately.  I did not understand.  I asked if there was a panel of people that make these type of decision and she said no just the treating d0ctor. So in this situation it sound like she a doctor that saved her life. I think had she received treatment here for the condition the treatment level would have been about the same with her sharing a small fraction of the total cost.

 With our current system all three situations would have be treated quickly with less suffering for at least 2 of the 3 cases. The trade off would have been the patients would have had to pays a small portion of the overall treatment.

With the new health care reform pushing Universal Care through an Employer Based plan I fear we are going down the socialized medicine route.  The route is going to ration health care on a very large scale if you are insured through a subsidized health plan.  Will US citizens have to wait 8 months for diagnostic imaging? Will it take 3 out patient surgeries to correct a condition? If your condition is not life threatening will you wait indefinitely?

After 2014 we could see to market of health care in this country. Subsidized plans like welfare and medicaid could have a huge drop off of quality of care and rationing. While the private health insurance market will dictate that you get immediate treatment and the quality of that care is the best.

Only time will tell.

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A new group, the States Alliance for Balanced Insurance Regulation, will represent small and midsize insurance-related businesses in the looming battle over the role of federal regulators. With health care reform we have seen the Office of Consumer Information and Insurance Oversight created by the Federal Goverment and SABIR is being created to in protecting the interests of small and mid-sized businesses within and related to the insurance industry.

David Bass will be the executive director of SABIR, and  former Congressman Barry Goldwater Jr. will be the president.

“SABIR will be fundamentally different from other major insurance associations in that we won’t be inclined to support federal regulation,” Bass says. “We were born of the sentiments and frustration from insurers across the nation. They have always operated under state regulation, and the intrusive federal government threatens not only their way of business but their existence as a whole…. SABIR aims to be the collective organ for the protection and promotion of balanced regulation of insurance.”

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With Sept. 23rd right around the corner health plans are ordered by law to cover certain aspect of reform.

There is real uncertainty in the carrier market. We have already seen an exodus of stand alone children policies being offered. The only carrier offer standalone children’s plan is Anthem. There is a chance that they too could pull out of that market. The problem the carriers are having is as Sept 23rd any child under 19 year age is guaranteed issue which means they can not be declined or pre x for any kind of health coverage.  This could lead to major premium increases if the policies are even available.  The government has agreed to allow the carriers to have an open enrollment period for these type of plans which will help.

The other uncertainty right now is the preventive care coverage that is being mandated under the health care reform. The individual carriers are looking to the government to give clarification on these rules. The problem then occurs is designing a plan that is compliant with health care reform and then getting the new plan design approved with the department of insurance in each state.

With these current issues we could see a black out of indiviudal coverage for new policies.  So on Sept. 23rd you might not be able to get a new individual policy. If you are in the market for a policy you need to act fast because who knows how long it could take before carriers clear up these issues with both the Federal Gov. and local Gov.  On a positive note they could get all this resolved before Sept. 23rd.

Current estimates on possible price increase for individualplans for this aspect of health care reform is anywhere from 4%-8%.  There are no available estimates on the price increases for a stand alone child’s policy.

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