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These Treatments will no longer have annual or life time limits

Alcoholism- Related Services
Ambulance Services
Asthma Education
Bariatric Surgery
Diagnostic Services
Durable Medical Equipment
Enteral Formula/Modified Low Protein Food Products
Hospice
Infusion Therapy
Kidney Disease Treatment
Mental Health
Ostomy Supplies                             
Pharmacy
Physician Office visit (Diagnostic Services)
Preventive Care Services
Prosthetic Devices/Limbs
Transplant  Services
Treatment of TMJ

Replace any annual or lifetime dollar limit with visit limit

Chiropractic Manipulation /Osteopathic manipulation services
Mental health/Substance Abuse In/Out Patient
Outpatient Occupational Therapy
Outpatient Physical Therapy
Outpatient Speech Therapy

Replace any annual or lifetime dollar limits with frequency limits
Hearing Aids

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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 anthem.com. 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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The Obama administration on Thursday told health insurers that it will track those who enact “unjustified” rate increases linked to the health overhaul and may block those companies from a new marketplace for insurance coverage.

Kathleen Sebelius, secretary of Health and Human Services, issued the warning in a letter to Karen Ignagni, the insurance industry’s top lobbyist.

Ms. Ignagni, president of America’s Health Insurance Plans, said: “It’s a basic law of economics that additional benefits incur additional costs, and the impact on premiums depends on the type and amount of coverage policyholders had before.” She attributed rising premiums to the higher price of medical services and the impact of younger and healthier people dropping their insurance during the weak economy, as well as the additional benefits required under the new law.

Sebelius acknowledges that the new law will cause an increase in premiums, albeit “minimal.”

So what we have here is the health insurance industry reacting the the new coverages that addressed in the Health Care Reform. Whe the Gov. forces health carries to cover additional benefits that were not covered before you have a price increase. If the plan is paying for more coverages how can there is no way for the carriers not to increase rates if they want to stay in business.

The White House now wants to make threats to the health insurance companies stating if they raise premiums they do not get to participate in the future health insurance exchange. The White House might be faced with carriers choosing not to participate in the exchanges in the first place. If the White House is upset about the rate increase coming at the end of this month then they are really going to be up set when the cost of the exchange plans. The exchange is going to operate with guaranteed Issue meaning no one can be declined. This is going to increase premiums significantly.

From a broker standpoint I feel that the White House has no clue of what they are doing with health care reform.

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As a result of the health care reform Individual health premiums are going up. As of Sept. 23rd we will see rate increases from anywhere of 20%-54%. This is a direct result of Health Care Reform.

Under health care reform all policy will have to cover “Essential Benefits”. The Essential Benefits will have no annual max which means they are unlimited. So for an example bariatric  medicine would be covered with no limitation. This sounds great if you are one that needs those services but the problem is everyone is going to have to pay for that benefit.

For new Individual policies the price is going to up. If you are on a policy that was in place prior to 3-23-10 you will be grandfathered in. Being grandfathered in might help you save a significant amount form the rate increase that is coming. If you are not grandfathered in your policy will include all of the new coverages and then you will see the rate increase at your renewal. Some carriers might give the rate increase immediately while other will wait for the renewal date.

As of Sept. 23 there will be an open enrollment period for children’s under 19. This open enrollment period will be a time where children can not be declined coverage. We expect the premium amount for a stand alone child policy to be in the ball park of $400 a month.  Outside of that open enrollment children will have to go through underwriting to get a policy. If a child is approved for the policy they cannot be pre x. Right now we do not have an estimate of what that policy cost could look like.

With this health care reform we are about to see health insurance premiums at an all time high.

Please check back with us as more details become available.

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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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