The confidence of care - 2022 Anthem, Maine - Individual Market
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The
confidence
of care
2022 Anthem, Maine – Individual Market
What’s changing for 2022?
Transform
FFE vs. SBE - Maine is moving from a Federally Facilitated Exchange (FFE) to a State Based Exchange
(SBE). The website to enroll will be called CoverME.gov, launched by the Maine Department of Health and
Human Services (DHHS).
New Medical Network! – Individual ACA plans will use the Maine HMO Tiered Options network.
This network is used in the Anthem small group market today
Includes access to New England providers outside of Maine (CT, NH, MA, VT & RI) through the New
England HMO regional networks sponsored by those Blue Cross and Blue Shield plans.
The network is Tiered, with providers in Tier 1 having the lowest cost shares over Tier 2 providers.
Tiered Benefits - All plans will have Tiered benefits, except for CAT and American Indian plans.
Out-of-Network and BlueCard – plans will continue to have emergency and urgent care services outside
of the network. BlueCard will continue to use the Traditional Par network and cover emergency and urgent
care.
2
What’s changing for 2022?
Transform
Plan Discontinuation – all 2021 plans are required to be discontinued, and members will be transitioned
into similar new HMO Tiered plan designs.
HMO Plans w/PCP Selection and Referrals – all plans will be on the HMO platform with gatekeeper
requirements. Members on POS plans, including the renewal only plans on the HMO Maine network, will
be transitioned to the new HMO Tiered plans.
Service Area – HMO plans will now be statewide.
Northern Light facilities and providers have been added to the network, in the North, in Tier 1 for
network adequacy.
Counties and rating regions remain the same.
3
Coverage, choices, Tier 1 hospitals
and savings here and 1. Franklin Memorial Hospital, Farmington
2. LincolnHealth, Damariscotta
across the region. 30
Fort Kent
3. Maine Behavioral Healthcare/Spring
Harbor Hospital, Westbrook
Once employees choose a primary 4. MaineGeneral Medical Center, Augusta
care physician (PCP), they have 25 5. Maine Medical Center, Portland
Aroostook 6. Mid Coast Hospital, Brunswick
the freedom to decide when and
Presque Isle
where they obtain their care —here 7. New England Rehabilitation Hospital, Portland
and in neighboring states. 22
8. Pen Bay Medical Center, Rockport
9. St. Mary’s Regional Medical Center, Lewiston
Piscataquis 10. Southern Maine Health Care, Biddeford
27 11. Stephens Memorial Hospital, Norway
12. The Memorial Hospital, N. Conway,NH
13. Waldo County General Hospital, Belfast
14. York Hospital, York
15. Northern Light Acadia Hospital, Bangor
17
28 16. Northern Light Blue Hill Hospital, Blue Hill
Somerset
17. Northern Light CADean Hospital, Greenville
31
18. Northern Light Eastern Maine Medical Center, Bangor
Dover-Foxcroft Penobscot 19. Northern Light Maine Coast Hospital, Ellsworth
24
20 20. Northern Light Mayo Hospital, Dover Foxcroft
Franklin Washington 21. Northern Light Sebasticook Valley Hospital, Pittsfield
15 22. Northern Light ARGould Hospital, Presque Isle
32
Machias
21 33
18
19 23. Togus VAMedical Center, Augusta
26
1 Hancock
Oxford
Waldo
38 Kennebec
36
Augusta
13
29
Tier 2 hospitals
Androscoggin
4
23
16 24. Calais Community Hospital, Calais
11 35
Knox 25. Cary Medical Center, Caribou
Lincoln
9 8 26. Down East Community Hospital, Machias
Sagadahoc
12 34 2
27. Houlton Regional Hospital, Houlton
Cumberland 6
28. Millinocket Regional Hospital, Millinocket
Portland
Westbrook
3 7 29. Mount Desert Island Hospital, Bar Harbor
37 30. Northern Maine Medical Center, Fort Kent
York 5
31. Penobscot Valley Hospital, Lincoln
10
32. Redington-Fairview General Hospital, Skowhegan
33. St. Joseph Hospital, Bangor
14
34. Bridgton Hospital, Bridgton
35. Central Maine Medical Center, Lewiston
36. Northern Light Inland Hospital, Waterville
37. Northern Light Mercy Hospital, Portland
38. Rumford Hospital, Rumford
What’s changing for 2022?
Transform
◦ Unlimited $5 copay through LiveHealth Online ($5 after Ded for HSAs; Same as PCP for CAT plans)
Online visits with physicians 24/7 through LHO
LHO allows members to select a doctor who can diagnose, prescribe meds and order labs
◦ Medical (K)chats – Covered in Full (covered in full after Ded for HSA and CAT plans)
Convenient, text‐based conversations from your phone
Licensed doctors respond between the hours of 7 a.m. to 11 p.m. EST, seven days a week
Symptom checker offers reliable answers
Prescriptions are sent to your local pharmacy
Benefit limitations apply to certain benefits such as chiropractic services so please see the full summary of
benefits available on anthem.com under producer for further details.
5What’s changing for 2022?
Transform
◦ Cost Share Highlights –
Tiered deductibles and out‐of‐pocket maximums (OOPMS). Tier 1 and Tier 2:
Deductibles are separate and do not cross accumulate (except CAT plans)
OOPMS do cross accumulate together
Family deductible and OOPM is two times the single amount
Urgent and Emergency Care – Tier 2 is covered at the same cost shares as Tier 1
Plan names –
Standard plans will include “Clear Choice” in the plan name
Off exchange plans will include “Off Marketplace” in the plan name
The two Silver HSA compatible plans are offered Off the exchange only
◦ Catastrophic Plans – the ME BOI is requiring that LD 2007 rules regarding PCP/Behavioral Health office visits (OVs) be applied to CAT plans. They
excluded CAT plans in 2021. PCP/Behavioral Health (BH) OVs (PCP & BH accumulate separately) cover:
1st PCP OV is $0, the 2nd & 3rd are covered at $50 and all other visits are covered at 0% after deductible.* In order to pass
Mental Health Parity testing, Anthem’s CAT plan will cover the 1st 3 BH OVs at $0 and all other OVs at 0% after the deductible. All
other non‐CAT plans will cover just the 1st BH OV at $0.** The 2nd and 3rd copays will accumulate to the deductible.
*PCP, online and retail health clinic visits are considered similar types of visits and accumulate to the same first 3 visits that apply to LD 2007. There is only one visit covered in full for these three visit types combined and for Tiers
combined. Does not apply to HSA plans.
6
**All mental health and substance abuse office visits accumulate to the same first office visit covered in full. Catastrophic plan covers 1st 3 visits CIF then 0% after the deductible. Does not apply to HSA plans.2022 Product Offerings by Metal Level
Transform
ON/OFF BRONZE SILVER GOLD
Catastrophic
EXCHANGE
FMaine HMO Tiered Options Network
HMO 3 6* 1 1
*The Silver Clear Choice Tiered 3500 w/HSA and the Silver Clear
Choice Tiered 4500 w/HSA plans are only available off the
exchange.
7Pharmacy Network & Formulary
Transform
• Rx Choice Tiered Network • Select Formulary
Includes about 25,000 preferred
pharmacies in the network
Members pay less out of pocket for Level
prescriptions 1 Level
Lower contract rates mean lower cost for
members PHARMACIES INCLUDE: 1
• CVS • Walmart • Kroger
• Target • Sam’s Club • Costco
Level 2 pharmacy examples: Walgreens, Rite Aid, Giant Eagle
82022 Pediatric Dental & Vision for Individual Plans
Transform
• NO Changes to Embedded Pediatric Vision/Dental
• Embedded Pediatric Vision on All plans
• Embedded Pediatric Dental on Off HIX plans Only
Dental and Vision renewals:
We’ll send renewal details to members with standalone dental, vision or dental and vision benefits in their
on- or off-exchange renewal packet. Members who also have a renewing health plan will receive one
mailing containing their health, dental, and/or vision packets in the same envelope
92022 Foundational Packages Include
Transform
MedsRX Right Drug Right Channel –
24/7 Nurseline
Medical to Rx
Autism Spectrum Disorder (ASD)
MedsRX Right Drug Right Channel – Rx
Program V2 (with ABA Benefit
to Medical
Utilization Management/ Precert)
MedsRX Site of Care
Behavioral Health Case Management
(COMB) MyHealth Advantage Gold V2 (MHA
Care Optimization Program IngenioRX
Level
Gold V2 Plan fully insured roll‐out)
Sydney
– Basic 1
Case Management (includes ESRD) Transplant
Commercial Outbound Call Program Utilization Management
MedsRX Medical Specialty Drug Health Assessment
Review
102022 Engagement Packages Include *NEW*
Transform
For the very first time in 2022, Anthem is
providing opportunities for IND members to NEW!
earn rewards for participating in select wellness
activities
‐ The member and covered spouse/domestic partner 18+ Adult Wellness Exam or
is eligible to receive up to $45 per plan year. Well Woman Exam
‐ Rewards are in the form of a digital Retailer Health
Rewards card. Level
Claim based incentive Adult (in
person) Wellness Exam or Well
Woman Exam within first 90 days of
‐ Can be redeemed at anthem.com or Sydney member’s plan year $25
‐ If the member chooses to receive a physical gift card, a
1
small processing fee will be deducted from the reward. WebMD Health Assessment
Completion of WebMD Health
‐ The member is encouraged to use the reward for a Assessment $20
product or service that promotes good health.
‐ If the member has any questions about whether receipt
of rewards results in taxable income to them, Anthem
recommends that they consult Your tax advisor.
11
Details can be found on Sydney or anthem.comThe rewards redemption experience 12
Transform
Engaging consumer- In-person care
Virtual Primary Care centric platform integration
◦ AI symptom assessment ◦ Care navigation
Integrated, 24/7 digital support
◦ Personalized content ◦ In-network referral
through Sydney HealthSM for self-care ◦ Direct lab and imaging
◦ Personalized EMR ◦ Pharmacy
Text and video visits with ◦ Text-based visits
integrated provider practices ◦ Video visits
360° digital electronic medical Robust primary care Transparency
record (EMR) with automatic ◦ A care team ◦ Robust population health data
imports ◦ Primary and urgent care ◦ Bidirectional data sharing with
◦ Chronic conditions employers and providers
Automated health insights ◦ Therapy and psychiatry1
and follow-up ◦ Pediatrics (not yet available)
Integrated labs, pharmacy,
and in-person routing
86% 78%
of consumers who use of respondents wish to
virtual care visits love it.2 continue virtual visits.3
1. Appointments are subject to the availability of a therapist. Psychologists or therapists using LiveHealth Online cannot prescribe medications. Online counseling is not appropriate for all kinds of problems. If your employees are in crisis or having suicidal thoughts, it is important that you seek help immediately. Please call the National Suicide Prevention
Lifeline at 800-273-TALK (800-273-8255), or 911 for help. If it is an emergency, call 911 or go to your nearest emergency room. LiveHealth Online does not offer emergency services. Prescriptions determined to be a “controlled substance” (as defined by the Controlled Substances Act under federal law) cannot be prescribed using LiveHealth Online.
13 Psychiatrists on LiveHealth Online will not offer counseling or talk therapy.
2. J.D. Power 2020 US Telehealth Satisfaction Study.
3. Association of American Medical Colleges and Vizient Report, April 2021Connect
Sydney Health , our innovative mobile app
Matches members with the right provider at the right time
to quickly resolve health issues and care gaps
$19 vs. $150
cost of a text visit with a doctor using Sydney
Health versus the cost of an urgent care visit
Symptom Checker
◦ Members receive information and advice tailored
to their gender, age, and medical history
◦ Through artificial intelligence, it narrows down 14
millions of medical data points
◦ Assesses specific symptoms before even
seeing a doctor
14Confidence creates overall wellness
Anthem is your trusted partner in health.
Questions?
15You can also read
