- On November 1, 2023
Kettering Health is moving to a new network tier
Kettering Health hospitals and doctors are moving from Tier 1 to Tier 2 in your clients’ 3 Tier health plan network on January 1, 2024.
As a result, your clients’ employees may pay more for care they receive from Kettering Health doctors and facilities starting on January 1. Their copays, percentage of the cost for care (coinsurance), and hospital costs may be higher.
Your clients’ employees have access to top doctors and hospitals in all network tiers, but their costs are lower when they receive care from Tier 1 doctors and hospitals. Tier 2 offers a broader network across the U.S. and worldwide, with higher out-of-pocket costs. Tier 3 doctors and hospitals are out of network, so employees’ costs will be higher if they see a doctor or go to a hospital in this tier.
January Grandmothered Renewals:
- Due to IRS Guidelines, we have increased the minimum deductible on embedded HSA plans from $3000 to $3250. This change was not reflected in our original renewal packets. Fix: Groups currently on the affected plans will be mapped to a $3250 deductible plan on the new renewal packets. This will result in a small rate DECREASE.
- Some renewal packets do not include alternate plan options. Fix: All renewals (except for one person groups) will include all alternate plan options and pricing.
You should receive a notification when the updated renewal packets are available. Please be assured that the renewals your clients will receive in the mail later this month will reflect the correct information. We apologize for the inconvenience and appreciate your patience as we work to fix these issues.
Bonus Program Announced
Anthem announced a new business bonus again for “NEW” SOCA MEWA, Ohio Farm Bureau MEWA, Anthem Balanced Funding and ACA small groups with an effective date of 1/1/24. (Please note this does not apply to existing Anthem Grandmothered or ACA groups moving to SOCA MEWA, Ohio Farm Bureau MEWA or Anthem Balanced Funding.)
This bonus amount is based on submissions date received.
If your paperwork arrives
Quoting for all products is live and underwriting is on top of turnaround on prescreens. If you need to work with underwriting to help on a risk factor OR need to look at an Anthem Balanced Funding option, reach out to ExpressLink for help.
Small Group ACA Special Open Enrollment Window: Nov. 15 – Dec. 15
The Affordable Care Act (ACA) requires health insurers to offer a one-month Special Open Enrollment Window, when eligible small groups can enroll in ACA coverage without having to meet standard employer-contribution and/or employee-participation ratios.
The special open enrollment period occurs November 15th through December 15th of each year, allowing eligible small group employers to enroll for coverage effective January 1st of the following year—there is no extension beyond these dates so please be sure to review your paperwork to ensure it’s complete.
Anthem doesn’t accept deposit checks so the group can have the deposit drafted one-time thru EFT or can have recurring payments set up on a deposit and ongoing basis—recurring payments eliminate the $25 admin fee.
If your employer groups are struggling with participation and/or contribution, the Special Open Enrollment Window for ACA is the time to enroll them in coverage.
Per ACA guidelines, participation and employer contribution requirements are waived for SOLD ACA cases RECEIVED between 11/15 – 12/15 for a 1/1 effective date.
- Group still has to qualify as a group and meet all other guidelines
- Participation & Contribution window does NOT apply to MEWA – applies to ACA only
- 1/1 eff dates only
- Group must submit required documents between 11/15 – 12/15