News

Anthem Balance Funding sales over the past 12-14 months have increased. Anthem is one of the only carriers who offers both ACA and Balance / Level Funding and allow their HMO to be written alongside ABF. Anthem ABF (Level Funded) plans may be sold alongside Anthem fully insured Small Group ACA HMO plan(s) when certain criteria are met. Anthem has provided helpful information when speaking to your clients about this product.

Eligibility
•    The group must qualify as a Small Group (100 or fewer eligible employees).
•    This applies statewide (CA). Plan Offering
•    Adding ACA HMO plan(s) does not reduce the number of ABF plans offered.

Enrollment / Participation Requirements
The group must satisfy both ABF minimum enrollment requirements and ACA participation rules:
•    Overall participation: At least 75% of net eligible must have comprehensive medical coverage (through ABF enrollment, ACA HMO enrollment, and/or valid waivers, as applicable).
•    ABF minimum enrollment: At least 50% of net eligible must enroll in Anthem ABF.
•    Important: Even if ACA HMO enrollment counts as a valid waiver for ABF, it does not reduce the ABF requirement that 50% of net eligible must enroll on ABF.

Waiver Treatment (Alongside)
•    ABF enrollees are considered valid waivers for ACA HMO participation.
•    ACA HMO enrollees are considered valid waivers for ABF participation; however, they do not offset the 50% ABF enrollment requirement.

RFP Requirement (Must Be Requested Up Front)
•    An alongside sale must be requested at the time of the RFP.
•    Please include:
•    The fully insured quote request for the ACA HMO plan(s), and
•    A census reflecting the anticipated HMO enrollees.

Out of State flexibility that is specific to ABF
Effective immediately, Anthem will follow the below guidelines for ABF opportunities where CA does not have the majority of eligible employees.
•    If CA has the majority of the eligible employees, no UW approval is needed (Normal guidelines .. same as ACA)
•    If CA and Anthem state(s) have the majority of the eligible employees, no UW approval is needed ( New guidelines that apply to ABF ONLY, see example below)
•    If members are in CA but not majority and also not in Anthem states as majority, UW approval will be required (contact appropriate Anthem SAE based on Boker / Territory)

***** Anthem States (CA,NV,CO,MO,OH,WI,KY,GA,ME,IN,CT,VA,NH, NY)

For More Information or Help Quoting Anthem, Please Contact Your Dickerson Sales Representative.