2017 enterprise producer manual 4.27.17 formatted (5.5.17)file.anthem.com/03673mubenmub.pdf · this...
TRANSCRIPT
Producer Manual
Individual Market Under Age 65
2017
Form 03673MUBENMUB 12/4/17
Form 03673MUBENMUB 12/4/17 Page 2 of 33
Table of Contents
Introduction ............................................................................................................................. 3 Welcome ............................................................................................................................. 3
Tools ....................................................................................................................................... 4 Producer Toolbox .............................................................................................................. 4 Sales and Training ............................................................................................................ 5 E-Submit ........................................................................................................................... 5 Producer Online News ....................................................................................................... 5 Transformation Central .................................................................................................... 5 Plan Selection Tools ........................................................................................................ 5
Annual Enrollment ................................................................................................................... 6 Annual Enrollment Period (ACA plans only) ..................................................................... 6
Special Enrollment .................................................................................................................. 8 Special Enrollment Periods ............................................................................................... 8 Effective Dates for Special Enrollment Periods ................................................................ 8 Supporting Documentation Requirements for Special Enrollment Periods ...................... 8
Selling .................................................................................................................................... 9 Selling On-Exchange ......................................................................................................... 9 Selling Off-Exchange ...................................................................................................... 10 Welcome Materials .......................................................................................................... 11
Premium Payments ............................................................................................................... 12 Initial Premium Payments for On-Exchange plans .......................................................... 12 Initial Premium Payments for Off-Exchange plans .......................................................... 13 On-going Premium Payments for On- & Off-Exchange plans .......................................... 14
Agent/Broker/Producer Request & Forms ............................................................................. 15 Agent of Record, Broker of Record, Producer of Record (AOR/BOR/POR) Requests ..... 15 Agent of Record Change Requests ................................................................................. 15
On-Exchange AOR Change Requests ....................................................................... 16 Forms for On-Exchange AOR Change Requests ....................................................... 17 Off-Exchange and Legacy AOR Change and Missing Agent Requests ..................... 18 Forms for Off-Exchange and Legacy AOR Change and Missing Agent Request ....... 19 On-Exchange AOR Missing Agent Requests ............................................................. 20 Forms for On-Exchange AOR Missing Agent Request .............................................. 21
Servicing Your Clients .................................................................................................... 22 Additional Coverage Available .................................................................................. 23 Servicing Your Clients on ACA-compliant Plans ...................................................... 23 Cancellation of Coverage .......................................................................................... 25 Servicing Your Clients on Non-ACA Plans ................................................................ 28
Contact Information .............................................................................................................. 32
Form 03673MUBENMUB 12/4/17 Page 3 of 33
Introduction
Welcome This Producer Manual contains the information you need to write Individual business with us, and continue servicing your existing clients. This manual contains most of the information you need to do business with us. While every scenario and policy is not included in this manual, you will find detailed information for the most common situations.
Along with this manual, we have several teams to support you:
Support of your selling efforts via our Local Leadership and Local Sales Teams
Our trained Broker Technical Support Team can help you put all our technical tools to work for you
Provide answers by email or phone from our Experienced Broker Sales Support Team
Retain your clients with help from our experienced and dedicated Health Plan Advisors (HPAs).
Note:
The term “producer” in this Producer Manual refers to agents and brokers, as well as producers. This guide is an overview of current procedures, and producers are expressly NOT authorized to make any promises or representations about whether, or what type of, coverage or outcome may be offered. The information contained in this manual is intended for use by authorized producers only and may not be copied or distributed for any other purpose. Any benefit descriptions are intended to be a brief overview of some benefits available to our members. The information provided in this manual is subject to change.
References in this document to “our website” include:
Anthem.com
Bcbsga.com
Empire.com
Anthem.com/ca
Form 03673MUBENMUB 12/4/17 Page 4 of 33
Return to Table of Contents
Tools
Producer Toolbox Our Producer Toolbox on our website is available 24/7 to provide you with up-to-date information, custom sales tools and helpful resources. It is a user-friendly tool to help you quote and sell new Affordable Care Act (ACA) compliant plans both On- and Off-Exchange. You can also manage your book of business enrolled in ACA or Pre-ACA plans.
Important messages and alerts are posted on the home page, right after you log in. For example, you will see alerts:
If you have In Progress or Incomplete Individual applications that have not yet been submitted.
Your commission statements are available on the Commission tab.
The tabs and features on the Producer Toolbox include:
The Manage Account link on the top right of the page, allows the user to make password changes, add and remove delegates, and add Exchange Certifications if required. In order to view On-Exchange options, you must be certified by the Exchange for the year of the plan you are quoting or selling.
The Incoming Business section has 2 sub-sections:
The Quotes and Comparisons section is used to create a Quote and Comparison of ACA compliant On- and Off-Exchange plans for your clients. Also, in this section, an agent-assisted online application may be started on behalf of your client.
The Applications and Enrollments section is used to check the status of in-progress and submitted applications.
The Current Business section includes 3 sub-sections:
The Client section provides information about your current clients enrolled in On- and Off-Exchange plans. You can view a copy of past bills (under Billing tab at the bottom of the Client tab), order an ID card, view and print a Temporary ID card, and view the Certificate of Coverage.
The Billing section provides information about your client’s current bill status. You can view a copy of the current bill.
The Rate Actions & Renewals section provides key renewal information including current and renewal rates, subsidy applied (if applicable), as well as contract and policy information for your clients.
Form 03673MUBENMUB 12/4/17 Page 5 of 33
Return to Table of Contents
Tools
Sales and Training The Sales and Training section has links to our sales collateral ordering site. Applications and brochures can be downloaded on that site. It also includes 2 sub-sections:
The Product Information section includes links to product guides and other resources.
The Policies and Procedures section includes links to view this Producer Manual and forms.
The AgentConnect section allows you to create a customized AgentConnect link to place on your business website or share with clients. When a client uses your AgentConnect link, they can get a quote and apply online while ensuring you get credit for the sale.
E-Submit E-Submit lets you scan and submit paper applications on-line. Instructions on how to use E-Submit are available on Producer Online News (see below). Enter “E-Submit” in the search bar, look for article titled, “Don’t forget to use E-Submit”.
Producer Online News Producer Online News helps keep you informed about the latest news and changes that impact your new sales and existing business. Link: news.Anthem.com
Transformation Central Transformation Central provides access to valuable broker resources to support your business including decision support tools and open enrollment information. Click on the Transformation Central Link on news.Anthem.com.
Plan Selection Tools These tools help assess the best plan options On-Exchange for your new and existing clients:
Subsidy Estimator: This helps you and your clients check if they may be eligible for a subsidy/tax credit or cost-share reduction.
Individual Online Store: The Individual Online Store is what we call our online quoting and application tool, which is seamlessly accessed from within the Producer Toolbox to help you to quote plans and start an online application for your client. Quoting and starting applications from the Producer Toolbox or your AgentConnect link allows you to get credit for helping your client.
Find a Doctor & Find My Medications: Available in the quoting process under Incoming Business. This lets you search and match providers and medications to plans during the quoting process.
MyAnthemChoices/MyBCBSGaChoices/MyEmpireChoices. This convenient tool lets your existing Individual clients view their current coverage, compare it with other ACA compliant plans and easily make changes.
Plan Selection Tools are available during Open Enrollment, and may not be available in all states outside of Open Enrollment.
Form 03673MUBENMUB 12/4/17 Page 6 of 33
Return to Table of Contents
Annual Enrollment
Annual Enrollment Period (ACA plans only) Open Enrollment Period:
The 2017 open enrollment period for On- and Off-Exchange plans was 11/1/16 through 1/31/17.
The earliest effective date for the next open enrollment period was 1/1/17.
The Exchange determines the effective date of On-Exchange plans.
We determine the effective dates for Off-Exchange plans as follows:
Scenario Application and full premium received: Effective Date:
All States – New Sales or Renewing Off-Exchange members who are requesting a PLAN CHANGE*
Between 11/1/16 and 12/15/16 1/1/17 Between 12/16/16 through 1/15/17 2/1/17 Between 1/16/17 through 1/31/17 3/1/17
Renewing Off-Exchange members who are requesting a PLAN CHANGE*
Between 11/1/16 and 12/31/16 1/1/17
Between 1/1/17 through 1/31/17: Current coverage** renews 1/1/17 at new 2017 rate.
Plan change effective 2/1/17
Renewing Off-Exchange members who are NOT requesting a plan change
Automatically renewed in an ACA plan** at their new 2017 rate.
1/17/17
*Plan changes for current members can be done by contacting an HPA or broker, or via:
MyAnthemChoices.com (All states except GA/NY) MyBCBSGaChoices.com (GA only) MyEmpireChoices.com (NY only) Plan Change Form (CO/NV only) Note that Renewal Free Look plan changes are effective on the renewal date, but must be received by January 31. **Provided eligibility for the plan still exists. Some plan changes/modifications to current plans may apply at renewal. Members no longer eligible for a catastrophic plan may be presented with an ACA plan, or provided notice of discontinuation without replacement.
Qualifying Events may occur during Open Enrollment
If a Qualifying Event (QE) that triggers a Special Enrollment Period (SEP) occurs during Open Enrollment, the appropriate QE box must be checked on the application, and the appropriate supporting documentation must be provided, in order for the SEP eligibility and effective date rules to apply. If a QE is not noted on the application, the Open Enrollment eligibility and effective date rules will be applied.
Form 03673MUBENMUB 12/4/17 Page 7 of 33
Return to Table of Contents
Special Enrollment
Special Enrollment Periods This occurs when a Member or an individual experiences certain qualifying events or changes in eligibility. They may enroll in a plan or change enrollment in a plan, On or Off-Exchange. On-Exchange qualifying events may be different than qualifying events Off-Exchange.
Qualifying Events for plans On-Exchange
In non-FFM states, go to the Marketplace/Exchange, in FFM states, go to healthcare.gov, and select “Special Enrollment” for qualifying event and effective date information for your On-Exchange clients. Eligibility is determined by the Exchange. On-Exchange qualifying events may be different than qualifying events Off-Exchange
Qualifying Events for plans Off-Exchange
Details about Qualifying Events (QE’s) can be found in Appendix A of the application. There is a link to QE information in the eligibility section of the online application. If enrolling using a paper application, Appendix A is included with the application. Applications are available on the ordering site on the Sales and Training tab on the Producer Toolbox. The same enrollment application is used for the Annual Open Enrollment Period and Special Enrollment Periods. Make sure to submit Appendix A with the application if applying during a Special Enrollment Period.
For qualifying events that involve birth, adoption, guardianship or marriage, the eligibility for the Special Enrollment Period applies to all family members. For loss of Minimum Essential Coverage, a Special Enrollment Period is triggered only for the person(s) who lost coverage.
Minimum Essential Coverage refers to plans that must include “essential health benefits” as defined by the Affordable Care Act (ACA). Plans must include items and services from at least these 10 categories of care:
1 Ambulatory patient services
2 Emergency services
3 Hospitalization
4 Maternity and newborn care
5 Mental health and substance use disorder services, including behavioral health treatment
6 Prescription drugs
7 Rehabilitative and habilitative services and devices
8 Laboratory services
9 Preventive and wellness service and chronic disease management
10 Pediatric services, including oral and vision care
Form 03673MUBENMUB 12/4/17 Page 8 of 33
Return to Table of Contents
Special Enrollment
Effective Dates for Special Enrollment Periods On-Exchange: Effective dates will be assigned by the Exchange.
Off-Exchange: The online application for coverage explains the effective rules and options and provides the user the ability to upload supporting documentation, eliminating the need for you to mail or fax the documentation. Effective date rules are also on the paper applications. The paper application is available on the ordering site accessible on the Sales and Training tab on the Producer Toolbox.
Effective date rules vary based on type of qualifying event. If an applicant experiences two qualifying events on or around the same date, refer to the effective date rules and application submission timelines and only select one qualifying event on the paper or online application. The effective date assigned will be based on the rules for the QE checked on the paper or online application.
Supporting Documentation Requirements for Special Enrollment Periods On-Exchange:
The Exchange is responsible for any supporting documentation requirements that may be necessary to validate qualifying events on the Exchange.
Off-Exchange:
Applicants are required to submit supporting documentation of a qualifying event with all applications for plans sold Off-Exchange during a Special Enrollment Period. Make sure the applicant’s name(s) is written on the top of each page of the supporting documentation before any documents are scanned, copied or faxed. We need legible copies of the required documents from your clients. Advise your clients to keep all original documents for their personal records, as we will not be able to return any documents to them. Requirements vary based on the type of qualifying event.
Details about required supporting documentation for Qualifying Events (QE’s) can be found on the paper application and during the online enrollment process.
We will validate each applicant for eligibility due to a qualifying event. We reserve the right to request additional documentation. Please note that supporting documentation requirements and our process for validating qualifying events are subject to change.
Form 03673MUBENMUB 12/4/17 Page 9 of 33
Return to Table of Contents
Selling
Selling On-Exchange Certification requirements
Producers must be certified in order to quote and sell plans On-Exchange. Training is provided by the Exchange. Producers must enter their Certification number they receive from the Exchange in the “Manage Account” section of the Producer Toolbox.
California Administrative Guidelines
Please be sure to review these certification administration guidelines available on the Producer Toolbox under Sales & Training and then Policies & Procedures.
Certification Requirement for Commission Payments: http://www.anthem.com/ca/shared/f0/s0/t0/pw_g270531.pdf
Certification Requirements When Assisting Clients: http://www.anthem.com/ca/shared/f0/s0/t0/pw_g270532.pdf
What is the Exchange?
The Exchange is an online marketplace where individuals can shop for insurance and compare health plans, get answers to questions, find out if they are eligible for tax credits for health insurance and enroll in a health plan that meets their needs.
Individuals can also purchase an Off-Exchange plan from an insurance company without going through the Exchange. Cost Share Reduction plans and Subsidies are only available for plans purchased On-Exchange.
Cost Share Reduction Plans and Tax Subsidies
Cost Share Reduction Plans are plans with reduced out-of-pocket costs. These plans are only sold On-Exchange.
Tax Subsidies are also called Advance Premium Tax Credits (APTC’s). The APTC is based on income and is applied to the premium to reduce the amount owed each month. Members don’t have to wait until tax time to receive their APTC, but they will have to include it when they file their taxes and the actual APTC amount may result in a balance due on their taxes (if the APTC amount applied to their bill was too high), or a refund (if the APTC amount applied to their bill was too low). The APTC can be used for any individual plan sold On-Exchange.
Who may qualify for a tax credit?
In non-FFM states, go to the Marketplace/Exchange, in FFM states, go to healthcare.gov, to get information about eligibility for tax credits and cost share reduction plans.
Eligibility
The Exchange is responsible for determining the eligibility of each applicant. All applicants deemed eligible will be sent to us for enrollment. Refer to Initial and On-going Premium Payments for information about payments and options.
Application submission – On Exchange Plans
The easiest way to shop and apply for an On-Exchange plan is to go to our website.
Form 03673MUBENMUB 12/4/17 Page 10 of 33
Return to Table of Contents
Selling
Selling Off-Exchange Eligibility
Detailed eligibility rules for subscribers and dependents are documented in the Eligibility Section of the Evidence of Coverage (EOC) for each product. The EOC can be viewed by accessing the Summary of Benefits and Coverage (SBC) for a product. In the box at the top of the SBC, there is a link to the EOC. SBC’s can be found at: https://sbc.anthem.com Enter that site as a Member/Consumer and then enter the search criteria for the product you are interested in.
Military service
An applicant or dependent is not eligible to apply for an Individual health care plan/policy if they are on active duty with any branch of the Armed Services.
Entry age determination
Entry Age is based on each applicant’s age as of the assigned effective date of coverage. If the actual effective date of the policy is different from the requested effective date on the application, the final premium may be different from the rate shown on the quote if an applicant has a birthday near the requested and actual effective date.
Application submission
Initial Premium Payment is required and must accompany the application. We accept applications through any of the following methods:
Online (MO and NV ONLY: Not available outside of enrollment period): Applications and initial premium payment can be submitted online 24 hours a day, 7 days a week on our website. The member can also sign up for on-going EFT payments at the same time as making their initial payment with the online application.
E-submit: Agent may submit completed application using E-submit.
Fax: Completed applications can also be faxed to the number indicated on the application
Mail: Completed applications may be mailed to us at the address indicated on the application
Signature requirements
The subscriber (and spouse/domestic partner, if applying) must sign and date the application. All applicants age 18 and over also need to sign and date the application. The parent/legal guardian of a dependent child applying must sign and date the application. Applications without the required signatures will be returned to the applicant. Payment options are detailed in the “Initial and On-going Premium Payments” section of this manual.
Application tracking and status
After your clients submit their paper or online applications, you can view status of their application on the Producer Toolbox on the Incoming Business tab under Applications and Enrollments. The application and status will not be displayed on the Producer Toolbox until the QE documentation has been validated by us.
Form 03673MUBENMUB 12/4/17 Page 11 of 33
Return to Table of Contents
Selling
Welcome Materials ID Cards and Certificate of Coverage or Evidence of Coverage (EOC) Information
Once approved, your client will receive their ID cards with the toll-free phone number for Member Services. Under separate cover they will receive their Welcome letter and their eCertificate information. If your client needs their ID card before it arrives, or if they misplace it, you can order, email or print a temporary ID card for them on the Producer Toolbox. Please refer to the Sales and Training tab of the Producer Toolbox for instructions on how to do this. Your client can also do this on the member portal (see below).
Member Self-service
Members have the ability to manage their health benefits at any time, day or night, and can register on our website. Members who log in will be able to:
Find a doctor or hospital
Order a new ID card
View their benefits
View status of their claims
View their plan’s prescription formulary
Pay their premiums online
Form 03673MUBENMUB 12/4/17 Page 12 of 33
Return to Table of Contents
Premium Payments
Initial Payments for On-Exchange plans Payment of the initial payment must be received before the applicant will be enrolled.
California:
The Exchange does not collect initial payment.
Once approved, the Exchange directs the applicant to Anthem’s payment portal, where s/he can make the first payment and can set up automatic monthly bank account drafts or credit/debit card charges. They are also given an option to submit a paper payment.
If payment is not made through the portal, we will contact the applicant directly to make payment arrangements.
Colorado:
The Exchange can collect initial payment, but it is not required to be submitted through the Exchange for enrollment approval. Once approved, the Exchange directs the applicant to the Exchange Payment Web Service, where s/he
can make the first payment by credit/debit card charge or ACH.
If payment is not submitted through the Exchange Payment Web Service, we will contact the applicant directly to make payment arrangements.
Connecticut and New York:
These Exchanges do not collect the initial payment, nor do they send the applicant to Anthem’s payment portal.
Anthem will contact the applicant directly to make payment arrangements.
Remaining states (Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, Virginia, Wisconsin):
These Exchanges do not collect initial payment.
Once approved, the Exchange directs the applicant to Anthem’s payment portal, where s/he can make the first payment and can set up automatic monthly bank account drafts or credit/debit card charges. They are also given an option to submit a paper payment.
If payment is not made through the portal, we will contact the applicant directly to make payment arrangements.
Form 03673MUBENMUB 12/4/17 Page 13 of 33
Return to Table of Contents
Premium Payments
Initial Payments for Off-Exchange plans The initial payment is required and must accompany the application. Payment of the initial premium must be received before the applicant will be enrolled.
The initial payment may be made with a paper check, electronic check, money order, or credit/debit card.
A Payment Page accompanies the paper application and lists the payment options available for the initial payment, as well as ongoing payments
The online application will display the payment options available for the initial payment, as well as ongoing payments.
The initial payment will not be processed until the complete application is enrolled. If the application is not enrolled, the payment will not be processed or refund will be issued accordingly.
Form 03673MUBENMUB 12/4/17 Page 14 of 33
Return to Table of Contents
Premium Payments
On-going Payments for On- & Off-Exchange plans Members have the following options to pay after the initial payment is applied:
Monthly Automatic Payments
Members can sign up to have their payments automatically deducted every month and can:
Choose to have premiums automatically debited from a checking / savings account or from a credit/debit card.
Select a debit date of the 1st to the 6th.
Sign up using the “Automatic Monthly Payment for Individual Plan” form located in the download forms section on our website or can be found on the Producer Toolbox on CustomPoint
Sales and Training tab, lower left corner below External Links under 2016 materials “Individual Supplies” link.
The completed form can be mailed or faxed.
Sign up online. Members must register and login into our website and click on the “Online Bill Pay” tab to get started.
Online Payments
By registering on our website, a member can take advantage of many benefits:
Make one-time monthly payments, either by checking/savings account or credit/debit card.
Ask to stop receiving paper invoices and view them online.
Members will receive an email reminder when an invoice is ready to view and can choose to download, print, or save invoices for future use.
View payment history and manage one-time and automatic payment options.
Make payment any time - 24/7!
Payments over the phone:
Payments can be made through our Automated IVR Payment system or through one of our Customer Service Representatives.
We accept check or Visa or Master Card credit/debit cards payments via phone.
Payments by check or money order:
Paper payments should be sent with the identification number written on the check or money order and accompanied with the monthly invoice.
Please Note: Payment submitted as paper check will be converted to a one-time bank draft / electronic transaction and the original check will be destroyed.
Payments must be submitted to the address provided on the invoice.
Payments by Mobile App: Make payments using the “Anthem Anywhere” mobile app, available at Google Play or iTunes
Form 03673MUBENMUB 12/4/17 Page 15 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Agent of Record, Broker of Record, Producer of Record (AOR/BOR/POR) Requests The term “agent” in this section refers to agents and brokers, as well as producers. The term “AOR” in this section refers to AOR, BOR as well as POR.
An agent must have an active appointment with us to be named as the AOR. For On-Exchange business an agent must have an active Exchange certification in the applicable state.
There are 2 types of AOR requests that can be made:
Change Requests – These are submitted when a member is requesting a change from their current agent to a new agent.
Missing Agent Requests – These are submitted when a member who has an agent was set up without an agent tied to the member.
Agent of Record Change RequestsOn-Exchange AOR Change Requests
California
On-Exchange AOR Change Requests
Before completing the AOR change form, check:
The process in the Agent of Record Administrative Guideline on Producer Toolbox (Sales & Training tab under Policies & Procedures)
Your Agent Agreement to make sure you can change the AOR. In some cases, an additional form may be required or the AOR change request may not be possible.
New: For On-Exchange business, when the AOR change request is initiated through Covered California, Anthem recognizes the agent identified as the AOR in the enrollment information received from Covered California. Anthem will also accept a fully completed and signed AOR change request form.
Form 03673MUBENMUB 12/4/17 Page 16 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
On-Exchange AOR Change Requests
All other states
On-Exchange AOR Change Request
In the following states, requests for On-Exchange AOR changes must be sent to the local state Exchange:
Colorado
Connecticut
New York
In the following FFM states, it is the agent’s responsibility to contact us using the state-specific form in the chart below AND it is the assuming Agent’s responsibility to contact the Exchange in the applicable state to ensure the Agent is assigned as the AOR in the Exchange’s system.
Georgia
Indiana
Kentucky
Maine
Missouri
New Hampshire
Nevada
Ohio
Virginia
Wisconsin
It is important to notify us and the Exchange so that all records are in sync. If both files don’t reflect the current agent, the agent could be overwritten with outdated information. We do not notify the FFM of AOR changes and the FFM does not notify us of an AOR change only.
The FFM’s process must be followed to get added in their system. If there are specific FFM questions, you or your client may call the FFM Consumer Call Center at 1-800-318-2596
Form 03673MUBENMUB 12/4/17 Page 17 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Forms for On-Exchange AOR Change Requests Change forms are used when a member is requesting a change from one agent to another. State-specific forms are provided below. Follow all of the instructions on the form. These forms are also available on CustomPoint.
On-Exchange AOR Change Form: Email completed form to:
Agent of Record Change form IN/KY/MO/OH/WI
Agent of Record Change form - GA
Agent of Record Change Form - ME/NH
Agent of Record Change Form - VA
Agent of Record Change Form - CA
Agent of Record Change form - NV
NOTE: CO, CT and NY do not have On-Exchange AOR change forms. Notification of changes must be sent directly to the state Exchange.
Form 03673MUBENMUB 12/4/17 Page 18 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Off-Exchange and Legacy AOR Change and Missing Agent Requests
California
Off-Exchange and Legacy AOR Change and Missing Agent Requests:
Before completing the AOR change form, check:
The process in the Agent of Record Administrative Guideline on Producer Toolbox (Sales & Training tab under Policies & Procedures)
Your Agent Agreement to make sure you can change the AOR. In some cases, an additional form may be required or the AOR change request may not be possible.
Requests for AOR changes for CA Off-Exchange plans must be submitted using the form in the chart below and emailed to [email protected].
Connecticut
Off-Exchange AOR Change and Missing Agent Requests:
Requests for AOR changes or missing agent requests for Off-Exchange plans must be submitted in writing and emailed to [email protected]. CT does not have a form for AOR changes or missing agent requests.
CO/NV ONLY
Missing Agent Requests:
If the agent is not listed on the application, we must have a signed letter from the member stating that the agent assisted them and they would like the agent added to the policy. CO/NV do not have a form for Missing AOR.
All other states
Off-Exchange and Legacy AOR Change and Missing Agent Requests:
In all other states, requests for AOR changes and missing agent must be submitted using the state-specific form provided in the chart below. Follow all of the instructions on the form. These forms are also available on CustomPoint.
Form 03673MUBENMUB 12/4/17 Page 19 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Forms for Off-Exchange and Legacy AOR Change and Missing Agent Requests
Off-Exchange and Legacy AOR Change and Missing Agent Request Forms
Completed Forms To Be Emailed To
Agent of Record Change Form - IN/KY/MO/OH/WI
Agent of Record Change Form - ME/NH
Agent of Record Change Form - VA
Agent of Record Change Form - GA
Agent of Record Change Form - NY Empire BC
Agent of Record Change Form - NY Empire BCBS
Agent of Record Change Form - CA
Agent of Record Change Form - CO (changes only)
Agent of Record Change Form - NV (changes only)
CT Only: Off-Exchange AOR Change and Missing Agent Requests must be submitted in writing (no form required)
CO Missing Agent Only: Off-Exchange Missing AOR Requests must be submitted in writing (no form required)
NV Missing Agent Only: Off-Exchange Missing AOR Requests must be submitted in writing (no form required)
Off-Exchange: [email protected]
Legacy: [email protected]
Form 03673MUBENMUB 12/4/17 Page 20 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
On-Exchange AOR Missing Agent Requests
California
On-Exchange AOR Missing Agent Requests:
Before completing the AOR change form, check:
The process in the Agent of Record Administrative Guideline on Producer Toolbox (Sales & Training tab under Policies & Procedures)
Your Agent Agreement to make sure you can change the AOR. In some cases, an additional form may be required or the AOR change request may not be possible.
New: Anthem recognizes the agent identified as the AOR in the enrollment information received from Covered California. Anthem will also accept a fully completed and signed AOR missing agent request form.
All other states
On-Exchange AOR Missing Agent Requests:
In the following states, requests to add a missing AOR for On-Exchange business must be sent to the local state Exchange:
Colorado
Connecticut
New York
In the following FFM states, it is the agent’s responsibility to contact us using the state-specific form in the chart below AND the Exchange when requesting to add a missing AOR for On-Exchange business.
Georgia
Indiana
Kentucky
Maine
Missouri
New Hampshire
Nevada
Ohio
Virginia
Wisconsin
Form 03673MUBENMUB 12/4/17 Page 21 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Forms for On-Exchange AOR Missing Agent Requests Missing AOR forms are used when a member was assisted by an agent, but was set up without the agent tied to the policy. State-specific forms are provided below. Follow all of the instructions on the form.
On-Exchange Enrollment Confirmation Forms (when adding a missing agent)
Completed Forms To Be Emailed To
Health Insurance Marketplace Enrollment Confirmation Form -
IN/KY/MO/OH/WI/ME/NH/VA
Health Insurance Marketplace Enrollment Confirmation Form - GA
Health Insurance Marketplace Enrollment Confirmation Form - CA
Health Insurance Marketplace Enrollment Confirmation Form - NV
IN, MO, OH, WI: [email protected]
ME, NH, VA: [email protected]
NOTE: CO, CT and NY do not have On-Exchange AOR Missing Agent forms. Notification of changes must be sent directly to the state Exchange.
Form 03673MUBENMUB 12/4/17 Page 22 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Servicing Your Clients Additional Coverage Available Dental, Vision, Interim (short term) and Critical Illness plans are available for sale as follows:
Dental Vision* IHC-Interim (ST) IHC - Critical Illness
CA Yes Yes Yes Yes
CO Yes Yes Yes Yes
CT Yes Yes No No
GA Yes Yes Yes Yes
IN Yes Yes Yes Yes
KY Yes Yes Yes Yes
ME Yes Yes Yes No
MO Yes Yes Yes Yes
NH Yes Yes No No
NV Yes Yes Yes Yes
NY Yes Yes No No
OH Yes Yes Yes Yes
VA Yes Yes Yes Yes
WI Yes Yes Yes Yes
*Blue View Vision is available to be purchased with Off-Exchange Individual medical orindividual dental coverage (except the standalone Dental Pediatric plan). Blue View Vision is not available On-Exchange. Blue View Vision is bundled and can only be sold with a dental or medical plan. It works as a standalone but cannot be purchased without medical or dental.
Form 03673MUBENMUB 12/4/17 Page 23 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Servicing Your Clients on ACA-compliant Plans
Address changes
Members enrolled in Off-Exchange plans can make address changes by contacting Member Services. Members can also change their address by submitting a written request to Member Services or by contacting their producer. If you submit the address change on your client’s behalf, please submit the change in writing, by fax or email to Agent Services.
NOTE: If your client moves from one geographical rating region to another, their rates may be subject to change, and the plan they are on may not be offered in the new rating region.
Change Requests
All change requests (adding or removing a dependent) for On-Exchange business must be handled by the Exchange. The Exchange will make all eligibility determinations. Please contact the Exchange directly.
Adding members to an existing plan (newborns, adoption, marriage, divorce, civil union/domestic partner, etc)
Eligible family members can only be added during open enrollment or during a Special Enrollment Period. Please refer to the Special Enrollment section of this manual and the enrollment application for eligibility rules and enrollment timeframes. Proof of qualifying event is required to be included with the application. Members adding a dependent to plans Off-Exchange can use the same application used for new business. Application submission timeframes vary based on the reason for enrollment.
NV Only:
While NV has a year round enrollment provision, the year round enrollment does not apply to existing Members. Existing Members can only add dependents to existing plans during the Annual Open Enrollment Period or if a Qualifying Event occurs.
Form 03673MUBENMUB 12/4/17 Page 24 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Dependents who reach age limitation (Overage dependents)
See chart below for maximum age and coverage end dates.
Maximum dependent age rules (On- or Off-Exchange)
Max Dependent Age Coverage end date after reaching max age(Off‐Exchange)*
CA 26 End of birth month
CO 26 End of birth month
CT 26 End of calendar year
GA 26 End of birth month
IN 26 End of birth month
KY 26 End of birth month
ME 26 End of birth month
MO 26 End of birth month
NH 26 End of birth month
NY 26, or 29 with rider End of birth month
OH 26, or 28 if eff date prior to 1‐1‐16 End of birth month
VA 26 End of birth month
WI 26 End of birth month *The Exchange determines and communicates the last date of eligibil ity
Off-Exchange Dependent Maximum Age:
We will send notification to the parent that their dependent will no longer be eligible to remain on their policy, up to 90 days in advance. We will also provide the overage dependent with information about plans available and how they can enroll on their own policy. Refer to Special Enrollment Periods section for more information.
Coverage may continue for over-age dependents with a physical or mental disability who meet the eligibility requirements. The parent should follow the instruction provided in the letter and submit all requested documentation.
On-Exchange Dependent Maximum Age:
The Exchange will send notification to the parent that their dependent will no longer be eligible to remain on their policy. We will not cancel the overage dependent until the Exchange notifies us to cancel the dependent.
The Exchange is also responsible for determining the dependent’s eligibility to remain on the parent’s policy.
Coverage changes
Changes in current coverage are only allowed during the Annual Open Enrollment or Special Enrollment period. See section under Special Enrollment period for qualifying events.
All change requests for On-Exchange business must be handled by the Exchange. The Exchange will make all eligibility determinations. Please contact the Exchange directly.
Form 03673MUBENMUB 12/4/17 Page 25 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Cancellation of Coverage Members may cancel at any time. If it is a voluntary cancellation, it is not a qualifying event and does not create a Special Enrollment Period.
ALL STATES EXCEPT NV:
If coverage is terminated voluntarily, members must wait until the next Annual Open Enrollment Period to enroll in new coverage unless they experience a qualifying event in the interim
NV Only:
If coverage is terminated voluntarily, members may later apply for coverage. If they have a qualifying event, the Special Enrollment Period eligibility, effective date and application submission timeline rules apply. If they don’t have a qualifying event, coverage is effective on the 1st of the month following 90 days from the date the completed application is received. After October 1st, current-year plans are not available for year round enrollment because the 90 day waiting period would result in a January 1st effective date. After October 1st, applicants may apply if they have a qualifying event or during the annual open enrollment period.
On-Exchange Coverage:
Members must contact the Exchange to request cancellation
The Exchange will send cancellation information to Anthem
Off-Exchange Coverage:
Members with multiple products (i.e., medical and dental) must specify which products are to be cancelled when a cancellation request is submitted. If the member does not specify which product should be cancelled, all active products will be cancelled.
Cancellation for non-payment of premium:
When premiums are not paid, coverage will cancelled due to non-payment following our standard grace period rules (see below). Members will receive a notice when premium is past due. The notice includes the date when the grace period ends and that coverage will terminate unless the member sends the full past due amount before the grace period ends. Reinstatement is not allowed if the policy is cancelled for nonpayment.
The grace period is an additional period of time during which coverage remains in effect and refers to either:
The three month grace period required for individuals receiving Advance Payments of the Premium Tax Credit (APTC), or
For individuals not receiving the APTC it refers to any other applicable grace period (All States except NY: 31 days; NY: 30 days).
If the full amount of the premium is not paid by the premium due date, the grace period begins. If the required premium is not paid by the date listed in the grace period letter, coverage is terminated. The member is not be eligible to apply for other coverage until the next open enrollment period unless they experience a qualifying event. See below for specific information about the two types of grace periods.
Form 03673MUBENMUB 12/4/17 Page 26 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Grace period for members receiving Advanced Premium Tax Credits (APTC)
Members who receive APTC are provided with a three month grace period. During the first month of the three month grace period, coverage remains in effect. During the second and third month of the grace period coverage will be suspended and the member(s) will be ineligible for benefits under their health benefit plan unless they pay all premiums due before the end of the grace period. Any outstanding authorizations, approvals for services or certifications for health care services to be provided during or after the second and third month of the grace period are also suspended. We will not provide any benefits or coverage for services, supplies, or prescription drugs obtained while the suspension is in effect even if previously approved, authorized or certified.
The application of the grace period to claims is based on the date of service and not on the date the claim was submitted.
If full premium is not received during the grace period, members:
Will have no coverage for claims incurred after the first month of the three month grace period. They are liable for the full cost of any services they receive after the first month of the three month grace period.
May be required by their health care providers to pay for any health care services they need.
Will be liable to us for the premium payment due for the period through the last day of the first month of the three month grace period.
Will be liable to us for any claims payments made for services incurred after the last day of the first month of the three month grace period.
May be required to repay any premium tax credits the government paid on their behalf during the second and third months of the grace period.
If your client makes timely payment of all premiums due before the end of the grace period, coverage will be reinstated, and claims for covered services received during the grace period will be processed.
Grace period for members not receiving APTC
These members have a grace period of 31 days (in all states except On-Exchange in ME and NY which is 30 days). This means if any premium payment is not paid on or before the date it is due, it may be paid during the 31 (30 in ME and NY) day grace period. During the grace period, coverage will stay in force. If the full premium payment is not made during the grace period, coverage will be terminated on the last day of the grace period (in CA, CO, CT, GA, ME and VA or the last day through which the Premium is paid (in KY, MO, NH, NV, OH, IN, NY and WI). They will be liable to us for the premium payment due including those for the grace period, as well as for any claims payments made for services incurred after the grace period.
Form 03673MUBENMUB 12/4/17 Page 27 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Cancellation during the free look period:
Members may cancel their policy during the free look period. Please refer to Right to Examine section of the policy.
Cancellation due to death:
Written notification must be sent to us to cancel due to death of any member on a policy. Cancellations for that member will be effective the date after death to ensure eligible benefits are paid up to that date. Any unused premiums will be refunded. A Death Certificate is required if we are notified more than one year following the date of death. If the request to cancel does not come from an adult member on the policy (age 18 and over), we will need an affidavit or other documentation completed in order to process the request. Unless otherwise specified, only the deceased member will be cancelled. If the deceased member is the policyholder, all other members will be transferred to their own policy(s) (same benefits as prior plan) effective the date the deceased member is cancelled.
Cancellation due to other coverage:
Individual coverage is not automatically cancelled when transferring to one of our Group plans or a Senior plan. In these cases, the member must request cancellation of the Individual coverage.
Reinstatements
Generally, reinstatements for Off-Exchange ACA plans are not allowed. Final decisions will be made by us. The Exchange will make any reinstatement decisions for On-Exchange policies.
Form 03673MUBENMUB 12/4/17 Page 28 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Servicing Your Clients on Non-ACA Plans (Legacy Grandfathered and Grandmothered plans)
This section applies to Grandfathered and Grandmothered plans (non-ACA plans) in states where those plans are still active. Please see chart below:
Legacy membership as of 1-1-17
State GF members GM members
CA YES NO
CO YES NO
CT NO NO
GA NO NO
IN YES NO
KY YES YES
ME NO NO
MO YES YES
NH YES YES
NV YES NO
NY NO NO
OH YES YES
VA YES NO
WI YES YES
Most of the policies for servicing your clients on non-ACA-compliant plans are the same as Off-Exchange ACA-compliant plans. Any exceptions are noted below. Please refer to the Off-Exchange rules in the “Servicing Your Clients on ACA-compliant Plans” section unless otherwise noted below.
Address changes
Please refer to the Off-Exchange rules in the “Servicing Your Clients on ACA-compliant Plans”
NOTE: If your client moves from one geographical rating region to another, their rates may be subject to change, and the plan they are on may not be offered in the new rating region.
Form 03673MUBENMUB 12/4/17 Page 29 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Membership changes on an existing non-ACA plan (newborns, adoption, marriage, divorce, civil union/domestic partner, etc)
Any current member on a non-ACA plan may add an eligible dependent at any time. Dependents added to non-ACA plans are subject to medical underwriting with the exception of newborns and adoption if they apply within 31 days of the date of birth or placement for adoption. Adding a member requires a full application to be completed. Coverage for newborns and adoptions will be effective on the date of birth or placement for adoption if they apply within 31 days of the date of birth or placement for adoption. For all other eligible dependents added to a non-ACA plan, coverage is effective as shown in the chart below.
Effective date for adding members to a Legacy plan
State Replacing Coverage* No Prior Coverage CA 1. Earliest possible effective date is the day after our receipt, -or-
2. If a specific effective date is not requested, day application isapproved by us.
Earliest possible effective date is 10 days after our receipt
CO 1st of the month following approval or at a later effective if requested by member.
Earliest possible effective date is 10 days after our receipt
CT GA IN 1. Earliest possible effective date is the day after our receipt, -or-
2. If a specific effective date is not requested, day application isapproved by us.
Earliest possible effective date is 10 days after our receipt
KY 1. Earliest possible effective date is the day after our receipt, -or-2. If a specific effective date is not requested, day application isapproved by us.
Earliest possible effective date is 10 days after our receipt
ME MO 1. Earliest possible effective date is the day after our receipt, -or-
2. If a specific effective date is not requested, day application isapproved by us.
Earliest possible effective date is 10 days after our receipt
NH 1. Earliest possible effective date is the day after our receipt, -or-2. If a specific effective date is not requested, day application isapproved by us.
Earliest possible effective date is 10 days after our receipt
NV 1st of the month following approval or at a later effective if requested by member.
Earliest possible effective date is 15 days after our receipt
NY OH 1. Earliest possible effective date is the day after our receipt, -or-
2. If a specific effective date is not requested, day application isapproved by us.
Earliest possible effective date is 10 days after our receipt
VA 1. Earliest possible effective date is the day after our receipt, -or-2. If a specific effective date is not requested, day application isapproved by us
Earliest possible effective date is 10 days after our receipt
WI 1. Earliest possible effective date is the day after our receipt, -or-2. If a specific effective date is not requested, day application isapproved by us.
Earliest possible effective date is 15 days after our receipt
*Must not have any lapse in coverage prior to enrolling in our plan
Form 03673MUBENMUB 12/4/17 Page 30 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Marriage and Domestic Partners
Current members who wish to add a domestic partner or a spouse due to marriage must submit a change application. The spouse is subject to full medical underwriting. Both the current member and the spouse must sign the application and standard effective date rules (see above) apply.
Dependents who reach age limitation (Overage dependents)
Please refer to the Off-Exchange rules in the “Servicing Your Clients on ACA-compliant Plans”. When an overage dependent is cancelled off a non-ACA plan due to reaching the maximum age, we will provide the overage dependent with information about plans available and how they can enroll on their own ACA-compliant plan. The loss of GF/GM coverage is considered a qualifying event for the overage dependent to apply for an ACA plan. Refer to rules for qualifying events and Special Enrollment Periods.er
Plan changes
Members on Grandfathered or Grandmothered plans who want to change to an ACA plan On- and Off-Exchange during open enrollment or following a qualifying event may call our Health Plan Advisors or use our online tool, MyAnthemChoices.com/MyBCBSGaChoices.com/MyEmpireChoices.com. Members on Grandfathered or Grandmothered plans may also apply for an ACA Plan at their renewal date.
Plan Changes for moves out-of-state
If a current member moves outside their state of residence in which the policy is held, the member must apply for a plan in the new state of residence. It is the policyholder’s responsibility to notify us of such a move. A move to a new service area with access to new plans is a Qualifying Event that will trigger a Special Enrollment Period for ACA Plans.
Cancellation of coverage
A member may cancel their Grandfathered or Grandmothered policy at any time, but may only apply for an ACA plan during the open enrollment period (exception is NV, please see Cancellation of Coverage (for ACA plans) section for more information about enrollment options).
Members with multiple policies (i.e., medical and dental) must specify which policies are to be cancelled. If the member does not specify which policies should be cancelled, all active coverage will be cancelled.
Individual policies are not automatically cancelled when transferring to an Anthem Group plan or a Senior plan. In these cases, the member must request cancellation of the Individual coverage.
A member’s voluntary cancellation of the policy (including cancellation for non-payment) is not a qualifying event and does not trigger a special enrollment period.
Form 03673MUBENMUB 12/4/17 Page 31 of 33
Return to Table of Contents
Agent/Broker/Producer Requests & Forms
Death of a member or subscriber
Please refer to the Off-Exchange rules in the “Servicing Your Clients on ACA-compliant Plans”
Reinstatements
If a current member allows his/her contract to cancel and wishes reinstatement, he/she will be eligible if:
Written or telephone request for reinstatement and full premium owed is received within 60 days of the last paid-to date of the policy for cancellations due to non-payment of premium.
Written or telephone request for reinstatement and full premium owed is received within 30 days of the last paid-to date of the policy for cancellations that were due to member’s request.
If a member does not fall within the above guidelines, the Grandfathered or Grandmothered policy will not be reinstated. A new application for coverage may be completed for an ACA-compliant plan during open enrollment or during a special enrollment following a qualifying event (exception is NV, please see Cancellation of Coverage (for ACA plans) section for more information about enrollment options). NOTE: A member’s voluntary cancellation of the policy is not a qualifying event and does not trigger a special enrollment period.
Form 03673MUBENMUB 12/4/17 Page 32 of 33
Return to Table of Contents
Contact Information
The chart below provides email and phone contact information for our Broker Sales Support team:
State Phone number Email address CA (800) 678‐4466 [email protected]
CO (866) 317‐9021 [email protected]
CT (866) 627‐6537 [email protected]
GA (866) 215‐4879 [email protected]
IN (800) 742‐8199 [email protected]
KY (800) 742‐8199 [email protected]
ME (877) 596‐6551 [email protected]
MO (800) 742‐8199 [email protected]
NH (877) 596‐6551 [email protected]
NV (866) 317‐9022 [email protected]
NY (800) 382‐4832 [email protected]
OH (800) 742‐8199 [email protected]
VA (800) 225‐3611 [email protected]
WI (800) 742‐8199 [email protected]
Form 03673MUBENMUB 12/4/17
Note: The information in this Producer Manual is subject to change without notice.
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health
Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem
Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Anthem Blue Cross
and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by
HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by
going to anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In
Georgia: Anthem Blue Cross and Blue Shield is the trade name of Blue Cross and Blue Shield of Georgia, Inc. Independent licensee
of the Blue Cross and Blue Shield Association. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of
Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance®
Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by
HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-
funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products
underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans
are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio:
Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in
Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123.
In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies;
Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare
and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield
Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and
symbols are registered marks of the Blue Cross and Blue Shield Association. Services provided by Empire HealthChoice Assurance,
Inc., licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and
Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.