NEWS renew coverage for 2017 when in fact it is not adequately informing consumers that the new plans provide no coverage if a physician is not participating in Anthem’s network, according to Consumer Watchdog. “Anthem is breaking the law and its promises to consumers by attempting to automatically renew its 2016 members for 2017 in coverage that actually provides no out-of-network care whatsoever. In an effort to retain its market share, Anthem is failing to adequately inform its members that they are losing out-of-network benefits for 2017,” said Laura Antonini, staff attorney for Consumer Watchdog. The group says that this change leaves customers potentially facing thousands of dollars or more in medical bills that their existing plan covered, without them knowing it. Many consumers likely face loss of access to their physicians altogether, a prospect particularly harmful for those in the midst of treatment, as paying full cost of out-of-network care is untenable for all but the wealthiest. (Click here to download the new class action lawsuit: http://tinyurl.com/hlsf4zk.) Consumers who renew their Anthem coverage by the December 15 deadline will be locked into those plans for all of 2017. The lawsuit announced today alleges that Anthem violated federal and state laws by doing the following: • Breaching its health plan contracts with its 2016 members by failing to provide guaranteed renewal of existing coverage as required under the contract. • Attempting to automatically renew members currently enrolled in PPO plans into EPO plans as of January 1, 2017, rather than correctly disclosing to consumers that Anthem is discontinuing their 2016 coverage. (The lawsuit alleges that the transformation of the plans into EPO plans renders the 2016 PPO plans discontinued.) • Sending out misleading renewal notices rather than discontinuation notices that would inform 2016 members of the loss of out-of-network benefits for 2017. “We believe that Anthem is trying to take advantage of consumers during the open enrollment period,” said Travis Corby of Shernoff Bidart EchDECEMBER 2016
everria LLP. “They are selling 2017 Affordable Care Act health plans as being the same as their 2016 products. But they are not adequately informing consumers that the new plans provide no coverage if a physician is not participating in Anthem’s network. Existing customers are being completely misled, and will potentially face thousands of dollars or more in medical bills that would have been covered under their existing plan. Many consumers likely face loss of access to their doctors altogether.” Leslie Burkes, an affected Anthem consumer said, “We are caught in a double bind. Many of my family member’s doctors are specialists that are out-of-network under our current Anthem PPO plan, which is
why we purchased a PPO in the first place. Under a PPO, Anthem pays for out-of-network doctors. If Anthem is allowed to convert these plans to EPO plans we will have no coverage for the doctors we need. Furthermore, we cannot switch to another health insurer because Anthem’s care management team has been managing my family members complicated health needs for the last year. Changing companies now would severely impact my family members health because a new team of staff would have to learn about my family members complex needs and history.”
EMPLOYEE BENEFITS THE ACA SPURS GROWTH OF DENTAL PLANS Dental benefit offerings have seen an uptick as the Affordable Care Act (ACA) has become more ingrained in the U.S. health care system, according to an A.M. Best report. Companies - CalBrokerMag.com -
that filed an annual health statement with the National Association of Insurance Commissioners increased their dental net premiums written by 77% over the past decade. The largest annual rate of growth came in 2014, when net premiums written increased 14% year-over-year. Similarly, enrollment grew 53% for the same period, with a 19% year-over-year increase in 2014. Despite geographic and provider network challenges, dental business has given health insurers steady net operating gain profitability over the past decade, with a fairly substantial improvement in results since 2009. The consistent operating profitability has been supported by a loss ratio from 60% in 2008 to 64% in 2013. Dental writers benefit from the mostly consistent utilization of policyholders. They usually don’t experience large one-time shock claims that may be associated with more typical health lines of business, which keeps the loss ratio fairly manageable and predictable. As companies expand into individual dental markets where adverse selection is a potential risk, the products are modified to include longer waiting periods for major dental services and lower annual maximums. The top 10 dental writers account for 62% of the market, with MetLife holding the dominant share at 17%. The individual dental market also is highly concentrated as the top 10 players account for 67% of the market, led by MCNA Insurance Company’s 30%. Individual dental benefits are relatively new, with interest emerging and premium growing rapidly over the past 10 years. Regardless of some provider network challenges and certain underserved geographic areas, the dental insurance industry is poised for growth as employees continue to value the benefit offering and more dental insurers participate in the ACA exchanges. Increasing competition, including numerous small carriers expanding their exchange offerings, may pressure operating results. But underwriting gains in each of the past five years are substantially higher than levels recorded in 2005-2009, according to A.M. Best. To get a copy of the report, visit www3. ambest.com/ bestweek /purchase. asp?record_code=254956. H CALIFORNIA BROKER | 45