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Filing at a Glance
Company: Anthem Health Plans, Inc dba Anthem Blue Cross and Blue
Shield of Connecticut
Product Name: Individual 2020
State: Connecticut
TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)
Sub-TOI: HOrg02I.005D Individual - HMO
Filing Type: Rate
Date Submitted: 07/08/2019
SERFF Tr Num: AWLP-131988460
SERFF Status: Closed-Reduced - Approved
State Tr Num: 201904057
State Status:
Co Tr Num:
ImplementationDate Requested:
01/01/2020
Author(s): Tu Nguyen, Mary McCarthy, Jeremy Chernofsky, Kristin
Roberts, Austin Lederman
Reviewer(s): Paul Lombardo (primary), Tricia Dave
Disposition Date: 09/12/2019
Disposition Status: Reduced - Approved
Implementation Date:
State Filing Description:
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Crossand Blue Shield of Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
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General Information
Project Name: Status of Filing in Domicile: Not Filed
Project Number: Date Approved in Domicile:
Requested Filing Mode: Review & Approval Domicile Status
Comments:
Explanation for Combination/Other: Market Type: Individual
Submission Type: New Submission Individual Market Type:
Overall Rate Impact: 15.2% Filing Status Changed: 09/13/2019
State Status Changed:
Deemer Date: Created By: Kristin Roberts
Submitted By: Kristin Roberts Corresponding Filing Tracking
Number:
Filing Description:
July 8, 2019
Mr. Paul Lombardo, ASA, MAAAActuary, Life & Health
DivisionState of Connecticut Insurance DepartmentP.O. Box
816Hartford, CT 06142-0816
Re: Anthem BCBS 2020 Individual Rate FilingSERFF Tracking Number
AWLP-131988460
Dear Mr. Lombardo:
For your approval, Anthem Blue Cross and Blue Shield (ABCBS) is
submitting proposed premium rates for its new andrenewing
Individual Products for both On & Off the Connecticut Exchange,
effective January 1, 2020. The following policyforms are affected
by the requested rate change.
CT ON HIX HMO (1-20)CT OFF HIX HMO (1-20)CT ON HIX PPO (1-20)CT
OFF HIX PPO (1-20)
Please see the enclosed files for the scope of changes and the
supporting documents:
•Anthem Individual State - Actuarial Memorandum•Anthem 2020
Actuarial Certification•Anthem 2020 FMHP Test•Anthem Individual
Federal – Actuarial Memorandum•Anthem 2020 Unified Rate Review
Template•Unique Plan Design Supporting Documentation•Actuarial
Value Screenshot for each Individual Plan•Anthem 2020 Rates
Template•Anthem 2020 Schedule of Benefits
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Crossand Blue Shield of Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
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Company and Contact
Filing Fees
State Specific
All Individual products include pediatric dental benefits
embedded in the benefits. The Individual Rates are developed from
the2018 Individual ACA experience and this same experience data is
used for the Claim Lag Triangle exhibit.
This filing includes the impact of the actual 2018 risk
adjustment based on the report produced by CMS and released on
June28, 2019.
Thank you for your attention to this filing. If you have any
questions regarding this matter, please feel free to contact me at
203677-8510. You may also email me at [email protected].
Sincerely,
Tu Nguyen, FSA, MAAADirector & Actuary III
Attachments
Filing Contact InformationTu Nguyen, Director & Actuary III
[email protected]
108 Leigus Road
Wallingford, CT 06492
203-677-8510 [Phone]
Filing Company InformationAnthem Health Plans, Inc dbaAnthem
Blue Cross and BlueShield of Connecticut
108 Leigus Road
Wallingford, CT 06492
(203) 677-4000 ext. [Phone]
CoCode: 60217
Group Code: 671
Group Name: WellPoint Inc Group
FEIN Number: 06-1475928
State of Domicile: Connecticut
Company Type: Life,Accident, Health
State ID Number:
Fee Required? No
Retaliatory? No
Fee Explanation:
Individual, Small group and non-employer group health filings
require rates to be filed. Does this filing comply with
therequirements of item 17 of the general instructions?: YesA
number of long standing Department positions have been reviewed and
modified. As a result, some checklists have beenamended, for your
convenience we have summarized all of these modifications under
General Instructions entitled "AmendedDepartment Positions", have
you reviewed this attachment at the bottom of the General
Instructions?: Yes
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Crossand Blue Shield of Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
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Correspondence Summary DispositionsStatus Created By Created On
Date SubmittedReduced -Approved
Tricia Dave 09/12/2019 09/13/2019
Objection Letters and Response LettersObjection Letters Response
Letters
Status Created By Created On Date Submitted Responded By Created
On Date SubmittedChangeRequest
Tricia Dave 09/04/2019 09/04/2019 Kristin Roberts 09/09/2019
09/09/2019
RequestingAdditionalInformation
Tricia Dave 07/24/2019 07/24/2019 Kristin Roberts 07/31/2019
07/31/2019
Filing NotesSubject Note Type Created By Created On Date
SubmittedAnthem response to CID questions on 7/24/19 Note To
Reviewer Kristin Roberts 07/31/2019 07/31/2019
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Cross and Blue Shieldof Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
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Disposition
Disposition Date: 09/12/2019
Implementation Date:
Status: Reduced - Approved
Comment: See attached disposition file.
Company
Name:
Overall %
Indicated
Change:
Overall %
Rate
Impact:
Written Premium
Change for
this Program:
Number of Policy
Holders Affected
for this Program:
Written
Premium for
this Program:
Maximum %
Change
(where req'd):
Minimum %
Change
(where req'd):Anthem Health Plans, Incdba Anthem Blue Crossand
Blue Shield ofConnecticut
15.200% 15.200% $45,881,364 21,892 $307,035,360 25.700%
0.100%
Schedule Schedule Item Schedule Item Status Public
AccessSupporting Document (revised) Actuarial Memorandum
NoSupporting Document Actuarial Memorandum YesSupporting Document
Consumer Disclosure Form YesSupporting Document (revised) Actuarial
Memorandum and Certifications YesSupporting Document Actuarial
Memorandum and Certifications YesSupporting Document (revised)
Unified Rate Review Template YesSupporting Document Unified Rate
Review Template YesSupporting Document Unique Plan Justifications
YesSupporting Document AV Screenshots YesSupporting Document
(revised) Rate Template NoSupporting Document Rate Template
YesSupporting Document Summary of Benefits YesRate (revised)
Actuarial memorandum Exhibit A NoRate Actuarial memorandum Exhibit
A Yes
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Cross and Blue Shieldof Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
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STATE OF CONNECTICUT
INSURANCE DEPARTMENT
www.ct.gov/cid
P.O. Box 816 Hartford, CT 06142-0816
An Equal Opportunity Employer
Anthem Health Plan Individual 2020
Finding of Facts
1. This is a rate filing for the Individual market ACA-compliant
plans offered by Anthem Health Plans, Inc., also referred to as
Anthem.
2. The proposed rates in this filing will be effective for the
2020 plan year beginning January 1, 2020, and apply to plans both
On-Exchange and Off-Exchange.
3. Policy forms in this rate filing are as follows:
Form Number
CT ON HIX HMO (1/20)
CT OFF HIX HMO (1/20)
CT ON HIX PPO (1/20)
CT OFF HIX PPO (1/20)
4. The proposed annual rate changes by plan from 0.1% to 25.7%.
These ranges are based on the renewing plans, and are consistent
with what's reported in the
Unified Rate Review Template.
5. Factors that affect the rate changes for all plans
include:
Morbidity: There are anticipated changes in the market-wide
morbidity of the covered population in the projection period.
Trend: This includes the impact of inflation, provider
contracting changes, and changes in utilization of services.
Benefit modifications, including changes made to comply with
updated AV requirements.
Changes in taxes, fees, and some non-benefit expenses, including
the reinstatement of Health Insurer Tax in 2020.
6. Although rates are based on the same claims experience, the
rate changes vary by plan due to the following factors:
Changes in benefit design that vary by plan.
Updates in benefit relativity factors among plans.
Updated adjustment factors for catastrophic plans.
Changes in some non-benefit expenses that are applied on a PMPM
basis.
Changes in the claim cost relativity by area.
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7. The experience period premium and claims reported in
Worksheet 1, Section I of the Unified Rate Review Template (URRT)
are for the non-grandfathered, single
risk pool compliant policies of the identified legal entity in
the Individual market.
8. The experience reported reflects the incurred claims from
January 1, 2018 through December 31, 2018 based on claims paid
through March 31, 2019.
9. The preliminary MLR rebate estimate is $0, which is
consistent with Anthem's December 31, 2018 general ledger estimate
allocated to the non-grandfathered
portion of Individual business.
10. The allowed claims are determined by subtracting non-covered
benefits, provider discounts, and coordination of benefits amounts
from the billed amount. Allowed
and incurred claims are completed using the chain ladder method,
an industry
standard, by using historic paid vs. incurred claims patterns.
The method
calculates historic completion percentages, representing the
percent of cumulative
claims paid of the ultimate incurred amounts for each lag month.
Claim backlog
files are reviewed on a monthly basis and are accounted for in
the historical
completion factor estimates.
11. The annual pricing trend used in the development of the
rates is 9.3%. This annual pricing trend is applied to both years 1
and 2 in Worksheet 1 of the URRT. 12.0
months of trend is applied to Year 1 and 12.2 years of trend to
Year 2. The trend
is developed by normalizing historical benefit expense for
changes in the
underlying population and known cost drivers, which is then
projected forward to
develop the pricing trend. Examples of such changes include
contracting, cost of
care initiatives, workdays, average wholesale price, and
expected introduction of
generic drugs. For projection, the experience period claims are
trended 24.2
months from the midpoint of the experience period, which is June
26, 2018, to the
midpoint of the projection period, which is July 1, 2020.
12. Morbidity Adjustment:
Adjustments are made to account for the differences between the
average morbidity of the experience period population and that of
the anticipated
population in the projection period.
The projected population consists of expected retention of
existing policies and new sales. The new sales include the
previously uninsured population and
previously insured populations from other carriers or coverage.
The morbidity
adjustment reflects projected Anthem and market changes in
morbidity. Prior
experience has exhibited market shrinkage and morbidity
increases year over
year. With anticipated growing market volatility, the
expectation is that
selective lapse and market deterioration will continue in 2020
due to increased
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selective entry and exit as members make health care decisions
in the
guaranteed issued, community rated ACA marketplace.
13. Changes in benefits include the following items:
Rx Adjustments: Adjustments are made to reflect differences in
the Rx formulary, Rx networks and discounts, and mail order
programs between the
experience period and the projection period.
Network Adjustments: Adjustments are made to account for the
member cost sharing change for Out-of-Network benefits between the
experience period
and the projection period for some plans.
14. Changes in Demographics (Normalization): The experience
period claims are normalized to reflect anticipated changes in
age/gender, area, network, and
benefit plan in the projection period:
Age/Gender: The assumed claims cost is applied by age and gender
to the experience period membership distribution and the projection
period
membership distribution.
Area/Network: The area claims factors are developed based on an
analysis of allowed claims by network, mapped to the prescribed
rating areas using the
group’s 5-digit zip code.
Benefit Plan: The experience period claims are normalized to
reflect the average benefit level in the projection period using
benefit relativities. The
benefit relativities include the value of cost shares and
anticipated changes in
utilization due to the difference in average cost share
requirements.
15. Other Adjustments:
Grace Period: The claims experience has been adjusted to account
for incidences of enrollees not paying premiums due during the
first month of the
90-day grace period when the QHP is liable for paying
claims.
Change in Medical Management: This adjustment reflects the
medical management impact not already included in the claims
experience and trend.
Induced demand Due to Cost Share Reductions: Individuals who
fall below 250% of the federal Poverty Level and enroll in
On-Exchange silver plans will
be eligible for cost share reductions. The percentage of
enrollment in CSR
Plans in the experience period is compared to that of the
projection period to
adjust for the different induced demand level due to CSR between
the two
periods.
Rx Rebates: The projected claims cost is adjusted to reflect
anticipated Rx rebates. These projections take into account the
most up-to-date information
regarding anticipated rebate contracts, drug prices, anticipated
price inflation,
and upcoming patent expirations.
Projected cost of pediatric dental and vision benefits are
included.
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Benefits in excess of the essential health benefits in the
projection period are included. Exhibit F provides details of
additional non-EHB benefits.
As an initiative to provide affordable coverage, Anthem
performed an analysis to identify low quality and high cost
inefficient providers, and removed them
from our network. The rate development reflects 1.7% savings for
this
initiative.
16. The experience period claims are 100% credible based on the
credibility method used. Based on analysis of historical data, the
standard for fully credible
experience is 10,500 members. With 38,281 members, the
credibility level
assigned to the experience period claims is 100%. Therefore, a
manual rate was
not used in the rate development.
17. Experience period risk adjustments are based on the 2018 CMS
report published June 28, 2019.
18. The projected risk adjustment PMPMs reported in the URRT are
on a paid claim basis. The projected amount applied to the
development of Market Adjusted Index
Rate is on an allowed claim basis. Exhibit C and Exhibit G
provide details.
19. Experience for all individual policy forms in this
filing:
Premium Incurred Claims
CY PMPM PMPM Loss Ratio
2013 $339.84 $302.92 89.1%
2014 $438.77 $307.98 70.2%
2015 $482.18 $396.04 82.1%
2016 $486.46 $468.17 96.2%
2017 $564.14 $515.50 91.4%
2018 $698.04 $531.72 76.2%
20. Trend Historical Exhibit
Rating Trend
Anthem proposes a 9.3% rating trend. The rating trend is
developed from the expected paid trend.
Observed Paid Trends
Observed trends have been normalized to remove the impact of
aging and morbidity, shifts in gender, mandates, and impact of
medical benefit changes.
Benefit Buy Downs
Cost and utilization data in the experience periods includes the
impact of benefit buy-downs. The trend process is
normalized for benefit buy-down to develop a projected trend for
2017, 2018, and 2019.
Leveraging
The use of Paid Claims removes the need to adjust for
Leveraging.
Other Trend Components
Medical technology trend is included in observed experience and
is not an independent assumption.
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(1) (2) (3) (2)/(1) (3)/(2)
Trend Trend
2016 2017 2018 2017 2018
Member Months 619,923 597,297 459,703
Utilization/1000
Inpatient 355.9 389.7 363.9 9.5% -6.6%
Outpatient 4,454.3 4,432.8 4,417.6 -0.5% -0.3%
Professional 9,460.1 9,622.6 9,923.7 1.7% 3.1%
Medical SubTotal 14,270.2 14,445.0 14,705.2 1.2% 1.8%
Pharmacy 13,095.8 13,464.0 13,615.9 2.8% 1.1%
Total 27,366.0 27,909.1 28,321.2 2.0% 1.5%
Unit Cost
Inpatient 4,137.9 4,340.3 4,832.8 4.9% 11.3%
Outpatient 531.0 556.4 632.4 4.8% 13.7%
Professional 188.6 200.3 207.1 6.2% 3.4%
Medical SubTotal 393.9 421.3 449.4 6.9% 6.7%
Pharmacy 128.2 132.6 141.8 3.4% 6.9%
Total 266.8 282.0 301.5 5.7% 6.9%
Allowed PMPM
Inpatient 122.7 140.9 146.6 14.9% 4.0%
Outpatient 197.1 205.5 232.8 4.3% 13.3%
Professional 148.7 160.6 171.3 8.0% 6.6%
Medical SubTotal 468.5 507.1 550.7 8.2% 8.6%
Pharmacy 139.9 148.8 160.8 6.3% 8.1%
Total 608.4 655.9 711.5 7.8% 8.5%
Paid PMPM
Inpatient 116.4 133.4 138.0 14.6% 3.5%
Outpatient 163.8 165.2 181.3 0.9% 9.7%
Professional 104.6 110.0 116.2 5.1% 5.6%
Medical SubTotal 384.8 408.6 435.5 6.2% 6.6%
Pharmacy 121.2 127.7 138.4 5.3% 8.4%
Total 506.0 536.3 574.0 6.0% 7.0%
2016 2017 2018 2019
Paid Thru 4/30 (PMPM) 516.4 536.5 553.0 592.9
Paid Thru Trend 3.9% 3.1% 7.2%
21. The proposed retention charge in the rate development is
19.4%. This is comprised of both fixed and variable expenses and
includes selling expense,
administrative expense, federal fees, federal income tax,
exchange fees and risk
and net profit margin. The December 31, 2018 Annual Statement
for Anthem
Health Plans, Inc. has a retention amount of 21.4%. This amount
is calculated
from the Analysis of Operations by Lines of Business exhibit on
page 7: 1 – [line
17, column 2 $797,384,558 / line 7, column 2 $1,015,000,670] =
21.4%.
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22. Exchange User Fee: The expected charge is estimated at 1.65%
of premium. The resulting fee/percentage is applied evenly to all
plans in the risk pool, both On and
Off Exchange.
23. Premium taxes, federal income taxes, and state income taxes
are also included.
24. Profit & risk margin is reflected on a post-tax basis as
a percentage of premium.
25. Exhibit I shows the projected Federal MLR for the products
in this filing. The calculation is an estimate and is not meant to
be a true measure for Federal or
State MLR rebate purposes. The products in this filing represent
only a subset of
Anthem's Individual business. The MLR for Anthem's entire book
of Individual
business will be compared to the minimum Federal benchmark for
purposes of
determining regulation-related premium refunds. Also note that
the projected
Federal MLR presented here does not capture all adjustments,
including but not
limited to: three-year averaging, credibility, dual option, and
deductible. Anthem's
projected MLR is expected to meet or exceed the minimum MLR
standards at the
market level after including all adjustments. The estimated
Federal MLR is
87.83%.
26. The 2020 Individual plan portfolio contains six plans with
tiered in-network benefits. These plans have up to three networks
of provider care and different cost
share provisions for each network:
The Tier 1 network is a subset of preferred in-network
providers; members have the lowest cost share amounts when
utilizing this preferred network.
The Tier 2 network is comprised of the remaining in-network
providers and has higher cost share amounts compared to the Tier 1
network.
For tiered PPO plans, the Tier 3 network is comprised of the
out-of-network providers and has the highest cost share
amounts.
Additional cost of care savings are expected from increased
utilization and new providers contracting of Tier 1 providers.
These savings are used to
reduce the tiered plan rate compared to a non-tiered plan with
similar cost
share provisions.
27. The RBC Ratio for Anthem Health Plans, Inc. is 462.6% as of
12/31/2018. Current capital and surplus for Anthem Health Plans,
Inc. is $360,256,649.
28. The Department received 1 public comment requesting that the
rate increase be disapproved and received 4 public comments
regarding all of the ACA filings
generally.
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Department Summary
Since this filing reflects rates that incorporate all the new
rating requirements of PPACA
effective 1/1/2014, the Department used criteria spelled out in
the latest HHS rate
regulations as a template for review along with previously
issued CT Insurance
Department bulletins that discuss the requirements for rate
filings.
The Department reviewed the 9.3% annual trend for 24.2 months
assumption used in the
rate filing and believes that based upon the experience data
submitted this assumption is
excessive and should be reduced to 7.75% for 24 months.
The Department reviewed the June 2019 CCIIO Summary Report on
Permanent Risk
Adjustment transfers for the 2018 Benefit year report for
Connecticut, as well as the
August 2019 Report with Risk adjustment Data Verification (RADV)
adjustments. Based
on these reports Anthem received $6,208,972 ($13.52 pmpm) in
risk adjustment
payments for the individual market, with a 2018 RADV payment
adjustment of $61,573
($0.13 pmpm) also determined. In addition, a significant net
amount of $3.90 pmpm
($5.27 minus the cost of $1.37) was received from the High Risk
Pool, for a total 2018
receipt of $17.29 pmpm. The Department believes the risk
adjustment receipt of $13.52
pmpm, built into this rate filing should be changed to a receipt
of $17.29 pmpm for 2020.
Anthem assumed a .2% Grace Period adjustment. The Department
does not believe this is
necessary and is requiring it be removed.
The Department reviewed the Dental and Vision assumptions and
justification data
provided and believes the assumptions are excessive and should
be reduced from
$2.65/$0.23 pmpm for Dental/Vision to $1.09/$0.07 pmpm.
The Department reviewed the Rx Rebate assumption of $12.86 pmpm
in Exhibit C and
believes it is insufficient and should be equal to $16.16
pmpm.
The Department reviewed the proposed area factor change and
evidence to support the
change and is requiring Anthem to stay at the 2019 area factor
levels. The Department
was not comfortable that the MLR analysis provided as
justification did not include
differences for population morbidity by geographic area.
Anthem assumed a morbidity deterioration factor of 4.7%. Based
on the Departments
review of the data provided and the Department’s assessment of
expected deterioration in
the overall market, the Department believes this factor is
excessive and should be reduced
to 1.0%.
Based upon the federal MLR for this filing of 87.83% the
Department believes that the
proposed pricing supports the federally required 80% loss ratio
for individual business.
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Department Disposition
Based upon the finding of fact, and the summary information
described above, the
proposed average rate increase of 15.2%, with a range from 0.1%
to 25.7% is found to be
excessive and is disapproved as submitted.
As a result, the final approved average increase is 6.5% with a
range from -7.3% to
16.7%.
The approved rates, with the required changes implemented, are
reasonable in
relationship to the benefits being provided, and are neither
excessive, nor inadequate nor
unfairly discriminatory.
Dated September 13, 2019.
_______________________________
Tricia Davé, F.S.A., M.A.A.A.
Insurance Actuary
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Objection Letter Objection Letter Status Change Request
Objection Letter Date 09/04/2019
Submitted Date 09/04/2019
Respond By Date 09/09/2019
Dear Tu Nguyen,
Introduction: See attached file
Conclusion:
Sincerely,
Tricia Dave
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Crossand Blue Shield of Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
09/13/2019 10:09 AM
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Based upon the Departments findings, please make the following
changes and submit a complete
revised filing for review with all updated exhibits and rates,
including a clear indication of the final
approved average rate increase and range if applicable, no later
than Monday, September 9, 2019:
1) Revise the proposed annual trend from 9.3% to 7.75%.
2) Revise the period that trend is applied to from 24.2 months
to 24 months.
3) Revise the morbidity adjustment from 4.7% to 1.0%.
4) Revise the Rx Rebate from $12.86 to $16.16.
5) Revise the Risk adjustment receipt from $13.52 to $17.29.
6) Revise the Pediatric Dental/Vision Claim adjustments from
$2.65/$0.23 PMPM to $1.09/$.07 PMPM.
7) Remove the Grace Period adjustment.
8) The proposed area factor changes for 2020 are not allowed,
please maintain current 2019 area
factors for all counties.
This correspondence will be held confidential, we request that
the company’s response to this change
request be marked confidential, not for public access. The
Department will send official dispositions to
each carrier with a more detailed explanation and will post all
final filings simultaneously.
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Objection Letter Objection Letter Status Requesting Additional
Information
Objection Letter Date 07/24/2019
Submitted Date 07/24/2019
Respond By Date 07/31/2019
Dear Tu Nguyen,
Introduction: Upon review of this Filing, we had some additional
questions. Please see the attached document for a summary.Thanks,
in advance, for your response on or before July 31, 2019.Tricia
Dave, FSA, MAAA
Conclusion:
Sincerely,
Tricia Dave
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Crossand Blue Shield of Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
09/13/2019 10:09 AM
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Anthem
2019 Individual Rate Filing
Questions/Comments
1. How come the experience period member months in the URRT
(459,312) don’t match
the member months in Exhibit B and Exhibit S (459,373)?
2. The filing states that there has been market shrinkage.
Please provide data to support
this assertion for the individual market.
3. The morbidity change factor has been estimated at 1.047.
Please provide a detailed
pmpm claim analysis supporting this morbidity deterioration
assumption from year to
year.
4. Provide detailed data to support the experience period and
future population factors for
each category in Exhibit D.
5. How does the Network adjustment under Plan Design changes in
Exhibit E differ from
Area/Network normalization in Exhibit D?
6. As described on page 4, Other Adjustments includes Change in
Medical Management,
yet there doesn’t appear to be any adjustments in Exhibit C,
please explain.
7. Isn’t pediatric dental and vision (from Exhibit F) included
in Exhibit B experience and
therefore already included in the starting paid claims in
Exhibit C? If not, explain why
they aren’t and provide historical pmpm experience for each
separately.
8. Provide a detailed actuarial analysis that supports the 1.7%
savings developed for the
Provider Scoping Initiative impact.
9. On page 7, under the Projected Loss Ratio, it states that the
products in this filing
represent only a subset of Anthem’s individual business. What
other individual business
does Anthem have in Connecticut that is applicable to the
federal MLR calculation and is
not included in this filing?
10. Provide a detailed actuarial analysis that supports the
revised 2020 area rating factors
contained in Exhibit M, including claim pmpm data by county, to
explain the proposed
area factors.
11. Could not locate the explicit CSR Silver load in the filing,
please provide along with a
detailed actuarial analysis of all assumptions and the
development of the actual factor.
-
Response Letter Response Letter Status Submitted to State
Response Letter Date 09/09/2019
Submitted Date 09/09/2019
Dear Paul Lombardo,
Introduction:
Response 1
Comments: For your approval, Anthem Blue Cross and Blue Shield
(ABCBS) is submitting proposed premium rates for its Individual
Products effective January 1, 2020 based onupdated changes per your
guidance on 09/04/2019. This results in an overall increase of
6.5%.
Please see the supporting documents:
Anthem Exhibit A Anthem Individual State - Actuarial Memorandum
Redline Anthem Individual State - Actuarial Memorandum Anthem
Individual Federal Actuarial Memorandum Anthem 2020 Unified Rate
Review Template Anthem 2020 Rates Template
Thank you for your attention to this filing. If you have any
questions regarding this matter, please feel free to contact me at
203-677-8510. You may also email me [email protected] .
Sincerely,
Tu Nguyen, FSA, MAAADirector and Actuary III
Changed Items:
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Cross and Blue Shieldof Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
09/13/2019 10:09 AM
-
Supporting Document Schedule Item ChangesSatisfied - Item:
Actuarial MemorandumComments:
Attachment(s): 2020 Actuarial Memorandum_CT IND -
G1800-State_20190909.pdf2020 Actuarial Memorandum_CT IND -
G1800-State_20190909 Redlined.pdfPrevious VersionSatisfied - Item:
Actuarial MemorandumComments:Attachment(s): 2020 Actuarial
Memorandum_CT IND - G1800-State_20190708.pdf
Supporting Document Schedule Item ChangesSatisfied - Item:
Actuarial MemorandumComments:
Attachment(s): 2020 Actuarial Memorandum_CT IND -
G1800-State_20190909.pdf2020 Actuarial Memorandum_CT IND -
G1800-State_20190909 Redlined.pdfPrevious VersionSatisfied - Item:
Actuarial MemorandumComments:Attachment(s): 2020 Actuarial
Memorandum_CT IND - G1800-State_20190708.pdf
Satisfied - Item: Actuarial Memorandum and
CertificationsComments:
Attachment(s):CT Anthem Individual 2020 MHP Test
20190708.pdfAnthem Actuarial Certification.pdf2020 Actuarial
Memorandum_CT IND - G1800-Federal_20190909.pdf
Previous VersionSatisfied - Item: Actuarial Memorandum and
CertificationsComments:
Attachment(s):CT Anthem Individual 2020 MHP Test
20190708.pdfAnthem Actuarial Certification.pdf2020 Actuarial
Memorandum_CT IND - G1800-Federal_20190708.pdf
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Cross and Blue Shieldof Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
09/13/2019 10:09 AM
-
Supporting Document Schedule Item ChangesSatisfied - Item:
Actuarial MemorandumComments:
Attachment(s): 2020 Actuarial Memorandum_CT IND -
G1800-State_20190909.pdf2020 Actuarial Memorandum_CT IND -
G1800-State_20190909 Redlined.pdfPrevious VersionSatisfied - Item:
Actuarial MemorandumComments:Attachment(s): 2020 Actuarial
Memorandum_CT IND - G1800-State_20190708.pdf
Satisfied - Item: Actuarial Memorandum and
CertificationsComments:
Attachment(s):CT Anthem Individual 2020 MHP Test
20190708.pdfAnthem Actuarial Certification.pdf2020 Actuarial
Memorandum_CT IND - G1800-Federal_20190909.pdf
Previous VersionSatisfied - Item: Actuarial Memorandum and
CertificationsComments:
Attachment(s):CT Anthem Individual 2020 MHP Test
20190708.pdfAnthem Actuarial Certification.pdf2020 Actuarial
Memorandum_CT IND - G1800-Federal_20190708.pdf
Satisfied - Item: Unified Rate Review
TemplateComments:Attachment(s): URRT-CT-IND-86545-1Q20
-Submission-2019-09-09.pdfPrevious VersionSatisfied - Item: Unified
Rate Review TemplateComments:Attachment(s): URRT-CT-IND-86545-1Q20
-Submission-2019-07-08.pdf
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Cross and Blue Shieldof Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
09/13/2019 10:09 AM
-
Supporting Document Schedule Item ChangesSatisfied - Item:
Actuarial MemorandumComments:
Attachment(s): 2020 Actuarial Memorandum_CT IND -
G1800-State_20190909.pdf2020 Actuarial Memorandum_CT IND -
G1800-State_20190909 Redlined.pdfPrevious VersionSatisfied - Item:
Actuarial MemorandumComments:Attachment(s): 2020 Actuarial
Memorandum_CT IND - G1800-State_20190708.pdf
Satisfied - Item: Actuarial Memorandum and
CertificationsComments:
Attachment(s):CT Anthem Individual 2020 MHP Test
20190708.pdfAnthem Actuarial Certification.pdf2020 Actuarial
Memorandum_CT IND - G1800-Federal_20190909.pdf
Previous VersionSatisfied - Item: Actuarial Memorandum and
CertificationsComments:
Attachment(s):CT Anthem Individual 2020 MHP Test
20190708.pdfAnthem Actuarial Certification.pdf2020 Actuarial
Memorandum_CT IND - G1800-Federal_20190708.pdf
Satisfied - Item: Unified Rate Review
TemplateComments:Attachment(s): URRT-CT-IND-86545-1Q20
-Submission-2019-09-09.pdfPrevious VersionSatisfied - Item: Unified
Rate Review TemplateComments:Attachment(s): URRT-CT-IND-86545-1Q20
-Submission-2019-07-08.pdf
Satisfied - Item: Rate TemplateComments:Attachment(s):
1Q20_CT_86545_IND_On-Off_All-Plans_RateTables 20190909.pdfPrevious
VersionSatisfied - Item: Rate Template
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Cross and Blue Shieldof Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
09/13/2019 10:09 AM
-
Comments:Attachment(s):
1Q20_CT_86545_IND_On-Off_All-Plans_RateTables_07082019.pdf
No Form Schedule items changed.
Rate/Rule Schedule Item Changes
Item
No. Document Name
Affected Form
Numbers
(Separated with
commas)
Rate Action Rate Action
Information
Attachments Date Submitted
1 Actuarial memorandumExhibit A
CT ON HIX HMO (1-20), CT OFF HIX HMO(1-20), CT ON HIXPPO (1-20),
CT OFFHIX PPO (1-20)
Revised Previous State FilingNumber:201803932Percent Rate
ChangeRequest:6.5
Exhibit A 2020_CT IND- G1800-20190909.pdf,
09/09/2019By: Kristin Roberts
Previous Version1 Actuarial memorandum
Exhibit ACT ON HIX HMO (1-20), CT OFF HIX HMO(1-20), CT ON
HIXPPO (1-20), CT OFFHIX PPO (1-20)
Revised Previous State FilingNumber:201803932Percent Rate
ChangeRequest:15.2
Exhibit A 2020_CT IND- G1800-20190708.pdf,
07/08/2019By: Kristin Roberts
Conclusion:
Sincerely,
Kristin Roberts
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Cross and Blue Shieldof Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
09/13/2019 10:09 AM
-
Response Letter Response Letter Status Submitted to State
Response Letter Date 07/31/2019
Submitted Date 07/31/2019
Dear Paul Lombardo,
Introduction: Please see Anthem response to the CID questions
from 7/24/19 in a Note to reviewer
Response 1
Comments: Please see note to reviewer dated 7/31/2019.
Changed Items:
No Supporting Documents changed.
No Form Schedule items changed.
No Rate/Rule Schedule items changed.
Conclusion:
Sincerely,
Kristin Roberts
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Crossand Blue Shield of Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
09/13/2019 10:09 AM
-
Note To Reviewer
Created By:
Kristin Roberts on 07/31/2019 03:23 PM
Last Edited By:
Paul Lombardo
Submitted On:
08/06/2019 01:08 PM
Subject:
Anthem response to CID questions on 7/24/19
Comments:
Please see the attached document in response to the questions
for Individual on 7/24/19.
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Crossand Blue Shield of Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
09/13/2019 10:09 AM
-
Anthem Health Plans Individual 2020
SERFF Tracking AWLP‐131988460
1.
How come the experience period member months in the URRT (459,312) don’t match the member months in Exhibit B and Exhibit S (459,373)?
The URRT sums membership by HIOS ID. Some members of the experience period are in the data without a HIOS ID, but we believe they belong in the experience data. In those cases, those members (i.e., 5 members) would not be included within the URRT.
2.
The filing states that there has been market shrinkage. Please provide data to support
this assertion for the individual market.
The above chart is from the NAIC Quarterly Financial Statement Exhibits for the Individual Market Enrollment. The exhibit shows how the size of the market has decreased 13.8% from 2017 to 2018 and then an additional decrease of 9.2% from 2018 to 2019. We expect the membership to shrink further by the end of 2019.
3.
The morbidity change factor has been estimated at 1.047. Please provide a detailed
pmpm claim analysis supporting this morbidity deterioration assumption from year to year. The market contraction component of the morbidity adjustment factor estimates the claims impact due to continued selective drop of coverage, assuming that individuals with greater healthcare needs will be more likely to retain coverage in a guaranteed issue market in which premium levels continue to increase. We expect this trend to continue in part due to the elimination of the individual mandate penalty and potential movement into other markets. We estimated lapse rates by APTC eligibility, Cost‐Share‐Reduction (CSR) eligibility, and risk score cohorts weighing to an overall market lapse rate of 4.4% per year in 2019 and 2020. The selection of the overall lapse rate was guided by historical market enrollment data points with adjustments for lesser future disruption. The estimated lapse rates by APTC eligibility, CSR eligibility, and risk score cohorts were guided by the following assumptions: 1) Individuals with lower healthcare needs will lapse at higher rates than
CT Members Yr to Yr chng1Q17
153,729 1Q18 132,462 ‐13.8%1Q19
120,226 ‐9.2%
-
those with higher healthcare needs. 2) Rate increase impacts to premium non‐subsidy members are higher than premium subsidy members, causing non‐subsidy members to lapse at higher rates. The assumed lapse rates show this pattern. Lastly, pre‐lapse membership distributions were calibrated to approximate the 2018 CT market, so as to estimate the claims cost change at a market‐level, where the impact to Risk Adjustment transfers among carriers is neutral.
4.
Provide detailed data to support the experience period and future population factors for each category in Exhibit D.
Age/Gender: Based on 2018 Individual ACA experience data, the member‐weighted age
factor was 1.002. Based on 2020 rating period membership distribution of members by age, the assumed member‐weighted age factor is 1.015. The projected 2020 membership is based off of early 2019 Individual ACA membership, which reflects that the average age is slightly older than 2018. The projected 2020 membership reflects a slight increase in members in the older age cohort and a slight decrease in membership proportion in the younger age cohort. The Age/Gender Normalization Factor = 1.015/1.002 = 1.013.
Area/Network: Based on 2018 Individual ACA experience data, the member‐weighted area/network factor was 1.006. Based on Networks that will be offered in 2020, the member‐weighted area/network factor is 1.008. The Networks offered in 2020 are leaner with a focus on Pathway X and Tiered Networks, resulting in a lower factor for the future projection population as compared to the experience period population. The Area/Network Normalization Factor = 1.008/1.006 = 1.002
201812 Snapshot Market EXPERIENCE BASE TABLECharacteristics
Membership EstimatedPercentile Risk Subsidy CSR
Distribution Claims PMPM
0%‐75% APTC CSR 19.2%
203.48$ 75%‐95%
APTC CSR 5.9%
1,057.93$
95%+ APTC CSR 1.5%
3,868.88$ 0%‐75%
APTC Non‐CSR 17.3%
223.16$ 75%‐95%
APTC Non‐CSR 3.6%
1,030.93$
95%+ APTC Non‐CSR 0.8%
4,218.63$ 0%‐75%
Non APTC Non‐CSR 40.1%
186.55$ 75%‐95%
Non APTC Non‐CSR 9.8%
1,025.11$
95%+ Non APTC Non‐CSR 2.0%
4,154.64$ Total APTC
48.1%
555.33$
Total nonAPTC 51.9%
495.24$ Total
100.0%
524.16$
-
Benefit Plan: Based on 2018 Individual ACA experience data, the member‐weighted benefit relativity factor was 0.693. Based on projected 2020 Individual ACA membership and the new plans we are offering, the member‐weighted benefit relativity factor is .675. The 2020 Individual portfolio of plans includes leaner plan options than 2018, and it is expected that membership will shift towards leaner plan designs, lowering the average benefit relativity factor in 2020. The Benefit Plan Normalization Factor = .676/.693 = .975.
5.
How does the Network adjustment under Plan Design changes in Exhibit E differ from Area/Network normalization in Exhibit D?
The Network adjustment under Plan Design changes in Exhibit E represents the weighted average change in Out of Network claims adjustments. The Area/Network normalization in Exhibit D reflects the forecasted change in paid claims PMPM from the experience period to the rating period due to forecasted changes in distribution of membership by rating area/network and network contracting.
6.
As described on page 4, Other Adjustments includes Change in Medical Management, yet there doesn’t appear to be any adjustments in Exhibit C, please explain. Change in Medical Management was mentioned on page 4 because we considered whether any changes could have an impact to the rates. We determined that there was no impact and, therefore, we did not build any dollar impact into the rates and there was nothing to list on Exhibit C.
7.
Isn’t pediatric dental and vision (from Exhibit F) included in Exhibit B experience and therefore already included in the starting paid claims in Exhibit C? If not, explain why they aren’t and provide historical pmpm experience for each separately. Pediatric dental/vision is not in our starting base claims experience because those claims are processed on a different claims system than the medical claims. Accordingly, cost estimates for pediatric dental and vision are added separately into our rate development. $2.65 PMPM for dental and $0.23 PMPM for vision.
Per your request, the table below shows dental and vision claim pmpm experience by year from 2016 through 2018.
In light of the minimal impact that this benefit cost assumption has on total premium compared to more material and volatile assumptions, Anthem has been trending the pediatric dental and vision cost assumptions from prior filings for the past several years,
Year Dental Vision2016 1.08$
0.06$ 2017
1.22$
0.09$ 2018
0.96$
0.07$
-
and has not performed a study to reset the cost assumptions. We will study and revise the cost assumptions accordingly in future rate filings.
8.
Provide a detailed actuarial analysis that supports the 1.7% savings developed for the Provider Scoping Initiative impact. Anthem performed an analysis to identify low quality and inefficient providers, and those providers were sculpted from our network to deliver the greatest value to our customers while ensuring compliance with network adequacy standards The average cost per episode of the providers who will be sculpted from the 2020 network is 36.5% higher than the average cost per episode of the providers participating in the 2020 network. Roughly 4.7% of the episodes will be impacted by our network modification, resulting in 1.7% savings (36.5% x 4.7%).
9.
On page 7, under the Projected Loss Ratio, it states that the products in this filing
represent only a subset of Anthem’s individual business. What other individual business does Anthem have in Connecticut that is applicable to the federal MLR calculation and is not included in this filing?
This statement could apply for Temp products or to companies that have grandmother or grandfather business. This is not applicable for CT.
10.
Provide a detailed actuarial analysis that supports the revised 2020 area rating factors
contained in Exhibit M, including claim pmpm data by county, to explain the proposed area factors. The proposed changes to the area factors was based on year‐to‐date medical loss ratio (YTD MLR) after adjusting for risk adjustment transfer payment. Below is a table showing YTD Risk‐ Adjusted MLR for each rating area compares to the overall YTD MLR. Negative means the YTD MLR for the county is running below the average overall YTD MLR. Anthem proposes to lower the area factors for Hartford, Middlesex, New Haven, Tolland and Windham as well as increasing the area factors for Litchfield and New London.
Region Name
2020 Area Rating Factor
2019 Area Rating Factor Change
RA LR Difference (Region ‐ Overall)
Fairfield 1.1 1.1 0.00
0.3% Hartford 0.94 0.96 ‐0.02
‐5.7% Litchfield 0.94 0.93 0.01
5.5% Middlesex 1.01 1.03 ‐0.02
‐3.1% New Haven 1.01 1.03 ‐0.02
‐5.3% New London 0.96 0.93 0.03
8.9% Tolland 0.92 0.93 ‐0.01
‐5.7% Windham 0.92 0.93 ‐0.01
‐2.0%
-
11.
Could not locate the explicit CSR Silver load in the filing, please provide along with a
detailed actuarial analysis of all assumptions and the development of the actual factor.
The starting claims costs initially assume the CSRs are spread out among all the plans. The process in the next paragraph explains how those costs are shifted from the non‐CSR plans to the CSR plans. Since the requirement is to rate plans starting from aggregate claims which include CSR claims, we estimate how much of those claims qualify as CSR claims and apply it only to the On Exchange Silver plan and remove the costs of CSRs from the non‐loaded plans.
First, we determine how much of our aggregate projected claims is from CSRs. To do this, we calculate the aggregate benefit relativity using only non‐CSR benefit relativities and compare to the actual projected aggregate benefit relativity, which includes the CSR variant BRs and assumed membership distributions across those variants. The difference between the BRs with and without CSRs is converted to a percentage of total projected claims, and all non‐loaded plans are reduced by that percentage. Whatever is needed to get us to the aggregate total projected claims including CSRs is then added to the loaded plans.
All non‐loaded plans were reduced by 4.6% and the Silver On‐Exchange plan was loaded by 9.5%.
-
Rate Information Rate data applies to filing.
Filing Method: Review & Approval
Rate Change Type: Increase
Overall Percentage of Last Rate Revision: -2.700%
Effective Date of Last Rate Revision: 01/01/2019
Filing Method of Last Filing: Review & Approval
SERFF Tracking Number of Last Filing: AWLP-131560564
Company Rate Information
Company
Name:
Overall %
Indicated
Change:
Overall %
Rate
Impact:
Written Premium
Change for
this Program:
Number of Policy
Holders Affected
for this Program:
Written
Premium for
this Program:
Maximum %
Change
(where req'd):
Minimum %
Change
(where req'd):Anthem Health Plans, Incdba Anthem Blue Crossand
Blue Shield ofConnecticut
15.200% 15.200% $45,881,364 21,892 $307,035,360 25.700%
0.100%
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Cross and Blue Shieldof Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
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-
Rate/Rule Schedule
Item
No.
Schedule
Item
Status
Document Name
Affected Form Numbers
(Separated with commas) Rate Action Rate Action Information
Attachments
1 Actuarial memorandum ExhibitA
CT ON HIX HMO (1-20), CTOFF HIX HMO (1-20), CT ONHIX PPO (1-20),
CT OFF HIXPPO (1-20)
Revised Previous State Filing Number:201803932Percent Rate
Change Request:6.5
Exhibit A 2020_CT IND- G1800-20190909.pdf,
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Cross and Blue Shieldof Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
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-
13
HIOS Plan Name 2020 HIOS Plan IDOn/Off
Exchange Metal Level Network Name Area(s) Offered Plan
Category
Plan Specific Rate Change (excluding
aging) {1},{2}
Catastrophic HMO Pathway X Enhanced 86545CT1230005 On
Catastrophic Pathway X Enhanced All Renewing -1.9%Bronze HMO
Pathway X Enhanced Tiered 86545CT1230013 On Bronze Pathway X
Enhanced Tiered All Renewing 11.2%Gold HMO Pathway X Enhanced
Tiered 86545CT1230016 On Gold Pathway X Enhanced Tiered All
Renewing -7.3%Anthem HMO Catastrophic Pathway Enhanced 8150/0%
86545CT1310033 Off Catastrophic Pathway Enhanced All Renewing
-1.9%Anthem Bronze HMO Pathway Enhanced Tiered 6100/7100/0%/50%
86545CT1310054 Off Bronze Pathway Enhanced Tiered All Renewing
7.7%Anthem Bronze HMO Pathway Enhanced 6200/12400/40% for HSA
86545CT1310019 Off Bronze Pathway Enhanced All Renewing 10.3%Anthem
Bronze HMO Pathway Enhanced 6500/50% 86545CT1310055 Off Bronze
Pathway Enhanced All New N/AAnthem Silver HMO Pathway Enhanced
Tiered 2800/3800/10%/40% for HSA 86545CT1310051 Off Silver Pathway
Enhanced Tiered All Renewing 2.7%Anthem Silver HMO Pathway Enhanced
Tiered 2500/5000/10%/40% 86545CT1310052 Off Silver Pathway Enhanced
Tiered All Renewing -0.3%Anthem Silver HMO Pathway Enhanced
4500/30% 86545CT1310056 Off Silver Pathway Enhanced All New
N/AAnthem Gold HMO Pathway Enhanced Tiered 2000/3000/10%/30%
86545CT1310050 Off Gold Pathway Enhanced Tiered All Renewing
0.6%Bronze PPO Standard Pathway X for HSA 86545CT1330009 On Bronze
Pathway X All Renewing 14.6%Bronze PPO Standard Pathway X
86545CT1330002 On Bronze Pathway X All Renewing 15.0%Bronze PPO
Pathway X 86545CT1330013 On Bronze Pathway X All New N/ASilver PPO
Standard Pathway X 86545CT1330001 On Silver Pathway X All Renewing
0.4%Gold PPO Standard Pathway X 86545CT1330003 On Gold Pathway X
All Renewing 16.7%Gold PPO Pathway X 86545CT1330015 On Gold Pathway
X All New N/A
NOTES:{1} Plan level increases in rates do not include
demographic changes in the population.
Exhibit A - Non-Grandfathered Rate Changes
Anthem Health Plans, Inc.Individual
Rates Effective January 1, 2020
-
Supporting Document Schedules Satisfied - Item: Actuarial
MemorandumComments:
Attachment(s): 2020 Actuarial Memorandum_CT IND -
G1800-State_20190909.pdf2020 Actuarial Memorandum_CT IND -
G1800-State_20190909 Redlined.pdfItem Status:Status Date:
Bypassed - Item: Consumer Disclosure FormBypass Reason: Not
needed at this time.Attachment(s):Item Status:Status Date:
Satisfied - Item: Actuarial Memorandum and
CertificationsComments:
Attachment(s):CT Anthem Individual 2020 MHP Test
20190708.pdfAnthem Actuarial Certification.pdf2020 Actuarial
Memorandum_CT IND - G1800-Federal_20190909.pdf
Item Status:Status Date:
Satisfied - Item: Unified Rate Review
TemplateComments:Attachment(s): URRT-CT-IND-86545-1Q20
-Submission-2019-09-09.pdfItem Status:Status Date:
Satisfied - Item: Unique Plan
JustificationsComments:Attachment(s): CT Anthem Individual 2020 All
Unique Plan Justification Sets 20190708.pdfItem Status:Status
Date:
Satisfied - Item: AV ScreenshotsComments:Attachment(s): CT
Anthem Individual 2020 Plan AVs 20190708.pdf
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Cross and Blue Shieldof Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
09/13/2019 10:09 AM
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Item Status:Status Date:
Satisfied - Item: Rate TemplateComments:Attachment(s):
1Q20_CT_86545_IND_On-Off_All-Plans_RateTables 20190909.pdfItem
Status:Status Date:
Satisfied - Item: Summary of BenefitsComments:Attachment(s): CT
Anthem Individual 2020 Summary of Benefits 7.8.19.pdfItem
Status:Status Date:
SERFF Tracking #: AWLP-131988460 State Tracking #: 201904057
Company Tracking #:
State: Connecticut Filing Company: Anthem Health Plans, Inc dba
Anthem Blue Cross and Blue Shieldof Connecticut
TOI/Sub-TOI: HOrg02I Individual Health Organizations - Health
Maintenance (HMO)/HOrg02I.005D Individual - HMO
Product Name: Individual 2020
Project Name/Number: /
PDF Pipeline for SERFF Tracking Number AWLP-131988460 Generated
09/13/2019 10:09 AM
-
State: ConnecticutHIOS Issuer ID: 86545NAIC Company Code:
60217
ACTUARIAL MEMORANDUM
1. General Information
• Company Identifying InformationCompany Legal Name: Anthem
Health Plans, Inc.
Primary Contact Telephone Number: (203) 677-8510Primary Contact
Email Address: [email protected]
2. Scope and Purpose of the Filing
As required by the Connecticut Insurance Department (CID) this
Actuarial Memorandum supersedes and replaces in its entirety of the
memorandum submitted to the CID on July 8, 2019. This is a rate
filing for the Individual market ACA-compliant plans offered by
Anthem Health Plans, Inc., also referred to as Anthem. The policy
forms associated with these plans are listed below. The proposed
rates in this filing will be effective for the 2020 plan year
beginning January 1, 2020, and apply to plans both On-Exchange and
Off-Exchange.
Market: IndividualEffective Date: January 1, 2020
• Company Contact InformationPrimary Contact Name: Tu Nguyen
CT OFF HIX PPO (1-20)
The Memorandum provides support to the rate development and
demonstrates that rates are established in compliance with state
laws and provisions of the Affordable Care Act. The rates proposed
in this submission reflect the insurer participation in the market
and regulatory framework as of September 9, 2019. If the regulatory
framework or insurer participation in the market change after this
date, proposed rates may no longer be appropriate and should be
reevaluated for revision and resubmission. This rate filing is not
intended to be used for other purposes.
Policy Form Number(s):CT ON HIX HMO (1-20)CT OFF HIX HMO
(1-20)CT ON HIX PPO (1-20)
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3. Proposed Rate Increase(s)
As a result of the rate filing process the CID has informed
Anthem that they will approve annual rate changes by plan that
range from 4.2% to 7.3%, with rate changes by plan from (7.3%) to
16.7%. These ranges are based on the renewing plans, and are
consistent with what is reported in the Unified Rate Review
Template. Exhibit A shows the rate change for each plan.
Factors that affect the rate changes for all plans include:
Trend: This includes the impact of inflation, provider
contracting changes, and changes in utilization of services.
Morbidity: There are anticipated changes in the market-wide
morbidity of the covered population in the projection period.
Changes in some non-benefit expenses that are applied on a PMPM
basis.
Changes in the claim cost relativity by area.
4. Experience and Current Period Premium, Claims, and
Enrollment
The experience period premium and claims reported in Worksheet
1, Section I of the Unified Rate Review Template (URRT) are for the
non-grandfathered, single risk pool compliant policies of the
identified legal entity in the Individual market.
• Paid Through Date
The experience reported in Worksheet 1, Section I of the URRT
reflects the incurred claims from January 1, 2018 through December
31, 2018 based on claims paid through March 31, 2019.
Benefit modifications, including changes made to comply with
updated AV requirements.
Changes in taxes, fees, and some non-benefit expenses, including
the reinstatement of Health Insurer Tax in 2020.
Although rates are based on the same claims experience, the rate
changes vary by plan due to the following factors:
Changes in benefit design that vary by plan.
Updates in benefit relativity factors among plans.
Updated adjustment factors for catastrophic plans.
• Current Date
The Current Date for Current Enrollment and Current Premium PMPM
in Worksheet 2, Section II of the URRT is April 30, 2019.
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The allowed claims are determined by subtracting non-covered
benefits, provider discounts, and coordination of benefits amounts
from the billed amount.
Allowed and incurred claims are completed using the chain ladder
method, an industry standard, by using historic paid vs. incurred
claims patterns. The method calculates historic completion
percentages, representing the percent of cumulative claims paid of
the ultimate incurred amounts for each lag month. Claim backlog
files are reviewed on a monthly basis and are accounted for in the
historical completion factor estimates.
Allowed and incurred claims reported in Worksheet 1, Section I
of the URRT are $305,154,820 and $245,830,467, respectively. These
amounts differ from those shown in Exhibit B due to the URRT
including Rx Rebates.
Exhibit S details historical experience for the policy forms
included in this filing.
5. Benefit Categories
The methodology used to determine benefit categories in
Worksheet 1, Section II of the URRT is as follows:
• Experience Period Premium
The earned premium prior to MLR rebate is $313,763,212. The
earned premium reflects the pro-rata share of premium based on
policy coverage dates.
The preliminary MLR rebate estimate is $0, which is consistent
with Anthem's December 31, 2018 general ledger estimate allocated
to the non-grandfathered portion of Individual business. This is an
estimated amount and will not be final until 7/31/2019. Using this
MLR estimate, the net earned premium is $313,763,212 for the legal
entity as reported in cell E18 of Worksheet 1, Section I of the
URRT.
• Allowed and Incurred Claims Incurred During the Experience
Period
Inpatient Hospital: Includes non-capitated facility services for
medical, surgical, maternity, mental health and substance abuse,
skilled nursing, and other services provided in an inpatient
facility setting and billed by the facility.
Outpatient Hospital: Includes non-capitated facility services
for surgery, emergency room, lab, radiology, therapy, observation
and other services provided in an outpatient facility setting and
billed by the facility.
Professional: Includes non-capitated primary care, specialist,
therapy, the professional component of laboratory and radiology,
and other professional services, other than hospital-based
professionals whose payments are included in facility fees.
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6. Projection Factors
The experience period claims in Worksheet 1, Section I of the
URRT are projected to the projection period using the factors
described below. Exhibit C provides a summary of the factors.
• Trend Factors (cost/utilization)
As part of the regulatory review process the CID has guided
Anthem to reduce trend from a proposed 9.3% trend in the initial
filing to 7.75% trend. The CID has also guided Anthem to revise the
rating period that trend is applied from 24.2 months to 24 months.
The annual pricing trend used in the development of the rates is
7.7%. This annual pricing trend is applied to both Years 1 and 2 in
Worksheet 1 of the URRT. 12.0 months of trend are applied to Year 1
and 12.0 months of trend to Year 2. The trend is developed by
normalizing historical benefit expense for changes in the
underlying population and known cost drivers, which are then
projected forward to develop the pricing trend. Examples of such
changes include contracting, cost of care initiatives, workdays,
average wholesale price, and expected introduction of generic
drugs. For projection, the experience period claims are trended
24.0 months from the member-weighted midpoint of the experience
period, which is June 26, 2018, to the member-weighted midpoint of
the projection period, which is July 1, 2020. Exhibit E has
details.
Other Medical: Includes non-capitated ambulance, home health
care, DME, prosthetics, supplies, vision exams, and dental
services.
Capitation: Includes all services provided under one or more
capitated arrangements.
Prescription Drug: Includes drugs dispensed by a pharmacy and
rebates received from drug manufacturers.
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• Morbidity Adjustment
Adjustments are made to account for the differences between the
average morbidity of the experience period population and that of
the anticipated population in the projection period.
• Plan Design Changes
Changes in benefits include the following items. Exhibit E shows
each adjustment factor.
Network Adjustments: Adjustments are made to account for the
member cost sharing change for Out-of-Network benefits between the
experience period and the projection period for some plans.
The projected population consists of expected retention of
existing policies and new sales. The new sales include the
previously uninsured population and previously insured populations
from other carriers or coverage. The morbidity adjustment reflects
projected Anthem and market changes in morbidity. Prior experience
has exhibited market shrinkage and morbidity increases year over
year. With anticipated growing market volatility, the expectation
is that selective lapse and market deterioration will continue in
2020 due to increased selective entry and exit as members make
health care decisions in the guaranteed issue, community rated ACA
marketplace. Exhibit E shows the morbidity factor. Per guidance
from the CID, the morbidity impact has been decreased from 1.047 to
1.01.
• Changes in Demographics (Normalization)
The experience period claims are normalized to reflect
anticipated changes in age/gender, area, network, and benefit plan
in the projection period. Exhibit D provides detail of each
normalization factor below:
Age/Gender: The assumed claims cost is applied by age and gender
to the experience period membership distribution and the projection
period membership distribution.
Area/Network: The area claims factors are developed based on an
analysis of allowed claims by network, mapped to the prescribed
rating areas using the subscriber's 5-digit zip code. Per guidance
from the CID, the 2020 area factors are unchanged as compared to
2019.
Benefit Plan: The experience period claims are normalized to
reflect the average benefit level in the projection period using
benefit relativities. The benefit relativities include the value of
cost shares and anticipated changes in utilization due to the
difference in average cost share requirements.
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Rx Adjustments: Adjustments are made to reflect differences in
the Rx formulary, Rx networks and discounts, and mail order
programs between the experience period and the projection
period.
• Other Adjustments
Other adjustments to the experience claims data include the
following items. Exhibit E and Exhibit F show the factors used for
each adjustment.
Benefits in excess of the essential health benefits in the
projection period are included. Exhibit F provides details of
additional non-EHB benefits.
7. Manual Rate Adjustments
The experience period claims are 100% credible based on the
credibility method used. Therefore, a manual rate was not used in
the rate development.
Change in Medical Management: This adjustment reflects the
medical management impact not already included in the claims
experience and trend.
Induced Demand Due to Cost Share Reductions: Individuals who
fall below 250% of the Federal Poverty Level and enroll in
On-Exchange silver plans will be eligible for cost share
reductions. The percentage of enrollment in CSR Plans in the
experience period is compared to that of the projection period to
adjust for the different induced demand level due to CSR between
the two periods.
Grace Period: The claims experience has been adjusted to account
for incidences of enrollees not paying premiums due during the
first month of the 90-day grace period when the QHP is liable for
paying claims. Per guidance from the CID, this adjustment has been
removed.
Rx Rebates: The projected claims cost is adjusted to reflect
anticipated Rx rebates. These projections take into account the
most up-to-date information regarding anticipated rebate contracts,
drug prices, anticipated price inflation, and upcoming patent
expirations. Per guidance from the CID, the Rx Rebate amount has
been revised from $12.86 to $16.16.
Projected costs of pediatric dental and vision benefits are
included. Per guidance from the CID, the Pediatric Dental/Vision
Claim assumptions have been revised from $2.65/$0.23 PMPM to
$1.09/$0.07 PMPM.
As an initiative to provide affordable coverage, Anthem
performed an analysis to identify low quality and high cost
inefficient providers, and removed them from our network. The rate
development reflects a 1.7% savings for this initiative. Exhibit C
shows this Provider Scoping Initiative impact.
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8. Credibility of Experience
• Credibility Method Used
Based on an analysis of historical data, the standard for fully
credible experience is 10,500 members.
• Projection Period Index Rate
The projection period Index Rate is equal to projected allowed
claims PMPM for the essential health benefits of Anthem's
non-grandfathered business in the Individual market. It reflects
the anticipated claim level of the projection period including
impact from trend, benefit and demographics as described in Section
6 of this memo.
The projected Index Rate is reported in Worksheet 1, Section II,
cell F42 of the URRT and is also shown in Exhibit C. Note there are
minor variances between the projection period Index Rate in the
URRT and Actuarial Memorandum due to rounding methodology in the
URRT. No benefits in excess of the essential health benefits have
been included in this amount.
To determine credibility, the following formula was used:
• Resulting Credibility Level Assigned to Base Period
Experience
With 38,281 members, the credibility level assigned to the
experience period claims is 100%.
9. Establishing the Index Rate
• Experience Period Index Rate
The experience period Index Rate is equal to the allowed claims
PMPM for the essential health benefits of Anthem's
non-grandfathered business in the Individual market. The experience
period Index Rate is $664.18. Due to rounding restrictions in the
URRT, the experience period Index Rate displayed in Worksheet 1,
Section II of the URRT may be slightly different from this number.
No benefits in excess of the essential health benefits have been
included in this amount.
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10. Development of the Market-wide Adjusted Index Rate
The Market-wide Adjusted Index Rate is calculated as the Index
Rate adjusted for all allowable market-wide modifiers defined in
the market rating rules. The three market-wide adjustments - Risk
Adjustment, Reinsurance, and Exchange User Fee adjustment - are
described below. In compliance with URR Instructions, these
adjustments were applied on an allowed basis in the development of
the Market-wide Adjusted Index Rate. Exhibit C illustrates the
development of the Market-wide Adjusted Index Rate. Note that there
are minor variances between the Market-wide Adjusted Index Rate in
the URRT and Actuarial Memorandum due to rounding methodology in
the URRT.
• Risk Adjustments PMPM
The Exchange User Fee is applied as an adjustment to the
Market-wide Adjusted Index Rate at the market level as shown in
Exhibit C.
11. Plan Adjusted Index Rate
The Plan Adjusted Index Rate is calculated as the Market-wide
Adjusted Index Rate adjusted for all allowable plan level modifiers
defined in the market rating rules. Exhibit J shows the
development. The plan level modifiers are described below:
AV and Cost Sharing Adjustments: This is a multiplicative factor
that adjusts for the projected paid/allowed ratio of each plan,
based on the AV metal value with an adjustment for utilization
differences due to differences in cost sharing.
Provider Network Adjustments: This is a multiplicative factor
that adjusts for differences in projected claims cost due to
different network discounts.
Per guidance from the CID, the Risk Adjustment receipt has been
revised from $13.72 to $17.29.
The projected risk adjustment PMPMs reported in Worksheet 2 of
the URRT are on a paid claim basis, while the projected amount
applied to the development of Market-wide Adjusted Index Rate is on
an allowed claim basis. Exhibit C and Exhibit G provide
details.
• Projected ACA Reinsurance Recoveries Net of Reinsurance
Premium
Beginning in 2017, the Federal reinsurance program is no longer
in effect. The projected reinsurance amount is $0.
• Exchange User Fees
Exchange User Fee: The expected charge is estimated at 1.65% of
premium. The resulting fee/percentage is applied evenly to all
plans in the risk pool, both On and Off Exchange.
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Adjustments for Benefits in Addition to the Essential Health
Benefits: This multiplicative factor adjusts for additional non-EHB
benefits shown in Exhibit F.
• Geographic Factor Calibration
The geographic factors are developed from historical claims
experience. The geographic calibration adjustment is calculated as
the member weighted average of the geographic factors, using the
projected membership distribution by area.
13. Consumer Adjusted Premium Rate Development
The Consumer Adjusted Premium Rate is calculated by calibrating
the Plan Adjusted Index Rate by the Age and Geographic calibration
factors described above, and applying consumer specific age and
geographic rating factors. Exhibit N has the sample rate
calculations.
Catastrophic Plan Adjustment: This adjustment reflects the
projected costs of the population eligible for catastrophic plans.
The catastrophic adjustment factor is applied to catastrophic plans
only; all other plans have an adjustment factor of 1.0.
Adjustments for Distribution and Administrative Cost: This is an
additive adjustment that includes all the selling expense,
administration and retention Items shown in Exhibit H, with the
exception of the Exchange User Fee. The Exchange User Fee has been
included in the Market-wide Adjusted Index Rate at the market
level.
12. Calibration
The Plan Adjusted Index Rate is calibrated by the Age and
Geographic factors so that the schedule of premium rates for each
plan can be further developed. Exhibit K shows both calibration
factors.
• Age Curve Calibration
The age factors are based on the Default Federal Standard Age
Curve. The age calibration adjustment is calculated as the member
weighted average of the age factors, using the projected membership
distribution by age, with an adjustment for the maximum of 3 child
dependents under age 21. Under this methodology, the approximate
average age rounded to the nearest whole number for the risk pool
is 50.
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14. Projected Loss Ratio
• Projected Federal MLR
17. Terminated Plans and Products
Exhibit P provides a listing of 2018 and 2019 plans that will be
terminated prior to January 1, 2020. The mapping of terminated
plans to the new plans is also included.
18. Plan Type
The plan type for each plan reported in Worksheet 2, Section I
of the URRT is consistent with the option chosen from the drop-down
box.
Exhibit I shows the projected Federal MLR for the products in
this filing. The calculation is an estimate and is not meant to be
a true measure for Federal or State MLR rebate purposes. The MLR
for Anthem's entire book of Individual business will be compared to
the minimum Federal benchmark for purposes of determining
regulation-related premium refunds. Also note that the projected
Federal MLR presented here does not capture all adjustments,
including but not limited to: three-year averaging, credibility,
dual option, and deductible. Anthem's projected MLR is expected to
meet or exceed the minimum MLR standards at the market level after
including all adjustments.
15. Actuarial Value Metal Values
The Actuarial Value (AV) Metal Values reported in Worksheet 2,
Section I of the URRT are based on the AV Calculator. To the extent
a component of the benefit design was not accommodated by an
available input within the AV Calculator, the benefit
characteristic was adjusted to be actuarially equivalent to an
available input within the AV Calculator for purposes of utilizing
the AV Calculator as the basis for the AV Metal Values. When
applicable, benefits for plans that are not compatible with the
parameters of the AV Calculator have been separately identified and
documented in the Unique Plan Design Supporting Documentation and
Justification that supports the Plan & Benefits Template.
16. Membership Projections
Membership projections are reported in Worksheet 2, Section IV
of the URRT. They are based on historical and current enrollment,
and expected new sales and lapses.
For Silver level plans in the Individual market, the portion of
projected membership that will be eligible for cost-sharing
reduction subsidies at each subsidy level are estimated from the
enrollment data in the experience period. Exhibit O provides
projected distributions for each plan.
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19. Tiered-Network Benefit Plans
The 2020 Individual plan portfolio contains six plans with
tiered in-network benefits. These plans have up to three networks
of provider care and different cost share provisions for each
network:
Current capital and surplus for Anthem Health Plans, Inc. is
$360,256,649 as shown on page 5, line 49 of the 2018 Annual
Statement.
21. State Actuarial Memorandum Requirements
Supplemental material to satisfy the 2020 filing requirements
from Bulletin HC-90-19 and Bulletin HC-81-19 issued on February 15,
2019, is included below.
The proposed retention charge in the rate development is 19.4%.
This is comprised of both fixed and variable expenses and includes
selling expense, administrative expense, federal fees, federal
income tax, exchange fees and risk and net profit margin. The
December 31, 2018, Annual Statement for Anthem Health Plans, Inc.
has a retention amount of 21.4%. This amount is calculated from the
Analysis of Operations by Lines of Business exhibit on page 7: 1 –
[line 17, column 2 $797,383,558 / line 7, column 2 $1,015,000,670]
= 21.4%.
Exhibit Q details Anthem's unit cost trend, utilization trend,
technology trend, and other trend components.
The Tier 1 network is a subset of preferred in-network
providers; members have the lowest cost share amounts when
utilizing this preferred network.
The Tier 2 network is comprised of the remaining in-network
providers and has higher cost share amounts compared to the Tier 1
network.
For tiered PPO plans, the Tier 3 network is comprised of the
out-of-network providers and has the highest cost share
amounts.
Additional cost of care savings are expected from increased
utilization and new providers contracting of Tier 1 providers. The
new provider contracting initiative for tiered products is still
ongoing at the time of the filing. These savings are used to reduce
the tiered plan rate compared to a non-tiered plan with similar
cost share provisions. Any new information different from current
assumptions would be reflected at the next rate filing.
20. Effective Rate Review Information
The RBC Ratio for Anthem Health Plans, Inc. is 462.6% as of
12/31/2018.
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Benefit buy-down analysis and impact on trend: No explicit
buy-down impact was used in the rate development.
22. Reliance
In support of this rate development, various data and analyses
were provided by other members of Anthem’s actuarial staff,
including data and analysis related to cost of care, valuation, and
pricing. I have reviewed the data and analyses for reasonableness
and consistency. I have also relied on Michele Archer, FSA, MAAA to
provide the actuarial certification for the Unique Plan Design
Supporting Documentation and Justification for plans included in
this filing.
23. Actuarial Certification
Exhibit R shows the claim lag triangle for the experience
data.
The Annual Certification for substituting non-dollar limits on
an essential health benefit can be found in Exhibit T.
Exhibit A in conjunction with Appendix A show a summary of the
requested rate changes.
H.B. No. 5210 an act mandating insurance coverage of essential
health benefits and expanding mandated health benefits for women,
children, and adolescents was passed. The estimated cost impact of
this bill is $2.11 PMPM and this has been built into the rates.
S.B. No 376 an act concerning health insurance coverage for
prosthetic devices was passed. The estimated cost impact of this
bill is $0.15 PMPM and this has been built into the rates.
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13
HIOS Plan Name 2020 HIOS Plan IDOn/Off
Exchange Metal Level Network Name Area(s) Offered Plan
Category
Plan Specific Rate Change (excluding
aging) {1},{2}
Catastrophic HMO Pathway X Enhanced 86545CT1230005 On
Catastrophic Pathway X Enhanced All Renewing -1.9%Bronze HMO
Pathway X Enhanced Tiered 86545CT1230013 On Bronze Pathway X
Enhanced Tiered All Renewing 11.2%Gold HMO Pathway X Enhanced
Tiered 86545CT1230016 On Gold Pathway X Enhanced Tiered All
Renewing -7.3%Anthem HMO Catastrophic Pathway Enhanced 8150/0%
86545CT1310033 Off Catastrophic Pathway Enhanced All Renewing
-1.9%Anthem Bronze HMO Pathway Enhanced Tiered 6100/7100/0%/50%
86545CT1310054 Off Bronze Pathway Enhanced Tiered All Renewing
7.7%Anthem Bronze HMO Pathway Enhanced 6200/12400/40% for HSA
86545CT1310019 Off Bronze Pathway Enhanced All Renewing 10.3%Anthem
Bronze HMO Pathway Enhanced 6500/50% 86545CT1310055 Off Bronze
Pathway Enhanced All New N/AAnthem Silver HMO Pathway Enhanced
Tiered 2800/3800/10%/40% for HSA 86545CT1310051 Off Silver Pathway
Enhanced Tiered All Renewing 2.7%Anthem Silver HMO Pathway Enhanced
Tiered 2500/5000/10%/40% 86545CT1310052 Off Silver Pathway Enhanced
Tiered All Renewing -0.3%Anthem Silver HMO Pathway Enhanced
4500/30% 86545CT1310056 Off Silver Pathway Enhanced All New
N/AAnthem Gold HMO Pathway Enhanced Tiered 2000/3000/10%/30%
86545CT1310050 Off Gold Pathway Enhanced Tiered All Renewing
0.6%Bronze PPO Standard Pathway X for HSA 86545CT1330009 On Bronze
Pathway X All Renewing 14.6%Bronze PPO Standard Pathway X
86545CT1330002 On Bronze Pathway X All Renewing 15.0%Bronze PPO
Pathway X 86545CT1330013 On Bronze Pathway X All New N/ASilver PPO
Standard Pathway X