Group Name: CITY OF NASHUA
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The proposed services, rates and fees are effective from July 1, 2016 through July 1, 2617.
This contract will be issued in New Hampshire.
Our quote assumes that 1923 employees will be enrolling for medical coverage, with an average member to employees ratio of 2.41.
Quoted rates are subject to review of audited financial statements and Dun & Bradstreet reports prior to final sale.
Anthem reserves the right to amend these rates due to any taxes, fees and assessments prescribed by any statutory, regulatory, or other
legal authority, which may bear directly on the financial consequences of this quote.
This proposal expires [60] days from the date of release of this proposal or on the effective date whichever is sooner.
The health benefit plan(s) reflected in this quote is not considered to be grandfathered under the provisions of the Patient Protection
and Affordable Care Act. Nongrandfathered plans are subject to additional provisions under the Patient Protection and Affordable Care
Act that do not apply to grandfathered plans. For further information, please contact your account representative.
This renewal rate includes changes to the standard medical plan to ensure compliance with the requirements of the federal health care
reform legislation for nongrandfathered plans, including 100 percent coverage of in-network preventive care services.
Anthem Blue Cross and Blue Shield reserves the right to revise this proposal under any of the following circumstances:
(1) a change to the Plan benefits initiated by Employer that results in a substantial change in the services to be provided by Anthem Blue
Cross and Blue Shield;
(2) a change in ownership
(3) a change in the total number of Subscribers or Members resulting in either an increase or decrease of [10%] or more of the number of
Subscribers or Members enrolled for coverage on the date the Administrative Services Fee was last modified;
(4) a change in Employer contribution
(5) a change in nature of Employer’s business resulting in a change in its designated Standard Industrial Classification (“SIC”) code; or
(6) a change in applicable law that resuits in an increase in the cost or amount of administrative services from those currently being provided
by Anthem Blue Cross and Blue Shield. The cost for our standard reporting package is included in the proposed ASO fee. Non-standard
reports may be subject to an additional fee depending on the complexity and frequency requested.
Electronic eligibility or tape feeds must be in a format compatible with our systems.
Anthem Blue Cross and Blue Shield’s proposal assumes claims incurred prior to the effective date are not included unless specifically noted.
A change in the contract period will require a recalculation of fees.
The cost of our standard reporting package is included in the proposed ASO fee. Non-standard reports may be subject to an additional
fee depending on the complexity and frequency requested.
Proposed rates are payable by the invoice due date.
Section 1341 of the Affordable Care Act (ACA or health care reform law) provides that a transitional reinsurance program be established in
each State to help stabilize premiums for coverage in the individual market during the vears 2014 through 2016. ACA Reinsurance Fees in
2014 are estimated to be $5.25 per participant per month. This quote or renewal does not include the ACA Reinsurance Fees, since it is
assumed that the employer will remit payment to HHS directly,
Federal law requires group health plans to cover services for mental health care or substance abuse at the same levels as your medical
services. Generally speaking, this means visit limits and the amounts you pay (such as copayments and deductibles) must be the same for
covered services that treat body or mind. This is called “mental health parity.”
For renewals on or after July 1, 2014, we reviewed your plan benefits to make sure they comply with the mental health parity laws. Certain
visit limits will no longer apply to autism services. No other changes are needed.
BlueCard Access fees are included in paid claims amount. The BlueCard Access Fee is charged at a percentage no greater than 4.79% of the
discount subject to a maximum of $2,000 per claim. Access fees vary depending on the specific arrangement in local plan areas. Fora
complete description of these fees, please consult your ASO Agreement.
City of Nashua_D Multi 051016.xlsm 05/10/2016 ASO PRICING ASSUMPTIONS 20f2
