Oct 19, 2022
We’re telling your Individual CDI grandfathered clients about benefit changes
THIS COMMUNICATION APPLIES ONLY TO CALIFORNIA INDIVIDUAL GRANDFATHERED POLICIES REGULATED BY THE CDI.
We’re sending a letter to your clients with individual grandfathered policies regulated by the California Department of Insurance (CDI) soon to let them know about changes to their benefits. We’ll include changes that went into effect on January 1, 2021, and January 1, 2022, and let them know the changes have been applied to care they’ve received since the changes began.
The letter summarizes the changes and encourages your clients to review their policy for more details.
The changes may include removing annual limits for footwear, preventive care services, physical exams, and wigs, in keeping with a change in California law.
The following clarifications may also be included:
- For clarification, Anthem will not reimburse any family member for participation in a behavioral health treatment program for autism spectrum disorder.
- Members can continue participating in a clinical trial or continue disease modifying therapy, even when accessing hospice care, as ordered by the treating provider.
- The member cost share for telehealth covered services will be the same as an in-person visit.
Pharmacy benefits
Pre-exposure and post exposure medicine for the prevention of AIDS/HIV are not subject to precertification or step therapy, due to a change in California law. Also, if the FDA has approved one or more therapeutic equivalent of a drug, device, or product for the prevention of AIDS/HIV, then at least one therapeutically equivalent version will be covered without precertification or step therapy.
Please contact your Anthem sales representative for more information.