Anthem Balanced Funding (ABF) is a health plan that gives your small business clients a fixed monthly payment and rewards them when their employees are healthier than expected. We want you to feel fully informed and confident while selling ABF and answered your frequently asked questions below.
Q: Can Multiple Employer Welfare Arrangement (MEWA) groups move to ABF?
A: No, the intent is to maintain the integrity of the MEWA pool and have many affordable options for Georgia small businesses.
Q: Is the pharmacy formulary the same as what is offered on MEWA plans?
A: Yes. All plans use the Advantage with R90 network and the Essential drug list.
Q: Will the terminal liability amount be on the quote?
A: Yes, the terminal liability component will be displayed on the quote.
Q: Is Medicare primary on ABF?
A: Medicare will be secondary on ABF groups due to the group having 20+ employees.
Q: Will there be fourth quarter carryover on ABF plans?
A: No, fourth quarter is not included.
Q: Is EFT required?
A: Yes, it is required.
Q: Do the plans run calendar year or plan year?
A: All ABF plans will run on a calendar year basis.
Q: If a member terms mid-month, when does their policy cancel?
A: For members who term mid-month, their policies will cancel at the end of the month unless the group specifies another date in Employer Access.
Q: If a group enrolled in ABF and within the first year, is the terminal reserve fully funded?
A: If a new client terminates before they have completed their 12-month policy period, our contract (billing process) states that we will require the client to pay the remaining portion of the funds we need for the terminals.
Q: Will we offer other surplus shares besides the 50%?
A: Our standard is 50%, but we do have other options to assist with matching the group’s current surplus share.
Q: What are the enrollment requirements for membership?
A: Small Group ABF is available for groups that enroll 20 employees with a maximum of 50.
Q: What is the enrollment deadline for a first of the month effective date?
A: We require the completed enrollment be received no later than the 15th of the month preceding the effective date.
Q: If the request for proposal (RFP) for ABF is declined, can I request an Affordable Care Act (ACA) or MEWA proposal?
A: Yes, however if the group declines to quote on ABF, ACA or MEWA would not be a competitive option.
Q: Are Patient-Centered Outcomes Research Institute (PCORI) fees included in the rates?
A: No. The employer will be responsible for filing and paying PCORI fees.
Q: Is Cobra administration included with ABF?
A: Cobra administration is available upon request at no additional cost. It’s not set up automatically.
Q: Can there be a 15th of the month effective date?
A: No, ABF is always the first day of the month.
Q: Is there specialty bundling discounts?
A: Yes. You can earn up to 2% savings on medical by adding dental and vision. You can also receive a 5% discount off the specialty lines when sold alongside the medical plan.
Q: How does the implementation process work for new ABF groups?
A: The ABF implementation paperwork is a two-part process on the Producer Toolbox:
- First, send the DocuSign link included in the email from your sales representative with the quote to the client to complete.
- Once you have received the completed information, locate the Quote ID on the Producer Toolbox and follow the same online steps as you would with MEWA. It will generate the new documents such as the stop loss application, Business Associate Agreement and Administrative Service Only applications, and will prompt you to add additional items such as the enrollment census. Instructional videos are available upon request.
- Note: if the client wants a medical plan that is on the “portfolio plans” page not the “featured plans” page, you will not be able to get past this step. If this happens, save everything and send the documentation in an email to galocalsgimpl@anthem.com and CC your sales representative.