Profile: Anthem Inc (ANTM.N)
Anthem, Inc., incorporated on July 17, 2001, is a health benefits company. The Company operates through three segments: Commercial and Specialty Business, Government Business and Other. It offers a full spectrum of network-based managed care plans to large and small employer, individual, Medicaid and Medicare markets. Its managed care plans include preferred provider organizations (PPOs); health maintenance organizations (HMOs); point-of-service (POS), plans; indemnity plans and other hybrid plans, including consumer-driven health plans (CDHPs); and hospital only and limited benefit products. In addition, it provides an array of managed care services to self-funded customers, including claims processing, underwriting, stop loss insurance, actuarial services, provider network access, medical cost management, disease management, wellness programs and other administrative services. It provides an array of specialty and other insurance products and services, such as dental, vision, life and disability insurance benefits, radiology benefit management and analytics-driven personal healthcare. It also provides services to the federal government in connection with the Federal Employee Program (FEP).
The Company offers various products and services, such as PPO, CDHPs, Traditional Indemnity, Health Maintenance Organization, POS, ACA Public Exchange and Off-Exchange Products, Administrative Services, BlueCard, Medicare Plans, Individual Plans, Medicaid Plans and Other State-Sponsored Programs, Pharmacy Products, Life Insurance, Disability, Radiology Benefit Management, Personal HealthCare Guidance, Dental, Vision Services and Products, and Medicare Administrative Operations. The Company's medical membership includes seven customer types: Local Group, Individual, National Accounts, BlueCard, Medicare, Medicaid and FEP. PPO products offer the member an option to select any healthcare provider, with benefits reimbursed by it at a higher level when care is received from a participating network provider. CDHPs provide consumers with increased financial responsibility, choice and control regarding how their healthcare dollars are spent. Indemnity products offer the member an option to select any healthcare provider for covered services.
The Company's HMO products include managed care benefits, through a participating network of physicians, hospitals and other providers. POS products blend the characteristics of HMO, PPO and indemnity plans. Members can have HMO-style benefits through participating network providers with minimum out-of-pocket expenses (co-payments) and also can go directly, without a referral, to any provider they choose, subject to, among other things, certain deductibles and coinsurance. In its Individual markets it offers bronze, silver and gold products, both on and off the public exchanges, in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. Additionally, it offers platinum products, both on and off the public exchanges, in California and New York. In its Small Group markets, it offers bronze, silver and gold products, off the public exchanges, in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. It offers platinum products, off the public exchanges, in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, New York, Virginia and Wisconsin. It offers bronze, silver and gold products, on the public exchanges, in Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio and Virginia. Additionally, it offers platinum products on the public exchange in Connecticut.
The Company provides administrative services to Large Group employers that maintain self-funded health plans. These administrative services include underwriting, actuarial services, medical cost management, disease management, wellness programs, claims processing and other administrative services for self-funded employers. Self-funded health plans are also able to use its provider networks and to realize savings through its negotiated provider arrangements, while allowing employers the ability to design certain health benefit plans in accordance with their own requirements and objectives. It also underwrites stop loss insurance for self-funded plans. Its BlueCard is a national program that links participating healthcare providers and independent Blue Cross and Blue Shield Association (BCBS) plans. BlueCard host members are generally members residing in or travel to a state in which an Anthem subsidiary is the Blue Cross and/or Blue Shield licensee and who are covered under an employer sponsored health plan serviced by a non-Anthem controlled BCBS licensee, which is the home plan. It performs certain administrative functions for BlueCard host members, for which it receives administrative fees from the BlueCard members' home plans. Other administrative functions, including maintenance of enrollment information and customer service, are performed by the home plan.
As of December 31, 2016, the Company offered a range of plans, products and options to individuals age 65 and older, such as Medicare supplement plans; Medicare Advantage, including special needs plans; Medicare Part D Prescription Drug Plans (Medicare Part D); and Medicare-Medicaid Plans (MMPs). Medicare Advantage plans provide Medicare beneficiaries with a managed care alternative to Medicare and often include a Medicare Part D benefit. In addition, its Medicare Advantage special needs plans provided benefits to Medicare beneficiaries having chronic diseases and also covered certain dual eligible customers, who are low-income seniors and persons under age 65 with disabilities, as of December 31, 2016. Medicare Part D offers a prescription drug plan to Medicare and MMP beneficiaries. MMP is a demonstration program focused on serving members who are dually eligible for Medicaid and Medicare, which was established as a result of the passage of the ACA. It offers these plans to customers through its health benefit subsidiaries throughout the country, including Amerigroup, CareMore and Simply Healthcare. It offers a range of health insurance plans with a range of options and deductibles for individuals who are not covered by employer-sponsored coverage and are not eligible for government sponsored plans, such as Medicare and/or Medicaid. Individual policies are sold through independent agents and brokers, retail partnerships, its in-house sales force or through the Internet. Individual business is sold on a fully-insured basis. It offers on-exchange products through public exchanges and off-exchange products.
The Company offers an array of individual and group life insurance benefit products to both Large Group and Small Group customers in conjunction with its health plans. The life products include term life and accidental death and dismemberment. It offers short-term and long-term disability products in conjunction with its health plans. It offers outpatient diagnostic imaging management services to health plans. These services include utilization management for diagnostic imaging procedures, network development and optimization, patient safety, claims adjudication and provider payment. It offers evidence-based and analytics-driven personal healthcare guidance. Its dental plans include networks in certain states in which it operates. Its vision plans include networks within the states in which it operates. Its Medical Management Programs include Precertification, Care Coordination, Case Management, Formulary management, Medical policy, Quality programs, External review procedures, Service management, Provider Cost Comparison Tools, Personal HealthCare Guidance and Anthem Health Guide. Its Care Management Programs include ConditionCare and FutureMoms, 24/7 NurseLine, ComplexCase Management, MyHealth Advantage, MyHealth Coach, HealthyLifestyles, Behavioral Health Case Management, Autism Spectrum Disorder and Employee Assistance Programs.
The Company's Commercial and Specialty Business and Government Business segments both offer a diversified mix of managed care products, including PPOs, HMOs, traditional indemnity benefits and POS plans, as well as a range of hybrid benefit plans, including CDHPs, hospital only and limited benefit products. Its Commercial and Specialty Business segment includes its Local Group, National Accounts, Individual and Specialty businesses. Business units in the Commercial and Specialty Business segment offer fully-insured health products; provide an array of managed care services to self-funded customers, including claims processing, underwriting, stop loss insurance, actuarial services, provider network access, medical cost management, disease management, wellness programs and other administrative services; and provide an array of specialty and other insurance products and services, such as dental, vision, life and disability insurance benefits, radiology benefit management and analytics-driven personal healthcare guidance. The Company's Government Business segment includes Medicare and Medicaid businesses, National Government Services (NGS), and services provided to the federal government in connection with FEP. Medicare business includes services, such as Medicare Advantage, Medicare Part D, and Medicare Supplement. Medicaid business includes its managed care alternatives through publicly funded healthcare programs, including Medicaid; Temporary Assistance for Needy Family programs (TANF); programs for seniors and people with disabilities (SPD); programs for long-term services and support (LTSS); CHIP; and ACA-related Medicaid expansion programs. NGS acts as a Medicare contractor for the federal government in several regions across the nation.
220 Virginia Avenue
INDIANAPOLIS IN 46204
Company Web Links
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