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Information about your Individual health benefit plan

Dear 1STNM<MI<LSTNM:

Thank you for choosing Anthem Blue Cross (Anthem) for your Individual health coverage.

What is included in this package

This letter and the enclosures include:

  • Information about a change in your rate (also called Premium, which is the amount you pay each month)
  • Annual notices for your plan
  • Subscriber and Premium Notice
  • Information about Grandfathered status and your options due tohealth care reform

Medical plan premium

As of Rate Change Date the monthly premium on your health benefit plan coverage is changing. Yournew premium will be $<MED-NEW-RATE, [an increase of $<MED-RT-DIFF> or <MED-%>%,[a decrease of $<MED-RT-DIFF or <MED-%>%] [resulting in no change in your rate].

  • Why rateschange: Several factors can impact your rate. These factors include:
  • increased consumer demand for services
  • rising medical and prescription drug costs
  • advances in medical technology
  • changes in benefits and/or taxes required by state and federal law

In addition, your rate may reflect a change in your age. And, your rate may have been impacted if you moved to an area with higher or lower medical costs, or changed the number of people covered by your plan.

  • What we’re doing to help keep costs down : While factors drive up costs, the ways wehelp control them, include:
  • Pursuing the best rates for health care products and services on your behalf
  • Giving you tools that can help you better manage your health and out-of-pocket costs
  • Working with our network providers to get higher quality care

Subscriber and Premium Notice

The enclosed Subscriber and Premium Noticeslist your premium amount and contact information about yourplan.

Please note:This notice is based on information in our system as of <Date of Letter> and does not reflect changes after that date. An updated Subscriber and Premium Notice will be mailed to you any time changes are made that affect your monthly premium amount.

Your coverage options and what to consider before changing coverage

Anthem Blue Cross Life and Health Insurance Company believes your current plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to our Health Plan Advisors at 866-636-8991. You may also contact the U.S. Department of Health and Human Services at

You coverage options include the following:

  • Keep your current plan and new rates

If you want to continue your current coverage, just keep paying your premium on time. We’ll adjust your rates automatically on your bill for the Anniversary Month>planperiod.

  • Note:If you are enrolled in automatic payments through your financial institution, your monthly payment may need to be adjusted to reflect the change in premium.
  • If Available, Choose another Anthem Individual Health Plan and keep your grandfathered status

Your plan provides an option to move to a health benefit plan providing equal or lesser benefits, as determined by Anthem, without medical underwriting.If you’re considering a new Individual health benefit plan, be sure to compare the benefits to your existing Individual plan. If a grandfathered health benefit plan of equal or lesser value exists and you elect to change plans under this option, you will retain your grandfathered status. Changing health benefit plans or remaining on a grandfathered plan does not guarantee your rates will be lower – now or in the future.Rates quoted on anthem.com may not take into account factors that apply to you. Do not rely on an online quote as a promise or guarantee of a specific rate. To find out the premium of a plan you’re considering, call us at 866-636-8991, and select the option to speak with a Health Plan Advisor Monday through Friday, 8:30 a.m. to 6 p.m. PST. You can also talk with your Anthem agent.

  • Choose A New Non-Grandfathered Affordable Care Act (ACA) compliant Anthem Individual Health Plan

You can also consider a new health benefit plan that meets the new health care reform requirements from Anthem. Again, if you’re considering a new Individual health benefit plan, be sure to compare the benefits to your existing Individual plan. There are many plans to choose from and some may offer lower cost options for you. You will have to complete an enrollment application by February 15, 2015. If you change health benefit plans under this option, you will lose your grandfathered status.

  • Choose a different plan during the current Open Enrollment

It’s important to understand the effective date of a new plan is determined by the date we receive your completed application in our offices.

  • If you want to choose a different policy and would like it to become effective the 1st day of the next month, your completedapplication must be received in our offices by the 15th of the current month.
  • If you submit an application and we receive it after the 15th of the current month, your effective date will be 1st day of the second month following the receipt of your completed application. For example, if you submit an application and it is received in our offices on Jan 16, 2015, your policy will be effective March 1, 2015.

You may be eligible for a Special Enrollment period if you have a life-changing event such as marriage, divorce, a new child or loss of a job.

Who to contact with questions

We want you to have the right plan for your needs. And we’re ready to help you. Call our Health Plan Advisors at 866-636-8991Monday through Friday, 8:30 a.m. to 6 p.m. PST. You can also go to changemycoverage.com to see your Individual coverage options, or you can talk with your Anthem agent if you have one.

Thank you forchoosing Anthem for your health coverage. We look forward to continuing to serve you.


Colin Havert

Vice President and General Manager

California Individual Business

Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.