How to read an Anthem small group renewal

This page covers what is specific to Anthem. The checks that apply to any carrier are in how to read a carrier rate sheet. Anthem documents vary by state, and the public ones are most complete for California, so each point says which state it comes from. Several sources are Anthem documents, carrying Anthem form numbers, that are publicly posted only by brokers or general agencies. Sources names each host.

First, is it Anthem?

Elevance Health operates Anthem as the Blue Cross licensee for California and the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 Kansas City-area counties), Nevada, New Hampshire, New York (the New York City metro area and upstate), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.) and Wisconsin [1]. The Blue Cross Blue Shield Association is an association of independent plans [1]. A "Blue" renewal from another state is a different company's document, and nothing below applies to it.

What you'll see on an Anthem renewal

• Producer Toolbox for brokers. Anthem calls it the broker's "command center for quotes and renewals" [2].
• A market verification in EmployerAccess. Anthem says every small group must complete its market verification and certification paperwork at renewal. If it doesn't, coverage may be cancelled. The form is submitted from a Complete Market Verification button in EmployerAccess [4]. In the states Anthem listed in 2024 (CO, CT, IN, NH, NV, WI, GA), the digital form opens 90 days before the renewal date and stays open until that date [5].
• A paperwork deadline. In Connecticut, Anthem asks for renewals to be submitted by the 15th of the month before the renewal date [6].
• Notice and guarantee periods (Nevada). Anthem may change rates and benefits with 60 days' written notice. Medical rates are guaranteed for at most 12 months, dental for 12 or 24 months, and vision for 24 months [8].

Walking through the document

Plan names (California)

Matched against Anthem's 2026 California benefit charts, the numbers after the metal and plan type give the primary care copay, the individual in-network deductible and the coinsurance, in that order. "Anthem Gold PPO 30/500/20%" has a $500 individual deductible and 20% coinsurance. Its family deductible, $1,500, is not in the name [9]. Copay-only plans carry a single number: "Anthem Gold HMO 30" [10]. Anthem does not publish this order as a rule. We read it off the charts, so confirm each plan on its SBC.

HSA plans are written differently. "Anthem Gold PPO HSA/H 1900/3400/3800 15% PrevRx" carries three deductible figures. The chart's footnote explains that these plans have a different deductible for a subscriber enrolled alone, a subscriber enrolled with a family, and a family. "PrevRx" marks plans where the deductible is waived for drugs on the PreventiveRx Plus list [9].

Network names matter as much as the numbers. California's charts name Vivity (Los Angeles and Orange counties), Prudent Buyer PPO (Anthem's most comprehensive statewide PPO network), Select PPO and several HMO networks [9].

Contract codes

Each plan and network pair has its own four-character contract code. The same Gold PPO 30/500/20% design is 94JT on Prudent Buyer PPO and 94JV on Select PPO [9]. HSA plans have separate codes for self-only and family coverage, for example 8VBM(S) and 8VBL(F) [10]. The code also appears in the SBC footer. An Anthem California SBC reads "CA/SG/Anthem Gold PPO 5/1500/30%/8V7T/01-26": state, segment, plan name, contract code and date. Its evidence of coverage link ends in the same code [11]. Pair every rate with its SBC by the code, not the name.

Rating basis

Anthem's rating basis is not the same in every state.

• California. The premium depends on the principal business ZIP code. Rates are based on each person's age at the group's effective date. A family's rate adds the employee, every dependent 21 and older, and up to the three oldest dependents 20 or younger. Medical rates are guaranteed for at least 12 months and adjust for age at renewal. Dental and vision are guaranteed for 24 months [7].
• Nevada. Member rating or two-tier composite rating is available to any medical group on request. The composite uses an average adult rate (ages 21 and over) and an average dependent rate (under 21). Age changes take effect at renewal [8].

California's guidelines also set participation: 60% for groups with 1 to 4 enrolled employees, 25% for 5 to 100, and 100% when the employer pays the whole premium [7].

Bundled lines and 2026 changes

Anthem says small groups may get up to a 5% discount on rates when they add dental, vision, life, disability or medical coverage. Pharmacy is integrated through CarelonRx [3]. California's 2026 broker cheat sheet adds chiropractic visits to all HMO plans (30 visits, $15 copay) and new EPO options for Anthem Balanced Funding [12].

Anthem Balanced Funding

Anthem Balanced Funding (ABF) is Anthem's level-funded plan. Anthem describes it as giving businesses predictable monthly payments, a limit to their financial responsibility, and money back if claims experience is favorable. Eligible group size varies by state [13]. Anthem's ABF flier, a 2024 form, gives the mechanics [14]:

• The monthly payment covers a claims fund, fixed costs (administrative fees, stop-loss coverage and premium taxes) and a terminal liability fund.
• The settlement is calculated within 90 days of renewal. A surplus is shared only if the group renews, and it is applied to the next invoice. Deficits do not carry forward.
• The run-out period is 15 months. The contract basis is 12/12 (incurred/paid) in the first year and 24/12 in the second.
• In most markets the standard surplus share is 50%.

Anthem's Georgia notes add that the terminal liability component is shown on the quote, plans run on a calendar year, EFT is required, and PCORI fees are not included in the rates. Adding dental and vision can save up to 2% on medical [15]. In Georgia, ABF has been open to groups of 10 to 50 enrolled employees since July 1, 2025 [16].

The terminal liability and surplus share belong in the comparison beside the monthly figure. Stop-loss terms on a level-funded quote and the level-funded renewal guide cover how.

Pitfalls when comparing it with another carrier's quote

1. Names read in a different order. Anthem California's 35/1250/20% is a $35 visit and a $1,250 deductible. Kaiser Permanente California's 250/35 is a $250 deductible and a $35 visit (see how to read a Kaiser Permanente renewal). Read the numbers off the SBC, not the name.
2. The family deductible. An Anthem California name carries the individual deductible only, or three figures for an HSA plan. Compare family deductibles from the SBCs.
3. Same design, different network. A Prudent Buyer PPO and a Select PPO plan can share a name and a design and still be different products, with different contract codes and rates. Put the network on the comparison as its own row.
4. Composite beside member-level rates. In a state where Anthem offers two-tier composite on request, check whether the quote is composite or member-rated before comparing it with another carrier's member-level rates. How to read a carrier rate sheet covers the difference.
5. Bundling netted into the rate. If a bundling discount is folded into the Anthem medical rate, show the other carrier on the same basis, or show both gross.
6. Balanced Funding beside fully insured. The ABF monthly payment includes a terminal liability fund and buys stop-loss. Compare the worst case as well as the monthly figure: level-funded vs fully insured covers how.

Checklist

1. Confirm the group is in an Anthem state. Other Blue Cross Blue Shield plans are separate companies with their own documents.
2. Pull the renewal from Producer Toolbox, and complete the market verification in EmployerAccess before the renewal date.
3. Note the paperwork deadline: in Connecticut, the 15th of the month before renewal.
4. Read each plan name for copay, deductible and coinsurance, then confirm them on the SBC, including the family deductible.
5. Match each rate to its four-character contract code, which differs by network, and for HSA plans by self-only and family.
6. Check the rating basis for the state: member-level by age in California, member or two-tier composite on request in Nevada.
7. Re-age the census: Anthem medical rates adjust for age at renewal.
8. List any bundling discount separately, with the lines it depends on.
9. For Anthem Balanced Funding, record the terminal liability, the surplus share and the settlement terms, not just the monthly payment.