Elevance Health, Inc. and its subsidiaries (Elevance Health) operates as health company.
The company serves people across their entire health journey to better address their full range of needs with an integrated whole-health approach. Through the company’s broad view, it aims to meaningfully improve the health of the people and communities the company serves. The company strives to deliver on the company’s mission by maximizing the power of partnerships, innovating to fuel growth and health eq...
Elevance Health, Inc. and its subsidiaries (Elevance Health) operates as health company.
The company serves people across their entire health journey to better address their full range of needs with an integrated whole-health approach. Through the company’s broad view, it aims to meaningfully improve the health of the people and communities the company serves. The company strives to deliver on the company’s mission by maximizing the power of partnerships, innovating to fuel growth and health equity, and maintaining a high-performance culture.
The company is one of the largest health insurers in the United States in terms of medical membership, serving approximately 45.7 million medical members through its affiliated health plans as of December 31, 2024. The company offers a broad spectrum of network-based managed care risk-based plans to Individual, Employer Group, Medicaid and Medicare markets. In addition, the company provides a broad array of managed care services to fee-based customers, including claims processing, stop loss insurance, provider network access, medical management, care management, wellness programs, actuarial services and other administrative services. The company provides services to the federal government in connection with its Federal Health Products & Services business, which administers the Federal Employee Program (FEP). The company provides an array of specialty services both to customers of its subsidiary health plans and to unaffiliated health plans, including pharmacy services, stop loss insurance, dental, vision and supplemental health insurance benefits, as well as integrated health services.
The company is an independent licensee of the Blue Cross and Blue Shield Association (BCBSA), an association of independent health benefit plans. The company serves its members as the Blue Cross licensee for California and as the Blue Cross and Blue Shield (BCBS) licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (in the New York City metropolitan area and upstate New York), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.) and Wisconsin. In most of these service areas, the company do business as Anthem Blue Cross and Anthem Blue Cross and Blue Shield. The company also conduct business through arrangements with other BCBS licensees, as well as other strategic partners. In addition, it serves members in numerous states as Wellpoint, Carelon, MMM and/or Simply Healthcare. The company is licensed to conduct insurance operations in all 50 states, the District of Columbia and Puerto Rico through its subsidiaries. Through various subsidiaries, it also offers pharmacy services through its CarelonRx business, and other healthcare related services as Carelon Insights and Carelon Health.
The company has organized its brand portfolio into the following core go-to-market brands:
Anthem Blue Cross/Anthem Blue Cross and Blue Shield — represents its Anthem-branded and affiliated Blue Cross and/or Blue Shield licensed plans;
Wellpoint — unites select non-BCBSA licensed Medicare, Medicaid and commercial plans under the Wellpoint name; and
Carelon — this brand brings together its healthcare related services and capabilities, including the company’s CarelonRx and Carelon Services businesses, under a single brand name.
The company reports its results of operations in the following four reportable segments: Health Benefits, CarelonRx, Carelon Services and Corporate & Other (the company’s businesses that do not individually meet the quantitative thresholds for an operating segment, as well as corporate expenses not allocated to its other reportable segments).
Segments
The company operates through four segments: Health Benefits, CarelonRx, Carelon Services and Corporate & Other
Health Benefits segment offers a comprehensive suite of health plans and services to its Individual, Employer Group risk-based, Employer Group fee-based, BlueCard, Medicare, Medicaid and FEP members. The Health Benefits segment offers health products on a full-risk basis; provides a broad array of administrative managed care services to the company fee-based customers; and provides a variety of specialty and other insurance products and services such as stop loss, dental, vision, and supplemental health insurance benefits.
CarelonRx segment includes its pharmacy services business. CarelonRx markets and offers pharmacy services to the company’s affiliated health plan customers, as well as to external customers outside of the health plans its own. CarelonRx offers a comprehensive portfolio of pharmacy services, which includes all core pharmacy services, such as home delivery and specialty pharmacies, claims adjudication, formulary management, pharmacy networks, rebate administration, a prescription drug database and member services. In addition, CarelonRx includes ambulatory infusion centers, added to the company’s portfolio in March 2024 through its acquisition of Paragon Healthcare, Inc., and its subsidiaries.
Carelon Services segment integrates physical, behavioral, pharmacy, and social services with the aim of delivering whole health affordably by offering a broad array of healthcare related services and capabilities to internal and external customers through the company’s Carelon Health and Carelon Insights businesses. The company’s Carelon businesses promote affordability by managing complex areas of the healthcare system, leveraging data and insights to improve how its members receive safe, appropriate, high-quality care and providers are reimbursed accurately and timely. The company’s approach to cost management relies on capabilities including provider enablement, value-based networks, member engagement, and utilization management. The company’s care delivery services primarily target serving chronic and complex populations by providing personalized care in the home and virtually. As a part of Carelon Health, it completed the company’s acquisition of RSV QOZB LTSS, Inc. and certain affiliated entities (d/b/a CareBridge) at the end of 2024, which provides virtual care to complex Medicaid and Medicare patients and supports plans in managing home, and community-based services.
Corporate and Other segment includes the company’s businesses that do not individually meet the quantitative threshold for an operating segment.
Membership
The company’s medical membership includes the following customer types: Individual, Employer Group risk-based, Employer Group fee-based, BlueCard, Medicare, Medicaid and FEP. In addition, it serves customers who purchase one or more of the company’s other products or services that are often ancillary to the company’s health business.
The company products are generally developed and marketed with an emphasis on the differing needs of its customers. The company’s product development and marketing efforts consider the differing characteristics between the various customers served by the company, as well as the unique needs of educational and public entities, labor groups, the FEP, national employers and state-run programs servicing low-income, high-risk and underserved markets. Overall, the company seeks to establish pricing and product designs to provide value for its customers while achieving an appropriate level of profitability for each of the company’s customer categories balanced with the competitive objective to grow market share. The company believes that one of the keys to its success has been the company focuses on these distinct customer types, which better enables the company to develop benefit plans and services that meet its customers’ unique needs.
The company markets its Individual, Medicare and certain Employer Group products with a smaller employee base through direct marketing activities and an extensive network of independent agents, brokers and retail partnerships. Products for commercial customers with a larger employee base are generally sold through independent brokers or consultants retained by the customer who work with industry specialists from the company’s in-house sales force. In the Individual markets, the company offers on-exchange products through state- or federally facilitated marketplaces (the Public Exchange) in compliance with the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended (collectively, the ACA) and off-exchange products. Federal subsidies are available for certain members, subject to eligibility, who purchase Public Exchange products.
The company continues to participate in the Public Exchange in nearly all its Anthem Blue Cross and Anthem Blue Cross and Blue Shield service areas. The company anticipates growth in its Public Exchange membership as former Medicaid members, no longer eligible for Medicaid coverage, continue to seek alternative coverage options. Additionally, the company is entering select service areas in Florida, Maryland, and Texas in 2025, using its Simply Healthcare and Wellpoint brands, and the companies are actively evaluating expansion opportunities in additional marketplaces.
Being a licensee of the BCBS association of companies, of which there were 33 independent primary licensees including the company as of December 31, 2024, provides significant market value, especially when competing for very large multi-state employer groups. For example, each BCBS member company can utilize other BCBS licensees’ substantial provider networks and discounts when any BCBS member works or travels outside of the state in which their policy is written. This program is referred to as BlueCard. BlueCard host members are generally members who reside in or travel to a state in which an Elevance Health subsidiary is the Blue Cross and/or Blue Shield licensee and who are covered under an employer-sponsored health plan serviced by a non-Elevance Health controlled BCBS licensee, which is the home plan. The company performs certain administrative functions for BlueCard host members, including claims pricing and administration, for which the company receives service fees from the BlueCard members’ home plan. Other administrative functions, including maintenance of enrollment information and customer services, are performed by the home plan. See BCBSA Licenses below in this Business section for additional information on its BCBSA licenses. The company refers to members in its service areas licensed by the BCBSA as the company’s BCBS-branded, or Anthem BCBS, business. Non-BCBS-branded business refers to members in its non-BCBS-branded plans, which include Wellpoint, MMM and Simply Healthcare plans.
Product and Services
Various forms of managed care products have been developed to contain the cost of healthcare by negotiating contracts with hospitals, physicians and other providers to deliver high-quality healthcare to members at favorable rates. These products usually feature medical management and other quality and cost optimization measures such as pre-admission review and approval for certain non-emergency services, pre-authorization of outpatient surgical procedures, network credentialing to determine that network physicians and hospitals have the required certifications and expertise, and various levels of care management programs to help members better understand and navigate the healthcare system.
Health Benefits
Commercial Risk-Based Products. The company offers employer groups a diversified mix of managed care risk-based products including Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Consumer-Driven Health Plans (CDHP), Traditional Indemnity and Point-of-Service (POS) plans. PPO plans generally provide members the freedom to choose any healthcare provider but require the member to pay a greater portion of the provider’s fee in the event the member chooses not to use a provider participating in the PPO’s network. HMOs include comprehensive managed care benefits generally through a participating network of physicians, hospitals and other providers. CDHPs generally combine a high-deductible PPO plan with an employer-funded and/or employee-funded personal care account, which may result in tax benefits to the employee and allow some or all the dollars remaining in the personal care account at year-end to be rolled over to the next year for future healthcare needs. Traditional indemnity plans offer the member an option to select any healthcare provider for covered services, with coverage subject to deductibles and coinsurance and with member cost-sharing usually limited by out-of-pocket maximums. POS products blend the characteristics of HMO, PPO and indemnity plans. In general, POS plans allow members to choose to seek care from a provider within the plan’s network or outside the network, subject to, among other things, certain deductibles and coinsurance.
The company also offer Individual risk-based products on and off the Public Exchange, covering essential health benefits (as defined in the ACA) along with many other requirements and cost-sharing features.
Commercial Fee-Based Products. The company provides a broad array of managed care services to fee-based groups, including claims processing, provider network access, medical management, care management and wellness programs, actuarial services and other administrative services. Fee-based health plans are also able to use the company 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. The company also charge a premium to underwrite stop loss insurance for employers that maintain fee-based plans but want to limit their retained risk.
In addition, the company performs certain administrative functions for BlueCard host members, discussed under Membership above, including claims pricing and administration, for which the company receives service fees from the BlueCard members’ home plans. Other administrative functions, including maintenance of enrollment information and customer service, are performed by the home plan.
Specialty Products. The company offers an array of products and services to both risk-based and fee-based customers in conjunction with its health plans as well as to unaffiliated healthcare plans that are not Elevance Health subsidiaries.
Stop Loss Insurance. The company’s stop loss insurance arrangements are built around its clients’ needs while assuming 100% of the risk. The company offers specific and aggregate plans that will provide options to meet its clients’ coverage terms, budget and risk tolerance; active claims management to help avoid errors and missing claims; as well as cost containment to assist its clients with claims and cost control.
Dental. The company’s dental plans include networks in certain states in which the company operates and are offered on both a risk-based and fee-based basis. The company members also have access to additional dental providers through its participation in the National Dental GRID, a national dental network developed by and for BCBS plans that offers in-network discounts across the country.
Vision. The company’s vision plans include networks within the states in which it operates and are offered on both a risk-based and fee-based basis.
Supplemental Health. The company offers supplemental health products, including accident, critical illness and hospital indemnity, which provide coverage for specific conditions or circumstances.
Medicare Plans. The company offers a wide variety of plans, products and options to individuals aged 65 and older such as Medicare Advantage, including Special Needs Plans (SNPs), dual-eligible programs through Medicare-Medicaid Plans (MMPs), Medicare Supplement plans and Medicare Part D Prescription Drug Plans (Medicare Part D).
Medicare Advantage plans provide Medicare beneficiaries with a managed care alternative to traditional Medicare and often include a Medicare Part D benefit. In addition, the company’s Medicare Advantage SNPs provide tailored benefits to special needs individuals who are institutionalized or have severe or disabling chronic conditions and to dual-eligible customers, who are low-income seniors and persons under age 65 with disabilities. Medicare Advantage SNPs are coordinated care plans specifically designed to provide targeted care, covering all the healthcare services considered medically necessary for members and often providing professional care coordination services, with personal guidance and programs that help members maintain their health. Medicare Advantage membership also includes Medicare Advantage members in the company’s Group Retiree Solutions business who are retired members of commercial accounts or groups who are not affiliated with its commercial accounts that have selected a Medicare Advantage product through the company. MMP is focused on serving members who are dually eligible for Medicaid and Medicare. Medicare Supplement plans typically pay the difference between healthcare costs incurred by a beneficiary and amounts paid by the traditional Medicare Fee-For-Service program. Medicare Part D offers a prescription drug plan to Medicare and MMP beneficiaries.
Medicaid Plans and Other State-Sponsored Programs. The company’s Medicaid business includes its managed care alternatives through public-funded healthcare programs, including Medicaid; Medicaid expansion programs; Temporary Assistance for Needy Families (TANF); programs for seniors and people with disabilities (SPD); Children’s Health Insurance Programs (CHIP); and specialty programs such as those focused on long-term services and support (LTSS), HIV/AIDS, children living in foster care, behavioral health and/or substance abuse disorders, and intellectual disabilities and/or developmental disabilities. The Medicaid program makes federal matching funds available to all states for the delivery of healthcare benefits for low income and/or high medical risk individuals. These programs are managed by the individual states based on broad federal guidelines. The company Medicaid plans also cover certain dual-eligible customers, as previously described above, who also receive Medicare benefits. The company provides Medicaid and other state sponsored services, such as administrative services, in Arkansas, California, Colorado, District of Columbia, Florida, Georgia, Indiana, Iowa, Kentucky, Louisiana, Maryland, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia and Wisconsin.
Federal Employee Program. FEP members consist of United States government employees and their dependents within the company’s geographic markets.
Medicare Administrative Operations. The company serves as a fiscal intermediary, carrier and Medicare administrative contractor for the federal government by providing administrative services for the Medicare program, Parts A and B, which generally provides coverage for persons who are 65 or older and for persons who are under 65 and disabled or with end-stage renal disease. Part A of the Medicare program provides coverage for services provided by hospitals, skilled nursing facilities and other healthcare facilities. Part B of the Medicare program provides coverage for services provided by physicians, physical and occupational therapists and other professional providers, as well as certain durable medical equipment and medical supplies.
Carelon
Carelon integrates physical, behavioral, social and pharmacy services to deliver whole health affordably by creating value through the offering of market-competitive services powered by analytics.
CarelonRx
The company’s subsidiary CarelonRx markets and offers pharmacy services to its affiliated health plan customers throughout the country, as well as to customers outside of the health plans the company owns. The company’s comprehensive pharmacy services portfolio includes all core pharmacy services, such as home delivery and specialty pharmacies, claims adjudication, formulary management, pharmacy networks, rebate administration, a prescription drug database and member services, as well as infusion services and injectable therapies through owned ambulatory infusion centers.
CarelonRx delegates certain core pharmacy services to CaremarkPCS Health, L.L.C., which is a subsidiary of CVS Health Corporation (CVS), pursuant to an agreement (the CVS Agreement) with the current contractual term extending through December 31, 2027.
Carelon Services
Carelon Services integrates physical, behavioral, pharmacy, and social services with the aim of delivering whole health affordably by offering a broad array of healthcare related services and capabilities to internal and external customers through the company’s Carelon Health and Carelon Insights businesses. Carelon businesses promote affordability by managing complex areas of the healthcare system, leveraging data and insights to improve how the company members receive safe, appropriate, high-quality care and providers are reimbursed accurately and timely. The company’s approach to cost management relies on capabilities including provider enablement, value-based networks, member engagement, and utilization management. The company’s care delivery services primarily target serving the chronic and complex populations by providing personalized care in the home and virtually.
Carelon Health: Carelon Health, powered by clinical excellence, curates value-based whole health solutions for populations, one person at a time. Carelon Medical Benefits Management provides specialty care enablement and utilization management support for specialized clinical domains. Carelon Post Acute Solutions manages home health, post-acute institutional management, and durable medical equipment costs. Carelon Behavioral Health provides comprehensive behavioral health management services through clinical services and network administration. Carelon Care Navigation provides comprehensive care management services. The company Carelon Advanced Primary Care business includes palliative care services and management of its partnership with Augusta Topco Holdings L.P. (Mosaic Health), a joint venture with Clayton, Dubilier & Rice (CD&R). At the end of 2024, the company completed its acquisition of CareBridge, which provides virtual care to complex Medicaid and Medicare patients and supports plans in managing home and community-based services.
Carelon Insights: Carelon Insights aims to improve the health of the healthcare system by simplifying workflows and providing real-time insights. Carelon Insights capabilities include payment integrity, subrogation, clinical data exchange through the company’s HealthOS platform, research and data services, reporting and clinical analytics, and information technology services and global business process support.
Networks and Provider Relations
The company relationships with physicians, hospitals and professionals that render healthcare services to its members are guided by local, regional and national standards for network development, reimbursement and contract methodologies. While following industry standards, the company is simultaneously seeking to lead transformation efforts within the company’s healthcare system, moving from a fragmented model premised on episodic intervention to one based on proactive, coordinated care built around the whole health needs of the patient.
The company establish market-based hospital reimbursement payments that the company believes are fair, but aggressive, and among the most competitive in the market. The company also seek to ensure that physicians in its network are paid in a timely manner at appropriate rates. In most instances, the company deploy multi-year contracting strategies, including fixed case rates and fee schedules, to limit the company’s exposure to medical cost inflation and to increase cost predictability.
The company’s hospital contracts provide for a variety of reimbursement arrangements depending on local market dynamics and current hospital utilization efficiency. Most hospitals are reimbursed a per-case amount, per admission, for inpatient covered services. The company per-case reimbursement methods utilize many of the same attributes contained in Medicare’s Diagnosis Related Groups methodology. Hospital outpatient services are reimbursed by fixed case rates, fee schedules or percent of approved charges. A small percentage of hospitals, primarily rural, sole community hospitals, are reimbursed on a discount from approved charge basis for covered outpatient services. The company’s hospital contracts recognize unique hospital attributes, such as academic medical centers or sole community hospitals, and the volume of care performed for its members. To improve predictability of expected costs, the company frequently use a multi-year contracting approach with providers. In addition, most of its hospital contracts include a pay-for-performance component where reimbursement levels are linked to improved clinical performance, patient safety and medical error reduction.
Seasonality
Seasonality in the company’s Medicaid business can vary depending on the timing of the recognition of premium rates during the year (year ended December 2025), and the company typically experience additional costs in its Medicare business in the fourth quarter to support the annual enrollment period.
Medical Management Programs
The company has a broad array of medical management activities that facilitate improvements in the quality of care provided to the company members and promote cost-effective medical care. These medical management activities and programs are administered and directed by physicians and nurses with the goal of ensuring that the care delivered to the company’s members is supported by appropriate medical and scientific evidence, is received on a timely basis and occurs in the most appropriate setting. The medical management programs available to the company’s members may vary depending on the plan or product in which they participate.
Care coordination is one of the strategies the company utilizes and is based on nationally recognized criteria developed by third-party medical specialists to help coordinate inpatient as well as outpatient care and monitor appropriate utilization of such services. The company’s case management focuses on identifying membership that will require a high level of intervention and providing assistance to manage their healthcare needs. Precertification is utilized to assess appropriateness of certain medical services and sites of care prior to the services being rendered. The company’s medical policy committee determines its national policies and guidelines for the application of medical technologies, procedures and services and reviews these policies and guidelines at least once a year or as new published clinical evidence becomes available. The companies are actively engaged with its hospital and physician networks to enable them to achieve better outcomes for the company’s members. The company also work with outside experts through a process of external review to provide its members scientifically and clinically evidence-based medical care. The company’s web-based tools allow its members to obtain or compare cost estimates for care, including out-of-pocket costs.
The company remain committed to assisting its members in making informed and value-based healthcare decisions, providing for easier navigation of healthcare services and delivering a better healthcare experience.
Care Management and Wellness Products and Programs
The company continues to expand its suite of integrated care management programs and tools. Availability of these programs and tools to the company’s members may depend on the particular plan or product in which they participate. The company’s care management tools and programs are designed to increase quality and reduce medical costs for its members and help them make better decisions about their well-being as they navigate the healthcare system. The company’s digital engagement platform, Sydney Health, is designed to give its members access to personalized health and wellness resources, medical, pharmacy, dental and vision benefits details, and virtual care services, all in one place. The company’s care management, infertility services and maternity management programs serve as adjuncts to physician care. Through these programs, medical professionals help to educate participants regarding their care and condition. The company’s 24/7 Nurse Line offers access to qualified, registered nurses to allow its members to make informed decisions about the appropriate level of care and avoid unnecessary worry. The company’s Carelon Palliative Care Services subsidiary engages with members near end of life and/or requiring palliative care to manage serious illnesses and improve quality of life during a difficult time. With the company’s integrated information systems and sophisticated data analytics, the company helps its members improve their compliance with evidence-based care guidelines, provide personal care notes that alert members to potential gaps in care, enable more prudent healthcare choices and assist in the realization of member out-of-pocket cost savings. The company employee assistance programs provide 24/7 telephonic support for personal and crisis events and provide resources such as counseling and referral assistance with childcare, health and wellness, financial issues, legal issues, adoption and daily living. The company has a comprehensive behavioral health case management program supporting a wide range of members who are impacted by their behavioral health conditions, including specialty areas such as eating disorders, anxiety, depression and substance abuse. The program assists members and their families with obtaining appropriate behavioral health treatment, offering community resources, providing education and telephonic support, and promoting provider collaboration.
Healthcare Quality Initiatives
Increasingly, the healthcare industry can define quality healthcare based on effective, safe, equitable and affordable care in preventive health, and optimal care management for chronic disease. A key to the company’s success has been its ability to develop partnerships by working with the company’s network physicians, hospitals, and social resources providers to improve the quality outcomes of the healthcare and social impact services provided to its members, their families, and the community-at-large. The company’s ability to promote quality medical care and patient safety, address health-related social risks and advance health equity has been recognized by the National Committee for Quality Assurance (NCQA), the largest and most respected national accreditation program for managed care health plans, and the company was awarded the NCQA 2023-2024 Innovation Award for the advancement of better maternal and neonatal outcomes.
Several quality healthcare measures, including the Healthcare Effectiveness Data and Information Set (HEDIS), has been incorporated into NCQA’s accreditation processes. HEDIS measures range from preventive services, such as screening mammography and pediatric immunization, to elements of care, including decreasing the complications of diabetes, improving treatment for patients with heart disease, integration of behavioral health, and racial and ethnic stratification measurement to help close healthcare disparities.
Through the company’s Carelon Medical Benefits Management, Inc. subsidiary, it promotes appropriate, safe and affordable member care in areas including maternity care, imaging, sleep disorders, cardiac testing, oncology drugs and musculoskeletal procedures. These expanded specialty benefit management solutions leverage clinical expertise and technology to engage provider communities and members in the more effective and efficient use of outpatient services and to promote the most appropriate use of clinical services to improve the quality of care.
The company performs management review for home health and post-acute institutional services provided to Medicare members through the company’s Carelon Post Acute Solutions, Inc. subsidiary, with the goal of ensuring they receive appropriate, high-quality care and supporting their transition back into the home. Effective management of these services can help reduce preventable hospital admissions and readmissions, thereby improving healthcare outcomes for patients. Additionally, Carelon Medical Benefits Management, Inc. has developed programs to address healthcare quality by identifying and closing care gaps. A social determinants of health program screens its members for social needs and connects members to appropriate community resources to encourage better care outcomes. Both medical benefits management and post-acute solutions programs are examples of how it facilitates improvements in the quality of care provided to the company’s members and promote cost-effective, affordable medical care.
The physical aspects of health have been traditionally the focus and the priority for healthcare. However, unique life circumstances and experiences impact every individual and their health. The company seeks to understand its members' health-related social needs to create a healthcare system that synchronizes care delivery for physical, behavioral, social and pharmacy needs. The company has invested in several strategies to improve how it addresses health related social needs. The company is advancing its efforts through consistent screening of its members for their social needs by using industry-standard tools such as the Protocol for Responding to & Assessing Patients’ Assets, Risks & Experiences, co-creating social action plans with the compay’s members, connecting members to related social support services, and evaluating the entire process for continuous quality improvement. The company has also implemented its Food as Medicine strategy across many of the company’s lines of business to create interventions that not only prevent, manage, and treat diseases but also address food and nutrition insecurity among the company’s members. The company is committed to ensuring that all people, regardless of age, race or ethnicity, sexual orientation, gender identity, disability, and geographic or financial access can receive individualized care. Harnessing data gives a more complete picture of each member and their health needs and can help make healthcare more personalized and equitable. Strengthening communities has a positive effect on health; therefore, the company value and nurture its local ties, which are a key component of the company’s whole-health approach and drive the company to work closely with community organizations that create support networks. Using the company’s data, it also identifies the resources needed to support local residents, including the people who the company serves, to ensure those resources can better meet local needs.
BCBSA Licenses
The company is a party to license agreements with the BCBSA that entitle the company to the exclusive, and in certain areas, non-exclusive, use of the Blue Cross and Blue Shield names and marks in assigned geographic territories. BCBSA is a national association of independent Blue Cross and Blue Shield companies, the primary function of which is to promote and preserve the integrity of the BCBS names and marks, as well as provide certain coordination among the member companies. Each BCBSA licensee is an independent legal organization and is not responsible for obligations of other BCBSA member organizations. Although previously the company did not have a right to sell products and services using the BCBS names and marks outside of its exclusive service areas, under the terms of the In re Blue Cross Blue Shield Antitrust Litigation subscriber settlement agreement and release (Subscriber Settlement Agreement) some large national employers with self-funded plans (specifically identified in the Subscriber Settlement Agreement), have a right to request a second Blue plan bid in addition to a bid from the local Blue plan, effective as of September 2024.
Regulation
The states of domicile of the company’s regulated subsidiaries have statutory risk-based capital (RBC) requirements for health and other insurance companies and HMOs based on the Risk-Based Capital (RBC) For Health Organizations Model Act.
Since its enactment in 2010, the ACA has introduced new risks, regulatory challenges and uncertainties, has impacted its business model and strategy and has required changes in the way the company products are designed, underwritten, priced, distributed and administered. The company expect the ACA will continue to significantly impact the company business and results of operations, including pricing, minimum medical loss ratios (MLRs) and the geographies in which the company’s products are available. The company will continue to evaluate the impact of the ACA as any further developments occur.
The provision of services to certain employee welfare benefit plans is subject to the Employee Retirement Income Security Act of 1974, as amended (ERISA), a complex set of laws and regulations subject to interpretation and enforcement by the Internal Revenue Service and the Department of Labor. ERISA regulates certain aspects of the relationships between the company, the employers that maintain employee welfare benefit plans subject to ERISA and participants in such plans.
In addition, the company’s non-U.S. operations are subject to U.S. laws regulating the conduct and activities of U.S.-based businesses operating abroad, including but not limited to, the Foreign Corrupt Practices Act and corresponding foreign laws governing anti-bribery, anti-corruption, anti-money laundering, data protection and privacy, employment, and other regulatory oversight initiatives.
The Consolidated Appropriations Act of 2023 decoupled Medicaid eligibility redetermination from the COVID-19 Public Health Emergency, initially declared in January 2020. As a result, states were permitted to begin removing ineligible beneficiaries from their Medicaid programs starting April 1, 2023, and most of the company’s Medicaid markets began doing so as of June 30, 2023. Although most states have completed this process, CMS has if states have until December 31, 2025, to complete these eligibility redeterminations.
The Inflation Reduction Act of 2022 contains a variety of provisions that have impacted, and continue to impact, the company’s business including extending the American Rescue Plan Act of 2021's enhanced Premium Tax Credits (PTC) through 2025; imposing a new corporate alternative minimum tax; providing a one percent excise tax on repurchases of stock; allowing CMS to negotiate prices on a limited set of prescription drugs beginning in 2026; instituting caps on insulin cost sharing in Medicare; redesigning the Medicare Part D benefit; requiring drug manufacturers to pay rebates if prices increase beyond inflation; and delaying the implementation of the Trump Administration Medicare drug rebate rule to 2032.
History
The company was incorporated in 2001. It was formerly known as WellPoint, Inc. and changed its name to Anthem, Inc. in 2014. Further, the company changed its name to Elevance Health, Inc. in 2022.
