Anthem, Inc. is a health insurance company in the United States. The entity is the Blue Cross Blue Shield Association’s biggest for-profit managed health care business. The business has about forty million members as of 2018. Previous to 2014, the company was known as WellPoint, Inc. The business was established in 2004 when WellPoint, headquartered in California, and Anthem, located in Indianapolis, merged after the acquisition of numerous health insurance companies by both corporations.
In California, where it serves about one million members as Anthem Blue Cross, the business is the biggest health insurer. It is known in New York as Empire Blue Cross Blue Shield and in ten other states as Anthem Blue Cross and Blue Shield.
BACKGROUND ON EMPIRE BLUE CROSS BLUE SHIELD ANTHEM
Blue Cross Blue Shield Association (BCBSA) is a federation of thirty-five United States health insurance undertakings providing health insurance to more than a hundred million people in the United States. The merging of its two namesake organizations was established in 1982: Blue Cross was established in 1929 and in 1960. Blue Shield was formed in 1939 and the Blue Shield Association in 1948.
The group is known as the ‘Association’ in the health insurance business and has two offices, one in Chicago and the other in Washington, D.C. BCBSA controls access for the United States and more than 170 other countries to Blue Cross and Blue Shield trademarks and names, which it then licenses for some exclusive geographical regions to associated businesses. The BCBSA handles communication between its members and the operational policies which must be licensed. This allows each BCBSA business to provide domestic insurance cover even if it only operates in its specified service region.
The Blue Cross and Blue Shield insurance businesses are licensed, independent from, and historically mutually exclusive of an association, providing insurance policies under one or both Association trademarks within specified areas. Blue Cross Blue Shield insurers in all U.S. states provide some kind of health insurance coverage. They also serve as Medicare administrators in several states or areas of the United States.
The Blue Cross Blue Shield Federal Employee Program is a national option for U.S. federal government workers and retirees under the Federal Employer Health Benefits Program (FEHB) and has been part of FEHB since FEHB was launched in 1960. The FEP is the biggest insurer of federal workers and the world’s largest single health plan organization with more than five million members.
Empire Health Choice HMO, Inc., Empire HealthChoice Assurance, Inc., and HealthPlus HP, LLC are independent licensees of the Blue Cross Blue Shield Association. Empire BlueCross BlueShield (Empire) is the trade name of Empire HealthChoice Assurance, Inc., and Empire Blue Cross Blue Shield HMO is the trade name of Empire HealthChoice HMO, Inc., independent licensees of the Blue Cross Blue Shield Association, serving residents and businesses in the twenty-eight eastern and southeastern counties of New York State.
ADHERENCE TO HIPAA RULES
The Health Insurance Portability and Accountability Act of 1996 was a law enacted at the federal level creating national standards for disclosure of sensitive patient information. This prevented information from being disclosed without the patient’s consent. The act itself covers health insurance coverage for workers and their families [Title I of HIPAA,] national identifiers and electronic health care transaction provisions [Title II,] guidelines for pre-tax medical spending accounts[Title III], health insurance reform, including individuals with pre-existing conditions and those seeking continued coverage. Title IV], and Title V governs company-owned life insurance policies.
HIPAA is critical law because it guarantees the sustainability and accessibility of healthcare programs. It establishes the basis for healthcare in the United States and prohibits the indiscriminate trading of medical data. Because healthcare is a need, it also pre-empts state law in order to guarantee consistency in the country’s medical laws [unless the state has more stringent medical standards].
HIPAA is a federal law that governs a broad range of medical services. It sets regulations governing healthcare services, as well as standards for technology and record-keeping. The latter is relevant to health insurance and billing companies, as well as health maintenance organizations, with penalties for noncompliance.
HIPAA PRIVACY RULE
Medical identity theft has been a major issue in the healthcare sector. Consequently, the HIPAA Privacy Rule was enacted by the US Department of Health and Human Services and addresses the use and disclosure of information to the patients. Entities that are responsible for the same who are subject to the Privacy Rule are called ‘covered entities’ and are required to comply with the standards laid down for the protection of healthcare information.
Primarily, a balance is struck in the Privacy Rule between the protection of individual health information as well as ensuring data is sourced for high-quality healthcare. The Rule does not lay down rigid and impermeable rules insofar as each individual seeking care requires diversity in their treatment but provides standards for covered entities as well as the rights of the individuals themselves. The HIPAA Privacy Rule is sustained by national regulations for the use and disclosure of Protected Health Information (PHI) in healthcare treatment, payment, and operations by covered entities.
Protected Health Information is information that can be connected to the individual through certain identifiers which can include: name, Social Security number (SSN), driver’s license, state identification card, account, credit/debit card, passport, or alien registration numbers — among other items. However, this does not include publicly available information that is lawfully made available to the general public from federal, state, or local government records or widely distributed media.
The entity can only share personal information externally only where federal and state law allows or requires it. It is the duty of the entity to ensure that the access, use, and disclosure of Protected Health Information adhere only to what is strictly, as well as applicable law. It must be known that any claim concerning privacy should be specifically served to Anthem’s Privacy Office.
WHAT DOES THE EMPIRE BLUE CROSS BLUE SHIELD
Commercial & Specialty Business, Government Business, and Other Miscellaneous Activity are the three major segments of Anthem. The Commercial & Specialty Business and Government Business segments offer a diverse portfolio of managed care products, including PPOs, HMOs, traditional indemnity benefits, and point-of-sale (POS) plans, and also a multitude of hybrid benefits plans, such as CDHPs, hospital-only, and limited benefit products.
A. Commercial & Specialty Business is composed of the Local Group, National Accounts, Individual, and Specialty companies. These business units offer fully-insured health care products, provide a greater range of self-financed customers with managed health care services, including claims handling, underwriting, stoppage insurance, acting services, provider network access, medical cost management, disease management, wellness, and other administrative services, and provide a range of financial products and services.
B, Government business sector includes Medicare and Medicaid companies, National Government Services or NGS services, and FEP®-related federal government services. Medicaid makes federal matching money available to all nations to assist medically eligible individuals, primarily those with limited income that meet other government requirements. Medicaid is intended to allow individual states to select their own eligibility criteria, benefits packages, payment rates, and program administration in accordance with wide federal standards. Medicare customers are eligible individuals with 65 or older age and who have registered with Medicare Advantage or Medicare Supplements, certain handicapped persons under 65, or members of all ages with kidney disease.
SUBSIDIARIES EMPIRE BLUE CROSS BLUE SHIELD ANTHEM
HOW TO SERVE LEGAL PAPERS ON ANTHEM BLUE CROSS FOUNDATION, L.L.C.
Anthem Blue Cross Foundation’s place of formation is in Delaware, although the business is located in New York. Anthem Blue Cross Foundation registered itself on 20th August 2010, predominantly in the business of Aircraft Engine and Engine Parts Manufacturing as a limited liability company for purposes of Process Service.
The Anthem Blue Cross and Blue Shield Foundation an independent license holder of the Blue Cross and Blue Shield Association supports Anthem’s business goal of improvement of individuals’ and families’ health and well-being in the communities served by Anthem Blue Cross and Blue Shield. The Fund concentrates its financing on strategic projects which address and provide creative solutions to the problems of health care, as well as the promotion of healthy generations, a multi-generation effort that focuses on particular disease states and medical disorders. These include the first quarter of pregnancy, low birth weight, cardiac morbidity rates, long-term activities which reduce obesity and promote physical activity, the incidence of diabetes among adult populations, pneumococcal adult and influenza immunizations, and a stop of smoking. The foundation also administers the Associate Giving program of the business, which gives 50 percent of its associated campaign commitments and its Community Service Volunteer Time Off and Dollars for Doers. ANTHEM is THE Anthem Insurance Companies, Inc. registered trademark. The names and emblems of the Blue Cross and the Blue Shield are recognized Blue Cross and Blue Shield Association trademarks. The entity retains CT corporation as its registered agent.
For New York purposes, if the LLC is established in another state it is recognized in New York as a foreign LLC. In other words, foreign does not imply alien. It implies that the company was established in accordance with the legislation of another state. On the other hand, a domestic LLC is established in the state in which it does business. This terminology is prevalent in the United States.
According to the New York LLC Law, any foreign company must be registered with New York, if they are ‘transacting business’ or ‘doing business in New York for the purpose of New York City Process Service. As with other jurisdictions, the New York LLC Act does not explicitly define either ‘commercial transactions’ or ‘commercial transactions’ with regard to international registrations.
However, State rules regulating the collection of state sales tax in international businesses offer some clarity. Under these rules, a company must be physically present in the state—or associated with it—in order to be obliged to collect state sales tax on sales to its citizens for purposes of New York City Process Service.
HOW TO SERVE LEGAL PAPERS ON ANTHEM HEALTH CAREERS, LLC
Anthem Health Careers, LLC is a subsidiary group of the Anthem Corporation and filed for incorporation with the Department of State on September 14th, 2007 in the county of Suffolk. The entity itself is classified as a Domestic Limited Liability Company that falls under New York jurisdiction for New York City Process Service guidelines to be used.
New York City Process Service needs to be rendered on the Secretary of State as an agent of a domestic limited company. However, Anthem Health Careers, LLC retains a registered agent on record, such that New York City Process Service may be forwarded from the Department of State. Consequently, New York City Process Service can be sufficiently done by personally delivering to and leaving with the Secretary of State duplicate copies of such New York City Process Service with the statutory fee, at the Albany office of the Department of State. The Department of State then needs to send one of these copies by certified mail to New York City Process Service with the return receipt requested, to the Anthem Health Careers address on file in the Department of State.
HOW TO SERVE LEGAL PAPERS ON ANTHEM PREMIUM SERVICES CORP.
Anthem Premium Services Corp registered with the New York Department of State on 7th December 2001. Since Anthem Premium Services Corp was thus formed in New York and in Queens County, the entity qualifies as a domestic business corporation and will have New York City Process Service levied upon it. The United States Department of State is under an obligation to send the New York City Process Service documents that it has received to the entity. If it is required, the Department of State may receive New York City Process Service on behalf of the organization.
In accordance with New York law, New York City Process Service on a registered agent may be performed by serving the person or entity by delivering a summons. In this instance, the agent’s involvement in the process essentially presumes that the agent stands in as a defendant and thus satisfies New York City Process Service. However, New York City Process Service may also be provided upon a higher officer. While this service usually necessitates two copies of the New York City Process Service being served on the New York Secretary of State or anyone authorized by them, an individual may perform this service if they are serving one copy to the New York Secretary of State or anyone authorized by them. If an entity accepts New York City Process Service on their behalf, the Department of State will send the package to their offices via mail. In any event, the Department of State may undertake a process for this New York City Process Service in the State of New York, identifying designated officials who are ranked highly to receive New York City Process Service.
HOW TO SERVE LEGAL PAPERS ON ANTHEM MEDICAL HEALTHCARE, P.C.
The Anthem Medical Healthcare, P.C. is an entity of the Anthem Corporation established with the Department of State of New York relatively recently, having its initial filing completed on 10th May 2010. The entity is entirely New York-based, filing for incorporation in Suffolk County for the purposes of New York City Process Service.
The Anthem Medical Healthcare, P.C. is thus a domestic professional service corporation entirely coming under New York jurisdiction and requiring the corporation to adhere to rules of New York City Process Service. A business corporation may be formed by filing a Certificate of Incorporation pursuant to Section 1503 of the Business Corporation Law. This entity retains The Corporation as a registered agent to accept New York City Process Service on its behalf, New York City Process Service on the corporation is often complete when the Secretary of State is served. The Secretary of State then will send one of these copies by certified mail for New York City Process Service to the corporation, with Anthem Medical Healthcare, P.C. Inc itself supplying the address while providing the Certificate of Incorporation which is on file in the Department of State.
A professional corporation is one that is composed of several kinds of professionals, including physicians, attorneys, architects, accountants, engineers, and psychologists. Professionals seeking to incorporate their practice may do so in the majority of states by establishing a professional corporation or a professional service company.
A professional service corporation is distinct from a professional corporation in that the former is formed in accordance with particular Internal Revenue Service rules (IRS.) Professional corporations must be organized in the state in which the professionals do business. While ordinary companies exempt shareholders from personal responsibility, professional corporations enable professionals to benefit from the benefits of corporations while restricting their personal liability in specific circumstances.
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1. ‘Health Insurer Wellpoint Switches Name To Anthem’. San Diego Union-Tribune, 2021, https://www.sandiegouniontribune.com/sdut-health-insurer-wellpoint-switches-name-to-anthem-2014dec03-story.html.
2. Writer, DIANE LEVICK; Courant Staff. ‘BLUE CROSS, ANTHEM MERGE.’ Courant.com, 19 Sept. 2018, www.courant.com/news/connecticut/hc-xpm-1997-08-02-9708020019-story.html.
3. The headquarters is in Chicago on 225 North Michigan Avenue in the Illinois Centre.
4. Bizjournals.com, www.bizjournals.com/louisville/stories/1999/07/12/daily7.html.
5. Mathews, Anna Wilde, and Brent Kendall. “Antitrust Rulings Put Chill on Health-Insurance Mergers.” The Wall Street Journal, Dow Jones & Company, 15 Feb. 2017, www.wsj.com/articles/cigna-calls-off-merger-with-anthem-1487104016.
6. King, Michael W. “Health Care Efficiencies: American Journal of Law & Medicine.” Cambridge Core, Cambridge University Press, 6 Jan. 2021, www.cambridge.org/core/journals/american-journal-of-law-and-medicine/article/health-care-efficiencies/FE2F04AB0EEE0EA0798022F4C0CD4592.
8. Anthem assesses the suitability of the reportable segments on a regular basis, especially in light of organizational changes, mergers, and acquisitions activity, and changing laws and regulations
9. C T CORPORATION SYSTEM
Address:28 LIBERTY ST., NEW YORK, NY, United States, 10005
10. DOS ID:3567894
11. NY LLC L § 303 (2012) § 303. Service of process on limited liability companies.
12. THE LLC, C/O JEAN MARIE BRAAT
Address:31 BRIDLE PATH, WESTHAMPTON BEACH, NY, United States, 11978
13. This authorized individual may also be the deputy, or any person authorized by the secretary of state to receive such service
14. DOS Process (Address to which DOS will mail process if accepted on behalf of the entity)
HE LLC, C/O JEAN MARIE BRAAT
Address:31 BRIDLE PATH, WESTHAMPTON BEACH, NY, United States, 11978
15. C/O DEBRA FINE
Address:33-21 157TH ST., FLUSHING, NY, United States, 11354
16. Chief Executive Officer’s Name and Address
Name: DEBRA S FINE
Address:33-21 157TH ST, FLUSHING, NY, United States, 11354
17. THE CORPORATION
Address:205 SMITHTOWN BLVD, NESCONSET, NY, United States, 11767