If you are going to be spending an extended period of time outside of your plan area, for work, vacation, or going to college, carefully review your plan’s Evidence of Coverage to make sure the BlueCard Program is part of the covered benefits. I was surprised to learn that both Blue Cross and Blue Shield HMO plans included the BlueCard Program for 2017.
Anthem Blue Cross is terminating many of their 2016 PPO and Tiered PPO plans across different regions of California. They are being replaced with an EPO version in 2017. Covered California has misleading information placed on the consumer’s accounts that the new EPO is the same as the old PPO plans.
For the second time since the launch of Obamacare and Covered California, Anthem Blue Cross has cut the commissions they will pay agents for assisting consumers with enrollment into individual and family plans. Anthem Blue Cross now has one of the lowest commission structures for agents helping individuals and families apply for health insurance in California. This commission cut, coupled with rules limiting Covered California delegated agents from receiving commissions, has resulted in agents thinking twice before assisting consumers with Anthem Blue Cross health plans.
The Department of Managed Health Care (DMHC), who regulates most of the individual and family plans offered through Covered California, has developed a website to allow consumers to compare health insurance companies. The Health Plan Dashboard website does not assign any performance review ratings. But it does give consumers a high level view of some of the data collect on the health plans such as enrollment, complaints, and enforcement actions for medical, dental, and vision plans.
It is a reasonable expectation to assume that when a family enrolls in a health plan through Covered California that there will be local doctors to address their health care challenges. Unfortunately, some health plans have a virtual vacuum of providers in fairly large communities. This is the case for members of Anthem Blue Cross PPO individual and family plans in Livermore, California. For one family, the nearest in-network pediatrician is over 15 miles away from their Livermore home.
In 2016 Anthem Blue Cross introduced their new Tiered PPO Network health plans in four counties of California. The Tiered PPO marketing literature noted the member’s cost share would be less if he or she used a Tier 1 hospital, but it didn’t indicate how much less expensive it would be.
While Covered California standard benefit design health plans have very specific limitations on member responsibility for in-network health care services, the coverage for out-of-network services can vary greatly between PPO health plans. The insurance carriers that offer PPO health plans through Covered California (Anthem Blue Cross, Blue Shield of California, and UnitedHealthcare) with out-of-network coverage seem to have made up their own rules for this PPO benefit. Because the Covered California individual and family health plans have such narrow networks, many families are finding that they must go out-of-network to receive certain health care services.
Updates and announcements regarding the Anthem Blue Cross cyber attack data breach. Anthem Blue Cross, February 17th Members to get an email from us about the cyber attack To our valued business partner: We want to keep you informed about our actions in response to the cyber attack. We will begin sending emails to […]
Anthem Blue Cross of California has included a section called Transgender Services in their Evidence of Coverage (EOC) documents for individual and family plans offered in California for 2015. While the seven paragraph section doesn’t provide a lot of details, it is a major step toward recognizing that individual plans must include such coverage to address the medically […]
There was tremendous confusion over which doctors were in-network for the new individual and family plans offered through Covered California in early 2014. While the major health insurance plans offering PPO and EPO plans maintained the provider networks were the same regardless of whether they were purchased on or off the exchange, doubts persisted fueled […]