September 16, 2015
For 2016, we’re pleased to introduce product changes for the Individual market that offer greater value and flexibility. And to go with these changes, we have brand-new sales materials to help guide members with the kind of clear, easy-to-use information they’ve been asking for, all to help them make informed choices about our plans.
EPO Plans are now Tiered PPO Plans
The exclusive provider organization (EPO) is now a tiered preferred provider organization (PPO) plan. Members on 2015 EPO plans will be transitioned to Tiered PPO plans effective 1/1/16 (unless they choose a different plan). While EPO plans offered in-network benefits only, the new Tiered PPO plans will offer both in-network and out-of-network benefits. That means your clients can have the flexibility of a PPO with the lower prices of a two-tier hospital network, plus out-of-network benefits. Of course, they pay less when they stay in our network. But if they need to, they have the flexibility to go out of the network.
BlueCard® works for travel
PPO and Tiered PPO plans cover emergency treatment at any hospital, wherever your clients travel within the U.S. — as well as non-emergency care when you visit participating BlueCard providers in the U.S. or abroad. You can see any provider you wish, but you’ll pay less out of pocket when you use BlueCard providers and hospitals.
Network Groups
Anthem Blue Cross of California has grouped their networks into four different groups that cover different counties. Some counties will be offered only PPO plans while another county may have the option of a PPO Tiered or HMO network plans. They have plans that are offered through Covered California as well as off-exchange directly from Anthem.
Summary of Benefits and Coverage
The Summary of Benefits and Coverage (SBC) are the actual specifics of the health plan regarding deductibles, copayments, coinsurance regarding the covered benefits. I have broken the SBCs into three groups for plan that apply to
- Alaska Natives and American Indians
- Covered California; plans purchased through the exchange.
- Off-Exchange; plans purchased directly from Anthem Blue Cross
For the Covered California and Off-Exchange plan it is possible to have several different plan types for each metal tier level. For example, you can have Platinum HMO, Platinum PPO, and a Platinum PPO Tiered. Consequently, it is very important to know exactly what plan you have in order to download the correct SBC. You will also see plan designated with a “D” under the Off-Exchange group. The D plans are the mirror image of the standard benefit design plans sold through Covered California. Many Off-Exchange plans are not a standard benefit design and can have different benefits. You will also notice the designation of “Multi-State Plan” on some of the Covered California plans. This does not mean they are good in another state outside of California. It means that they conform certain federal regulations and benefits. See: What is a Multi-State plan.
To view and download all the marketing and plan material visit Anthem Blue Cross of California 2016 ACA Plans.