In order to give members impacted by this change plenty of time to plan for their coverage needs in 2018, we are notifying affected members over the next few days that their current plan will be discontinued on December 31, 2017. This includes all on and off exchange members outside of rating regions 1, 7 and 10, and HMO members in rating region 7. It’s important to note that until 2018, their coverage stays the same. All they need to do is keep paying their premiums.
Next year, we will offer plans in three regions of Northern California only, which will include Redding, Santa Clara County, and Stockton/Modesto. The coverage options will include EPO plans available both on-exchange and off-exchange, and at all metal levels. Staying in these three key areas will help ensure Californians in those regions have access to health plans.
As part of our ongoing efforts to manage these drug costs, we are expanding our precertification program to include medical specialty edits. The expansion of our precertification program will allow clients who currently have our precertification program to benefit from these enhancements. There are two components to this expansion:
If you receive services from an In-Network Facility at which, or as a result of which, you receive non –Emergency Covered Services provided by an Out-of-Network Provider, you will pay no more than the same cost sharing that you would pay for those same non-Emergency Covered Services received from an In-Network Provider, and you will not owe the Out-of-Network Provider more than the In-Network cost sharing for such non-Emergency Covered Services.
Members can make an appointment with a licensed doctor to come to their home or office in two hours or on their schedule. Hours of availability are from 8 a.m. to 8 p.m., seven days a week, including holidays.
To make it easier than ever to find local level 1 pharmacies for your clients, refer to this Rx Choice Tiered Pharmacy list for California. A circle with either a 1 or a 2 next to each pharmacy indicates whether it’s a level 1 or a level 2.
Misuse of emergency rooms (ERs) for non-emergency medical concerns is a big cost driver for our clients and members. The average cost to go to the ER for a non-emergency is $1,200 (1). Yet 66% of members go to the ER whenever they (or someone they care for) are sick and the doctor’s office is closed.(2) And, 25% believe the best place to go is the ER, regardless of how sick or injured they are, no matter the time of day.(2) This not only costs members more – in terms of both time and money
Anthem has worked with the National Urban League, City of Hope and Pfizer, Inc., to launch Take Action for Health, a free, interactive website aimed at reducing some of the greatest health risks facing the African American community today, like breast cancer, heart disease and emotional well-being.
The Rx Choice Tiered Network is comprised of more than 70,000 retail pharmacy locations in all. The network is anchored in Anthem markets, where offered, by CVS, along with Target pharmacies, now owned and operated by CVS. Members have the option to pick pharmacies at other retail chains and big box stores, as well as many independent drugstores.
“Anthem is significantly disappointed by the decision as combining Anthem and Cigna would positively impact the health and well-being of millions of Americans – saving them more than $2 billion in medical costs annually,” said Joseph R. Swedish, Chairman, President and Chief Executive Officer, Anthem.