The membership of our grandfathered plans continues to get smaller every year. When a plan’s membership drops below 500 members, we need to review our portfolio and consider changes that benefit all Blue Shield members. Therefore, we are withdrawing the following Blue Shield of California grandfathered plans from the Individual and Family Plans market.
When individuals go to an in-network facility for care but receive services from an out-of-network doctor or healthcare provider, they only have to pay their in-network cost-sharing amount that counts toward the annual deductible and annual out-of-pocket maximum limits according to their health plan.
the AHCA as currently drafted is flawed as well. The tax credits it provides do not vary based on either a person’s income or the cost of care where they live. There is no help with deductibles and co-pays for those with lower incomes. Millions of people, particularly older Americans, would not be able to afford health insurance or to get care when they need it. In addition, the recent amendments could return us to a time when people who were born with a birth defect or who became sick could not purchase or afford insurance, and when benefits were not there when people needed them the most.
Beginning in April, we will transition to a new payment system that will offer our members the same convenient choices with an improved online payment experience. Members will notice some changes if they pay their bill online or are enrolled in Easy$PaySM, our automatic payment program.
We are pleased to announce that Blue Shield and Sutter Health have signed a new 3-year agreement effective January 1, 2017. This means that Sutter Health hospitals and providers are part of Blue Shield’s statewide network.
Blue Shield of California and Sutter Health have been engaged in discussions on rates and terms for a new network contract (HMO/PPO and in some cases, Group Medicare Advantage). Though we are still actively involved in negotiations, the current contract expired at 11:59 p.m. on December 31, 2016 and Sutter Health is no longer Blue Shield’s in-network provider effective January 1, 2017.
Blue Shield of California has experienced ongoing system issues that have recently been corrected. As a result of these issues, some Individual and Family Plan members received past billing statements showing incorrect amounts due. Affected members will receive a detailed statement of corrections for these past months and, in some cases, previous years, in their January billing statements. Those who have been over billed will be credited, and those who have been under billed will only be responsible for adjustments to the December premium, not for past months of accrued charges.
After the presidential election, it is likely that you will receive questions regarding the future of the Affordable Care Act (ACA) and how it could affect our customers. While we do not yet know the full outcome, we do know that the ACA and Covered California is working for over 21 million Americans and repealing or replacing it would not be a simple or fast process.
Blue Shield of California and Health Net are two of the health plans that are currently in negotiations with Sutter Health regarding contracted in-network doctors and hospitals for 2017. Both health insurance companies are alerting agents to the potential that Sutter hospitals and doctors may not be covered in many of their health plans in 2017 if they don’t come to an agreement soon.
In 2017, we will be selecting a primary care physician (PCP) for you so you can begin building a relationship with your doctor. As a PPO member, read our frequently asked questions about choosing a PCP.