Members who live in rating regions 1, 7, and 10 and who transition into a new Anthem EPO plan for 2018 can apply for Continuity of Care coverage if their current provider is no longer in network. They can call member services and ask for assistance with their ongoing treatment with their current providers.
The Blue Shield Trio HMO plans include such medical groups as Dignity Health, Hoag Memorial, John Muir, Providence St. Joseph, St. Jude, and UC San Francisco. Your PCP will refer you to specialists within the network of doctors and providers within his or her medical group. Trio HMO plan will be available in 24 California counties. Trio HMO plan will also include the BlueCard program for urgent care outside of California similar to the PPO plans.
All the plans offered will EPO (Exclusive Provider Organization) with no out-of-network coverage. Anthem will retain the BlueCard for travel coverage for its Blue Cross members. The 2018 plans will continue to use the Pathway network of providers.
The Kaiser plans Bronze 60 HDHP 5500/40%, Silver 70 2000/45, and Silver 60 HDHP 2700/15% are only available off-exchange. The Silver 73, 87, adn 94 plan are only available through Covered California. The Silver 70 Off Exchange plan virtually mirrors the Covered California Silver 70 plan but the rate does not include the Covered California Silver plan surcharge making it less expensive.
Any beneficiary who resides in, or resided in, an area for which the Federal Emergency Management Agency (FEMA) has declared an emergency or major disaster (see www.fema.gov/disasters or the list below*) is eligible for the SEP, if the beneficiary was unable to enroll in a plan during another qualifying election period. In addition, beneficiaries who do not live in the impacted areas but receive assistance from someone living in one of the affected areas also qualify for this SEP.
Individuals and families who are enrolled in a health plan that is being closed must actively enroll in another plan through Covered California. Those households will not be automatically renewed into a new plan. Without an enrollment selection, the family may have no health insurance at the beginning of 2018. Off-exchange members who have plans being closed will be migrated to a similar plan if the household has not changed their plan for 2018.
The Department of Health Care Services notified all county welfare directors in a letter dated July 31, 2017, that for eligibility determinations, same-sex married couples will be treated the same as opposite-sex married spouses. One of the significant changes is that county eligibility workers will no longer have to request verification of the same-sex marriage. They same-sex couple, regardless of which state they were married in, will just have to attest under penalty of perjury that they are legally married.
Western Health Advantage (WHA) has announced that the Department of Managed Health Care has approved their expansion for small group plans into the Bay Area. They also noted that they will not seek re-certification of their Covered California small group plans because of this expansion. WHA’s exit from the Covered California for Small Business plans does not affect their individual and family plan offerings through Covered California.
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.
Thanks to the actions of President Trump, in April I took the unprecedented step authorizing health insurers to file two sets of rates for 2018,” said Insurance Commissioner Dave Jones. “We in California are doing everything we can to keep carriers and plans in the individual market, but President Trump continues to undermine the ACA and as these rate filings demonstrate, California is not immune to his efforts to wreck the Affordable Care Act. If President Trump continues down this path, premiums will increase substantially in 2018. The average premium increase doubles if Trump continues to refuse to fund the cost-sharing assistance in the ACA.