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.
For 2017, Anthem Blue Cross will offer a new Silver Pathway HMO 2650 plan for Individual business. This plan meets Affordable Care Act (ACA) rules and will be sold off the exchange only. We also will expand our Pathway HMO network in Los Angeles County for members who buy plans on or off the exchange.
Anthem Blue Cross has made it easier for members with off-exchange plans to change plans without filling out a new application. Current off-exchange members who want to change from their 2016 ACA compliant Anthem plan (purchased off the exchange) to a different off-exchange plan for 2017 can use the appropriate new form instead of having to complete the full enrollment application.
For 2017, Health Net is offering a variety of health plans throughout California. There are EPOs, HSPs, HMOs, and PPOs plans. Some of the plans are offered through Covered California and some, like the PPO plans, are only offered off-exchange direct from Health Net.
The California Office of the Patient Advocate (OPA) has released their health plan quality report cards in time for the 2017 open enrollment period. Now in its 16th year, the 2016/2017 OPA Health Care Quality Report Cards are available online at www.opa.ca.gov. This timely release of the Report Cards is critical as consumers prepare in making the important decision of choosing a new health plan for themselves and their families during 2017 open enrollment. Quality matters when consumers choose a health plan or medical group, and this free tool helps ensure they have the information they need to make an educated decision.
For 2017, we have adjusted our product portfolio to include an exclusive provider organization (EPO) in most rating regions. Rating Regions 10 – 14 (Southern San Joaquin Valley counties) will continue to be offered PPO plans. Members on some 2016 PPO plans and all Tiered PPO plans in these areas will be transitioned to EPO plans effective 1/1/17 (unless they choose a different plan). Members will have access to our Pathway network of doctors and hospitals, but their EPO plan will not cover out-of-network benefits.
Blue Shield of California will make Teladoc consultations a $5 copayment for members of their individual and family plans. The $5 Teladoc consultation will be available to both Blue Shield’s HMO and PPO non-grandfathered plans in 2017.
Health Net of California has announced that all of their 2016 individual and family health plans will roll into 2017. There will be no plan closures making it easier for current members to renew their health plan for the 2017 calendar year. In letters being sent out on September 30, Health Net will be offering a $50 gift card as a reward for certain healthy initiatives on the member’s part.