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.
Cigna has released their 2017 health plans available in select counties of Northern and Southern California. Cigna has decided not to pay agents commissions for 2017. (Cigna Cuts All Agent’s Commissions to 0% for 2017) Consumers will have limited options for assistance with enrollment and the explanation of the health plans from Cigna in 2017. Most all Cigna plans have been converted to EPO plans. The exception is one Bronze plan that still remains a PPO product.
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.
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.
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.
Health Net has announced that they must discontinue their 2016 PPO plans at the request of the California Department of Insurance. Health Net had originally filed for a 23% rate increase for their 2017 PPO plans. Through negotiations with the Department of Insurance, Health Net lowered the rate increase to an average 12.1%. Because of the changes to the PPO plans, Health Net will need to cancel their 2016 PPO Plans on December 31, 2016 and offer a new PPO plan design to new and existing members. On October 4, 2016, the Department of Insurance concluded that the lower rate increase was not unreasonable.
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.