2016 COVERED CALIFORNIA FAQ S University Healthcare Alliance Effective 1/1/2016

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1 COVERED CALIFORNIA FAQ S University Healthcare Alliance Effective 1/1/ When addressing patient questions, it is helpful to identify the following qualifiers before proceeding to the FAQ s: Which health plan has the patient/caller selected or is considering for their benefits? What type of product has been purchased: Individual and Family Plan (IFP) or Covered California- Small Business If an Individual and Family Plan, was it purchased through Covered California or directly from the health plan? Is UHA contracted with any of the Individual and Family Plans (IFP) through Covered California? UHA providers are contracted with the following Individual and Family Plans available for purchase through Covered California or directly through the health plan (aka mirrored plans): Health Net EPO (available in Contra Costa/San Mateo Counties) Health Net (available in Santa Clara County) Health Net PPO- only available through HealthNet directly Cigna PPO- only available through Cigna directly UHA providers participation may vary based on IPA affiliation. Please reference the Active Contract List for additional exceptions. Affinity Medical Group IPA is not a contracted provider group with the Individual and Family Plans participating in Covered California. Is UHA contracted with any of the Covered California Small Business Plans (formerly known as SHOP) offered through employers and Covered California? UHA providers are contracted with the following SHOP plans Blue Shield of California PPO Blue Shield of California Health Net PPO Which Individual and Family Plans are offered in Alameda County through Covered California? There are three plans offered in Alameda County (Region 6): a. UHA providers are not considered in-network with any Covered California products in Alameda County UHA does not participate in the following products: Blue Shield PPO, Anthem PPO, and Kaiser Which Individual and Family Plans are offered in Contra Costa County through Covered California? There are four plans offered in Contra Costa County (Region 5): a. UHA participates in the following products: Health Net EPO b. UHA does not participate in the following products: Anthem PPO, Blue Shield PPO, and Kaiser

2 Which Individual and Family Plans are offered in San Mateo County through Covered California? There are five plans offered in San Mateo County (Region 5): a. UHA participates in the following products: Health Net EPO b. UHA does not participate in the following products: Anthem PPO, Blue Shield PPO, Chinese Community Health Plan, and Kaiser Which Individual and Family Plans are offered in Santa Clara County through Covered California? There are six plans offered in Santa Clara County (Region 7): a. UHA participates in the following products: Health Net b. UHA does not participate in the following products: Anthem PPO, Anthem, Blue Shield PPO, Kaiser, and Valley Health Plan I purchased an Anthem Blue Cross plan (Pathway or Pathway X) through Covered California. Is my plan accepted at UHA locations? For Anthem Blue Cross Pathway or Pathway X products, all UHA provider services will be considered out-ofnetwork. Not all Covered California products have out-of-network benefits and you would need to verify your benefits and additional financial responsibilities (deductible, co-insurance, etc ) before deciding to see a UHA provider. I purchased a Blue Shield of California PPO or EPO plan through Covered California. Is my plan accepted at UHA locations? For Blue Shield individual and family plans, all UHA provider services will be considered out-of-network. Not all Covered California products have out-of-network benefits and you would need to verify your benefits and additional financial responsibilities (deductible, co-insurance, etc ) before deciding to see a UHA provider. I purchased a Health Net EPO/ plan through Covered California. Is my plan accepted at UHA locations? UHA providers are in-network with their EPO and plans. There may be some restrictions on PCP selection based on where the physician is located for members. We are also in their Small Business/SHOP plans. I purchased XYZ health plan through Covered California. Is my plan accepted at UHA locations? It is most likely out-of-network but you should to call the health plan phone number on your insurance card to confirm. I have a Covered California-Small Business Plan (formerly known as SHOP.) Is my plan accepted at UHA locations? UHA physicians are in-network with the Blue Shield PPO, Blue Shield and Health Net PPO SHOP plans. Participation in the Blue Shield may differ by IPA affiliation and the patient should check with their health plan, all UHA providers are affiliated with Affinity Medical Group IPA. UHA providers are not participating in the Kaiser SHOP product offering. I have a Blue Shield of California group plan offered through my employer. Is this plan accepted at UHA locations? It s likely that it is accepted but you should call the telephone number on your insurance card to confirm. I have a Health Net group plan offered through my employer. Is this plan accepted at UHA locations? It s likely that it is accepted but you should call the telephone number on your insurance card to confirm.

3 I have an Anthem Blue Cross of California group plan offered through my employer. Is this plan accepted at UHA locations? It s likely that it is accepted but you should call the telephone number on your insurance card to confirm. Look for the Prudent Buyer or Select name on the bottom right corner of your ID card. I bought an individual/family plan directly from Anthem Blue Cross instead of the Covered California exchange. Is this plan accepted at UHA locations? Individual and Family Plans bought directly from Anthem are designed the same as the plans offered on the Covered California exchange. These are called mirrored plans. They have the same deductibles, out of pocket maximums, provider networks, etc. UHA physicians are not in-network with any Anthem Blue Cross Individual and Family Plans. I bought an individual/family plan directly from Blue Shield instead of the Covered California exchange. Is this plan accepted at UHA locations? Individual and Family Plans bought directly from Blue Shield are designed the same as the plans offered on the Covered California exchange. These are called mirrored plans. They have the same deductibles, out of pocket maximums, provider networks, etc. UHA physicians are not in-network with any Blue Shield Individual and Family Plans. In, Covered California plans are offering HSA products, what are these? HSA accounts are high deductible plans which allow for a Health Savings Account to be created. The HSA products are only offered at the Bronze benefit level. In addition to the high deductible requirement, the member normally has a higher co-insurance requirement than other products offered through Covered California. I signed up for a Covered California plan that does not include my doctor as in-network, can I switch my plan? In previous years, Covered California has allowed people to switch their plan before the end of enrollment deadline. The deadline this year is 1/31/. Please contact Covered California or a broker to inquire about switching health plans. Is my primary care physician in any Individual and Family Plan s provider network available on the Covered California exchange? If your PCP is a UHA provider they are participating in the Health Net EPO and products, depending on where the PCP is located. Is Covered California the same as MediCal? No. Is Covered California the same as Obamacare? The Patient Protection and Affordable Care Act (PPACA), passed by the U.S. Congress in 2010, often times is called Obamacare. PPACA details all the requirements for implementation of the law. One element of implementation calls for the establishment of insurance exchanges which are technically online marketplaces for people to buy health insurance. The name of the exchange in the State of California is Covered California

4 Is Covered California a health plan? No. Covered California is a purchaser and works with existing health plans operating in the state of California to offer coverage for individuals and small businesses. Is MediCal part of/offered through Covered California? No. I have been coming to UHA for treatment prior to 1/1/ and now the plan I selected for is not contracted with UHA, what should I do? You should check your health care insurance policy on provisions for Continuity of Care. To see if you might qualify for continuing services for a limited period of time. Following a review, your health plan should advise you of your options. Is there a health plan that is offered through Covered California that you would recommend I choose? The needs of each individual seeking health care benefits are unique. We encourage you to call a Covered California representative at or go to their website for more information specific to you or your family s needs. (FOR ALL OTHER QUESTIONS) Where can I go to get more information on Covered California? For more information on Covered California, you can visit the Covered California FAQ page at or call a representative at o

5 Covered California Individual and Family Plan product offering by Region for Region 5 Contra Costa County Covered California Individual and Family Plan product Anthem PPO 5.60% Blue Shield PPO 35.70% Health Net EPO 0.70% Kaiser Permanente 58.00%

6 Region 6 Alameda County Covered California Individual and Family Plan product Anthem PPO 21.90% Blue Shield PPO 25.40% Kaiser Permanente 52.70% Region 7 Santa Clara County Covered California Individual and Family Plan product Anthem PPO 49.20% Anthem 3.00% Blue Shield PPO 12.60% Health Net 1.50% Kaiser Permanente 30.40% Valley Health 3.30% Region 8 San Mateo County Covered California Individual and Family Plan product Anthem PPO 15.80% Blue Shield PPO 20.90% CCHP 8.70% Health Net EPO 1.60% Kaiser Permanente 53.00%