Member ID card update for 2015 ACAcompliant health plans Members purchasing or continuing an Affordable Care Act (ACA)-compliant individual or small group health plan for the 2015 plan year will receive new member ID cards issued by Anthem Blue Cross and Blue Shield s affiliate HealthKeepers, Inc. New ID cards have a similar format to other Anthem and HealthKeepers, Inc. member ID cards, but some information on the card may be new or look slightly different. This information is critical, as it provides details about the member s benefits and the provider network supporting the member s health plan. Some ACAcompliant health plans have limited or no out-of-area and/or out-of network benefits. Please read this information carefully and share with your office staff as appropriate. The following summary shares information about member ID cards for 2015 ACA-compliant Anthem and HealthKeepers, Inc. health plans (often referred to as plans purchased on or off the exchange). At the end of the summary, we ve included sample copies of these member ID cards offered through HealthKeepers, Inc. for your reference. Card Detail Description Important Information Benefit Information Claim and Contact Information Drug List Member ID cards continue to include benefit information such as the health plan deductible, coinsurance, or out of pocket details. The backs of ID cards include the claim submission address and important contact information, such as phone numbers for Provider Service and preauthorization requests. ID cards for ACA-compliant plans indicate the name of the drug list utilized by the health plan either the Select Drug List or the National Drug List. Providers may receive questions from members about their current prescriptions, as they make decisions about their health care coverage. Find more information about the Drug List at this link: NATIONAL (For Virginia s SELECT drug list, click on the Virginia link.) 1 Providers should continue to verify eligibility and benefit information for all members via Availity or by contacting Provider Service using the phone number indicated on the member ID card. It is important to note that effective December 12, 2014, functionality for eligibility and benefit inquiries transitions to Availity exclusively and will no longer be accessible on Point of Care. The claim submission address and contact information for pediatric dental benefits are indicated on the back of the member ID card. Many ACA-compliant health plans use the Select Drug List, which covers a select number of medications in all therapeutic categories and classes. Providers may receive questions from members about their current prescriptions as they make decisions about their health care coverage.
Group Number Limited Benefit Disclaimer The presence of a group number on an ACA-compliant member ID card indicates that the plan is a small group policy. PPO health plans with limited out-of-area benefits include a disclaimer on the back of the member ID card. If the member ID card does not have a group number, this indicates that the plan is an individual health plan. This disclaimer advises providers when PPO plan benefits may be limited to Urgent or Emergency care outside of the member s Home Plan service area. If the member s plan requires a specialty care review (referral) to a specialist, there will be a primary care physician (PCP) listed on the ID card. Therefore, the member is required to have referrals to see specialists. If there is no PCP listed on the card, then there is no PCP requirement. Some plans include little or no outof-network benefits. Services rendered by non-contracted providers will be processed as outof-network. Providers should always review the network name indicated on the member ID card and confirm that the provider participates in the network that supports the member s health plan. Network IMPORTANT - This field reflects the name of the provider network that supports the member s health plan. The Network field is located on the bottom front of the ID card. In Virginia, there are two networks Pathway X Tiered Hospital and Pathway Tiered Hospital. HealthKeepers, Inc. established a focused HealthKeepers, Inc. provider network in 2014 called the Pathway X Tiered Hospital Network that supports individual and small group health benefit plans purchased ON the exchange. Consumers may opt to buy plans OFF the exchange that also have a focused provider network called Pathway Tiered Hospital Network. Our traditional PPO and HMO plans continue to be offered OFF the exchange for our small group business. 2
Prefixes Product Member ID cards include prefixes as part of the member identification number. Prefixes are specific to medical ACAcompliant plans sold on and off the exchange. The following alpha prefixes will be used for members with ACAcompliant plans: YTY, YTO, XTO, YTR, YTZ, YTN, YTB and YTU The product name is indicated on the top right side of the member ID card. While many 2015 health plans will have a new product name, some plan names will remain the same. Prefixes can help providers identify members with medical ACAcompliant health plans. The 2015 product names for plans purchased on or off the exchange include the reference to a metal level (bronze, silver, gold, or platinum). Member ID card sample Please note that this is a sample copy of a member ID card. The policy and benefit information indicated on this sample does not necessarily represent actual information for any member health plan. Policy and benefit information on actual member ID cards will vary by plan and final copies of member ID cards may vary slightly from this sample. Front and Back Sample ID Card Product 3
BlueCard for exchanges and Multi-State Plan products (sold by other Blue Cross and Blue Shield entities) Under the Affordable Care Act, the Office of Personnel Management (OPM) is required to offer OPM-sponsored products on the exchange and implement a Multi-State Plan (MSP) product. For coverage beginning January 1, 2015, Blue Cross and Blue Shield health plans will participate in this program by offering Multi-State Plans on exchanges in 33 states and in the District of Columbia. BlueCard is an existing national program that enables members of one Blue Plan to obtain health care service benefits while traveling or living in another Blue Plan s service area. Because of the possibility that variations may exist on how exchange plans operate from state to state, the Blue Cross and Blue Shield Association, along with Blue Plans, has developed a Blue System Multi- State Plan Program that operates within the BlueCard program. This enhanced BlueCard program is supported by the national exchange network called the National BlueCard PPO Basic Network. Anthem s PPO health plans utilizing this national exchange network for out-of-area covered services will carry the new suitcase logo PPOB on the member ID card. Please note, other Blue Plans acting as the Home Plan make their own decisions regarding which networks their PPO exchange members will have access to when traveling out-of-area. Providers should continue to verify eligibility and benefits for all out-of-state members. Logos on ID Cards with the Exchange Card Detail Description Important Information The presence of the PPO B suitcase logo on a Blue Plan member ID card indicates the member has access to the National BlueCard PPO Basic Network (the national exchange network) for covered services received out-of-area. Suitcase Logo Member ID cards for PPO health plans purchased ON the exchange may include a PPO suitcase logo followed by the letter B. Member ID cards for PPO health plans purchased OFF the 4 If you are participating in Anthem s PPO network in Virginia, and an exchange member from another state is seeking care, then you are participating in the National BlueCard PPO Basic Network (PPOB). More information about BlueCard for Exchanges is provided on the preceding page. PPO health plans with limited outof-area benefits include a disclaimer on the back of the member ID card. Providers should continue to verify eligibility and benefits for all members. The presence of the PPO suitcase logo (without the letter B) indicates a member has access to the BlueCard PPO Network for covered services received
exchange include the PPO suitcase logo. Some ON exchange health plans may also include the PPO suitcase logo. ID cards for members with HMO health plans include the blank suitcase logo. out-of-area. If you are participating in Anthem s PPO network in Virginia, and a member from another state is seeking care, then you are participating in the BlueCard PPO Network (PPO). PPO health plans with limited out-of-area benefits include a disclaimer on the back of the member ID card. Providers should continue to verify eligibility and benefits for all members. The presence of the blank suitcase logo indicates a member has access to the BlueCard Traditional Network for services received out-of-area that are urgent or emergent care only. Providers should continue to verify eligibility and benefits for all members. Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield n Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. are independent licensees of the Blue Cross Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 5