2017 IFP Open Enrollment- FAQ

                   General Questions

Will the HDHP (formerly known as HSA) be HAS qualified?

·         Yes, we’re now required to call them a high deductible health plan (HDHP), but they’re still HAS qualified.

Are paper applications changing for 2017?

·         Yes, this is due to the different contract codes that will be changing in some areas as well as other small updates.

When will the 2017 Rates be available?

·         The rates have been available since 10/01 via window shopping in Producer Toolbox. There was also a rate sheet that was sent via Producer Newsletter. You can find this in the Producer Toolbox under “Sales and Training” or reach out to your ISE.

Will the existing clients be automatically mapped over to the new plans without having to complete the change form?

·         Existing clients will be automatically rolled over into a 2017 plan, as long as the premiums are paid. This also includes members going from a PPO to EPO plan. These notices have already been mailed and can also be viewed in the Producer Toolbox

Is there a 2016-2017 product mapping guide availed yet? If so, where can I find it?

·         Both the Crosswalk Guide and Tool can be found in Producer Toolbox under “Sales and Training” or you can also reach out to your ISE who can email these.

Will I be able to enroll “off- exchange” plans online, or will I need to continue using a paper application?

·         During Open Enrollment, you’re able to enroll all Anthem Off-Exchange plans either online or via paper applications.  Note: online applications will go live on 11/01/2016.

When and where can members go to change their coverage for 2017?

·         Members may utilize myanthemchoices.com to make online plan changes starting 11/01/2016. We also have short plan change forms that will be available 11/01/2016 for current members to make plan changes.

Can a doctor reject an “on-exchange” plan, but still accept an “off-exchange” plan?

·         No, if a provider is participating within the Pathway network, they must take both On and Off Exchange plans as it is all one network.

Will there be any changes regarding Pathway In-Network Physicians?

·         No major changes are expected; however, our Pathway hospital list is changing for 2017.

                                   PCP Related

PCP assignment – will this be a required element for an online application?

·         We are still working out some system improvements and we will let you know once this is determined.

Are EPO/PPO members going to be required to designate PCP OFF-EXCHANGE as well as ON-EXCHANGE?

·         Yes, designation of PCP assignment will be for both ON and OFF exchange products.  We will auto assign a PCP to our new and existing members. This PCP information will be communicated to our members early in Q1 of 2017.

Does the PCP assignment to members only apply in the INDIVIDUAL market or does it apply for members who are on a group plan?

·         The PCP requirement only applies to Individual Business; it’s not applicable to Small Group at this time.

Will grandfathered PPO plans also have a PCP requirement?

·         No, this will not impact the members that are grandfathered.

How can a member change their PCP assignment?

·         Once the member receives the notice in the mail of their assigned PCP early in Q1 2017 and their premium is paid current, they may call member services or change it through the member portal (highly recommended).

Do you have to change your auto-assigned PCP, or can you leave it as is while continuing to see another In-Network PCP?

·         In regards to EPO and PPO members, the assigned PCP is only a suggestion and not a gatekeeper. They may see any physician in the network without changing the assigned PCP.

How is Anthem determining the PCP assignment?

·         We are using both geographic and demographic data to assign PCP.  For instance, if we have a member who has requested Spanish material, we will assign a Spanish speaking physician if possible

                                      RX Choice

How can we find a list of level 1 and Level 2 pharmacies for the RX Choice network?

·         It’s in the works, but we don’t have an exact ETA yet. We should have a formal listing by late-October. The RxChoice network is found only on our non-mirrored Off/Off Exchange plans.

Is RxChoice generally bigger or smaller than the other drug network?

·         The RxChoice pharmacy network is the same list of pharmacies, but we have delineated them into Level 1 and Level 2… with the member having a lower cost share for Level 1.
The RxChoice network is found only on our non-mirrored Off/Off Exchange plans.


If someone is currently using an out of state facility due to a special illness, will they be able to continue using this facility on both EPO and PPO plans?

·         Yes, both plans will continue to have BlueCard benefits which will allow a client to visit a participating provider/hospital within the BlueCard network for both emergency and non-emergency.

Does the BlueCard benefit only apply in the US or does it also work out of the country?

·         BlueCard is intended for use in the US but plans also include BlueCard Worldwide for emergency care ONLY outside of the US.

How do you activate the “BlueCard” for an EPO? Is it automatic, or does a member have to call customer Service?

·         BlueCard is automatically embedded on both our PPO and EPO products.

                                  EPO Related

Are all areas moving to an EPO in 2017?

·         Most areas will be moving to an EPO product, but some will be staying PPO. For a quick reference, rating regions 1-9 and 15-19 will offer EPO plans while rating regions 10-14 will still offer PPO plans. Please contact your Anthem ISE if you would like to discuss, they’ll be happy to help.

Are we going to have to rewrite our PPO plans to the new EPO plans?

·         No, we will automatically transition them over. There is both a Crosswalk Guide and a Crosswalk Tool that was sent out via email and is also available in Producer Toolbox under “sales and Training.”

If a member is in a PPO territory, but they have an EPO plan… can they see a provider within that PPO plan?

·         Yes, they would only need to verify that the provider is participating in the Pathway network.

Will there be a correction letter sent to members who received the incorrect information about their territory being changes from a PPO to an EPO? If so, when?

·         Anthem will be sending out a follow up notice to renewing members in rating regions 10-14 that will be staying on a PPO plan in 2017.
The notice, which will be sent by mail, will go out to members by October 15th. Anthem did advise the members accurately in the notice that they would be on a PPO plan in 2017 and the benefit grids provided were accurate.
The follow-up being sent will address the Notice of Change as well as one of the questions in the Q&A where we had not removed some PPO to EPO references that do not pertain to members in region 10-14.

When will brokers have access to the in network hospital for EPO members in 2017?

·         The list of hospitals that are not participating in already present in a disclaimer on Provider Finder. We will have additional materials available to you in the near future.
The Pathway hospital list will also be a dynamic document in that there may consistently be facilities added and removed based on interaction with our provider relations team.

Payment Related

Can online payments be made through the Agent Portal?

·         Agents are now able to make the INITIAL payment online on the member’s behalf ONLY when the payment is submitted with the application fails.

Will brokers be able to make future payments via Producer Toolbox?

·         The new enhancement on the broker portal will only be for initial payments for Off Exchange applications in the case that the original payment fails.
Agents will have 15 days to resubmit the payment but it is encouraged that this is completed in the first 24 hours. 

Share |

No Comments

Post a Comment
Required (Not Displayed)

All comments are moderated and stripped of HTML.
Submission Validation
Change the CAPTCHA codeSpeak the CAPTCHA code
Enter the Validation Code from above.
NOTICE: This blog and website are made available by the publisher for educational and informational purposes only. It is not be used as a substitute for competent insurance, legal, or tax advice from a licensed professional in your state. By using this blog site you understand that there is no broker client relationship between you and the blog and website publisher.
Blog Archive
  • 2019
  • 2018
  • 2017
  • 2016
  • 2015
  • 2014
  • 2013
  • 2012

View Mobile Version