CalCPA ProtectPlus

Health Maintenance Organizations (HMOs) represent “pre-paid” or “capitated” insurance plans in which individuals or their employers pay a fixed monthly fee for services, instead of a separate charge for each visit or service. The monthly fees remain the same regardless of types or levels of services provided by physicians who are employed by, or under contract with the HMO.

The end of the calendar year marks the ProtectPlus annual open enrollment period. It’s also the time to make plan changes. For employees who opted not to enroll in ProtectPlus for whatever reason, this is another chance to join. For current subscribers it’s an opportunity to make changes in their coverage.

Maintaining the longer open enrollment period adopted in 2007, the Group Insurance Trust has announced that open enrollment begins on November 2 and ends December 31.

CalCPA member firms that haven’t offered ProtectPlus plans to their employees can, of course, enroll in Group Insurance Trust plans at any time.

Firms can consider the full range of offerings for 2010 that include;

• 5 copay plans
• 3 HSA-eligible plans
• 2 Anthem Blue Cross HMO plans

This is also the time of year that the Trust announces plan changes and premium adjustments. As always, premium  increases are anticipated with concern, but the good news is:

The Trust has been able to maintain its single digit  premium increases for the seventh consecutive year.

This is a remarkable achievement when you consider that ProtectPlus also beat industry averages in each of these years.

Several benefit improvements will be implemented in 2010.

• All ProtectPlus copay plans will see a reduction in the copay amount for generic prescription drugs from $15 to $10.
• Improved coverage for mental health and substance abuse services on all copay, HSA-eligible, and Anthem Blue Cross HMO plans.
• Medical plans will now align all mental health and substance abuse member cost-sharing provisions with those offered for in-network and out-of-network medical services and remove any visit limitations (in accordance with the Mental Health Parity and Addiction Equity Act of 2008).

The Trust will also combine several copay plans for 2010.
Last year the Trust offered eight copay plans, including both regular and enhanced versions of:

• Protect 15
• Protect 25
• Protect 35

The enhanced versions of these plans—which waive the deductible for the first six in-network office visits—proved so popular that trustees were persuaded to include the enhanced benefits as standard features in the copay plans at these levels.

For 2010 the Protect 15, Protect 25 and Protect 35 plans will all feature the enhanced benefit of six office visits that are not subject to the plan’s deductible, while the Protect 10 and Protect 45 plans will retain their original structure.

Vision Service Plan and Delta Dental rates will be restructured for 2010.
Going forward, rates for both plans will be based on firm size in much the same way the medical plan rates are structured.

• Effective January 1, 2010, firms with two or more participants will see a reduction in VSP and Delta Dental rates while others will note a small increase.

Changes in Premiums
Some ProtectPlus members will see changes in their premiums next year that reflect altered geographical rate bands. Anthem Blue Cross has re-aligned several zip codes in rate areas one, two, and three, and the Trust has followed its lead in order stay consistent. For some, these changes will mean lower than average premium increases, while for others, unfortunately, it may mean an increase in excess of the average overall premium increase.

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This article is a continuation of The Brown & Toland Medical Group in San Francisco will no longer be a part of UCSF’s Provider Network, Part 1 Published October 1st, 2009.

What if a member doesn’t want to change medical groups and prefers to select a new PCP within Brown & Toland Medical Group?

Members who choose to select another primary care physician within Brown & Toland Medical Group, or any other medical group within their service area, can use Provider Finder on anthem.com/ca to locate a new physician.  Members who need assistance in selecting a different PCP and/or medical group are encouraged to call Anthem Blue Cross’ Customer Service department at the toll-free number listed on their ID card.  Once the member knows  the PCP they would like to be reassigned to, they need to contact Customer Service at the toll-free number on their Anthem Blue Cross membership card prior to December 31, 2009 and provide information regarding their new selection in order to be reassigned.

Will HMO members who remain with their UCSF Medical Group primary care physicians (by switching to Hill Physicians Medical Group on January 1, 2010) still have access to the same specialty care physicians (orthopedics, cardiologists, surgeons, oncologists, etc.) who were available through Brown & Toland Medical Group?

Possibly.  Many specialty care physicians are members of both Brown & Toland Medical Group and Hill Physicians Medical Group, but it is important for each individual member to confirm that the specialty care physician(s) they see regularly are also part of Hill Physicians Medical Group network. (continue reading…)

UCSF Medical Group and Hill Physicians Medical Group formed a new contractual affiliation to serve the healthcare needs of HMO members whose primary care physician (PCP) is based in the San Francisco area. This new healthcare option becomes effective January 1, 2010.

UCSF Medical Center and UCSF Children’s Hospital will be in both Hill Physicians Medical Group and Brown & Toland Medical Group’s networks after January 1, 2010.

After January 1, 2010, only Hill Physicians Medical Group will market and have UCSF primary care physicians in their network. On that date, Brown & Toland Medical Group will no longer offer UCSF primary care physicians in their network and will begin a ‘referral-only’ type relationship with the specialists at UCSF Medical Group and UCSF Medical Center. All access to UCSF services for Brown & Toland members, will require prior authorization and administrative review. (continue reading…)

Did you know that although most employers will elect to have partners and employees covered under a single plan, firms may chose to offer one or more, or all of CalCPA ProtectPlus plans to their owners and employees. However, if the firm wishes to include an HMO plan, only one the the Anthem Blue Cross plans may be offered.

Learn more about CPA ProtectPlus healthcare plans

Hospital Facilities:

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