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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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.

Are PPO members affected by UCSF’s new relationship with Hill Physicians Medical Group?

No, PPO members are not affected by UCSF’s new relationship with Hill Physicians Medical Group.

What products are potentially affected by UCSF’s new relationship with Hill Physicians Medical Group?

Members enrolled in CaliforniaCare HMO, Blue Cross Plus, Power Advantage HMO, and BlueCard POS can potentially be affected by UCSF’s new relationship with Hill Physicians Medical Group.

Is the quality of Hill Physicians Medical Group comparable to Brown & Toland Medical
Group?

Yes, both Hill Physicians Medical Group and Brown & Toland Medical Group provide high-quality healthcare to their patients. The PCPs and specialists from these medical groups maintain admitting privileges to top-ranked in-network facilities.  July 2009, Hill Physicians Medical Group received the designation of “Elite” on the California Association of Physician Groups annual survey for quality and affordability. This is the highest level possible on the survey.

In addition, UCSF was ranked one of the nation’s top ten hospitals by U.S. News & World Report.

What about members assigned to Brown & Toland Medical Group who were in a course of treatment prior to January 1, 2010 with a UCSF Medical Group provider or at a UCSF facility?

Brown & Toland members who are in a current course of treatment with a UCSF Medical Group specialist or at a UCSF facility will still be able to receive treatment after January 1, 2010.  HMO members should always remember to make sure that their referrals and authorizations are in place prior to receiving any specialty or facility care, and to coordinate their care through their assigned Brown & Toland primary care physician.  Brown & Toland Medical Group will perform the necessary clinical review to determine eligibility for continuation of covered services in 2010.

What if the member has a UCSF Medical Group primary care physician (and wants to keep that physician), but sees specialty care physicians that are members of Brown & Toland Medical Group?

If a member wants to remain with their UCSF Medical Group primary care physician beyond December 31, 2009, they will need to change medical groups to Hill Physicians Medical Group.  For any specialty care needs after January 1, 2010, the member will need to be referred to a participating specialist in Hill Physicians Medical Group.  Note: Many specialists in San Francisco do participate with both Brown & Toland Medical Group and Hill Physicians Medical Group, so it is important for the member to confirm that any specialists that they use will remain available to them after 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.

What changes will occur for the physicians of UCSF Medical Group?

The doctors who are affiliated with UCSF Medical Group include the faculty of the clinical departments of the UCSF School of Medicine. These physicians also practice at UCSF Medical Center and/or UCSF Children’s Hospital. As of January 1, 2010, the doctors from UCSF Medical Group will become participating physicians of Hill Physicians Medical Group and ‘referral only’ physicians of Brown & Toland Medical Group.

How will HMO members be affected by UCSF’s decision to enter into an arrangement with Hill Physicians Medical Group?

HMO members assigned to a UCSF Medical Group primary care physician through Brown & Toland Medical Group (approximately 2,400 members) will be affected by this new arrangement. Members will be given an option to either remain with their current UCSF Primary Care Physician by selecting Hill Physicians Medical Group as their new IPA, or selecting a new Primary Care Physician through Brown & Toland Medical Group.

Note:  Members with Anthem Blue Cross are not the only ones affected by this new arrangement. HMO members with other health plans are also affected by UCSF’s new arrangement with Hill Physicians Medical Group.

Will Anthem Blue Cross notify members about these changes?

Yes.  Anthem Blue Cross will send a letter (on or before October 1, 2009) to all members who are currently assigned to one of UCSFs primary care physicians through Brown & Toland Medical Group (approximately 2,400 members) and advise them to contact Customer Service prior to January 1, 2010, to inform us their Primary Care Selection (details explained in questions 7 & 8 below).  Members, who do not respond to the letter by contacting Customer Service, will be reassigned to a Brown & Toland primary care physician effective January 1, 2010.

When can the affected members call Customer Service to make their primary care physician change?

We are targeting October 1, 2009 to have all of the UCSF primary care physicians loaded to Anthem’s system as Hill Physicians Medical Group providers (for the effective date of January 1, 2010).  Affected members will receive a letter from Anthem Blue Cross when our system has been updated and is ready to make the appropriate enrollment changes.

What about HMO members assigned to Brown & Toland who receive emergency medical care from a UCSF facility after December 31, 2009?

Emergency medical services do not require pre-authorization, regardless of where they are delivered. Hospitals must still provide services for members requiring emergency care. Coverage will be provided according to the member’s policy benefits.

What should an HMO member do if they wish to remain assigned to their UCSF primary care physician?

HMO members who wish to remain assigned to a UCSF Medical Group primary care physician after December 31, 2009 should call Customer Service at the toll-free number on their Anthem Blue Cross membership card prior to December 31, 2009 and request to remain a patient of their current assigned primary care physician by changing groups to Hill Physicians Medical Group, in San Francisco (site code 0UC).

For more information, and updates we will be posting a part 2 of this article.

Learn more about CPA ProtectPlus healthcare plans