Download New member ID cards for plans purchased on

New member ID cards for plans purchased
on and off the Exchange
Health benefits for Anthem Blue Cross and Blue Shield (Anthem) plans purchased on and off the
Exchange are effective beginning January 1, 2014. Members purchasing these plans will receive
new Anthem member ID cards. The new ID cards will have a similar format to current Anthem
member ID cards, but some information on the card will be new or may look slightly different. This
information is critical, as it provides details about member benefits and the provider network
supporting the member’s health plan. Some new plans have limited or no out-of-area benefits.
Please read this information carefully and share with your office staff as appropriate.
The following summary shares new or updated information on member ID cards for Anthem plans
purchased on and off the Exchange. At the end of the summary, we’ve included a sample copy of
a new member ID card for your reference.
Card Detail
Description
Important Information
Benefit
Information
Member ID cards continue to include
benefit information such as the health
plan deductible, coinsurance, or out of
pocket details.
Claim and
Contact
Information
The back of ID cards includes the claim
submission address and important
contact information, such as phone
numbers for Provider Service and
preauthorization requests.
Drug List
Name
Group
Number
Ohio 2-14
New on and off Exchange member ID
cards indicate the name of the drug list
utilized by the health plan – either the
Select Drug List or the National Drug
List.
The presence of a group number on a
new on or off exchange member ID
cards indicates that the plan is a small
group policy.
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Providers should continue to verify
eligibility and benefit information for
all members via the Availity® Web
Portal or by contacting Provider
Service using the phone number
indicated on the member ID card.
The claim submission address and
contact information for pediatric
dental benefits is also indicated on
the back of the member ID card.
Many health plans sold on and off
the Exchange use the new 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.
Find more information about the
Select Drug List by going to
www.anthem.com>Providers (enter
Ohio >Health Insurance Exchange>
Important drug list information
for plans purchased on and off the
Exchange.
If the new on or off exchange
member ID card does not have a
group number, this indicates that the
plan is an individual health plan.
Limited
Benefit
Disclaimer
PPO health plans with limited out-ofarea benefits include a disclaimer on
the back of the member ID card.
Network
Name
IMPORTANT - This field reflects the
name of the provider network that
supports the member’s health plan. The
Network Name field is located in the
lower right portion of the ID card.
Prefixes
Member ID cards include new prefixes
as part of the member identification
number for plans sold on and off the
Exchange: JWR, JWT, JWS, JWQ.
Product
Name
New health plans have new product
names, which are indicated on the top
right side of the member ID cards.
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
Exchange will include
the PPO suitcase logo.
Some on exchange
health plans may also
include the PPO
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This disclaimer advises providers when
PPO plan benefits may be limited to
Urgent or Emergent care outside of the
member’s home state.
Some new plans include little or no outof-network benefits. Services rendered
by non-contracted providers will be
processed as out-of-network.
Providers should always review the
network name indicated on new
member ID cards and confirm that
the provider participates in the
network that supports the member’s
health plan.
The new prefixes can help providers
identify on and off exchange members.
** See page 5 for additional detail on
new prefixes, networks, and product
names.
The product name is not the same as
the network name. Product names
with references to a metal level (bronze,
silver, gold, or platinum) indicate the
plan was purchased on the Exchange.
The presence of the PPO B suitcase
logo on an Anthem member ID card
indicates the member has access to the
National BlueCard PPO Basic Network
(a new national exchange network) for
covered services received out-of-area.
If you are participating in Anthem’s
Pathway X Tiered Network in Ohio, and
an Exchange member from another
state is seeking care, then you are
participating in the National BlueCard
PPO Basic Network (PPOB). If you are
not participating in the Pathway X
Tiered Network in Ohio, then you are
not participating in the National
BlueCard PPO Basic Network (PPOB).
More information about BlueCard for
exchanges is provided below. 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 PPO suitcase logo
(without the letter B) indicates a
member has access to the BlueCard
PPO Network for covered services
received out-of-area. If you are
participating in Anthem’s Blue Access
PPO network and a member from
another state is seeking care, then you
suitcase logo.
ID cards for members
with HMO health plans
will include the blank
suitcase logo.
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.
Member ID card sample
Please note the following are sample member ID cards. The policy and benefit information
indicated on these samples do not necessarily represent accurate 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.
Individual Off Exchange front of member ID card (sample)
Individual Off Exchange back of member ID card (sample)
Ohio 2-14
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Individual On Exchange front of member ID card (sample)
Individual On Exchange back of member ID card (sample)
BlueCard for exchanges and Multi-State Plan products
Under the Affordable Care Act (ACA), 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, 2014, Blue Cross and Blue Shield health plans will
participate in this program by offering Multi-State Plans on exchanges in 30 states and in the
District of Columbia.
BlueCard is an existing national program that enables members of one Blue Plan to obtain
healthcare 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 a new national exchange network called the National BlueCard PPO
Basic Network. Anthem’s PPO health plans utilizing this national exchange network for out-ofarea 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.
Ohio 2-14
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** Prefix, Network, Plan Name
Prefix
Network
Plan Name
Product Plan Type
JWR
Pathway X Tiered Hospital
Bronze DirectAccess w/HSA
Individual On Exchange
JWR
Pathway X Tiered Hospital
Gold DirectAccess
Individual On Exchange
JWR
Pathway X Tiered Hospital
Bronze DirectAccess
Individual On Exchange
JWR
Pathway X Tiered Hospital
Bronze DirectAccess w/Child Dental
Individual On Exchange
JWR
Pathway X Tiered Hospital
Gold DirectAccess w/Child Dental
Individual On Exchange
JWR
Pathway X Tiered Hospital
Silver DirectAccess
Individual On Exchange
JWR
Pathway X Tiered Hospital
Silver DirectAccess w/HSA
Individual On Exchange
JWR
Pathway X Tiered Hospital
Catastrophic DirectAccess
Individual On Exchange
JWS
Pathway X Tiered Hospital
Bronze DirectAccess Plus w/HSA
Small Group On Exchange
JWS
Pathway X Tiered Hospital
Silver DirectAccess Plus w/HSA
Small Group On Exchange
JWS
Pathway X Tiered Hospital
Gold DirectAccess Plus
Small Group On Exchange
JWS
Pathway X Tiered Hospital
Silver DirectAccess Plus
Small Group On Exchange
JWT
Pathway Tiered Hospital
Preferred DirectAccess
Individual Off Exchange
JWT
Pathway Tiered Hospital
Core DirectAccess
Individual Off Exchange
JWT
Pathway Tiered Hospital
Core DirectAccess w/Child Dental
Individual Off Exchange
JWT
Pathway Tiered Hospital
Core DirectAccess w/HSA
Individual Off Exchange
JWT
Pathway Tiered Hospital
Essential DirectAccess
Individual Off Exchange
JWT
Pathway Tiered Hospital
Essential DirectAccess w/HSA
Individual Off Exchange
JWT
Pathway Tiered Hospital
Catastrophic DirectAccess
Individual Off Exchange
JWT
Pathway Tiered Hospital
Preferred DirectAccess w/Child Dental
Individual Off Exchange
JWQ
BLUE ACCESS
Essential DirectAccess w/HSA
Small Group Off Exchange
JWQ
BLUE ACCESS
Essential DirectAccess Plus w/HSA
Small Group Off Exchange
JWQ
BLUE ACCESS
Preferred DirectAccess w/HSA
Small Group Off Exchange
JWQ
BLUE ACCESS
Preferred DirectAccess w/HRA
Small Group Off Exchange
JWQ
BLUE ACCESS
Core DirectAccess w/HSA
Small Group Off Exchange
JWQ
BLUE ACCESS
Preferred DirectAccess Plus
Small Group Off Exchange
JWQ
BLUE ACCESS
Preferred DirectAccess Plus w/Dental
Small Group Off Exchange
JWQ
BLUE ACCESS
Preferred DirectAccess Plus w/HSA
Small Group Off Exchange
JWQ
BLUE ACCESS
Core DirectAccess Plus
Small Group Off Exchange
JWQ
BLUE ACCESS
Core DirectAccess Plus w/Dental
Small Group Off Exchange
JWQ
BLUE ACCESS
Core DirectAccess Plus w/HSA
Small Group Off Exchange
JWQ
BLUE ACCESS
Essential DirectAccess
Small Group Off Exchange
JWQ
BLUE ACCESS
Essential DirectAccess Plus
Small Group Off Exchange
JWQ
BLUE ACCESS
Essential DirectAccess Plus w/Dental
Small Group Off Exchange
JWQ
BLUE ACCESS
Preferred DirectAccess
Small Group Off Exchange
JWQ
BLUE ACCESS
Core DirectAccess
Small Group Off Exchange
Ohio 2-14
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Availity, an independent company, providers claims management services for Anthem Blue Cross and Blue Shield.
Anthem Blue Cross and Blue Shield is the trade name of: In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In
Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and
HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and
certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Ohio: Community Insurance Company. In Wisconsin:
Blue Cross Blue Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance
Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS
policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The
Blue Cross and Blue Shield names and symbols are the registered marks of the Blue Cross and Blue Shield Association.
Ohio 2-14
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