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

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.

Group Number

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 Wisconsin)>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

Health plans with limited out-of-area 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: VZE, VZS, VZH, VZU, VZC, VZX, and VZB.

Product Name

Suitcase Logo

New health plans have new product names, which are indicated on the top right side of the member ID cards.

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 Wisconsin

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This disclaimer advises providers when plan benefits may be limited to Urgent or Emergent care outside of the member’s home state. Some new plans include little or no out-of-network benefits. Services rendered by non-contracted providers will be processed as outof-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. The product name is not the same as the network name. Product names with references to a metal level (bronze, silver or gold 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 Blue Access PPO network in Wisconsin 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 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

exchange health plans may also include the PPO suitcase logo.

ID cards for members with HMO health plans will include the blank suitcase logo.

Access PPO network in Wisconsin 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.

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 member ID card (sample)

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Individual On Exchange 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. Your Anthem Provider Agreements include provisions for Out of Network (OON) compensation. With regard to our products supported by the Blue Priority X-WI and Blue Priority WI Networks, the following reimbursement guidelines will apply if you are an Anthem contracted provider but NOT an in-network provider for the Blue Priority X-WI or Blue Priority WI networks, and you render Covered Services to a member who is covered by a product/program supported by this network: In most cases, Wisconsin providers participating in Anthem’s networks are reimbursed according to the network rates attached to the member’s benefit type (e.g. Blue Preferred Plus for POS benefits). With products supported by the Blue Priority networks, OON benefits are limited to cover urgent or emergent services.

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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.

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