Exclusive Network guide

Transcription

1 guide For sma businesses with 1 to 50 eigibe empoyees Learn what s new in 2014

2 Use this guide to understand our provider networks, and to compare the providers avaiabe in our and Fu HMO networks. Understanding the network...2 What s new in How does it work?...4 New PPO network!...5 and Fu HMO comparison...6 Understanding the Beginning in 2014, Bue Shied wi offer sma business HMO pans with either a Fu HMO or an HMO. HMO pans may be the perfect answer for sma businesses that want to offer comprehensive benefits to their empoyees whie managing their bottom ine. HMO pans offer a the same benefits of our Fu HMO pans within a seect network. Depending on where your empoyees ive or work, you may benefit from savings off comparabe Fu HMO pans. To purchase an HMO pan with the HMO or the Fu HMO : 1) you, the sma business empoyer, must be ocated in the pan s service area, and 2) your eigibe empoyees must ive or work in the service area. The HMO pan is avaiabe in a or a portion of 18 counties: Contra Costa County* Kern County* Los Angees County* Marin County Orange County Riverside County* Sacramento County* San Bernardino County* San Diego County* San Francisco County San Luis Obispo County San Mateo County* Santa Cara County Santa Cruz County Sonoma County Stanisaus County Ventura County* Yoo County * Partia county avaiabiity. Pease see the Benefit Summary Guide (A16609) for a fu zip code isting. If you are an empoyer ocated in certain Caifornia counties whose eigibe empoyees ive or work in the HMO service area, you have the option of choosing the HMO pans or the Fu HMO pans, but not both. One HMO pan option must be seected; both options are not avaiabe to combine. The HMO pans have the same benefits as our Fu HMO pans. 2 HMO guide

3 What s new in 2014 In 2014, sma businesses wi purchase heath pans from one of Bue Shied s new pan packages. Sma businesses may aso purchase Bue Shied heath pans from Covered Caifornia s Sma Business Heath Options Program, known as SHOP. The network providers avaiabe to sma business customers differ based on where you and your empoyees ive, the type of pan purchased, and the pan package you choose. Understanding Bue Shied s pan packages: Bue Shied of Caifornia Off Exchange Package for Sma Business: Our fagship package features a range of HMO options. These pans are purchased from Bue Shied through a broker.* Utimate HMO for Sma Business $25 Preferred HMO for Sma Business $30 Enhanced HMO for Sma Business $55 Bue Shied of Caifornia Mirror Package for Sma Business: Pans in this package are identica to the ones offered on the SHOP, but are purchased from Bue Shied through a broker. Utimate HMO for Sma Business Preferred HMO for Sma Business Enhanced HMO for Sma Business To see a the heath pans in both packages, visit bueshiedca.com/empoyer. and Fu HMO provider counts: More than 17,000 doctors and 320 hospitas in HMO More than 38,000 doctors and 320 hospitas in Fu HMO Provider network The HMO provides: Access to approximatey 80% of the physicians in the Fu. The network of hospitas in the covered areas is the same for both the HMO pan and the Fu HMO pan. The HMO incudes a speciaities and eves of care. * The Bue Shied of Caifornia Off Exchange Package for Sma Business has 16 pans, 6 of which are HMO pans with a choice of the Fu or network. If you are an empoyer ocated in certain Caifornia counties whose eigibe empoyees ive or work in the HMO service area, you have the option of choosing any of the HMO pans or any of the Fu HMO pans, but not both. Pease review the Benefit Summary Guide (A16609) for detaied information regarding the HMO service area. The Bue Shied of Caifornia Mirror Package for Sma Business has 7 pans, 6 of which are HMO pans with a choice of the Fu or network. If you are an empoyer ocated in certain Caifornia counties whose eigibe empoyees ive or work in the HMO service area, you have the option of the HMO pans. If you are ocated in, and have eigibe empoyees who ive or work in, one of the foowing 7 counties, you have the option of the Fu HMO pans: Aameda, Butte, Fresno, Imperia, Kings, Madera, Nevada (partia county). Pease review the Benefit Summary Guide (A16609) for detaied information regarding the HMO service area. HMO guide 3

4 How does it work? Q. I m interested in purchasing an HMO pan from Bue Shied s Off Exchange package. What are my network options? A. Sma businesses can either purchase HMO pans with the Fu HMO or the HMO, but not both. See beow for an HMO county isting. See pages 6-11 to compare the HMO with the Fu HMO medica groups and IPAs. Q. I m interested in purchasing an HMO pan from Covered Caifornia s SHOP or Bue Shied s Mirror package. What are my network options? A. Sma businesses in the HMO pan service area purchase HMO pans with the HMO. Empoyers in the Fu HMO pan service area purchase HMO pans with the Fu HMO. See the tabe beow for the detais. County overview Off Exchange Package HMO pans with the HMO are avaiabe in the foowing counties: Contra Costa* Kern* Los Angees* Marin Orange Riverside* Sacramento* San Bernardino* San Diego* San Francisco San Luis Obispo San Mateo* Santa Cara Santa Cruz Sonoma Stanisaus Ventura* Yoo HMO pans with the Fu HMO are avaiabe in the foowing counties: Aameda Butte Contra Costa E Dorado Fresno Imperia Kern Kings Los Angees Madera Marin Merced Nevada* Orange Pacer Riverside Sacramento San Bernardino* San Diego* San Francisco San Joaquin San Luis Obispo San Mateo Santa Barbara Santa Cara Santa Cruz Soano Sonoma Stanisaus Tuare Ventura Yoo HMO pans with the HMO are avaiabe in the foowing counties: Contra Costa* Kern* Los Angees* Marin Orange Riverside* Sacramento* San Bernardino* San Diego* San Francisco San Luis Obispo San Mateo* Santa Cara Santa Cruz Sonoma Stanisaus Ventura* Yoo * Partia county avaiabiity. Pease see the Benefit Summary Guide (A16609) for a fu zip code isting. Mirror Package/SHOP HMO pans with the Fu HMO are avaiabe in the foowing counties: Aameda Butte Fresno Imperia Kings Madera Nevada* 4 HMO guide

5 New in 2014 an PPO network In 2014, Bue Shied wi offer PPO pans with an, as we as PPO pans with the Fu. The PPO pan is avaiabe from the Bue Shied of Caifornia Mirror Package for Sma Business. To purchase it, you must be ocated in an PPO service area, but you and your empoyees can access any provider in the PPO network. Bue Shied of Caifornia Mirror Package for Sma Business PPO The PPO pan avaiabe in the Mirror Package features the PPO. If purchased through this package, the empoyer must be ocated in an PPO service area; but members can access any provider in the PPO network. The PPO pan in the Mirror Package is avaiabe for purchase in the foowing counties: Aameda Butte Contra Costa* Fresno Imperia Kern* Kings Los Angees* Madera Marin Nevada Orange Riverside* Sacramento* San Bernardino* San Diego* San Francisco San Luis Obispo San Mateo* * Partia county avaiabiity. Pease see the Benefit Summary Guide (A16609) for a fu zip code isting. Bue Shied s Fu PPO network is avaiabe in a 58 Caifornia counties. Santa Cara Santa Cruz Sonoma Stanisaus Ventura* Yoo For more information, tak to your broker or Bue Shied saes representative. Visit bueshiedca.com/fap to ook up providers on our Find a Provider site. HMO guide 5

6 HMO guide To find out if an HMO is a good match for you, use this handy network comparison guide. It shows a the medica groups and IPAs in the covered areas compared with the Fu medica groups and IPAs. The chart beow compares the HMO network with the Fu HMO network medica groups and IPAs* for those counties. For more information on our Fu HMO network and its extensive coverage across Caifornia, pease visit bueshiedca.com/fap or tak to your broker or Bue Shied saes representative. Fu HMO network HMO network Name County Fu HMO HMO Contra Costa County, except for ZIP codes 94525, 94530, 94547, 94564, 94569, 94572, 94801, 94802, 94803, 94804, 94805, 94806, 94807, 94808, 94820, and Hi Physicians MG Contra Costa County Contra Costa John Muir Physician Contra Costa Sutter East Bay Medica Foundation Diabo Division Contra Costa Kern County, except for ZIP codes 93205, 93206, 93220, 93222, 93224, 93225, 93226, 93238, 93240, 93243, 93249, 93251, 93252, 93255, 93268, 93283, 93285, 93287, 93501, 93502, 93504, 93505, 93516, 93518, 93519, 93523, 93524, 93527, 93528, 93554, 93555, 93556, 93558, 93560, and Bakersfied Famiy Medica Group Kern Gemcare Medica Group Deano Kern Gemcare Medica Group MCS of Kern County Kern Heath Now, IPA Kern Independence Medica Group Kern Los Angees County, except for ZIP codes 90704, 93510, 93532, 93534, 93535, 93536, 93539, 93543, 93544, 93550, 93551, 93552, 93553, 93584, 93586, 93590, 93591, and Access Medica Group Inc. Los Angees AKM Medica Group Inc. Los Angees Aamitos IPA Los Angees A Care Medica Group Los Angees Aied Heathcare Providers Los Angees Aied Physicians of Caifornia Los Angees Atamed Heath Services Los Angees Angees IPA Los Angees Appecare Medica Group St. Francis Region Los Angees Appecare Medica Group Whittier Los Angees Appecare Medica Group Downey Los Angees Appecare Medica Group Seect Los Angees Associated Hispanic Physicians IPA Los Angees Axminster Medica Group Inc. Los Angees Bea Vista Medica Group IPA Los Angees Bright Heath Physicians of PIH Los Angees Brookshire IPA Los Angees * Medica groups and IPAs are subject to change. For a fu ist of providers, pease visit Find a Provider (bueshiedca.com/fap). 6 HMO guide

7 Fu HMO network HMO network The chart beow compares the HMO network with the Fu HMO network medica groups and IPAs* for those counties. Name County Fu HMO Cedars-Sinai Heath Associates Los Angees Cedars-Sinai Medica Group Los Angees Centinea Vaey IPA Los Angees Citrus Vaey Physicians Group Los Angees ECMG Avaon Medica Group Los Angees ECMG Greater LA Heathcare Los Angees ECMG Greater San Gabrie Vaey Physicians Los Angees ECMG Mabuhay Medica Group Los Angees ECMG Mid Cities IPA Los Angees ECMG Pasadena Prime Care Physicians Los Angees ECMG PCP IPA Los Angees ECMG Serendib Heathways Los Angees Facey Medica Foundation Burbank Los Angees Facey Medica Foundation San Fernando Vaey Los Angees Facey Medica Foundation San Gabrie Los Angees Facey Medica Foundation Santa Carita Los Angees Famiy Care Speciaists Montebeo Los Angees Famiy Care Speciaists IPA Los Angees Famiy Heath Aiance Los Angees Goba Care Medica Group Inc. Los Angees Good Samaritan Medica Practice Associates Los Angees Greater Covina Medica Group Inc. Los Angees Greater Newport Physicians Long Beach Memoria Los Angees Harriman Jones Medica Group A Division of Heathcare Partners Los Angees HCP Northridge Medica Group Inc. Los Angees Heathcare LA Inc. Los Angees Heathcare Partners Los Angees Heathcare Partners Physicians Associates Los Angees High Desert Medica Group Los Angees Hispanic Physicians IPA Los Angees Korean American Medica Group Inc. Los Angees Lakeside Medica Organization Los Angees Lakewood IPA Los Angees Memoria Care Medica Group Long Beach Los Angees Nuestra Famiia Prospect Medica Group Los Angees Omnicare Medica Group Los Angees Pacific IPA Los Angees Physicians Heathways IPA Los Angees Pioneer Provider A Medica Group Inc. Los Angees HMO * Medica groups and IPAs are subject to change. For a fu ist of providers, pease visit Find a Provider (bueshiedca.com/fap). HMO guide 7

8 Fu HMO network HMO network The chart beow compares the HMO network with the Fu HMO network medica groups and IPAs* for those counties. Name County Fu HMO Premier Physicians Los Angees Promed Heath of Pomona Vaey Los Angees Prospect Professiona Medica Group IPA Los Angees Prudent Medica Group Los Angees Rega Gendae Physicians Aiance Los Angees Rega Medica Group Los Angees Seou Medica Group Integrated Physician Services Los Angees Serra Community Medica Cinic Los Angees Sierra Medica Group Los Angees St. Mary IPA Los Angees St. Vincent IPA Medica Corporation Los Angees Torrance Hospita IPA Los Angees UCLA Medica Group Los Angees UCLA Medica Group Northwest Los Angees UCLA Medica Group SMBP Los Angees Universa Care LA South Los Angees HMO Marin County Fu county Meritage Medica Marin Orange County Fu county Affiiated Doctors of Orange County Orange AMVI Medica Group Orange ARTA Heath Orange Daehan Prospect Medica Group Orange ECMG United Care Medica Group Orange Edinger Medica Group Orange Famiy Choice Medica Group Orange Gateway Medica Group Orange Genesis Heathcare Orange Greater Newport Physicians Inc. Orange Heathcare Partners Medica Group Tabert Orange Orange MemoriaCare Medica Group Orange Mission Hospita Affiiate Physicians Orange Mission Interna Medica Group Orange Nobe AMA IPA Orange Prospect Northwest Orange County Medica Group Orange Prospect Medica Group Orange Orange Rega Medica Group Northwest Orange County Orange St. Joseph Heritage Medica Group Orange St. Joseph Hospita Affiiate Physicians Orange * Medica groups and IPAs are subject to change. For a fu ist of providers, pease visit Find a Provider (bueshiedca.com/fap). 8 HMO guide

9 Fu HMO network HMO network The chart beow compares the HMO network with the Fu HMO network medica groups and IPAs* for those counties. Name County Fu HMO St. Jude Affiiated Physicians Orange St. Jude Heritage Medica Group Orange HMO Riverside County, except for ZIP codes 92225, 92226, 92239, and Coachea Vaey Physicians Riverside Desert Oasis Heathcare Riverside Empire Physicians Medica Group Riverside Hemet Community Medica Group Famiy Seniors Riverside Hemet Community Medica Group Hemet Riverside Hemet Community Medica Group Meadowview Riverside Hemet Community Medica Group Menifee Riverside Hemet Community Medica Group PrimePartners Riverside Hemet Community Medica Group Temecua Riverside Inand Vaey IPA Coachea Vaey Riverside Inand Vaey IPA Temecua Vaey Riverside Primecare Medica Group Riverside Prospect Heath Corona Riverside Rega Medica Group Riverside Riverside Rega Medica Group Temecua Vaey Riverside Riverside Medica Cinic Riverside Riverside Physician Riverside Tri-Vaey Medica Group Riverside Vaey Physicians Inc. Riverside Vantage IPA Riverside Riverside Sacramento County, except for ZIP codes 95362, 95638, 95639, 95641, 95671, 95680, 95683, 95690, and Hi Physicians Sacramento Primed Inc. Sacramento Mercy Medica Group (Commercia) Sacramento Sierra Nevada Medica Association Sacramento Sutter Independent Physicians Sacramento Sutter Medica Group Sacramento UC Davis Heath System Sacramento San Bernardino County, except for ZIP codes 91759, 92242, 92252, 92256, 92267, 92268, 92277, 92278, 92280, 92284, 92285, 92286, 92304, 92305, 92309, 92310, 92314, 92315, 92317, 92321, 92322, 92323, 92325, 92326, 92327, 92332, 92333, 92338, 92341, 92342, 92347, 92352, 92356, 92358, 92363, 92364, 92365, 92366, 92368, 92372, 92378, 92382, 92385, 92386, 92391, 92395, 92397, 92398, 92407, 93562, and Aiance Desert Physicians San Bernardino Beaver Advantage Heath Center San Bernardino Beaver Medica Group San Bernardino Beaver Medica Group RYMG San Bernardino Choice Medica Group Appe Vaey San Bernardino Choice Medica Group Barstow San Bernardino * Medica groups and IPAs are subject to change. For a fu ist of providers, pease visit Find a Provider (bueshiedca.com/fap). HMO guide 9

10 Fu HMO network HMO network The chart beow compares the HMO network with the Fu HMO network medica groups and IPAs* for those counties. Name County Fu HMO Desert Vaey Medica Group San Bernardino Heritage Victor Vaey Medica Group San Bernardino High Desert Primary Care San Bernardino Inand Heath Care Group Inc. San Bernardino Inand Vaey IPA San Bernardino Lakeside Medica Organization San Bernardino San Bernardino My Famiy Medica Group San Bernardino Pinnace Medica Group San Bernardino Primecare Medica Group Chino San Bernardino Primecare Medica Group Inand Vaey San Bernardino Primecare Medica Group Redands San Bernardino Primecare Medica Group San Bernardino San Bernardino Rega Medica Group Pomona Vaey San Bernardino Rega Medica Group San Bernardino San Bernardino San Bernardino Medica Group San Bernardino United Famiy Care San Bernardino Upand Medica Group San Bernardino Vantage IPA San Bernardino San Bernardino HMO San Diego County, except for ZIP codes 91905, 91906, 91934, 91963, 91980, 91987, 92004, 92036, 92066, and Chidrens Physicians Medica Group San Diego Encompass Medica Group San Diego Greater Tri Cities IPA San Diego Mercy Physicians Medica Group San Diego Mid County Physicians Medica Group San Diego Muticutura Primary Care Medica Group San Diego Primary Care Associates Medica Group San Diego Primary Care Associates Medica Group Cassidy San Diego San Diego Physicians Medica Group San Diego Scripps Cinic Medica Group San Diego Scripps Coasta Medica Centers San Diego Sharp Community Medica Group San Diego Sharp Rees Steay San Diego San Francisco County Fu county Brown and Toand Medica Group San Francisco Chinese Community Heathcare Association San Francisco Hi Physicians San Francisco San Francisco San Luis Obispo County Fu county Coasta Communities Provider San Luis Obispo * Medica groups and IPAs are subject to change. For a fu ist of providers, pease visit Find a Provider (bueshiedca.com/fap). 10 HMO guide

11 Fu HMO network HMO network The chart beow compares the HMO network with the Fu HMO network medica groups and IPAs* for those counties. Name County Fu HMO Physicians Choice Medica Group of San Luis Obispo San Luis Obispo HMO San Mateo County, except for ZIP codes 94018, 94019, 94020, 94021, 94028, 94037, 94038, 94060, 94074, and Affinity Medica Group South Bay San Mateo Hi Physicians MG San Francisco San Mateo Pao Ato Medica Foundation San Mateo Sequoia Physicians San Mateo Santa Cara County Fu county Pao Ato Medica Foundation Santa Cara Physicians Medica Group of San Jose Santa Cara Santa Cara County IPA Santa Cara Santa Cruz County Fu county Pao Ato Medica Foundation Santa Cruz Santa Cruz Physicians Medica Group of Santa Cruz Santa Cruz Sonoma County Fu county Meritage Medica Sonoma Sonoma County Primary Care Sonoma Sutter Medica Group Redwoods Sonoma Stanisaus county Fu county ACare IPA Stanisaus Sutter Goud Medica Foundation Stanisaus Ventura County, except for ZIP codes 91358, 91359, 91360, 91362, 91377, 93020, 93021, 93040, 93042, 93062, 93063, 93064, 93065, 93094, and Facey Medica Foundation Simi Vaey Ventura Lakeside Medica Organization Ventura Rega Medica Group Ventura County Ventura Seaview IPA Ventura Vaeycare IPA Ventura Vaeycare IPA Seect Ventura Yoo County Fu county Sutter Medica Group Yoo Woodand Cinic Yoo * Medica groups and IPAs are subject to change. For a fu ist of providers, pease visit Find a Provider (bueshiedca.com/fap).

12 For detaied information on HMO pans or provider network, go to bueshiedca.com/fap or tak to your broker or Bue Shied saes representative. Bue Shied of Caifornia is an independent member of the Bue Shied Association A43007-SG (2/14) bueshiedca.com