Portfolio & Network Glossary

Transcription

1 Aetna Rev HMO HMO plans; network pairings include HMO, HMO Deductible, Aetna Value Network HMO, HMO Basic, WholeHealth ACO OA Managed Choice POS PPO plans utilizing the Managed Choice POS; network pairings include MC, WholeHealth ACO OA Managed Choice POS HDHP Managed Choice HSA compatible plans Open Choice PPO PPO plans utilizing the Open Choice PPO Network Aetna Whole Health EPO In-network only plan paired with Aetna's WholeHealth ACO network; no PCP or referral required Pick-A-Plan Full Aetna portfolio; Limited to 5 plan selection HMO Full HMO network (74,602 docs / 330 hospitals) HMO Basic Subset of HMO network; HMO and HMO Deductible plans may be paired with this network (17,616 docs / 197 hospitals) HMO Deductible Subset of HMO network specific to the HMO Deductible plans (66,335 docs / 441 hospitals) Aetna Value Network HMO Aetna Whole Health Subset of HMO network; may be paired with HMO plans for premium savings (42,704 docs / 307 hospitals) Network including PrimeCare, Providence, MemorialCare ; may be paired with specific MC and EPO plans OA Managed Choice POS Manage Choice POS network specific to the MC plans (80,519 docs / 337 hospitals) Savings Plus OA Managed Choice POS Subset of MC network; may be paired with MC plans for premium savings (189 hospitals) Open Choice PPO Open Choice PPO network specific to PPO plans (66,858 docs / 327 hospitals) Value Formulary Four-tier formulary for all plans Rx Mail Order Aetna Rx Mail Order Behavioral Health Aetna Mental Health network Pediatric Dental Dental network (National PPO) for embedded pediatric Dental benefits within Medical plans Pediatric Vision Vision network (EyeMed) for embedded pediatric Vision benefits within Medical plans Anthem Blue Cross Rev HMO HMO plans; available in Platinum, Gold and Silver metallic tiers PPO PPO plans; available for all metallic tiers HSA HSA-compatible PPO plans; Silver and Bronze metallic tiers only EPO In-network only plan paired with Anthem's Prudent Buyer PPO network; no PCP or referral required EmployeeElect Full Anthem portfolio CaliforniaCare HMO Full traditional HMO network; only available with certain HMO plan offerings (42,000 docs / 330 hospitals) Select HMO Subset of HMO network; high performance narrow network available for HMO plan offerings (26,000 docs / 250 hospitals) Prudent Buyer PPO Full statewide PPO network; only available with certain PPO plan offerings (60,000 docs / 330 hospitals) Select PPO Subset of PPO network; available for PPO plan offerings, including OOS employees (40,000 docs / 300 hospitals) Select Formulary Formulary available with all plans; 100% of the top 25 drugs are covered Rx Mail Order Express Scripts Behavioral Health Behavioral Health network Pediatric Dental Dental network (Prime Dental) for bundled pediatric Dental benefits with Medical plans Pediatric Vision Vision network (Blue View/EyeMed) for embedded pediatric Vision benefits within Medical plans

2 CaliforniaChoice Rev Anthem Select HMO HMO plans available to be paired with the Select HMO network (23,000+ docs / 250 hospitals) Anthem EPO In-network only HSA compatible plan paired with Anthem's Prudent Buyer PPO network (60,000+ docs / 330 hospitals) Anthem Select PPO PPO plans; available options include Advantage PPO and Select PPO (40,000+ docs / 300 hospitals) Health Net HMO HMO plans paired with Health Net's WholeCare network Health Net Salud y Mas HMO designs with cross-border coverage utilizing the Salud network Health Net HSP (Health Service Plan) EPO that requires members to select a PCP though they may self-refer to in-network providers from PureCare HSP network Kaiser HMO HMO plans paired with Kaiser's Full HMO network Kaiser HMO HSA HSA compatible HMOs paired with Kaiser's Full HMO network Sharp HMO HMO plans paired with Sharp's Premier or Performance HMO networks Sharp HMO HSA HSA compatible HMOs paired with Sharp's Full HMO network Sutter HMO HMO plans available through Sutter Health in 14 Northern California counties Sutter HMO HSA HSA compatible HMOs paired with Sutter's Full HMO network UHC SignatureValue HMO HMO plans with full HMO network UHC Alliance HMO Same benefit level as SignatureValue plans paired with Alliance network UHC Alliance HMO HSA HSA compatible HMOs paired with UHC's Full HMO network UHC Focus HMO Same benefit level as SignatureValue plans but paired with Focus network WHA HMO HMO plans paired with WHA's Full HMO network in limited Northern California counties WHA HMO HSA HSA compatible HMOs paired with WHA's Full HMO network All Two adjacent metallic tiers may be purchased Anthem Select HMO Subset of HMO network; available with Anthem HMO plan offerings (26,000 docs / 250 hospitals) Anthem Prudent Buyer PPO Full statewide PPO network; only available with certain PPO plan offerings (60,000 docs / 330 hospitals) Anthem Select PPO Subset of PPO network; available with certain PPO plan offerings; Blue Card available to OOS (40,000 docs / 300 hospitals) Anthem Advantage PPO Subset of PPO network; available with certain Anthem PPO plan offerings; Blue Card available to OOS Health Net WholeCare Health Net Salud y Mas HMO Expanded HMO network available in 30 counties; only available with Health Net HMO plan offerings (27,097 docs / 182 hospitals) Tailored HMO network in Southern California; available only with Salud y Mas plans (6,498 docs / 30 hospitals) Health Net PureCare HSP Very narrow network; paired with PureCare HSP plans (34,284 docs / 217 hospitals) Kaiser HMO Network Full HMO network; available with all Kaiser HMO and HMO HSA plan offerings Sharp Performance Sharp Premier Full HMO network in San Diego county; only available with certain Sharp HMO and HMO HSA plan offerings Subset of Performance network in San Diego county; only available with certain Sharp HMO plan offerings Sutter Health Plus HMO network through Sutter Health in 14 Northern California counties UHC SignatureValue Full HMO network; available with SignatureValue plans (48,000 docs / 210 hospitals) UHC Alliance Subset of HMO network; only available with Alliance plans (23,000 docs / 127 hospitals) UHC Focus Subset of HMO network; only available with Focus plans (14,000 docs / 110 hospitals) WHA HMO (includes Canopy Health) Anthem - Select Formulary Anthem's National Formulary Full HMO network in limited Northern California counties; available with all WHA HMO and HMO HSA plan offerings Anthem Pediatric Dental Dental network (Prime Dental) for bundled pediatric Dental benefits with Medical plans Anthem Pediatric Vision Vision network (Blue View/EyeMed) for embedded pediatric Vision benefits within Medical plans Health Net Pediatric Dental HMO Dental network (Dental Benefits Provider) for embedded pediatric Dental benefits within Medical plans Health Net Pediatric Dental PPO Dental network for embedded pediatric Dental benefits within Medical plans Health Net Pediatric Vision Vision network (EyeMed) for embedded pediatric Vision benefits within Medical plans

3 CaliforniaChoice Rev Kaiser Pediatric Dental Dental network (Delta Dental) for embedded pediatric Dental benefits within Medical plans Kaiser Pediatric Vision Vision network for embedded pediatric Vision benefits within Medical plans Sharp Pediatric Dental Dental network for embedded pediatric Dental benefits within Medical plans Sharp Pediatric Vision Vision network for embedded pediatric Vision benefits within Medical plans UHC Pediatric Dental Dental network (CA Select Managed Care DHMO) for pediatric Dental benefits within Medical plans UHC Pediatric Vision Vision network (Spectera) for embedded pediatric Vision benefits within Medical plans WHA Pediatric Dental Dental network (Delta Dental) for embedded pediatric Dental benefits within Medical plans WHA Pediatric Vision Vision network (MES Vision) for embedded pediatric Vision benefits within Medical plans Delta Dental Rev PPO Value & Enhanced PPO plan; balance billing when utilizing Premier dentists PPO Plus Premier Enhanced PPO plans with access to Premier network; no balance billing with Premier dentists PPO Plus Premier Value PPO plans with access to Premier network for groups of 5-99; no balance billing with Premier dentists DeltaCare HMO plans Options PPO PPO plans with 2-3 deductible options, CYM, Ortho coverage and max, Endodontics, and Periodontics coverage DeltaCare HMO network PPO PPO network; roughly 46% of dentists nationwide Premier Larger PPO network ; roughly 80% of dentists nationwide Vision EyeMed Vision network Guardian Rev Value 2-99 Dental PPO plan; fee schedule Network Access Plan (NAP) 2-99 Dental PPO Network Access Plan; UCR out of network Choice 2-99 Dental PPO plan that gives choice between Value Plan and Network Access Plan; may switch annually Vision Access Plan 2-99 Discounted vision services available with all Guardian Dental plans; VSP network Vision 2-99 VSP Vision plans DHMO 2-99 HMO network PPO 2-99 PPO network - Dental Guard Preferred Vision 2-99 VSP network Health Net Rev HMO HMO plans to be paired with the Full HMO network WholeCare HMO plans; only available in Platinum and Gold metallic tiers SmartCare HMO Available in regions 7, 9, 15-19; tailored network with expanded benefits CommunityCare HMO Available in Los Angeles & Orange Counties; tailored network with expanded benefits Salud y Mas HMO designs with cross-border coverage utilizing the Salud network PPO PPO plans available in all metallic tiers PPO Value PPO plans with integrated deductible for medical and pharmacy, where deductible applies to all benefits EnhancedCare PPO PPO plans available in Gold, Silver, and Bronze metallic tiers

4 Health Net Rev HSA Available only with PPO Network PureCare HSP (Health Service Plan) PureCare One EPO EPO plan using the PureCare One EPO network Enhanced Choice Package EnhancedCare PPO Choice Package EPO that requires members to select a PCP though they may self-refer to in-network providers from PureCare HSP network Full HMOs, WholeCare, HMOs, SmartCare HMOs, Salud y Mas HMOs, CommunityCare HMOs, HSPs, EPOs, and Full PPOs Full HMOs, WholeCare, HMOs, SmartCare HMOs, Salud y Mas HMOs, CommunityCare HMOs, HSPs, EPOs, EnhancedCare PPOs, Full PPO Bronze HSA and Full Bronze 60 PPO HMO Full HMO network (37,489 docs / 230 hospitals) WholeCare Subset of HMO network (27,097 docs / 182 hospitals) SmartCare HMO Subset of HMO network (11,108 docs / 89 hospitals) CommunityCare Subset of HMO network Salud y Mas PPO PPO network (57,276 docs / 323 hospitals) EnhancedCare PPO Tailored PPO network in Los Angeles Salud networks limited to specific service areas with cross border access to the SIMNSA network (6,498 docs / 30 hospitals) PureCare HSP Very narrow network; paired with PureCare HSP plans (34,284 docs / 217 hospitals) PureCare One Very narrow EPO network; paired with PureCare One plan (34,109 docs / 217 hospitals) Rx Mail Order CVS Caremark Behavioral Health Mental Health Network (HMO); PPO network (PPO) Pediatric Dental HMO/HSP Dental network (Dental Benefits Provider) for embedded pediatric Dental benefits within Medical plans Pediatric Dental PPO/EPO Dental network for embedded pediatric Dental benefits within Medical plans Pediatric Vision Vision network (EyeMed) for embedded pediatric Vision benefits within Medical plans MetLife Rev DHMO 2-99 HMO plans PPO 2-99 PPO plans utilizing the Preferred Dentist Program Plus network Vision 2-99 PPO vision plans DHMO 2-99 HMO network Preferred Dentist Program Plus 2-99 PPO network Vision 2-99 VSP network and MetLife direct retail network UnitedHealthcare Rev Choice HMO State HMO HMO plans unique to the Choice portfolio that may be paired with SignatureValue, Advantage, Alliance and Focus networks HMO plans unique to the State portfolio that may be paired with SignatureValue, Alliance and Focus networks HMO HSA HMO HSA plans within the Choice and State portfolio that may only be paired with the Alliance network Choice PPO PPO plans unique to the Choice portfolio that may be paired with the Select Plus, Core and Navigate networks State PPO PPO plans unique to the State portfolio that may be paired with the Core and Navigate networks Choice PPO HSA HSA-compatible plans unique to the Choice portfolio that may be paired with the Select Plus, Core and Navigate networks

5 UnitedHealthcare Rev State PPO HSA Navigate PPO HSA-compatible plans unique to the State portfolio that may be paired with the Core and Navigate networks PPO plans similar to EPOs consisting of in-network benefits only; PCP selection and electronic referrals are required. Choice Simplified Medical plans consisting of all metallic levels associated with all networks Multi-Choice State Medical plans consisting of all metallic levels that may be paired with all networks except Select Plus and Advantage network SignatureValue Full HMO network (48,000 docs / 210 hospitals) Advantage (includes Canopy Health) Subset of full HMO network (28,000 docs / 153 hospitals) Alliance Narrow HMO network comprised of specific medical groups (23,000 docs / 127 hospitals) Focus Narrow HMO network comprised of specific medical groups (14,000 docs / 110 hospitals) Select Plus Full PPO network (100,000 docs / 303 hospitals) Core Narrow PPO network comprised of distinct providers (75,000 docs / 295 hospitals) Navigate Select EPO Full PPO network for non-differential PPO only Narrow PPO network that pairs only with Navigate PPO plans ; network consist of approximate 72,000 docs / 285 hospitals. California Custom PDL Tier Prescription Drug List for PPO and EPO plans SignatureValue Formulary Tier Formulary for HMO Rx Mail Order OptumRx Behavioral Health United Behavioral Health network CA Select Managed Care DHMO HMO Dental network for DHMO National Options PPO Dental network for MAA PPO Dental plans National Options PPO Dental network for MAC/INO Pediatric Dental HMO Dental network (CA Select Managed Care DHMO) for embedded pediatric Dental benefits within Medical plans Pediatric Dental PPO Dental network (National Options 20) for embedded pediatric Dental benefits within Medical plans Pediatric Vision Vision network (Spectera) for embedded pediatric Vision benefits within Medical plans VSP Rev Signature 5-99 Higher premiums, richer benefits Choice 5-99 Lower premiums VSP 5-99 Full VSP network; 30,000 preferred providers and 50,000 access points nationwide