14,000 CalPERS members and their families need to find a new 2019 health plan. Here’s why
The
As a result of the changes, CalPERS will part ways with two major providers -- Health Net and
Health Net, a health plan managing care for Medicare and
The departure will affect an estimated 1,580 active and 308 retired CalPERS members and their dependents, according to a CalPERS official who attributes Health Net's service area change to its inability to "maintain viable rates in this region."
The official asked not to be identified because the information provided was collected and compiled from multiple CalPERS officials.
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Health Net representative
Those affected must choose another health plan during open enrollment, from
The CalPERS official said 9,908 active and 2,231 retired CalPERS members and their dependents will be affected by the
Continuity of care
These service area changes might mean affected CalPERS members and their families need to find a new doctor.
"The medical groups and hospitals members will have access to could change depending on their choice of health plan," the CalPERS official said. "Members can call the doctor's office and ask if they are affiliated with the health plan and the hospital they prefer to use. They may also contact the health plans directly."
The state maintains guidelines to ensure that individuals whose health plans have been terminated receive continuity of care.
"Continuity of care is available if you get your health plan from your employer, your employer stops offering that plan and you have to change to a plan that does not have your treating doctor or hospital," according to the
Individuals who believe continuity of care applies to them should contact their health plan. If dissatisfied by their plan's response, the health care department can be contacted for assistance at 1-888-466-2219 or www.HealthHelp.ca.gov, according to
Finding a new plan
To help members find a new health plan, CalPERS has made the "Find a Medical Plan" tool available on its internal website. Customer service representatives are also available to answer questions.
"Members can expect the same benefits and co-payment amounts under Health Net's SmartCare plan as they receive from
The window to enroll in a self-selected health plan will be less than a month long -- from
"A contained Open Enrollment period helps health care purchasers determine a relatively fixed risk pool -- population of healthy and sick individuals -- for the following year, which helps predict and keep costs low," the official said.
Reasons for the changes
A statement provided by
CalPERS approved
"
Only CalPERS members employed by contracting public agencies and schools in the
Total insureds affected
Service area changes from
The official from CalPERS did, however, report that a total of 135,417 letters were sent to inform members of the changes to health plans for the 2019 plan year. The agency sent a series of letters in July to affected members, informing them they would need to choose a new health plan.
It appears the insurers have not made efforts to notify affected people, but according to Robinson of the
Wardell from
"We have received zero written notice from the insurer," said
He confirmed its doctors take care of
Robinson said the
Entering and exiting
Health plans entering and leaving areas is not unusual.
"CalPERS health plans contract with a network of providers, and each year CalPERS and its contracted health plans re-evaluate these networks," the CalPERS official said. "Depending on a variety of factors, not least of which is cost, providers ask that their coverage areas change for certain plans."
The agency decides whether to grant the request by determining the burden a change in coverage will place on its members.
"It's one way CalPERS helps contain costs for members," the official said.
Average premium increases for CalPERS members for 2019 are below the national average.
"CalPERS brings many health providers to the table, which creates competitive pricing," the official said. "Its governing body (and) the
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