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51-99: Important Changes to Anthem Health Benefits

Jan 30, 2015

Effective April 1, 2015, members enrolled in certain 51-99 PPO/EPO/ACO plans regulated by the Department of Managed Health Care (DMHC) will experience a benefit change when they utilize emergency medical ambulance services from non-participating providers.
 
As always, members will pay their share of the charges for this service (that’s any copayment, coinsurance and deductible amounts). Anthem will then pay its share of the charges.
 
Here’s what will change
Effective April 1, 2015 for 51-99 groups, any charges for medical emergency ambulance services received from non-participating providers in excess of the allowed amount, and above what Anthem has paid, can be billed to members by the non-participating provider. This means the member will be held responsible for paying any difference between billed charges and what Anthem paid.  
 
Here are the affected plans
51-99 Plans
 
Letters to all affected groups are being mailed 60 days prior to the effective date notifying them of this benefit change.
 
Please Note: ACA 1-50 benefit plans have already implemented this change.

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