UC Santa Cruz learned on Friday that the agreement concerning Anthem Blue Cross, the insurance policy carrier of UC’s business PPO options (non-Medicare plans), and Dignity Wellness, a health treatment supplier which incorporates Dominican Clinic-Santa Cruz, finished, efficient July 15.
This deal termination has an effect on customers of the adhering to UC PPO plans: UC Care, Overall health Personal savings Program, and Main. This deal termination is deeply disappointing news, specially in the midst of a continuing pandemic.
We identify that this agreement termination and the resulting uncertainty of when a resolution may possibly be reached has sizeable impacts on lots of customers of our campus group and their people. We keep on being hopeful that Anthem and Dignity will arrive to settlement on mutually beneficial terms. UCSC management is performing carefully with the UC Business of the President, which manages the systemwide positive aspects program, to build steering for affected UC PPO customers.
We will present ongoing communications on this evolving problem as new details turns into obtainable. Please get hold of the UCSC Benefits Office at positive [email protected] to opt-in to communications and to request added concerns. Team Human Means is developing a webpage with solutions to often asked thoughts that will be released at shr.ucsc.edu later on this week.
If you are a member of an Anthem PPO prepare and get care from Dignity Health Providers soon after July 15, 2021
Customers of UC PPO plans who obtain treatment from Dignity Wellness and Dominican Healthcare facility soon after 5 p.m. July 15, 2021 should notice that:
- Statements for solutions obtained will be processed at the out-of-community protection tier.
- Yearly deductible quantities are higher for out-of-network care.
- Increased out-of-network co-insurance policies fees, besides for providers pre-accepted beneath the continuity of care regulations explained underneath, will be the patient’s obligation.
- The affected individual may perhaps be responsible for the balance of expenditures earlier mentioned the authorized sum for treatment obtained from non-network vendors.
- Emergency health care expert services do not need pre-authorization no matter of where by providers are shipped. Customers may possibly go to any clinic for unexpected emergency products and services, such as Dignity Health and fitness.
If you are now acquiring treatment
Underneath California’s continuity of treatment principles, some Dignity/Dominican-Santa Cruz people could continue to get limited care from Dignity Overall health companies. Continuity of treatment should be requested by the member and is subject to acceptance by the healthcare system. Anthem Blue Cross, at the enrollee’s request, must give for the completion of lined solutions as follows:
- For an acute issue
- For a serious serious ailment
- For the length of a being pregnant
- For the duration of a terminal illness
- For the treatment of young children concerning beginning and 36 months
- For surgery (or other methods) that have been approved by the program or its delegated company and is scheduled to happen in just 180 days of the contract’s termination date
To request continuity of care, individuals must connect with the health and fitness strategy variety on the back of their UC PPO approach member ID cards.
You can come across summaries of in-network and out-of-community summary charts linked underneath.
Additional data about your positive aspects is out there at the UC PPO plan site.
Lori and Sarah