San Francisco Marin Medical Society Blog

Differentiating Mirror Products from Covered California Products

Covered California reports that 289,021 Bay Area individuals have enrolled in exchange plans, which significantly surpasses original targets. For the San Francisco region, a wide array of new Exchange-based insurance products have been offered by 5 participating health insurance companies. Additionally, federal law requires that every plan offered through Covered California also be offered outside of the Exchange (called “mirror” products), with the same benefits, premiums, and provider networks.

How can I identify mirror products that are sold outside of Covered California but utilize the narrowed exchange provider networks?

Practices must review patient ID cards and eligibility information closely to identify whether the practice is in or out of network for that particular plan. Every plan offered in the exchange must also be offered outside of the exchange, using the same provider network. Confusion around these off-exchange products, also called “mirror” products, has resulted in a number of practices unknowingly seeing patients out-of-network for products that use a narrowed exchange provider network, as these ID cards will not have the Covered California logo. The issue is specific to just Anthem Blue Cross and Blue Shield of California, because they are the only two plans offering narrowed networks.

Blue Shield mirror products will list one of the following product names on the patient ID card:

  • Basic PPO/EPO
  • Enhanced PPO/EPO
  • Get Covered PPO/EPO
  • Preferred PPO/EPO
  • Ultimate PPO/EPO

  • Anthem Blue Cross mirror products will list “Pathway” on the bottom of the card. The product names for mirror products, which appear on the top of the ID card are:

    • Anthem Core DirectAccess (EPO/PPO)
    • Anthem Essential DirectAccess (EPO/PPO) 
    • Anthem Essential Guided Access (HMO) 
    • Anthem Preferred DirectAccess (EPO/PPO) 
    • Anthem Premier DirectAccess (EPO/PPO) 
    • Anthem Premier Guided Access (HMO)
A detailed list of exchange and mirror product names for the San Francisco region can be found by clicking here.

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