San Francisco Marin Medical Society Blog

Covered California Plan Specific Information for San Francisco



As of April 2014, 289,021 individuals have enrolled in health plans through Covered California, California’s health benefit exchange. Of those, a majority were eligible for federal subsidy.

A wide array of new Exchange-based insurance products have been offered by 5 participating health insurance companies in San Francisco. 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.

The San Francisco Medical Society has pulled together some key facts and detailed information about the health plans participating in Covered California.

Key Facts

  • Covered California does not contract directly with physicians, hospitals, or other providers. All plans contract directly with providers and the terms of those contracts—financial and non-financial—are proprietary to each plan.
  • The ID cards of all patients who purchased a plan sold through Covered California are co-branded, displaying the logo of the health plan and the logo of Covered California.
  • Beyond the required coverage of essential health benefits, the products offered to group purchasers are not required to have identical networks or benefits as those offered to individuals.

Plan Specific Information for San Francisco

ANTHEM BLUE CROSS

Health Plan

Anthem Blue Cross

Exchange product(s)

Pathway X – EPO (tiered): Anthem Platinum DirectAccess – ceac, Anthem Gold DirectAccess, Anthem Silver DirectAccess, anthem Silver DirectAccess, Anthem Bronze DirectAccess – cacg, Anthem Bronze Direct Access w/HAS – caci, Anthem Catastrophic DirectAccess

“Mirror” product(s)

Pathway

Provider network/

benefits

Anthem is the only plan that has a tiered hospital network. In the EPO network, enrollees have a lower out-of-pocket cost I they use Tier 1 hospitals (“Preferred Network”). Tier 2 hospitals are in network, but members have higher cost-sharing when using these facilities. Anthem reports EPO physicians were selected for the network based in part on a history of referring primarily or exclusively to Tier 1 hospitals.

Provider Directory

https://www.anthem.com/health-insurance/provider-directory/searchcriteria

Contact Information

Network Relations (855) 238-0095, networkrelations@Wellpoint.com

BLUE SHIELD

Health Plan

Blue Shield of California

Exchange product(s)

Ultimate PPO, Preferred PPO, Enhanced PPO, Basic PPO, Get Covered PPO, Native American PPO

“Mirror” product(s)

Same names as Exchange Products

Provider network/

benefits

Blue Shield reports 35,000 physicians from 28 counties in its individual Exchange/mirror PPO and EPO networks. Blue Shield PPO enrollees can go to any Blue Shield Exchange PPO physician in any region as “in network.”

Provider Directory

https://www.blueshieldca.com/bsca/find-a-provider/home.sp?contentid=DoctorPPY

Contact Information

Hugo Florez, Senior Director, PPO and Specialty Networks Network Management – (818) 228-2607, Hugo.Florez@blueshieldca.com

CHINESE COMMUNITY HEALTH PLAN

Health Plan

Chinese Community Health Plan

Exchange product(s)

Platinum90 HMO, Gold80 HMO, Silver70 HMO, Silver73 HMO, Silver87 HMO, Silver94 HMO, Bronze60 HMO, Minimum Coverage HMO

Provider Directory

http://www.cchphmo.com/sites/default/files/pdfs/Provider_Commercial.pdf

Contact Information

Larry Loo, Director, Business Development and Operations – (415) 955-8800 x3241, LLOO@cchphmo.com

HEALTH NET

Health Plan

Health Net

Exchange product(s)

Health Net PPO Platinum, Health Net PPO Gold, Health Net PPO Silver, Health Net PPO Bronze, Health Net PPO Catastrophic

“Mirror” product(s)


Provider network/

benefits

Health Net reports its PPO network includes 44,000 physician. This network is used for all of Health Net’s PPO plans, regardless of where they are purchased. Participation terms for physicians are the same for both Exchange and mirror products.

Provider Directory

www.healthnet.com

Contact Information

David Davidson, Director of Contracts Administration and Provider Services/Operations – (818) 676-7331, david.s.davidson@healthnet.com

KAISER PERMANANTE

Health Plan

Kaiser Permanente

Exchange product(s)

Kaiser Permanente Platinum 90 HMO, Kaiser Permanente Gold 80 HMO, Kaiser Permanente Silver 70 HMO, Kaiser Permanente Bronze 60 HMO, Kaiser Permanente Bronze 60 Health Savings Account HMO, Kaiser Permanente Minimum Coverage HMO

“Mirror” product(s)

KP Platinum 0/20, KP CA Gold 0/30, KP CA Gold 500/30, KP CA Silver 2000/45, KP CA Silver HAS 1500/20%, KP CA Silver 1250/40, KP CA Bronze 5000/60, KP CA Bronze HAS 4500/40%, KP CA Bronze HAS 3500/30%, KP Catastrophic 6350/0

Provider network/

benefits

Kaiser Permanente reports a network of over 14,000 physicians, covering all specialties, and 36 licenses acute care hospitals. The entire network is available to all individuals, regardless of plan type.

Provider Directory

https://healthy.kaiserpermanente.org

Click here to view a comparison of all 5 plans participating in Covered California for the San Francisco region.


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