Update – October 13, 2023:
Anthem and the UC Health System have agreed to extend their contract to March 1, 2024 (from December 31, 2023). Both parties have agreed to finalize the contract extension by December 31, 2023.
CalPERS Anthem Blue Cross (Anthem) members have reported receiving emails and letters from the UC Health System regarding a potential termination from Anthem’s network. Anthem’s contract with UC Health System is set to expire on January 1, 2024. Anthem and UC Health System are actively negotiating to renew the contract prior to the termination date. The potential termination affects the entire UC Health System, including hospitals and facilities, and medical groups.
Frequently Asked Questions
What is the status of the negotiations between Anthem Blue Cross and UC Health System?
Both Anthem and UC Health System have expressed a strong interest in negotiating a new contract prior to January 1, 2024, and are currently engaged in active negotiations. Contract discussions are a standard part of the health care industry.
What Anthem Blue Cross plans are affected by a potential UC Health System contract termination?
If a termination occurs, it will affect Anthem Blue Cross Basic members who are enrolled in PERS Platinum, PERS Gold, Anthem Blue Cross Traditional HMO, and Anthem Blue Cross Select HMO.
Members enrolled in the PERS Platinum Medicare Supplement, PERS Gold Medicare Supplement, and Medicare Preferred plans would not be impacted by this potential termination.
If a termination occurs, would it be considered a qualifying event, allowing CalPERS members to change health plans?
No, terminations are not considered a qualifying event, which include when you lose other health coverage or you have new family members, for example. Members would not be able to change health plans because of a termination.
If Anthem and UC Health System reach agreement after January 1, 2024, and I changed to a different health plan during Open Enrollment, am I able to change back to Anthem?
No, changes to a plan’s network are not a qualifying event to change your health plan.
Does this impact Anthem members who are being treated for ongoing conditions or other long-term conditions at UC Health facilities?
There would be no immediate impact to those currently receiving care or who have preauthorized services through UC Health. By state law, health contract terminations must provide for continuity of care. This means members with certain specified conditions — those who are pregnant or with a newborn, individuals with chronic conditions, significant mental health issues, and those undergoing treatment for a potentially terminal illness, for example — will continue to be able to see their current providers in-network for the time specified by the continuity of care provisions under state law.
Will members be notified if the contract terminates?
If there were to be a termination, five days after the termination from the network, Anthem Blue Cross would notify members who accessed UC Health Hospital Systems within the last 12 months by mail. Members authorized or scheduled for a service or procedure at a UC Health Hospital System would be also notified. The letters will instruct members to call Anthem Blue Cross at the toll-free member services number on their ID card if they are in a current course of treatment at UC Health Hospital System or have questions or concerns about the contract termination.
Members who have a UC Health System primary care physician, internist, general practitioner, obstetrician-gynecologist, pediatrician, family physician, or nonphysician medical practitioner who is serving as a primary care provider will receive a notification letter in advance of the January 1, 2024, termination. Anthem will likely send these letters out by early October to meet notice requirements under state law.
What is CalPERS’ policy on health provider disruptions?
CalPERS believes strongly that it is inappropriate for providers and health plans to involve members in contract disputes and has communicated that position to both parties in this negotiation. The CalPERS policy on potential provider disruptions is to allow the parties to continue negotiations and work toward resolution, without advantaging one side over the other by intervening.