April 2014 Essential Qualified Health Plans – New Florida Blue Individual Plans Refer Members to In-Network Providers A qualified health plan (QHP) is a health insurance plan that must be certified by a Marketplace (Exchange) in order to be offered by a licensed health insurer and must provide certain mandated benefits. We recently discovered that some providers are not certain which network applies to our new individual under 65 Essential qualified health plans, and these members are being referred to out-of-network providers. Our Essential health plans use the BlueSelect, BlueCare® or BlueOptionsSM provider networks. To help your patients keep out-of-pocket costs as low as possible, be sure to refer Essential members to providers who participate in the network that supports their Essential plan. Please Note: Our new Essential qualified health plans are different from our older PPO Essentials plan, and different provider networks apply to these plans. Tips for Identifying the Right Provider Network for Your Essential Member The Plan Sponsor Name section under Subscriber Information in Availity®1 shows when a member is enrolled in an Essential individual qualified health plan (QHP). However, it does not show the corresponding provider network. See example below. ____________________________________________________________________________ Example: Subscriber Information Address 1: 1234 FLORIDA BLUE DR City, ST, Zip: Group Number: Plan Sponsor Name: JACKSONVILLE, FL 322310014 99999 QHP INDIVIDUAL UNDER65 ESSENTI Plan: 02/01/2014 - 12/31/9999 Plan Begin: 01/01/2014 Plan End: 12/31/2014 ____________________________________________________________________________ 1 Availity, LLC is a multi-payer joint venture company. For more information or to register, visit Availity’s website at availity.com. 900-4341-0314 Important: To identify which provider network supports your patient’s Essential health plan, be sure to check the Plan/Product Information section of the eligibility and benefits tool in Availity. You will find the name of the health plan in which the member is enrolled. Additionally, the Payer field indicates which provider network supports the Essential product. In the example below, you can see that the member is enrolled in an Essential health plan and the supporting provider network is BlueSelect. ____________________________________________________________________________ Example: Plan/Product Information Status: Active Coverage Dental Care, Health Benefit Plan Coverage, Medical Care, Mental Health, Service Type: Pharmacy, Professional (Physician) Visit - Office, Vision (Optometry) Plan/Product: ESSENTIAL PLAN 1439C Payer: BLUESELECT 1439C Address 1: PO BOX 1798 City, ST, Zip: JACKSONVILLE, FL 32231-0014 ____________________________________________________________________________ For more information about Florida Blue’s health Insurance plans, please refer to the Manual for Physicians and Providers on our website at floridablue.com; select the Providers tab, then Provider Manual. 900-4341-0314