Health Insurance Marketplace / Affordable Care Act Quick

Health Insurance Marketplace / Affordable Care Act
Quick Reference Guide
Health Insurance
Marketplace
for plans effective January 1, 2015 – Nevada
The Affordable Care Act (ACA) compliant plans only apply to Individual and Small group business
Health Insurance Marketplace is commonly called the Exchange, but applies to both “on” and “off” exchange
plans
Difference between plans purchased: “On the Exchange” or “Off the Exchange”
• On the Exchange - refers to Individual and Small Group plans purchased through the Health Insurance
Marketplace (Nevada Health Link www.nevadahealthlink.com)
Network Names
Alpha Prefixes for
Health Insurance
Marketplace / ACA
plans
• Off the Exchange - refers to Individual and Small Group plans purchased through other channels such as a
broker, sales agent, or directly through a health insurance company (such as Anthem Blue Cross and Blue
Shield)
Network Name for plans sold ON Exchange:
• Pathway X – HMO
(Note: Currently a PPO product is not offered on the exchange, but a Pathway X – PPO network is in place
if a PPO product is expanded at a future date.)
Network Name for plans sold OFF Exchange:
• Pathway – HMO
− Available for Individual and Small Group products
• Pathway – PPO
− Available for Individual (new eff 1/1/15) and Small Group products
• PPO
− Available for Small Group products only
On Exchange
Alpha Prefix Health Plan Benefit Option
Product Type Network Name
(which will appear on Member ID card)
YFI, YFQ
Individual (Exchange)
HMO
Pathway X – HMO
Off Exchange
Alpha Prefix
YFC
YFH
XFR
YFD
YFO
Page 1 of 2
Health Plan Benefit Option
Product Type
Individual (OFF Exchange)
Small Group (OFF Exchange)
Individual (OFF Exchange)
New Effective January 1, 2015
Small Group (OFF Exchange)
Small Group (OFF Exchange)
HMO
HMO
Network Name
(which will appear on Member ID card)
Pathway - HMO
Pathway - HMO
PPO
Pathway - PPO
PPO
PPO
Pathway - PPO
PPO
Revised: November 20, 2014
Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba
HMO Nevada. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The
Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Sample Member ID
Cards
On and Off Exchange Sample
Plan Name inserted here
Note: The
templates will be
the same in 2015 as
they were in 2014
with the exception
of the Plan Names
and Network
Names will be
updated with the
new naming
structure for 2015
indicated in the box
to the right.
Network Name
inserted here
The naming structure for 2015 will look like the example below:
Member ID cards
will be replaced
upon renewal.
ACA compliant
plans offered in
2015
Health Insurance
Marketplace / ACA
plans Contact
Information
•
ACA Compliant plans offered in 2015 for Nevada (on and off exchange)
•
•
Provider Services for Exchange plans: 855-854-1438
UM Pre Authorization: 800-832-7850
Claims Mailing Address:
Anthem Blue Cross and Blue Shield
P.O. Box 5747
Denver, CO 80217-5747
Note: The preferred method for submitting claims is electronically, where the Payer ID would be the same as your
other Anthem claims.
Page 2 of 2
Revised: November 20, 2014
Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba
HMO Nevada. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The
Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

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