identification (ID) card and UnitedHealthcare administrative processes should be followed.
Medicare Advantage (MA): Health Net Northeast’s Medicare Advantage (MA) members in Connecticut and Part D Prescription Drug Plan members in New York who are enrolled in a Health Net plan for 2010 will continue to be served by Health Net under the terms of that plan, subject to continued eligibility under such Health Net plans.
Medicaid (Healthy Options): Health Net of New Jersey’s Healthy Options (NJ Medicaid and FamilyCare) members will be transitioned to UnitedHealthcare’s AmeriChoice plan upon approval by the Division of Medical Assistance and Health Services (DMAHS). Members enrolling in AmeriChoice will receive an AmeriChoice identification card. For Health Net’s Medicaid members in New Jersey, there are no expected changes until the middle of 2010.
The Health Net claims, medical management and reimbursement policies and protocols will remain unchanged as a result of the transaction with UnitedHealthcare for all members, in accordance with the administrative services agreements between UnitedHealthcare and Health Net. Health Net will continue to provide all administrative services functions, other than contract renewals, to its members and health care providers, including claims payment, provider relations, provider services, prior authorizations, concurrent reviews, recredentialing, appeals and grievances, and member services, until such time as Health Net Northeast members have all renewed with UnitedHealthcare or another carrier.
7. For my Health Net patients currently undergoing treatment in the Northeast, whose policies do I follow? What happens if the customer/employer group renews while a member is in the process of receiving care?
Until your Health Net patients in the Northeast renew with UnitedHealthcare or another carrier they will continue to be covered under the terms of their existing Health Net plan, subject to continued eligibility under such Health Net plans. The Health Net claims, medical management and reimbursement policies and protocols will remain unchanged as a result of the transaction with UnitedHealthcare. Members will have the option to renew coverage with UnitedHealthcare or another carrier. If they choose a UnitedHealthcare or Oxford product, the member is subject to the terms and conditions of their new policy, including UnitedHealthcare’s transition of care policy.
8. Will UnitedHealthcare notify health care professionals of a change in carrier, or will it be the patient’s responsibility?
As with any change in carrier, the member will be sent a new ID card and should present that to his or her doctor, pharmacy or other health care professional to advise them of a change in coverage. Health Net also encourages members to contact their physicians to notify them of that change.