UC Santa Cruz learned on Friday that the contract between Anthem Blue Cross, the insurance carrier of UC's commercial PPO plans (non-Medicare plans), and Dignity Health, a health care provider which includes Dominican Hospital-Santa Cruz, ended, effective July 15.
This contract termination affects members of the following UC PPO plans: UC Care, Health Savings Plan, and CORE. This contract termination is deeply disappointing news, especially in the midst of a continuing pandemic.
We recognize that this contract termination and the resulting uncertainty of when a resolution might be reached has significant impacts on many members of our campus community and their families. We remain hopeful that Anthem and Dignity will come to agreement on mutually beneficial terms. UCSC leadership is working closely with the UC Office of the President, which manages the systemwide benefits program, to develop guidance for affected UC PPO members.
We will provide ongoing communications on this evolving situation as new information becomes available. Please contact the UCSC Benefits Office at benefits@ucsc.edu to opt-in to communications and to ask additional questions. Staff Human Resources is developing a page with answers to frequently asked questions that will be published at shr.ucsc.edu later this week.
If you are a member of an Anthem PPO plan and receive care from Dignity Health Providers after July 15, 2021
Members of UC PPO plans who receive care from Dignity Health and Dominican Hospital after 5 p.m. July 15, 2021 should note that:
- Claims for services received will be processed at the out-of-network coverage tier.
- Annual deductible amounts are higher for out-of-network care.
- Higher out-of-network co-insurance rates, except for services pre-approved under the continuity of care rules described below, will be the patient's responsibility.
- The patient may be responsible for the balance of costs above the allowed amount for care received from non-network providers.
- Emergency medical services do not require pre-authorization regardless of where services are delivered. Members may go to any hospital for emergency services, including Dignity Health.
If you are currently receiving care
Under California's continuity of care rules, some Dignity/Dominican-Santa Cruz patients may continue to receive limited care from Dignity Health providers. Continuity of care must be requested by the member and is subject to approval by the medical plan. Anthem Blue Cross, at the enrollee's request, must provide for the completion of covered services as follows:
- For an acute condition
- For a serious chronic condition
- For the duration of a pregnancy
- For the duration of a terminal illness
- For the care of children between birth and 36 months
- For surgery (or other procedures) that have been authorized by the plan or its delegated provider and is scheduled to occur within 180 days of the contract's termination date
To request continuity of care, patients should call the health plan number on the back of their UC PPO plan member ID cards.
You can find summaries of in-network and out-of-network summary charts linked below.
More information about your benefits is available at the UC PPO plan website.
Sincerely,
Lori and Sarah
