Beginning Jan. 1, 2017, Anthem Blue Cross is the administrator for medical and behavioral health benefits for UC’s preferred provider organization (PPO) medical plans for employees (Core, UC Care and UC Health Savings Plan) and for retirees (UC High Option Supplement to Medicare, UC Medicare PPO and UC Medicare PPO without prescription drugs). OptumRx is the administrator for prescription drug benefits for these plans (except UC Medicare PPO without prescription drugs).
UC has worked to minimize disruptions for members, but there will be some changes to medical and behavioral health provider networks and to pharmacy costs. The steps below can help you prepare for this change:
- Confirm your current doctors and other providers (including behavioral health) are in-network. Call Anthem Health Guide or search for your provider on anthem.com/ca/uc.
- Check OptumRx formulary and prescription drug costs. OptumRx uses a different formulary than Blue Shield. Your current covered medications will continue to be covered, but the cost of the medications may change. View the OptumRx formulary on optumrx.com/UOCALIF or optumrx.com/UOCALIF2 (for Medicare plans with prescription drug benefits) and use the Optum Price and Save tool to help you identify cost options for your medications. You may want to talk to your doctor about an alternative formulary drug to help you manage your costs. For questions, call OptumRx Member Services.
- To request transition assistance, call Anthem Health Guide. If you are currently receiving medical or behavioral health care from a provider that will not be in-network in 2017, transition assistance may be available for:
- An acute (short-term) or serious chronic (long-term) medical or behavioral health condition
- Pregnancy and newborn care
- A planned surgery or other procedure
- A terminal illness
- To request prior authorization, call Anthem Health Guide. If you received a prior authorization for a medical or behavioral health service from Blue Shield or Optum, but the procedure or treatment is scheduled after Jan. 1, 2017, you will need to get another prior authorization from Anthem Blue Cross.
- If you need information about medical or pharmacy claims from 2016 and previous years, call Shield Concierge for assistance at 855-339-9973. If you registered for an online Blue Shield account by Dec. 31, 2016, you will have online access to your claims and other member information until December 31, 2017.
- If you need information about Optum behavioral health claims from 2016 and previous years, call Optum for assistance at 888-440-8225. Optum will continue to provide information and assistance to past UC members when needed.
In late December, Anthem began mailing ID cards to all members. If you need to access care before you receive your ID card, you can use your Social Security Number, print an ID card from the Anthem website or call Anthem Health Guide for assistance at 844-437-0486.
Members of UC High Option Supplement to Medicare and UC Medicare PPO will receive an additional ID card from OptumRx to access pharmacy/prescription drug benefits. If you need to access pharmacy benefits before you receive your ID card, you can print an ID card from the OptumRx website or call OptumRx for assistance at 855-489-0651.
In mid-January, some members may receive a second ID card from OptumRx. If you receive a second ID card, it will replace your initial card.
Medical and behavioral health services
Anthem Health Guide
844-437-0486 (Monday to Friday, 5 a.m. to 8 p.m. PT)
OptumRx Member Services
855-489-0651 (Monday to Friday, 7 a.m. to 10 p.m. PT)
optumrx.com/UOCALIF (Core, UC Care, UC HSP)
optumrx.com/UOCALIF2 (UC High Option Supplement to Medicare, UC Medicare PPO)
optumrx.com (register for online access to information about your prescriptions and pharmacy benefits)
Health Savings Account (HSA)
HealthEquity Member Services