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2017 vendor changes for UC’s Preferred Provider Organizations (PPO) plans

With Blue Shield of California’s rate guarantees expiring, a UC work group of benefit professionals, faculty and staff evaluated other vendors through a formal request for proposal process. After a thorough review, UC has selected Anthem to replace Blue Shield as the claims administrator and network provider for the following UC plans:

  • UC Care
  • Health Savings Plan (HSP)
  • Core
  • Blue Shield Medicare plans

Anthem will also administer behavioral health benefits for these plans, replacing Optum. Optum will continue to administer behavioral health benefits for Health Net Blue & Gold, Kaiser and Western Health Advantage plans. Prescription drug benefits for PPO plans will be administered through Optum Rx.

Changes will be effective Jan. 1, 2017.

Anthem is well-positioned to support UC as a long-term partner through a constantly changing health care landscape. Optum Rx is a pharmacy expert specializing in the delivery, clinical management and affordability of prescription medications.

What this means for current UC Care, HSP and Core members

Employees who are currently enrolled in UC Care, HSP, Core or Blue Shield Medicare plans will not see any changes in their coverage or provider network this year.

In 2017, these plans will continue to offer many of the same features, including the option to see a specialist without a referral and to see non-network providers. However, a few changes may affect you:

  • Provider network — Anthem’s medical provider network is very similar to Blue Shield’s, so most members will be able to continue seeing their current medical providers. There is considerable, but currently not complete, overlap between Anthem’s behavioral health provider network and Optum’s network. Throughout 2016, Anthem will be working actively to expand its behavioral health provider network to minimize any provider disruptions for UC employees.
  • Pharmacy benefits — Medications covered under your current plan will continue to be covered by Optum Rx. Some prescription copays may increase or decrease depending on the medication. Members will be able to confirm their prescription copays during Open Enrollment.


More information about these 2017 changes will be available during Open Enrollment this fall. We will also provide updates about 2017 provider networks and prescription costs as new details become available. In the meantime, please refer to our Frequently Asked Questions for general information about the transition.

This article originally appeared on UCnet.

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