City of Boston annual healthcare enrollment 2021

• If you do not take action during the Annual Enrollment period, you will be automatically enrolled in the new AllWays Value Network effective July 1, 2021.
• No plan design changes from current AllWays Standard HMO.
• In April, you will receive a letter from AllWays only if your Primary Care Provider (PCP) is no longer covered as an in-network provider in your new plan. At that time, we recommend also verifying with your other providers and facilities to ensure they are in the network or identifying alternative providers you can utilize.
• You will receive a new insurance card in June whether or not you chose to switch plans during the Annual Enrollment period.

If you do not take action during the Annual Enrollment period, you will be automatically enrolled in the new Blue Cross Blue Shield Standard (BCBS) HMO plan (Network Blue New England) effective July 1, 2021. 

• In April, you will receive a letter from BCBS only if your Primary Care Provider (PCP) is no longer covered as an in-network provider in your new plan. At that time, we recommend also verifying with your other providers and facilities to ensure they are in the network or identifying alternative providers you can utilize.
• In April, you will receive a letter from BCBS only if your prescription medications will no longer be covered under the continued BCBS Standard HMO plan.
• You will receive a new insurance card in June whether or not you chose to switch plans during the Annual Enrollment period.
• In addition, the City of Boston/PEC agreement includes plan design changes effective July 1, 2021:
  
  
  

•  If you do not take action during the Annual Enrollment period, you will remain in the BCBS PPO (Blue Care Elect Preferred) plan.
• In April, you will receive a letter from BCBS only if your prescription medications will no longer be covered under the continued BCBS PPO plan.
• You will receive a new insurance card in June whether or not you chose to switch plans during the Annual Enrollment period.
• In addition, the City of Boston and PEC agreement includes plan design changes effective July 1, 2021:

Will I receive a new ID card?

Yes, you will receive a new AllWays Health Partners ID card prior to the July 1, 2021, effective date.

Where can I check to see if a medication I'm on requires prior authorization or a formulary exception? Where can I see what tier my medication is on?

You can visit the AllWays website. You can type in the name of the medication and hit search or search by the therapeutic class. You will then be taken to a page that will let you know the status of the medication. Learn more on how to navigate the site.

Which providers are in the Value HMO network?

The Value HMO network is designed to help ensure access to the highest quality care with the greatest value for members in Massachusetts. Many of the region’s most respected institutions are part of the network. These include:

• Massachusetts General Hospital
• Brigham and Women’s Hospital
• Beth Israel Deaconess Medical Center
• Lahey Clinic
• Spaulding Rehab
• Mass Eye and Ear
• Boston Medical Center
• Newton-Wellesley Hospital
• North Shore Medical Center
• South Shore Hospital, and
• many more.

AllWays also works with many of the leading provider organizations like Atrius Health, including Harvard Vanguard. This network sheet provides examples of major providers who participate and do not participate in the network. We encourage you to see if your providers participate by searching AllWays' online provider directory. Learn more on how to navigate the site.

Which providers do not participate in the Value HMO network?

Boston Children’s Hospital, Dana-Farber Cancer Institute, and Tufts Medical Center are examples of hospitals that are not in the Value HMO Network. Members will be able to receive specialty care at many leading hospitals. These include the Mass General Cancer Center, Mass General Hospital for Children, and Mass Eye and Ear. Please see AllWays' network overview for a list of the major participating network providers. 

Are there any changes to the behavioral health providers?

There are no changes to the behavioral health provider network. Current behavioral health providers in the AllWays Standard HMO network will also be in the Value HMO network.

What if I have concerns about care transition?

If any of your current providers are not in the Value HMO network, and you are concerned about your care needs, AllWays has specially trained professionals that are available to discuss any current or planned health care needs you or your family may have. They can help get existing approvals from your current insurer transferred to AllWays, your you providers in the network, and ensure a smooth transition and coordination of care.

Want to learn more about your coverage? Download the FY22 AllWays Value HMO Summary of Benefits and Coverage plan.

Will I receive a new ID card?

Yes, you will receive a new Blue Cross Blue Shield MA (BCBSMA) ID card prior to the July 1, 2021, effective date.

What happens if I don't receive my ID card by July 1, 2021?

You can reach out to Member Services and request a new ID card. Member Service can also help you pull a Digital ID card on the MyBlue portal. 

Please note: If you didn't receive an ID card because your address is incorrect, you would need to update your address directly with the City. You cannot update your address through BCBSMA Member Services.

Will I need a separate ID card for prescriptions?

No, you will be able to use your BCBSMA card to fill prescriptions at the pharmacy.

My dependent has been approved to stay on the HMO plan past their 26th birthday due to disability. Will they remain eligible on the Blue Cross Standard HMO? 

Yes, all disabled dependents who Harvard Pilgrim Healthcare (HPHC) approved will be approved for eligibility on the BCBSMA Standard HMO plan for the first six months of coverage. 

You will need to request an extension of coverage for your disabled dependent to continue coverage after January 1, 2022. You will receive a letter from BCBSMA in July advising you of the six-month approval. Along with the letter, you will receive a form you can complete to request an extension for coverage for your dependent. You will also receive a reminder letter in December 2021 letting you know that you need to request an extension of coverage for your disabled dependent.

Will dependents living outside of New England still be covered?

Coverage will continue to be available for those dependents who reside outside of New England as a result of being a student. Any out-of-area dependent who is actively registered with Harvard Pilgrim prior to June 1 will be grandfathered and automatically rolled over to the BCBSMA HMO, including those who are no longer students. After July 1, if you are calling BCBS Member Service to newly register your out-of-area dependent, they must be either a full-time or part-time student. 

How can I find out if my doctor or provider participates with BCBSMA?

Before you get your ID card, you can see if your doctor or provider participates in the HMO Blue New England network by visiting the Blue Cross website and following the steps outlined below:

1. Select the HMO Blue New England network in the first search bar on the upper left side of the page. 

2. Next, on the upper right-hand side, enter the city or town your provider is located in. 

3. Then, you can enter the type of provider or your provider's name in the search box as pictured below. Start with the first initial and last name of your provider. As a reminder, some providers can be found by searching for their practice name. 

Once you receive your ID Card, you can register for an account on the MyBlue portal.  The plan network on the Find a doctor site will prepopulate if you are logged in through the MyBlue portal.  You will receive information on how to register.

What do I do if my provider is not in the BCBSMA HMO Network?

 We understand that it is difficult to leave doctors you've had long-term relationships with. To make this transition easier and minimize interruptions to treatment programs underway, you can request a temporary transition of care. If approved, the treatment program will be for a specific period to give you and your covered family members enough time to transition to a health care provider in the network. 

You can request a temporary transition of care by completing the form located online. Select the section that says Health Plans Miscellaneous and choose the second to last form listed titled Transition of Care for New Members.  

Do I need to select a Primary Care Physician (PCP) on this plan?

Yes, this plan requires you to select a Primary Care Physician.

Can I select an OBGYN as my PCP on this plan?

Unfortunately, the HMO plan does not allow you to select an OBGYN as a PCP. You can visit the Blue Cross website to find a PCP that is accepting new patients in your area.

What happens if my Primary Care Physician doesn't participate as a PCP with BCBSMA?

You will need to select another Primary Care Physician to list with BCBSMA. 

In most cases, the PCP you had listed with your previous insurance is a Physician's Assistant or Nurse Practioner that works under a Primary Care Physician. We recommend that you reach out to your provider's office and ask them who you should list as your Primary Care Physician with BCBSMA.

I had a referral to a specialist on my HPHC HMO. What happens to that referral on the BCBSMA HMO?

The City of Boston is sending all open referrals from the last 90 days of the Harvard Pilgrim plan to BCBSMA.  Any referral that is still active over the last 90 days (April 2021 - June 2021) of the plan will be transferred over to BCBSMA.

I had an authorization approved for a service on my HPHC HMO, what happens to that authorization on the BCBSMA HMO?

The City of Boston is sending all open authorizations from the last 90 days (April 2021 - June 2021) of the Harvard Pilgrim plan to BCBSMA.  Any authorization that is still active over the last 90 days of the plan will be transferred over to BCBSMA.

I was enrolled in the Case Management Program with Harvard Pilgrim.  Will I need to reach out to BCBSMA to enroll in their Case Management Program?

No, HPHC will be sending a file of all members currently enrolled in Case Management to BCBSMA.  Anyone currently enrolled will be automatically enrolled in Case Management with BCBSMA.

Where can I check to see if a medication I'm on requires prior authorization or a formulary exception?

You can visit the Blue Cross website. On the first page, you can type in the name of the medication and hit search. You will then be taken to a page that will let you know the status of the medication.  This feature is available to all new members today.

Will the cost of my medication change?

It is possible that the medication you are on will change tiers, and your cost will change. If the medication is changing tiers, Blue Cross will send you a letter in April letting you know that tier and cost changed.

Where can I see what tier my medication is on?

You can view the 2021 Express Scripts National Preferred Formulary List to see what tier your medication falls under. 

What happens if I’m on a medication that is not covered?

Blue Cross will send you a letter in April if you are on a medication that is not covered. The letter will detail the steps you need to take to request a formulary exception through your physician once the plan goes live on July 1, 2021.

Please note that formulary exceptions are not always approved.

What happens if I am on a medication that requires prior authorizations?

The new BCBS Standard HMO formulary does not require prior authorizations. 

What happens if I’m on a Step Therapy Medication?

The new BCBS Standard HMO plan formulary does not have a Step Therapy program.

Where do I get mail-order prescriptions from?

You can get your mail-order prescriptions through Express Scripts mail order pharmacy after July 1, 2021.

Will my existing mail-order prescriptions transfer over to Express Scripts?

The City has authorized HPHC to send a list of all open mail-order prescriptions and refills from Optum. Those prescriptions will transfer over to Express Scripts. Your mail-order will not be released until you create an account and provide billing information.

You can download the FY22 BCBS HMO Summary of Benefits and Coverage plan to learn more about your coverage.