In the Joint Health Management Board’s (JHMB) continual efforts to enable our PPO plan participants to be informed and responsible health care consumers, we have prepared the enclosed materials to help your transition into the 2022 plan year. Effective January 1, 2022, you will have both a new PPO network medical vendor (Aetna) and a new telehealth vendor (Teladoc). All existing in-network services provided by Anthem Blue Cross and PlushCare will end on December 31, 2021. We invite you to review the information below to better understand these changes, how they may affect you, and what you may need to do to prior to January 1, 2022.
Aetna Choice POS II Network – A Nationwide Network
Starting January 1, 2022, the District’s PPO plans will switch to Aetna’s nationwide Choice POS II Network for in-network medical services – allowing you more choice and broader access. This change does not affect your prescription drug services, as Elixir will continue to provide prescription drug services for the PPO plans. It also does not affect any of your other benefits – such as acupuncture, chiropractic, dental, vision, mental health and substance abuse. In addition, Delta Health Systems will continue to be your primary contact for PPO plan member services and claims.
Check if Your Current Medical Provider is in the Network
The majority of providers seen by our PPO plan participants in Anthem’s California network are also in Aetna’s national network.* The JHMB expects minimal disruption for our plan participants as a result of this change. Please review the Aetna Welcome Guide (available below) with detailed information about how to search for providers in their network. We recommend that you review the Aetna provider network to see if all of your existing providers are within the Aetna network. If they are not within the Aetna provider network, we recommend that you begin to identify in-network providers for medical services required on or after January 1, 2022, and schedule any necessary appointments.
* Please note this data is based on information provided during the JHMB’s earlier analysis and is subject to change.
NOTE: It is important to use Aetna’s dedicated microsite for the District’s plan (www.AetnaResource.com/p/FresnoUSD) when searching for medical providers, or contact Delta Health Systems at 1-800-807-0820. The use of any other site, including Aetna.com, will provide inaccurate search results based on our plan structure. In addition, please note that the following services and providers are not part of the Aetna network through the District’s PPO plans, even though you may see them listed in the online directory:
- Acupuncture
- Chiropractic
- Dental
- Mental health
- Pharmacy
- Substance abuse
- Sutter Health Systems providers
- Vision
For details on finding providers for these specific services available under the District’s PPO plans, please visit www.JHMBHealthConnect.com/locating-network-providers.
Download the Aetna Welcome Guide (PDF)
Transition-of-Care Benefits
If you’re receiving ongoing treatment from a provider who is currently in network for Anthem, but is not in the Aetna network, you can apply for transition-of-care (TOC) benefits. If approved, benefits will be paid based on in-network coverage for a short period of time, usually 90 days. Review the enclosed Aetna Welcome Guide for details on the types of situations that may qualify for transition of care. To apply for this benefit, visit www.AetnaResource.com/p/FresnoUSD to download the Transition Coverage Request form. You may also call Delta Health Systems at 1-800-807-0820 to request the form. The form will provide further instructions.
Also, be informed that if by chance you are receiving in-patient care for covered services at 11:59 PM on December 31, 2021, in a facility that is not affiliated with the Aetna PPO Network, then you will continue to receive uninterrupted care until you are discharged. Your in-network benefits will apply for your entire in-patient stay, so long as the in-patient facility is an Anthem network provider. Otherwise, out-of-network benefits apply.
Precertification (i.e., Prior Approval)
Certain services require precertification. For in-network services, the precertification will be handled by your in-network provider. They will start the process and communicate with Aetna. However, if you wish to use an out-of-network provider, it’s important that you ensure your out-of-network provider obtains precertification from Aetna, if applicable. If they do not obtain precertification, your care may not be covered. Visit www.AetnaResource.com/p/FresnoUSD to download the Aetna Precertification Information, which includes the full list of services and medications that need prior approval from Aetna.
NOTE: Not all of the services listed in Aetna’s Precertification Information are covered by the District’s plans. If you have any questions regarding covered services, contact Delta Health Systems at 1-800-807-0820.
24-Hour Nurse Line & Case Management
Aetna offers a 24-hour Nurse Line to provide information on a variety of health topics. While the nurses cannot diagnose, prescribe, or give medical advice, they can answer your questions and provide information to help you make health decisions. The Nurse Line is free of charge and available anytime – day or night – at 1-800-556-1555 (TTY: 711). In addition, as part of Aetna’s Case Management program, some plan participants may receive outreach calls from Aetna regarding their care. These calls are designed to help you and your doctor close gaps in your care, improve clinical outcomes, avoid unnecessary and costly health events, and help you maximize your health plan benefits. Aetna’s Case Management programs are 100% voluntary, but the JHMB encourages you to participate if you receive a call.
CVS CarePass
Starting January 1, 2022, you can register for a CVS CarePass membership at no cost as part of your Aetna network benefits. Enjoy CVS in-store and online perks that make healthier easier — from monthly rewards to discounts on thousands of your favorite CVS Health® brand products. Review the enclosed Aetna Welcome Guide for more details.
NOTE: Registration for CVS CarePass will only be available on or after January 1, 2022, and through the Aetna Member Portal.
Next Steps – New Member ID Cards & Medical Services After January 1, 2022
- December 2021: Prior to the network change on January 1, 2022, you’ll receive new Member ID cards from Delta Health Systems. While the physical cards are scheduled to arrive prior to January 1, 2022, you may have access to download and print an electronic version before that time. We invite you to log on to the Delta Health Systems member portal (www.deltahealthsystems.com) after December 15, to check and see if your new card is available for download.
Once you receive your new Member ID card, be sure to present your new card to medical providers on your next visit to ensure your claims are processed accurately and timely. In addition, should you wish to create an account on the Aetna Member Portal, you may do so only after you receive your new Member ID card. - January 2022: On January 1, 2022, begin scheduling and/or visiting Aetna providers for in-network medical services. You will continue to contact Delta Health Systems for member services and claims matters. And remember, when possible, we recommend you use in-network providers to reduce your out-of-pocket costs and avoid unnecessary fees. Services provided out-of-network could result in significant out-of-pocket costs that are not reimbursed by the District’s medical plan.
Teladoc to Replace PlushCare for Telehealth Services starting January 1, 2022
Effective January 1, 2022, Teladoc will provide telehealth services for PPO Plan Options A & B. With Teladoc, you can connect with leading board-certified physicians in your state through the internet or telephone, helping you avoid emergency rooms and urgent care centers. Teladoc can also assist with prescription medications and with many non-emergency illnesses, including:
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While you may download the Teladoc mobile app to get prepared, you will not be able to register for this service (via phone, web, or mobile application) until the January 1, 2022 effective date. We invite you to review the Teladoc flyer (available below) and keep it handy as January 1 nears. As a reminder, currently telehealth services remain free. The $0 copay shall continue until the COVID-19 national emergency is declared over.
NOTE: PlushCare remains the covered telehealth service for PPO Plan Options A & B through December 31, 2021. Continue to use this service through the end of the year (2021) for your telehealth needs. For more information regarding this service, please visit www.JHMBHealthConnect.com/telehealth-at-your-fingertips.
Download the Teladoc Flyer (PDF)
For More Information & Assistance
Below you’ll find some Frequently Asked Questions (FAQs) to help address some of your initial concerns regarding the upcoming plan changes. Should you have any additional questions after reviewing the FAQs, you may contact Delta Health Systems at 1-800-807-0820 for additional support or email the JHMB at jhmbhealthconnect@yahoo.com.
NOTE: The contact email address of JHMBHealthConnect.com is not a secure email address. For your safety and privacy, you should not include any information in your emails to this address that contain confidential information, such as patient medical information. Should we require this information to respond to your request, we will follow up with you directly.
Download the FAQs (PDF)
