Colorado Option Standard networks and plans are now active in market for 2023

Anthem Blue Cross and Blue Shield and our subsidiary company, HMO Colorado (Anthem), has launched Colorado Option Standard Plans and networks to support these new plans effective as of January 1, 2023.

We conducted provider webinar trainings on these new networks in 2022. If you missed one of these sessions, please access a recording via this link:

• Working with Anthem webinar: Colorado option – Part two
• Password (case sensitive): WwA092022

 

Anthem networks impacted

To be compliant with the Colorado Option laws, Anthem must offer the Colorado Option Standard plans on a network as broad or broader than used for its non-standard health plans in that area/market. To do so, we have created some new networks to support our Colorado Option Standard plans. As you can see, networks supporting the Colorado Option plans are called standard networks while networks supporting non-Colorado Option plans are called non-standard networks.

Five networks: Standard networks are used for the Colorado Option:

• Pathway Standard (New)
• Pathway PPO Standard (New)
• Pathway Essentials Standard (New)
• Pathway Essentials PPO Standard (New)
• Mountain Enhanced Standard (New)
  
  

Five networks: Non-standard networks are referred to as our original networks:

• Pathway
• Pathway PPO
• Pathway Essentials
• Pathway Essentials PPO (New (non-standard))
• Mountain Enhanced
   

Guidelines for participation:

• Providers participating in our Non-Standard (original) networks were invited to participate in our Standard (Colorado Option) networks.
• Per the law, Standard (Colorado Option) networks cannot be narrower than Non-Standard (original) networks. Therefore;
• Participation is required in both Non-Standard (original) and Standard (Colorado Option) networks.
• If a provider chooses not to participate in the New Standard (Colorado Option) networks, they may be removed from the Non-Standard (original) networks as well.

Identifying members tied to Standard Networks in a Colorado Option Plan:

Approved network name	Prefix	Network type	Medical product type	LOB	Product portfolio
Pathway Standard	P7F, P7G	HMO	HMO	IND	Standard
Pathway PPO Standard	F6W	PPO	EPO	SG	Standard
Pathway Essentials Standard	R8D, R8E	HMO	HMO	IND	Standard
Pathway Essentials PPO Standard	F6P	PPO	EPO	SG	Standard
Mountain Enhanced Standard	C8P, C9S, R8P	HMO	HMO	IND/SG	Standard

Note: Plans created for the Colorado Option will include Colorado Option within the plan name and networks created to support Colorado Option plans will include Standard within the network name.
As a couple of reminders about these new networks:

• Options for Enrollment for Affordable Care Act (ACA) plans:
  • Colorado Connect is a wholly-owned subsidiary of C4HCO which offers Colorado Option plans through a program called OmniSalud.
  • OmniSalud is a New program that provides undocumented Coloradans with a safe way to compare affordable health insurance plans and enroll on a secure online platform. For more information on OmniSalud visit: https://connectforhealthco.com/get-started/omnisalud/
• Individual members can enroll on exchange through Connect for Health Colorado (C4HCO) or off exchange:
• Small Group members (off exchange only) enroll through brokers or Anthem directly.

• Open access HMOs:

• For any plans utilizing the HMO Colorado Option Standard network, a member must select a primary care provider (PCP). That said, these HMO networks are open access, which means members do not need a referral from their PCP to see any of the providers within their specific Standard network:
  • For example:
    • A member in a plan utilizing the Pathway Essentials Standard network will select a PCP. The member can see any other provider within the Pathway Essentials Standard network (even another PCP) without a referral.
    • The member must stay within their designated network and does not have out of network benefits.
• PCP selection:
  • Since the Colorado Connect members come to us through the exchange, they don’t have the option to select a PCP at enrollment.
  • Anthem auto-picks a PCP for the member based on geography, and the member can change at any time on the member’s anthem.com website.

COBCBS-CM-017937-23