State of Connecticut Employer Group provider tiering updates

Beginning July 1, 2022, the State of Connecticut Employer Group is expanding the number of specialties eligible to be tiered.  

 

There will be two (2) tiers (cost share levels) for members of the State of Connecticut Employer Group networks. In addition to allowing these members to use different tiered levels of primary care providers (PCPs), the following expanded list of specialties will also be tiered:

 

·    Family practice	·     Pulmonary disease
·    Internal medicine	·     Gastroenterology
·    General practice	·     Otolaryngology
·    Pediatric medicine	·     Cardiac electrophysiology
·    Cardiology	·     Neurology
·    Orthopedic surgery	·     Allergy immunology
·    Psychiatry	·     Urology
·    Obstetrics gynecology	·     Colorectal surgery
·    Endocrinology	·     Dermatology
·    Emergency medicine	·     Nephrology
·    General surgery	·     Ophthalmology
·    Rheumatology	·     Thoracic surgery
·    Hematology/oncology

 

All other specialty care will not be tiered.  

 

Members who receive services from PCPs or specialists that are designated as Value Tier 1 will have lower cost shares than those who receive the same services from PCPs or specialists that are Participating Tier 2. Value Tier 1 PCPs and specialists will continue to have an identifier in our provider directory. 

 

The above applies to State BlueCare Prime, State Preferred, and State BlueCare networks. These changes only apply for State of Connecticut Employer Group members.

 

Updates specific to State of Connecticut BlueCare Prime Tiered Network ONLY

State of Connecticut Employer Group members who receive services from Value Tier 1 PCPs and specialists will have a $0 copay. Participating Tier 2 PCPs will have a $50 copay, and Participating Tier 2 specialists will have a $100 copay. Members who receive services from participating specialty care providers who are not tiered will have a $0 copay.

 

Referrals will no longer be required for State of Connecticut Employer Group members utilizing the State of Connecticut BlueCare Prime Tiered Network.

 

Sample of the new State of Connecticut BlueCare Prime tiered member ID card

   

 

 

State of Connecticut Employer Group and State Partnership Plan member ID number prefix list

 

Network Name	Product Type	State of Connecticut	State Partnership Plan
State Preferred	PPO	XGS	N/A
State BlueCare	HMO - Point of Service (PCP referral not required)	XGR	SHP
State BlueCare	HMO - Point of Enrollment (PCP referral not required)	XGT	N/A
State BlueCare	HMO - Point of Enrollment (PCP referral required)	XGL	N/A
State BlueCare Prime (Narrow Network)	HMO - Point of Service (PCP referral not required)	X6G	N/A

2755-0622-PN-CT