Streamlined medical services for SHBP retirees — Medicare Advantage plan from Anthem

At a glance:

• State Health Benefit Plan continues to offer a Medicare Advantage option through Anthem.
• Retirees will pay the same cost share for both in- and out-of-network services under this plan.
• Claims can be submitted electronically, and providers can access prior authorization details online.

Effective January 1, 2025, Anthem is anticipating group Medicare Advantage membership growth through State Health Benefit Plan (SHBP) retirees who are eligible for Medicare Parts A & B or Part B, but only enroll in a Medicare Preferred (PPO) plan from Anthem. Retirees have the freedom of receiving services from any provider if the provider is eligible to receive payments from Medicare. In addition, SHBP retirees will pay the same cost share for both in-network and out-of-network services. The Medicare Advantage Prescription Drug (MAPD) plan offers the same hospital and medical benefits that Medicare covers and covers additional benefits that Medicare does not, such as an annual routine physical exam, LiveHealth Online, and SilverSneakers.

The prefix on SHBP ID cards will be VGO. The cards will also show the SHBP logo.

Providers can submit claims electronically using the electronic payer ID for the Anthem plan or submit a UB-04 or CMS-1500 form to the Anthem plan. Claims should not be filed with original Medicare. Contracted and non-contracted providers may call the provider services number on the back of the member ID card for benefit eligibility, prior authorization requirements, and any questions about SHBP member benefits or coverage.

Detailed prior authorization requirements are also available to contracted providers by accessing the Provider Self-Service Tool at Availity.com.

We are committed to finding solutions that help our care provider partners offer quality services to our members.