Effective January 1, 2021, Electrical Workers Local 357 in Nevada will offer a Medicare Preferred (PPO) plan from Anthem. Anthem will provide medical benefits for the Electrical Workers Local 357 retirees through Anthem’s Local Preferred Provider Organization (LPPO) product, which includes the National Access Plus benefit. This plan allows members to receive services from any provider, as long as the provider is eligible to receive payments from Medicare.

 

Electrical Workers Local 357 member copays or coinsurance percentages will be the same whether their provider is in- or out-of-network. Locally or nationwide, doctors or hospitals — the member’s cost share doesn’t change.

 

Noncontracted providers may continue treating Electrical Workers Local 357 members and will be reimbursed 100% of Medicare’s allowed amount for covered services, less any member cost share.

 

The Medicare Advantage plan offers the same hospital and medical benefits that original Medicare covers and also covers additional benefits that original Medicare does not, such as hearing, LiveHealth Online* and SilverSneakers.*

 

The prefix on the Medicare Advantage ID cards is AFJ.

 

Detailed prior authorization requirements are also available to contracted providers by accessing the Provider Self-Service Tool on the Availity Portal* at https://www.availity.com.

 

Providers will follow their normal claim filing procedures for Electrical Workers Local 357 member claims.

 

Providers may call Provider Services at 1-833-848-8730 for eligibility, prior authorization requirements and any questions about the Electrical Workers Local 357 member benefits or coverage.

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. LiveHealth Online is the trade name of Health Management Corporation, an independent company, providing telehealth services on behalf of Anthem Blue Cross and Blue Shield. Tivity Health, Inc. is an independent company providing the SilverSneakers fitness program on behalf of Anthem Blue Cross and Blue Shield.

 

 

ABSCRNU-0197-20



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January 2021 Anthem Provider News and Important Updates -- Nevada