In our December 2018 edition of our provider newsletter, Anthem Blue Cross and Blue Shield announced the rollout of three new Exclusive Provider Organization (EPO) health benefit plans in the Virginia Small Group market.  We stated incorrectly that these new EPO benefit plans would use the alpha prefix “VLX.”  However, the correct alpha prefix is “VQW” for the new EPO benefit plans.  We regret this error and apologize for any inconvenience this situation may have caused you.


As a reminder, these EPO plans became effective January 1, 2019, and will use our KeyCare network which is currently also used by our PPO plans.  One new EPO plan is offered in each of the Bronze, Gold and Platinum metal levels of our health benefit plans. No Silver EPO plans are offered at this time.


The notable difference from our standard PPO plans will be the exclusion of out-of-network benefits – except in medical emergencies and for certain authorized services. The EPO plans will not have gatekeeper referral requirements. As such, they will be referred to as “open access” and will accordingly have the letters “OAEPO” in their names. Like the rest of our 2019 Small Group portfolio, they will have a primary care physician (PCP) assignment requirement and only be sold OFF the Health Insurance Marketplace or commonly called the exchange. The authorization process and reimbursement fee schedule will also follow what we have in place for PPO plans.


If you have questions, please contact our customer service area using the phone number on the back of the member’s ID card.


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April 2019 Anthem Provider Newsletter - Virginia