Products & ProgramsAnthem Blue Cross and Blue Shield | CommercialOctober 1, 2023

Pathway X Tiered PCP & Hospital Plans: New plan offering effective January 1, 2024

As a national player who can deliver healthcare coverage across the United States, Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers, Inc. provide a broad choice of quality and affordable products that keep pace with consumers’ needs in Virginia. The Blue Cross and Blue Shield Association symbols are hallmarks of quality healthcare coverage.

New plan offering complies with the Affordable Care Act (ACA)

To that end, Anthem is introducing a new benefit plan offering for the Individual market in select cities and counties in Virginia beginning January 1, 2024. Called the Pathway X Tiered PCP & Hospital Plans, these plans will be sold on our current ACA-compliant network – Pathway X Tiered network.   Members who no longer qualify for Medicaid coverage or who are not enrolled in any health benefits plan may find this lower cost, new product a potential coverage option.

Types of individual health plans in Virginia

Since the implementation of the ACA in 2014, Anthem has been offering ACA-compliant individual healthcare plans. Below are our Individual plans offered for 2024.  

Networks

Plans

Important details

Pathway X Tiered Hospital network* is the HMO network available since 2014.

 

* The name will be changed to Pathway X Tiered network effective 
 December 1, 2023.

Pathway X Tiered PCP & Hospital Plans

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pathway X Tiered PCP & Hospital Plans are new in 2024 in select cities and counties in Virginia.     

 

Primary care physicians (PCPs) and hospitals (including facilities) participating in these plans are in one of two tiers. Members’ cost shares are different depending on whether PCPs or hospitals are in:

 

Tier 1 (lower copayment requirement for PCP office visits and a lower coinsurance for hospitals) or,

 

Tier 2 (a standard copayment requirement for PCP office visits and a higher coinsurance for hospitals).   

 

Some physicians and hospitals are not in these plans’ network, except for emergency or urgent care. As always, members should check to ensure their physicians or hospitals are in their plan’s network before receiving care.

Important note:

These new Pathway X Tiered PCP & Hospital Plans are a gatekeeper product. This means that members must select a PCP to coordinate care and provide formal referrals through the health plan for most specialty care should members need to see a specialist. 


 

Pathway X Tiered Hospital Plans

These plans will continue to be offered throughout the Virginia service area in 2024 as in the past.  

Important note

Pathway X Tiered Hospital plans are open access and do not require PCP selection and referrals to specialists.     

PPO network 

KeyCare PPO

Individual plans will continue to be offered throughout the Virginia service area in 2024 as in the past.    

Referrals

As stated, the new Pathway X Tiered PCP & Hospital plans require referrals from members’ PCPs to cover care from most specialists. More details about our referral process for these plans will be shared in an upcoming edition of Provider News.

Looking ahead

Watch for further details about the new Pathway X Tiered PCP & Hospital Plans — including ID card illustrations and a quick reference guide — in upcoming editions of Provider News. Thank you for the quality care you continue to provide your patients — our members. We take seriously the confidence and trust our members have placed in us, as Anthem are an integral supporter of the Virginia community serving the healthcare coverage needs of Virginians for more than 85 years.

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PUBLICATIONS: October 2023 Provider Newsletter