VHP Health Insurance Coverage Updates

Chiropractic

Coding: Reimbursable codes include the following: 98940, 98941, 98942, 98943. Any other services billed including office visits, x-rays and therapies will not be reimbursed and may be denied.

Member Cost Share: For Commercial members, copayments may apply. Refer to the Summary of Benefits/Evidence of Coverage documentation for amounts.

Note: Chiropractic services are not included for Covered California/Individual and Family Plans.

What’s New in Medi-Cal? Medi-Cal Older Adult Expansion

Effective May 1, 2022, adults aged 50 and over are eligible for full-scope Medi-Cal regardless of their immigration status. This means they will have access to services including primary care, pharmacy, behavioral health, vision, dental and more.

People who are not currently enrolled in MediCal and meet eligibility requirements may apply by completing an application online at Covered California Website.

Adults who were enrolled in restricted-scope Medi-Cal because of their immigration status will automatically transition to full-scope MediCal. They will receive a packet in the mail from Health Care Options prompting them to choose a managed care health plan and primary care provider. Ensure they have the appropriate information to select you so they can continue to receive care from you.

Pregnancy and Postpartum Coverage

Previously, Medi-Cal offered coverage during pregnancy and up to 60 days after giving birth for those who otherwise did not qualify for Medi-Cal. As of April 1, 2022, individuals who are eligible for pregnancy and postpartum services under Medi-Cal will be able to retain that coverage for up to 12 months.

Medi-Cal Redeterminations

The Public Health Emergency (PHE) declared in January 2020 is expected to be ending soon. Under the PHE, annual redeterminations for Medi-Cal eligibility were suspended so that everyone could maintain health coverage throughout the COVID-19 pandemic. While the suspension was expected to expire in October 2022, it is now anticipated to expire at some point in 2023. As the managed care health plans, Social Security Administration (SSA), and Department of Health Care Services (DHCS) prepare for the lifting of this suspension, it is important to ensure that beneficiaries’ information is up to date so that they receive all communications.

Over the 12 months following the conclusion of the PHE, DHCS will verify approximately 75,000 beneficiaries each month based on when they would have been eligible for redetermination if the PHE had not been implemented. You can help by: • spreading the word about the upcoming restart of redeterminations and confirming if a notice has been received • becoming a DHCS Coverage Ambassador

Join the DHCS Coverage Ambassador mailing list

• verifying your patients’ contact and mailing information Patients can report any changes to their name, address, phone number or email address by contacting their local county SSA office via phone, in-person, email or online at:

www.mybenefitscalwin.org.

Qualifying Life Events Happen, Are Your Patients Ready for Them?

At times when open enrollment is not available for your patients, they may be eligible for Special Enrollment. During Special Enrollment, applicants must have a Qualifying Life Event to change coverage or enroll in a new plan. Special Enrollments require proof of a Qualifying Life Event within 60 days to enroll in new coverage or amend coverage. Events such as having a baby, moving to a new city, or losing employer coverage may qualify patients for Special Enrollment. Unfortunately, getting sick or in an accident is not a qualifying event, so it is important for patients to avoid gaps in coverage.

As a VHP Provider serving Covered California members, your patients are off to a great start. Covered California members are saving more than ever with VHP. If your patient experiences a change of income, it is important to report that change to Covered California within 30 days. Changes to income or household size may affect eligibility – resulting in a Qualifying Life Event. If your patient’s family is expanding or if they have high medical needs, switching to the silver or gold plan could potentially save them money over the course of the year.

The State of California requires everyone to have health insurance coverage year-round. Those uninsured may be subject to penalties unless they qualify for an exemption.

Our team is happy to help your patients review options and update coverage if they qualify for a Special Enrollment. For assistance, contact a VHP Broker or the VHP Sales team by emailing: BrokerRelations@vhp.sccgov.org or calling 1.408.885.3560.