Coverage Changes for Select Health Members with Addresses in Hawaii
Select Health will no longer enroll employees with addresses in Hawaii on fully insured Large and Small Employer plans. Members whose plan effective dates begin/began prior to January 1, 2023, can continue on their Select Health plan until their renewal date in 2023.
In order to provide continuing coverage to impacted members, we recommend you share the following options with your fully insured Large and Small Employer clients.
- Affected employees can transition to an approved Hawaii-based carrier through either separate group coverage or individual coverage on the Federally Facilitated Marketplace (FFM). The upcoming Individual open enrollment would give these members an opportunity to enroll with a January 1, 2023 effective date. If they choose not to enroll during open enrollment, members should be eligible for a Special Enrollment Period (SEP) at renewal, since their group coverage will terminate. We encourage you to help members prepare early for this termination of coverage in 2023. Learn more about state coverage requirements for employees in Hawaii.
- For questions regarding employees working temporarily in Hawaii, please contact your Select Health Sales Account Manager.
Please make note of the following:
- Employees with addresses in Hawaii on self-funded plans will continue to receive Third-Party Administrator (TPA) services from Select Health unless the self-funded client requests termination of coverage. Agents should review Hawaii coverage requirements with their self-funded clients and notify Select Health if any coverage or enrollment changes are needed.
- Dependents who are temporarily living in Hawaii can continue to maintain coverage with Select Health if the covered employee resides outside of Hawaii.
- Employees and their families, who are temporarily in Hawaii, can receive services covered within normal plan guidelines and networks. For example, a member whose permanent address is in another state can utilize the UnitedHealthcare Options PPO network for covered services while in Hawaii.
- Members who receive emergency care have in-network benefits anywhere, including Hawaii.
Please contact your Select Health Sales Account Manager.
Agents who intend to assist subsidy-eligible consumers must complete the state required annual training. Links for this information are listed below. In Utah, watch for updates using the link to the CMS.gov broker information page below. Agents in Nevada must complete an Intent to Sell form. In Utah, updates can be found using the CMS.gov broker information link (see below).
Idaho – Your Health Idaho (YHI)
Nevada – Nevada Health Link
National Network Access – UnitedHealthcare Options PPO Network
The UnitedHealthcare Options PPO network provides easy access to care outside of Utah, Idaho, and Nevada. This network includes access to 83% of all hospitals and two out of every three healthcare professionals in the U.S. Here is some helpful information to utilize when marketing to your clients.
- In-network benefits apply for covered services when members on a group point-of-service plan see providers who are contracted on this network outside of Utah, Idaho, and Nevada.
- No premium rate difference for using UnitedHealthcare Options PPO providers.
- Ideal for those who live or travel outside the service area.
- The member ID card is now easily recognized by providers across the country.
- Individual plans, FEHB, and group HMO plans will only be able to access this network for urgent or emergency care. This network is not available to Select Health Advantage members.
- In-network benefits only apply for emergency care and certain urgent care services when received in Utah, Idaho, and Nevada.
- To locate a provider, members will use our online provider search selecthealth.org/find-a-doctor and select the UnitedHealthcare Options PPO from the network drop-down menu.
- As the insurer, Select Health will provide customer service—including claims questions— administer pharmacy benefits, manage materials fulfillment, care reminders, care and disease management, ID cards, and explanations of benefits.
- Members have prescription benefits with Select Health with access to 55,000 pharmacies nationwide, RxSavings Solutions, and quick preauthorizations.
- The same benefits and plan designs are available for members residing outside Utah, Idaho, and Nevada.
- The ID number for members residing outside Utah, Idaho, and Nevada will include the numbers “776” prior to their regular Select Health ID number. Example: 776800000000.
- Providers will need to use the number on the front of the ID card when calling with questions.
- If a provider is contacting UnitedHealthcare for claims or questions, they will need to provide the full ID number. Example: 776800000000.
- Contact your account manager for additional questions and support.