HMO Transfer Program

If you are enrolled in Health Net or Western Health Advantage, and you provider's medical group leaves your plan's provider network, you may transfer to either Western Health Advantage, Health Net or Kaiser under the HMO Transfer Program. This program is designed to help UC employees cope with provider/medical group disruptions.

Please note that you may not transfer out of Kaiser under this program nor may you transfer into or out of Core Major Medical, Anthem Blue Cross PLUS or Anthem Blue Cross PPO plans. These transfers may only be done during the annual Open Enrollment period or at the time of a qualifying event.

To transfer from one HMO to another, employees must complete form
UPAY 850 and submit it to the Employee Benefits office by the 15th of any given month.

Forms received by the 15th will result in coverage by the new HMO effective the first of the following month.

Forms received after the 15th of the month will result in coverage by the new HMO effective the first of the second following month.

For example, a form received on February 10, would result in coverage under the new HMO on March 1. However, a form received on February 16, would result in coverage under the new HMO effective April 1.

Employee Checklist:

BEFORE YOU ENROLL:

To verify that you are eligible for the medical plan you are interested in based on your mailing address zip code, call the plan.
If you are transferring to Health Net or Western Health Advantage, you must choose a primary care physician (PCP) for yourself, and also PCP's for your family members. Visit the plan's website to verify that the PCP's you choose are in the new plan's provider network and obtain his or her enrollment id number.
If you choose a physician that you have never seen before, verify that the PCP you choose is accepting new patients. For the most current information, call that physician's office.
You may also want to ask the new plan about coverage for any specific benefits or prescription drugs if you or your family have such needs. You can view the plans' drug formularies online using the medical plan websites.
Complete form UPAY 850. List yourself and all enrolled family members, indicate the PCP and enrollment id for each individual. (If you don't, the plan will assign a PCP for each of you.)
Attach verification of the provider disruption (i.e. copy of letter from medical plan indicating provider termination date) to your form and submit to Employee Benefits. As mentioned above, forms received by the 15th of the month will result in coverage by the new HMO effective the first of the following month. Forms received after the 15th of the month will result in coverage by the new HMO effective the first of the second following month.

AFTER YOU ENROLL:

Call your new plan to ensure continuity of care if you or a family member is currently undergoing treatment.
Before seeking services - including pharmacy - call the plan to verify that your coverage is in effect. You should do this on the first of the month (the effective date of your transfer). If your new plan cannot yet verify your eligibility, call Employee Benefits.
Present your new ID card when seeking care. If you need to make an appointment before your card arrives, have your provider call your new plan to verify your eligibility.

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HMO Transfer Program

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