Your medical options are about to change. If you’re currently enrolled in an Aetna medical plan, you must take action by May 12 or you will not have medical coverage through LMU for the remainder of 2023. As communicated earlier, we are switching back to Anthem effective June 1, 2023. As part of this transition back to Anthem, we are holding a special Mid-Cycle Open Enrollment period from Monday, May 1 – Friday, May 12, 2023. This period will give all faculty and staff the opportunity to reevaluate their medical options and select the coverage that is best for them and their families.
Important!
- Aetna members: If you are currently enrolled in an Aetna plan and do not make a selection during this Mid-Cycle Open Enrollment period, you will not have any medical coverage through the university for the remainder of 2023.
- Kaiser members: If you are currently enrolled in a Kaiser plan and do not make a selection during this Mid-Cycle Open Enrollment period, your coverage will remain unchanged.
We are offering the same Anthem plans that were available before we switched to Aetna:
Coverage Options
- Anthem Blue Cross PPO Plan (formerly the Aetna Managed Choice POS)
- Anthem Advantage HMO (formerly the Aetna HMO)
- Anthem Blue Cross HealthSave Plan (formerly the Aetna Managed Choice POS HDHP)
Anthem plans will provide similar benefits and coverage that they previously provided in 2022, aside from IRS-required increases to the minimum deductible amounts in the Anthem Blue Cross HealthSave Plan, and other mandatory legislative and plan changes.
All faculty and staff have the opportunity to enroll in an Anthem plan during this Mid-Cycle Open Enrollment period, including those currently enrolled in the Kaiser Permanente HMO and those who previously elected to waive medical coverage.
How to Enroll
You’ll make your Mid-Cycle Open Enrollment elections in Workday. You’ll receive a task email in your Workday Inbox. Alternatively, you can log in to My.lmu.edu to access Workday and switch medical plans starting May 1, 2023, through May 12, 2023.
Cost of Coverage
The cost of coverage under the Anthem plans from June 1 through December 31, 2023, will be higher than current premiums under Aetna. However, the Anthem premiums will not increase in 2024. You can find the rates for all the Anthem plans at https://admin.lmu.edu/hr/openenrollment/.
Deductibles and Out of Pocket Maximums
Any eligible health care expenses you incurred January 1 through May 31 and applied to your Aetna plan’s deductible and out-of-pocket maximum will transfer to your new plan under Anthem. Kaiser members who decide to switch to Anthem will not receive credit for any contributions towards their current deductible or out-of-pocket maximums.
Medical Network Providers
If you are currently enrolled in an Aetna plan, it is likely that your doctor may be covered under Anthem. Please check with Anthem and your provider to confirm. Kaiser members switching to Anthem will need to find an in-network provider or elect a primary care physician for the HMO. To search for covered providers, visit www.anthem.com/ca and click “Find Care,” choose “Basic search as guest” and follow the on-screen prompts to search employer-sponsored medical plans.
When asked to select a plan or network:
To search for providers under this plan: | Choose the network: |
Anthem HMO Plan | Blue Cross HMO (CA Care) – Large Group |
Anthem Blue Cross PPO Plan | Prudent Buyer PPO/EPO |
Anthem Blue Cross HealthSave Plan | Prudent Buyer PPO/EPO |
Outside of CA – Anthem Blue Cross PPO & Anthem Blue Cross HealthSave Plan | National PPO (BlueCard PPO) |
Transition of Care
If you are currently with Aetna and in the middle of treatment or scheduled for treatment with a provider who is not in Anthem’s network, Anthem offers a Transition of Care program that may allow you to continue care with your current provider for a limited period. Each Transition of Care request is treated on a case-by-case basis and is subject to approval. You will need to fill out a Transition of Care form, which you can find posted here . Visit https://www.anthem.com/ca for more information.
Maintenance Medications
If you currently take maintenance medication, let your doctor know that you will be switching to an Anthem medical plan starting June 1, 2023. Have your doctor prescribe enough medication to last for 90 days after June 1 to give yourself plenty of time to transfer your prescription to Anthem. After the new plan goes into effect on June 1, have your doctor give you a new prescription, which you can fill at a retail pharmacy or through mail-order delivery. For a list of retail pharmacies and directions on how to begin mail-order delivery with Anthem, see the List of Network Pharmacies and the Home Delivery Flyer posted here.
Anthem has agreed to waive all prior authorization of formulary prescription medication for the remainder of 2023. If your prior authorization was waived in 2023, you will receive a notice from Anthem in early November stating that prior authorization will be required starting January 1, 2024. Anthem will send you a follow-up letter near January 1, 2024, reminding you that your medication will require prior authorization from that date onward.
What This Change Means for My Other Benefits
- If you are currently enrolled in either the Healthcare or Dependent Care Flexible Spending Accounts (FSAs), you may not change your deposit amount, even if you change medical plans. If you are contributing to a Healthcare FSA, you will not be eligible to contribute to a Health Savings Account (HSA), even if you switch to the Anthem Blue Cross HealthSave Plan.
- If you are NOT currently enrolled in either the Healthcare or Dependent Care FSAs, you cannot enroll in an FSA during this special enrollment period, regardless of which medical plan you elect. However, if you enroll in the Anthem Blue Cross HealthSave Plan, you will become eligible to contribute to a Health Savings Account (HSA).
- You may not make any changes to your dental, vision plans, life and AD&D coverage or voluntary benefits.
We regret any negative impact this change may have on you and your family and are working closely with Anthem to ensure the transition is as smooth as possible. We thank you for your continued patience and understanding.
If you have any questions, please send them to HR@lmu.edu.
Remember! You have until Friday, May 12 to enroll in a new medical plan.