NEWSROOM

As you work through the transition of groups off of Health Net and to other carrier options, we wanted to share a few areas you need to be aware of from an account management service perspective. 

Our team is here to help support these requests as we work through the transitions together.

Provider Search

As you market and find the best carrier alternative for your groups, make sure you are asking about needed providers, medical groups, or hospitals 

• Links to provider search links can be found on our carrier pages.
• Medical Group network comparison guides are available to help clients quickly look at medical groups by network. 
• W&B Account Management can help support provider search requests. Please complete the Provider Search Form and email it to AccountManagement@wordandbrown.com. Having the correct provider’s name and address is important to ensure you get the right information back. 

Rx Search

Every carrier has a different prescription drug (Rx) formulary. As you market and find the best carrier alternative for your groups, make sure you ask about any Rx needs. 

• Links to carrier Rx search and formularies can be found on our carrier pages.
• W&B Account Management can help support Rx search requests. Please complete the Provider Search Form (which includes Rx searches) and email it to AccountManagement@wordandbrown.com. Having the correct dosage is important to make sure you get the right information back. 

Deductible and Max Out of Pocket Transfers

For transitions that happen 1/1/2027, there will not be a need to transfer deductible and max out of pocket. 

For transitions that happen on other effective dates, each carrier will allow and need different information to transfer any credit for deductible and max out of pocket. 

Information on each carrier’s requirements can be found on our carrier pages. 

Continuity of Care

Continuity of Care is considered for qualifying conditions including acute conditions, serious chronic conditions, pregnancy and postpartum care, terminal illness, care of a child under 3 years old, and a surgery or procedure already scheduled within 180 days of the provider/network transition. 

These will all need to be reviewed and approved by the new carrier. 

In order to start this process, the new coverage must already be approved. Once approved, members will need to submit a continuity of care form to the new carrier. These forms can be submitted directly to the carrier by the member or submitted to AccountManagement@wordandbrown.com for our team to submit on the member’s behalf. Each request will need to be reviewed and approved by the carrier prior to receiving care to ensure coverage. 

Prior Authorization Requests

Any prior authorization requests previously received will need to be submitted to the new carrier for approval. 

We recommend employees communicate with their providers and fill any needed prescriptions under the current insurance prior the new effective date; this will ensure they have time for the prior authorizations to be reviewed with the new carrier. 

In order to start this process, the new coverage must already be approved.

Members should reach out to their providers to share the new insurance coverage, so each provider can initiate any authorization needed by the new carrier. All requests will need to be reviewed and approved by the carrier prior to receiving care to ensure coverage. 

Alignment of Renewal Dates

As groups decide on an effective date for the Health Net replacement coverage, they may wish to request to align renewal dates with other carriers being offered; that way all coverages have the same renewal and open enrollment date. 

When requesting this, most carriers have timelines of how early this needs to be requested. Also, the group will need to agree to the rates for the new renewal date requested and have an open enrollment to support the change. 

Additional details on the timeline and how to request it for each carrier can be found on our carrier pages. 

Notification to Health Net on Termination

If a group is moving to a new carrier prior to 3/1/2027, it will need to notify Health Net of termination of coverage. The authorized group contact should email HN_ACCOUNT_SERVICES@HEALTHNET.COM requesting the termination and include the requested termination date and indicating the lines of coverage to terminate. The employer should keep a record of this request and when it is sent. We always recommend groups do not request this termination until the new coverage is approved. Per Health Net, “Groups will need to provide timely notice, in accordance with their Health Net agreement.”