SuperMed Plus Network and Mercy Health Partners System Terminate Contracts With American Community
Certificate/Policy Holders to Be Moved to AC Network or PHCS Network
04-22-2010
SuperMed Plus Network and Mercy Health Partners System are terminating their contracts with American Community according to the timeline noted below. As a result, many of these providers will be considered out-of-network and members will pay more out-of-pockets costs if they continue to see these providers after the contract termination date. To ensure certificate/policy holders (policy holders) continue to have access to in-network providers, we will be moving them to either the PHCS Network or the AC Network as noted below. Premium rates will be adjusted to reflect the change in network factor.
First-Year Policy Holders Switched to AC Network
As you know, in Fall 2009 American Community launched its own AC Provider Network with thousands of providers throughout the state. All Individual policy holders and employer groups that had been in force at least one year were switched to the AC Network on March 1, 2010, with the exception of certain counties as noted below.
Because of the SuperMed contract termination, we will move all policy holders in the first-year of their policy who currently have the SuperMed Network to the AC Network according to the timeline noted below:
However, in-force Individual policy holders living in and employers domiciled in certain counties where the AC Network does not currently offer adequate provider coverage will be moved from the SuperMed Network to the PHCS Network. See the section below for more information on the exception counties.
Continuity of care will apply when a policy holder is being treated by a SuperMed in-network provider in one or more of the following situations before they are moved to the AC Network but treatment continues beyond that date:
Policy holders who meet the criteria for continuity of care should contact Customer Service at (800) 991-2642 and provide the name and contact information of their provider(s). We will then contact the provider(s) and attempt to work out a payment arrangement. To view a list of AC Network providers, please visit our Web site at www.american-community.com and click on Find a Health Care Provider on the left navigation.
Policy Holders in Certain Counties to be Switched from SuperMed Plus Network to PHCS Network
Because we are still finalizing provider contracts in certain areas of Ohio, the AC Network may not offer adequate coverage for some policy holders. Therefore, in-force Individual policy holders living in and employers domiciled in the following counties who currently have the SuperMed Plus Network will be switched to the PHCS Network according to the timeline noted below:
Groups: July 1, 2010
Individuals: June 1-28, 2010, depending on the due date of the policy
Counties
The vast majority of SuperMed providers also participate with the PHCS Network so there should be minimal disruption. To view a list of PHCS Network providers, please visit our Web site at
Mercy Health Partners System No Longer Participating in AC Network
Because Mercy Health Partners System is terminating their contract, the AC Network may no longer offer adequate provider coverage in certain counties. Therefore, in-force Individual policy holders living in and employers domiciled in the following counties who currently have the AC Provider Network will be switched to the PHCS Network according to the timeline noted below:
Groups: June 1, 2010
Individuals: May 13 - June 12, 2010, depending on the due date of the policy
Counties:
The vast majority of Mercy Health Partners System providers participate with the PHCS Network so there should be minimal disruption. To view a list of PHCS Network providers, please visit our Web site at
Notification of Policy Holders
Employer groups and Individual policy holders who are affected by a network change will be notified by postal mail and will receive new ID cards.
