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["\nGuidelines for Deductible & Out-of-Pocket Max Credit\nCarriers can apply different rules for credit based on plan type. In addition, rules can vary\nif a member is moving within a carriers own products or coming from another carrier.  \n\nCustomize the grid based on your group scenario to see how the carrier will handle credit."]
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["MEDDedCredit"]
["Aetna","Yes"]
["Anthem","Yes"]
["Blue Shield","Yes"]
["CalChoice","Yes"]
["Cigna + Oscar","Yes"]
["CovCA","Yes"]
["HN","Yes"]
["Kaiser","Yes"]
["MediExcel","Yes"]
["Oscar","Yes"]
["Sharp","Yes"]
["Sutter","Yes"]
["UHC","Yes"]
["WHA","Yes"]
["MovingSame","Yes"]
["MovingDiff","Yes"]
["FromHMO","Yes"]
["FromPPO","Yes"]
["FromEPO","Yes"]
["FromHSA","Yes"]
["ToHMO","Yes"]
["ToPPO","Yes"]
["ToEPO","Yes"]
["ToHSA","Yes"]
["Instructions","Yes"]
["CalChoiceDirect","Yes"]
["CovCADirect","Yes"]
["Q4","Yes"]
["Notes","Yes"]
["OONAcc","Yes"]

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["CA Deductible & Out-of-Pocket Max Credit Guidelines and Request Process"]
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[]
["Out-of-network Accumulation\nRules when \"Credit Availability\" applies; If carrier response is No then OON credit will also not apply.","Out of network accumulation will be credited for new groups only.",null,null,null,null,null,null,"Out of network accumulation will be credited Only if the member is moving from the plan with a separate out of network deductible to an Anthem plan with a separate out of network deductible. Documentation must be provided.",null,null,null,null,null,null,"Out of network accumulation will be credited.",null,null,null,null,null,null,"View the Reference sheet above.",null,null,null,null,null,null,"Out of network accumulation will not be credited.",null,null,null,null,null,null,"Refer to Enrolled Carriers' Guidelines",null,null,null,null,null,null,"Out of network accumulation will be credited for deductible only. ",null,null,null,null,null,null,"Out of network accumulation will not be credited.",null,null,null,null,null,null,"N/A",null,null,null,null,null,null,"Out of network accumulation will not be credited.",null,null,null,null,null,null,"Out of network accumulation will not be credited.",null,null,null,null,null,null,"Out of network accumulation will not be credited.",null,null,null,null,null,null,"Out of network accumulation will not be credited."]
["NOTES:","-",null,null,"Credit available from plan w/Rx deductible credit to plan w/Rx deductible credit (credit must be listed in the EOB as a Rx deductible credit). Not available from plan with combined medical/RX deductible credit to plan with separate medical/RX deductible credit.",null,null,null,"Credit available from plan w/Rx deductible credit to plan w/Rx deductible credit. Not available from plan with combined medical/RX deductible credit to plan with separate medical/RX deductible credit.\nDoes not apply in the case of spin-off or new entity.",null,null,"Credit available from plan w/Rx deductible credit to plan w/Rx deductible credit. Not available from plan with combined medical/RX deductible credit to plan with separate medical/RX deductible credit.",null,null,null,"1 If the prior HSA medical plan deductible included prescription drugs in the medical deductible, deductible credit will be available.",null,null,"1 If the prior HSA medical plan deductible included prescription drugs in the medical deductible, deductible credit will be available.\n2 Credit only applied if moving from/to the same plan type.",null,null,null,"-",null,null,"-",null,null,null,"-",null,null,"Cigna + Oscar will not credit Prescription drug coverage (unless coming from an HSA plan, where deductibles are combined with medical)",null,null,null,"-",null,null,"-",null,null,null,"1 If the pharmacy deductible is separate from the medical deductible it will continue to accumulate.",null,null,"1 If the Rx deductible is separate from medical deductible it will continue to accumulate.\n2 Available for PPO only \n3 The OOPM will be credited only equivalent to the amount any medical and/or Rx deductible is credited.\n4 Available for combined medical & Rx deductible \n",null,null,null,null,null,null,"-",null,null,null,"-",null,null,"-",null,null,null,"Member should always maintain records, and contact Sharp to receive credit if not applied.\n1 Must be approved by Sharp.",null,null,"1 OOP Max itself is not credited as part of the process, however the deductible that is credited will be applied toward the OOP Max. ",null,null,null,"-",null,null,"-",null,null,null,"Credit not available to new hires.",null,null,"1 OOP Max itself is not credited as part of the process, however the deductible that is credited will be applied toward the OOP Max. \n2 Credit only applied if moving to/from same plan type (HMO to HMO, HSA to HSA etc)\n3 New business only. Credit not available for new enrollees of an existing group.\n",null,null,null,"1 If a WHA member is enrolling under a new group number or different employer,  carryovers are not applied. If the employer is moving  between CalChoice or direct with WHA however, carryovers will be allowed. ",null,null,"1 From HSA to HSA only. "]
["How to Request Credit",null,null,null,null,null,null,null," "]
["What materials are needed:","EOB for all members requesting credit.",null,null,null,null,null,null,"Employee Level Submission:\n  -  Prior Carrier Term Date\n  -  Individual Breakdown by Participating/Non Participating Accumulator totals\n  -  Legible copy of Explanation of Benefits (EOB)\n  -  EOB with prior carrier logo or company letterhead\n  -  Group Name, Group Number & Employee Social Secuirity Number (SSN)\nGroup Level Submission (may submit via excel spreadsheet, sent secure and protected):\n  -  Suscriber SSN (employee)\n  -  Member first & last name\n  -  Member Date of Birth (DOB)\n  -  Deductible (shared deductible dollars)\n  -  In-network deductible dollars\n  -  Out-of-network deductible dollars",null,null,null,null,null,null,"Submit the Prior Carrier Accumulation form along with one of the following:\n - Most Recent EOB for each family member applying\n - Letter from previous carrier indicating the amount each member has accumulated\n - Pharmacy printout showing total deductible met",null,null,null,null,null,null,"Members must initiate the carryover process by calling their Health Plan’s Member Services Department.  View the CalChoice Reference Sheet above for carrier specific details.",null,null,null,null,null,null,"A completed Deductible Credit form located on hioscar.com/forms and an approved Deductible Credit spreadsheet; OR\nA copy of an EOB, for each family member, showing the amount of deductible and out-of-pocket each member has satisfied and a statement from your prior insurance carrier.",null,null,null,null,null,null,"Refer to Enrolled Carriers' Guidelines",null,null,null,null,null,null,"Submit relevent EOB.",null,null,null,null,null,null,"N/A",null,null,null,null,null,null,"N/A",null,null,null,null,null,null,"Deductible credit request form; one form required for each family member. Copy of most current EOB from prior carrier for each family member.",null,null,null,null,null,null,"N/A",null,null,null,null,null,null,"Deductible credit worksheet listing credit for all employees.  Copy of most current EOB from prior carrier for each family member.",null,null,null,null,null,null,"Prior carrier deductible documentation."]
["Where are materials sent:","Submit with initial enrollment.",null,null,null,null,null,null,"Email to: CASGBrokerServices@anthem.com\nSubscribers and their dependents may submit their  documents individually by faxing the claims department at (877) 287-1262.",null,null,null,null,null,null,"Fax to: (209) 371-3049",null,null,null,null,null,null,null,null,null,null,null,null,null,"Cigna + Oscar c/o Oscar Management Corporation\nMailing: PO Box 52146, Phoenix, AZ, 85072-2146\nFax: 888-977-2062\nEmail: documents@hioscar.com",null,null,null,null,null,null,null,null,null,null,null,null,null,"Submit EOB to underwriting with new group materials.",null,null,null,null,null,null,"N/A",null,null,null,null,null,null,"N/A",null,null,null,null,null,null,"Sharp Health Plan\nAttn: Customer Care\n8520 Tech Way, Suite 200, San Diego, CA 92123-1480\nFAX 858-499-8244",null,null,null,null,null,null,"N/A",null,null,null,null,null,null,"Include with initial enrollment submission, will be processed through underwriting department.",null,null,null,null,null,null,"Include with initial enrollment submission."]
["When request should be made:","Must submit with either initial enrollment or first claim.",null,null,null,null,null,null,"Must be submitted after the group is active.",null,null,null,null,null,null,"Materials may be submitted after the member has been issued a Blue Shield ID number.",null,null,null,null,null,null,null,null,null,null,null,null,null,"Request must be made within 60 days of becoming a member.",null,null,null,null,null,null,null,null,null,null,null,null,null,"Submit at initial enrollment.",null,null,null,null,null,null,"N/A",null,null,null,null,null,null,"N/A",null,null,null,null,null,null,"Within 90 days from coverage start date.",null,null,null,null,null,null,"N/A",null,null,null,null,null,null,"With initial enrollment submission.  ",null,null,null,null,null,null,"Submit within 30 days of the members effective date."]