After November 26^th, the use of CHI providers on the Broad Network will be considered out-of-network services. Out-of-network services have their own deductible that must be met prior to copays and coinsurance kicking in. Out-of-network services also have their own out-of-pocket maximum. To see specific out-of-network deductibles and out-of-pocket maximums for the Broad Network, please visit https://immanuel.com/benefits-enrollment.

If Trinity Health (MercyOne) does not come to an agreement, then after December 31, 2024, providers will be out of network. Out-of-network services have their own deductible that must be met before copays and coinsurance kick in.  Out-of-network services also have their own out-of-pocket maximum. Please visit our Immanuel Benefits website to see specific out-of-network deductibles and out-of-pocket maximums for the Broad Network.

After November 26th, the use of CHI providers on Simple Pay will be considered out-of-network. This means that CHI providers will no longer be reflected under any tier on Simple Pay, meaning you would be responsible for any costs associated with utilizing a CHI provider.

If Trinity Health (MercyOne) does not come to an agreement, then after December 31, 2024, providers will be out of network. That would mean Trinity Health providers will no longer be reflected under any tier on SimplePay, meaning you would be responsible for any costs associated with utilizing a Trinity Health provider.

True emergency services utilizing a CHI or Trinity Health emergency room will still be covered.

Your provider should complete a Transition of Care (TOC) form as soon as possible. If approved, this form could ensure pre-scheduled surgeries or other ongoing care from CHI providers remain in-network for up to an additional 90 days. Likewise, to be proactive if Trinity Health does not come to an agreement, it is also recommended that Trinity Health providers fill out a TOC form.

The Transition of Care (TOC) form initiates the process of transition of care coverage. TOC coverage can apply when your doctor or facility leaves the plan’s network or changes network status. TOC coverage allows a member who is receiving treatment to continue the treatment for a limited time at the highest plan's benefits level (in-network).

Sections 1-3 should be completed by the employee/dependent. Section 4 should be completed by the provider.

Yes, a TOC form would need to be completed for each CHI or Trinity Health provider. Your provider is the one who fills out the form and sends it off.

For medical requests, the TOC form should be faxed to 1-859-455-8650. For mental health/substance abuse requests, the form should be faxed to 1-888-463-1309.

Yes, Mercy Council Bluffs is a CHI provider.

Yes, you can keep your scheduled appointments and/or procedures.  However, any claims presented for CHI after November 26, 2024, or after an approved transition of care date will be treated as out-of-network. If Trinity Health disagrees, the same would apply to any claims after December 31, 2024.

You will either be subject to the out-of-network claims construct indicated above or you can move to a healthcare provider that is in Aetna’s network. 

No, your prescriptions and your pharmacy coverage do not change. 

The best approach is to contact your provider directly.  If your provider is not in the Aetna network, asking the question may encourage them to join.

Available resources include:

• Broad Network: We encourage you to use Aetna’s online provider search tool. That tool is linked on our website at https://immanuel.com/benefits-enrollment/health-insurance
• Simple Pay: Please utilize the Simple Pay Health App or reach out to a Simple Pay Health Valet at HealthValet@simplepayhealth.com
• Nebraska Medicine and Methodist are also providing resources:
  • Nebraska Med would like patients to call their main line as these teams are prepared to help members find care. Their main line number is 800.922.0000.  When calling, they just need to indicate that they would like to switch their care to Nebraska Medicine.  They can also utilize the Find Care Now button on Nebraska Med’s landing page and it takes you to this page:
    • Find care now | Nebraska Medicine Omaha, NE
    • For Methodist, members can call 402-354-CARE for help finding a Methodist provider. 

For the Broad network, please refer to the phone number on the back of your insurance card. For SimplePay, please reach out to Health Valet by phone at 1-800-606-3564 or by email at HealthValet@SimplePayHealth.com.