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Important News About 2023 - Exclusive Care Health Plan

Dear Valued Members/Providers,

Effective January 1, 2023, the Exclusive Care EPO plan option will no longer be offered to County of Riverside employees. All current Exclusive Care members have enrolled in new medical plans for dates of services on or after January 1, 2023.

Exclusive Care will remain open and operational to address all outstanding professional and facility claims for covered services incurred by eligible Exclusive Care members prior to January 1, 2023.

Member FAQs

    What will happen with my referrals or specialty care services on or after 01/01/2023

    All referrals issued by Exclusive Care Health Plan will expire, effective, 12/31/2022. Any services rendered on or after 12:01 a.m. on 01/01/2023 will be covered by your new insurance. Contact you new Health Plan for assistance with referrals.

    If I select a new Medical Health Plan for 2023 that has my current specialist, will I have to get a new referral?

    Yes. You will need to contact your newly elected Health Care Plan. Each Health Plan will have their own referral guidelines and processes that you must follow. The newly elected Health Plan will advise you if you need to schedule a consultation with a Primary Care Physician and or if you can self-refer.

    I'm currently under treatment for a medical condition. How do I continue this treatment when my Insurance changes?

    Your new PCP will direct your treatment and provide referrals to specialists in your new plan to continue your treatment.

    Can I still use my Exclusive Care or Navitus Prescription ID CARD on or after 01/01/2023?

    No. Your Exclusive Care and Navitus Prescription ID cards will expire, effective, 12:01 a.m. on 01/01/2023.

    What about my medications?

    If you are on maintenance medications, be sure you have a supply when your insurance changes. Your new PCP will need to provide ongoing refills. Contact your new Health Insurance for information about your Prescription Benefits and Network Pharmacies.

    What if one on my medication(s) isn't covered under the new plan?

    Contact your Primary Care Physician, Health Insurance, or Pharmacy Benefit Manager. In some cases, you may be eligible for a one-time 30-day supply under your new plan or an exception to continue the medication.

    What if I have difficulty obtaining care, medications, and treatment when my insurance changes?

    First contact your primary care physician. If problems persist, contact the member services department of your new Insurer.

    My Medical Records

    Once you have selected a new primary care physician, contact your previous physician, and ask for a transfer of your medical records to your new primary care physician. 

    If you are seeing specialists, ask them to transfer your medical records to your new primary care physician. Exclusive Care does not retain your medical records. 

    Health Care Provider FAQs

      What will happen to Exclusive Care patients in 2023?

      Current Exclusive Care members will have a new health plan for calendar year benefits, effective, January 1, 2023. Please request updated insurance information from former Exclusive Care patients continuing under your care in 2023.

      How can I find out which CalPERS medical health plans will be offered to Exclusive Care members and whether I am a participating provider?

      You may visit the CalPERS website to verify whether you’re a participating provider or contact the health plans directly. For your reference, below is a list of health plans available to active County of Riverside employees in the Riverside/San Bernardino/ LA County and Orange/San Diego counties for 2023 calendar year benefits.

      Will I be able to continue submitting claims for services rendered in 2022?

      Yes, Exclusive Care will continue to accept and process paper and EDI claims for dates of services rendered in 2022. The timely filing for claims is one (1) year from that date of service.

      Claims Mailing Address:

      Attn: Exclusive Care Health Plan

      PO Box: 1508

      Riverside, Ca 92502-1508

      What will happen with existing referrals and authorizations for specialty care services?

      Exclusive Care will not be accepting any new referrals, effective, January 1, 2023. All approved referrals and authorizations issued by Exclusive Care EPO Plan will expire on 12/31/2022. Any services rendered on or after 12:01 a.m. on 01/01/2023, will be covered by a new insurer. Please coordinate with your patients and their new Health Insurance to obtain referrals and authorizations to ensure continuity of care.

      Is Exclusive Care accepting new providers?

      No, the Exclusive Care network will not accept any new credentialing applications effective December 1, 2022.

      Will Exclusive Care be available if I have questions?

      Yes, Exclusive Care representatives will be available during normal business hours to assist you with claims and customer service questions about services rendered to Exclusive Care members prior to January 1, 2023. You may reach us at (800) 962-1133 or by email at [email protected].

      Exclusive Care Health Plan - PO Box: 1508 Riverside Ca, 92502-1508