Health Insurance Marketplace / Affordable Care Act
Quick Reference Guide
Health Insurance
Marketplace
for plans effective January 1, 2015
The Affordable Care Act (ACA) compliant plans only apply to Individual and Small group business
Difference between plans purchased: “on the exchange” or “off the exchange”
•
On the exchange - refers to Individual and Small Group plans purchased through the Health Insurance
Marketplace
•
Network Names
Off the exchange - refers to Individual and Small Group plans purchased through other channels such as a
broker, sales agent, or directly through a health insurance company
Network Name for plans sold ON exchange:
• Pathway X
• Pathway X Enhanced
Network Name for plans sold OFF exchange:
• Pathway
• Pathway Enhanced
• Blue Open Access POS
• Blue Choice HMO
• Blue Choice PPO
Alpha Prefixes for
Health Insurance
Marketplace / ACA
plans
On exchange
Alpha Prefix
JRC
JRA
JRB
Off exchange
Alpha Prefix
JRE
XKY
XKU
XKZ
XKW
XKX
Health Plan Benefit Option
Product Type
Individual
Individual
Small Group
HMO
HMO
POS
Health Plan Benefit Option
Product Type
Individual
Individual
Small Group
Small Group
Small Group
Small Group
POS
HMO
POS
POS
HMO
PPO
Network Name
(which will appear on Member ID card)
Pathway X
Pathway X
Pathway X Enhanced
Network Name
(which will appear on Member ID card)
Blue Open Access POS
Pathway
Blue Open Access POS
Pathway Enhanced
BlueChoice HMO
BlueChoice PPO
Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., are independent licensees
of the Blue Cross Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue
Cross and Blue Shield Association.
Sample Member ID
Cards
On exchange
Note: This sample
is from 2014, as
2015 sample cards
are not available
yet.
The templates will
be the same with
the exception of the
Product Names and
Network Names will
be updated with
the new naming
convention.
Health Insurance
Marketplace/ACA
plans Contact
Information
Off exchange
•
•
Provider Services for exchange plans: 855-855-2036
UM Preauthorization: 855-343-4851
Claims Mailing Address:
BCBSGa
P.O. Box 105370
Atlanta, GA 30348-5370
Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., are independent licensees
of the Blue Cross Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue
Cross and Blue Shield Association.