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Covenant Health, which operates St. Joseph’s hospital in Bangor and St. Mary’s hospital in Lewiston, has been negotiating a new contract with Anthem.  Covenant stated in early May that unless an agreement can be reached, they will remove their physicians, providers, and other facilities in Maine from the Anthem provider network, effective July 5, 2023.

While negotiations are ongoing, no agreement has been reached at this time.  We are hopeful that an agreement will be reached soon, but we are ready to assist members when and if these providers and facilities leave the Anthem network. 

The Health Trust is concerned about the potential lack of access to these established providers and hospitals, and we understand that members may be anxious about disruption with their current providers.  However, we also recognize that there is a balance to be maintained in order to control the costs of healthcare.  Covenant has asked for very large increases in the amounts they are paid for services provided, and these costs are shared by all Health Trust members.

Anthem has created a website to share updated information about this matter at https://www.anthem.com/covenantmaine/.

In early May, Anthem sent out letters to all members who utilized a Covenant Health provider within the past 12 months.  Members on a Health Trust POS plan who currently see a Covenant Health primary care physician (PCP) will also be receiving letters shortly assigning them to another, non-Covenant provider and subsequently a new ID card listing the new PCP.   If you receive a letter and would like to change your PCP to another in-network provider, please contact Member Services for assistance with this process. Please note that members on a Health Trust PPO plan are not required to have a PCP under their plan and therefore will not receive a letter assigning them to another non-Covenant PCP. However, if you continue to see a Covenant Health PCP after July 5, 2023, your benefits will be paid at the out-of-network level.

Under the Continuity of Care provisions, you may also be able to continue treatment with your current doctor(s) for a limited time past July 4th, if you are receiving certain types of care.

Under federal law, this includes care if you are:

• In treatment for a serious and complex condition. This can be a sudden (acute) illness that requires specialized treatment in order to avoid death or permanent harm. It can also be an ongoing (chronic) illness that is life threatening or potentially disabling and requires specialized care over a long period of time.
• In a hospital or other inpatient facility.
• Scheduled for nonelective surgery by your current doctor, including your post-operative care for the surgery.
• Pregnant.
• Terminally ill.

Continuity of Care Application Form

Please contact MMEHT Member Services so that we can assist you with the Continuity of Care process, or with finding a new in-network provider if you so choose.  Member Service Representatives are available Monday through Friday from 8:00 a.m. – 4:30 p.m. at 1-800-852-8300.

Covenant Health, which operates St. Joseph’s hospital in Bangor and St. Mary’s hospital in Lewiston, has been negotiating a new contact with Anthem.  Covenant has recently stated that unless an agreement can be reached, they will remove their physicians, providers, and other facilities in Maine from the Anthem provider network, effective July 5, 2023.

The Health Trust is concerned about the potential lack of access to these established providers and hospitals, and we understand that members may be anxious about disruption with their current providers.  However, we also recognize that there is a balance to be maintained in order to control the costs of healthcare.  Covenant has asked for very large increases in the amounts they are paid for services provided.

The Maine Municipal Employees Health Trust was founded in 1983 with the goal of containing healthcare costs while maintaining quality benefit programs and providing superior services. For forty years it has been our pleasure to serve municipal and quasi-municipal employees, retirees and their dependents.

As required by the Affordable Care Act, the Health Trust will be sending out Forms 1095-B to all employees (including non-Medicare retirees and COBRA participants) who were covered under a Health Trust health plan during calendar year 2022. The 1095-B forms provide information on each individual (employee and dependents) who had health coverage through the Trust in 2022, including which months they were covered. Forms were mailed in mid-February, prior to the March 2, 2023 deadline.

The 1095-B forms provide information that may assist you in preparing your taxes, however they do not need to be filed with the tax returns. The IRS has stated that taxpayers need not wait for these forms, and should file their returns as they normally would. Copies of all of the forms will be filed with the IRS by the Health Trust, through its eligibility vendor.

If you have any questions about your Form 1095-B, please contact the Billing & Enrollment staff at 1-800-452-8786, or htbilling@memun.com.

As we previously communicated, Maine Medical Center (MMC) has announced its intention to leave the Anthem network on January 1, 2023.

The dispute between the Anthem and MMC is about how the hospital is paid, and if MMC is charging appropriately for services as per their existing contractual agreement.  Anthem and MaineHealth also have disagreements regarding other financial and policy-related terms of their current contract.

Update July 2022: At the request of the Governor, a new mediator has a been appointed to work with Anthem and Maine Health, with the goal of resolving this dispute as soon as possible.  We speak frequently with leadership of both parties, and continue to urge them to resolve these issues without further delay.  We remain hopeful that the parties will work out their differences and that MMC will remain in the network.

Please note that MaineHealth has stated that they are withdrawing only the Maine Medical Center (MMC) hospital facility from the Anthem network.  MaineHealth has confirmed (on their own website) that “MaineHealth has no plans to remove its physicians and other providers in its system-wide medical group from the Anthem network.”

We understand the concerns raised by this announcement and this potential change. The Health Trust continues to work on contingency plans in the event an agreement cannot be reached.

We are monitoring this situation very closely, and are doing all we can to push for a quick resolution and to limit the impacts on our members.