Page 6 - Open Enrollment Guide Sample
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6
PPO Plan
Anthem Care How the PPO Plan Works
Comparison [Client Name] has partnered with Anthem to establish a network of
Shop Til You Drop! physicians and facilities for our team members to access. If you visit
doctors or hospitals in the network, you will pay less. For example, an
If you are having surgery, or need ofice visit to your primary care physician is $20 (your copay) if the doctor
to schedule inpatient or outpatient
services, you can compare facility is in the network. To ind out which doctors and hospitals are in the
(hospital) cost and quality, as well as network area, refer to the phone number on the back of your ID card or
patient experience ratings. log onto www.anthem.com.
Log on to www.anthem.com to
access your personal information Of course, you may always use any medical provider you like, but keep in
or use other resources mind in-network providers will cost both you and the company a lot less.
You will be able to review If you choose an in-network provider in your PPO network, you pay
Recent claims; compare a copayment for doctor’s ofice visits and 10% of charges after you
facility, costs and quality meet the deductible. For most other services, [Client Name] pays the
Treatment Cost Advisor— remainder of the cost. There are no claim forms to complete.
estimate in-network and
out-of-network costs for If you choose an out-of-network provider, the plan will only pay 50%
procedure comparison of “reasonable and customary” charges after the deductible is met. It
Future Moms is your responsibility to pay the out-of-network provider and to ile
1-800-828-5891. Anthem provides a your claims to the insurance carrier for reimbursement. In addition,
program for expectant mothers called you may be responsible for any charges that exceed the customary and
Future Moms. Any team member or reasonable amounts.
spouse enrolled in our medical plan Preventive care is covered at 100% when care is received through an
that becomes pregnant can enroll in
this program. in-network physician or facility.
We offer an incentive for successful Bi-Weekly Medical Contributions
completion of the Future Moms
Program. The eligible participant must PPO
enroll within the FIRST or SECOND Team Member $56.35
TRIMESTER of their pregnancy and Team Member + Spouse $170.47
successfully complete the program Team Member + Child(ren) * $141.24
to become eligible for one of the Family ** $247.62
following items—courtesy of [Client]!
* Team member + Child(ren) includes the Team member plus any number of children
You could be eligible to receive these ** Family includes the Team member, a Spouse, and any number of children
beneits.
Car seat
High chair
Pack ‘n Play
[Client]
Nine months of disposable diapers
PPO Plan
Anthem Care How the PPO Plan Works
Comparison [Client Name] has partnered with Anthem to establish a network of
Shop Til You Drop! physicians and facilities for our team members to access. If you visit
doctors or hospitals in the network, you will pay less. For example, an
If you are having surgery, or need ofice visit to your primary care physician is $20 (your copay) if the doctor
to schedule inpatient or outpatient
services, you can compare facility is in the network. To ind out which doctors and hospitals are in the
(hospital) cost and quality, as well as network area, refer to the phone number on the back of your ID card or
patient experience ratings. log onto www.anthem.com.
Log on to www.anthem.com to
access your personal information Of course, you may always use any medical provider you like, but keep in
or use other resources mind in-network providers will cost both you and the company a lot less.
You will be able to review If you choose an in-network provider in your PPO network, you pay
Recent claims; compare a copayment for doctor’s ofice visits and 10% of charges after you
facility, costs and quality meet the deductible. For most other services, [Client Name] pays the
Treatment Cost Advisor— remainder of the cost. There are no claim forms to complete.
estimate in-network and
out-of-network costs for If you choose an out-of-network provider, the plan will only pay 50%
procedure comparison of “reasonable and customary” charges after the deductible is met. It
Future Moms is your responsibility to pay the out-of-network provider and to ile
1-800-828-5891. Anthem provides a your claims to the insurance carrier for reimbursement. In addition,
program for expectant mothers called you may be responsible for any charges that exceed the customary and
Future Moms. Any team member or reasonable amounts.
spouse enrolled in our medical plan Preventive care is covered at 100% when care is received through an
that becomes pregnant can enroll in
this program. in-network physician or facility.
We offer an incentive for successful Bi-Weekly Medical Contributions
completion of the Future Moms
Program. The eligible participant must PPO
enroll within the FIRST or SECOND Team Member $56.35
TRIMESTER of their pregnancy and Team Member + Spouse $170.47
successfully complete the program Team Member + Child(ren) * $141.24
to become eligible for one of the Family ** $247.62
following items—courtesy of [Client]!
* Team member + Child(ren) includes the Team member plus any number of children
You could be eligible to receive these ** Family includes the Team member, a Spouse, and any number of children
beneits.
Car seat
High chair
Pack ‘n Play
[Client]
Nine months of disposable diapers
