Page 6 - Bar Bakers EE Guide 09-17 English Final

BENEFITS

MEDICAL INSURANCE

Anthem Blue Cross | Low HMO Value
With the Value Network Health Maintenance Organization (HMO) plan, you must choose a Primary Care Physician (PCP) or medical
group within the “Priority Select” network for all of your covered family members. All of your care must be directed through your
PCP or medical group. Any specialty care you need will be coordinated through your PCP and will generally require a referral or
authorization. You will receive benefits only if you use the doctors, clinics, and hospitals that belong to the medical group in which
you are enrolled, except in the case of an emergency. This plan uses a smaller network of the most cost effective providers to pro‐
vide lower per paycheck premiums. Please note that it is your responsibility to ensure that all family members choose providers
from the Anthem Priority Select Network HMO.

Anthem Blue Cross | High HMO Value
This plan works just like the Low HMO Value plan but uses a larger network of providers, California Care HMO network. Since this
plan offers more provider options, you will experience higher per paycheck premiums.

Anthem Blue Cross | PPO Medical Plan
The Anthem Blue Cross Preferred Provider Organization (PPO) plan allows you to direct your own care. You are not limited to the
physicians within the network and you may self-refer to specialists. If you receive care from a physician who is a member of the
PPO network, a greater percentage of the entire cost will be paid by the insurance plan. You may also obtain services using a non‐
network provider; however, you will be responsible for the difference between the covered amount and the actual charges and
you may be responsible for filing claims.

Plan Differences Low HMO Value High HMO Value Classic PPO

Employee Premiums $ $$ $$$
Out-of-Pocket Costs $ $ $$
Cost Sharing Contribution, Copay Contribution, Copay Contribution, Copay,
Deductible, Coinsurance
Network Size   

In-Network Benefits ✓ ✓ ✓
Non-Network Benefits ✓

Access to Providers Managed by Your PCP Managed by Your PCP Managed by You
- Primary Care Physician Required Required Not Required
- Referral for Specialist Required Required Not Required

Finding a Medical Provider
Go to www.anthem.com/ca or call (800) 227-3560 for HMO or (800) 888-8288 for PPO.
• Low HMO Value: Refer to the “Priority Select” network when prompted.
• High HMO Value: Refer to the “California Care HMO” network when prompted.
• PPO: Refer to the “Prudent Buyer PPO” network when prompted.

Summary of Benefits and Coverage (SBC)
This guide is designed to help you understand the medical plan options offered to you by Bar Bakers. Please refer to the SBC and
carrier contracts provided by Anthem Blue Cross for additional plan details.

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