Page 9 - TCW_Benefit Guide_2019 FINAL
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MEDICAL COVERAGE





              PREFERRED PROVIDER ORGANIZATION (PPO) OPTION – AVAILABLE TO ALL
              EMPLOYEES – ALL STATES
              The PPO option offers flexibility to obtain services in- and out-of-network with the additional
              freedom to select a specialist without a referral. In-network preventive care is covered at no
              cost to you. Of course, if you obtain services from providers outside the network, your out-of-
              pocket costs and deductible will generally be higher.

              The PPO option provides access to Anthem’s broad national provider network. If you choose
              to have your treatment provided by an in-network provider, you will benefit from lower out-of-
              pocket costs.

              HEALTH MAINTENANCE ORGANIZATION (HMO) OPTION - AVAILABLE TO CALIFORNIA
              RESIDENTS ONLY

              The HMO plan has no deductibles and LOW out-of-pocket expenses. The HMO plan strictly
              limits your coverage to in-network providers. You may only use an out-of-network provider in
              the case of a medical emergency. However, if your condition is determined not to be a medical
              emergency, Anthem may refuse to cover all related fees. If you select the HMO option, you will
              need to select a primary care physician (PCP). A referral from your PCP is generally required to
              see a specialist.




















































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