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Medical Insurance

Anthem Blue Cross| Value HMO Medical Plan (Select Network)
With the Anthem Blue Cross Value Health Maintenance Organization (HMO) plan, you must choose a primary care physician (PCP)
or medical group within the Anthem Blue Cross Select Network. The Select HMO Network provides access to a limited (or narrow)
network of providers. It is available to employees who live in a Select county or zip code at reduced rates for the same quality of
care and benefits level offered by Anthem’s HMO benefits plan. 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.

Anthem Blue Cross| Value HMO Medical Plan (Full Network)
With the Anthem Blue Cross Value Health Maintenance Organization (HMO) plan, you must choose a primary care physician (PCP)
or medical group within the HMO network. 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.

Anthem Blue Cross | Lumenos HSA PPO Medical Plan
The Lumenos Health Savings Account (HSA) PPO plan through Anthem Blue Cross combines a high deductible health plan (HDHP)
with a special, tax-qualified savings account. You may use your HSA funds to pay for current medical expenses or save toward
future medical expenses. You have the freedom to choose your doctor without the requirement of selecting a PCP and the ability
to self-refer to specialists. You may use a PPO provider whose negotiated rates provide richer levels of benefits with claim forms
filed by the providers. You may also obtain services from non-network providers however you will be responsible for the difference
between the covered amount and the actual charges and you may be responsible for filing claims.

HSA medical plan highlights:
• This plan includes a deductible for individual and family coverage. The deductible applies to all services except preventive care.
• You may elect to make contributions into the HSA account up to the IRS maximums through payroll contributions.
• The funds you contribute to your HSA account are not subject to federal income tax at the time of deposit, and will roll-over
and accumulate year-to-year if not spent.

Educational Video
Benefits terminology can get confusing. Click here to watch a quick video to
learn the basics of how our medical plans work.

Deductibles, Copays, Coinsurance, and Out-of-Pocket Maximums
http://video.burnhambenefits.com/terms/

Summary of Benefits and Coverage (SBC):

Health insurance issuers and group health plans are required to provide you with an easy-to-understand summary about your
health plan’s benefits and coverage, referred to as a Summary of Benefits and Coverage (SBC). This guide is designed to help you
understand the medical plan options offered to you by Advanced Sleep Medicine Services.

FINDING A MEDICAL PROVIDER:

Go to www.anthem.com/ca or call Member Services at (866) 207-9878 to find a provider near you.
To search, please click on MENU, then click: > FIND A DOCTOR
> Plan/Network: - Value HMO: Search, Blue Cross HMO (CACare) - Large Group
- Select HMO: Search, Select HMO
- HSA plan option - Search, Lumenos Plans

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