Page 5 - JFSLA - Benefits Guide 2018-2019

Benefits

Medical Insurance

Anthem | HMO Medical Plans
With the Anthem Health Maintenance Organization (HMO) plans, you must choose a primary care physician (PCP) or medical group
within the Anthem HMO network that corresponds with the plan you’ve selected. 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.

HMO Plan Options Available (please note each plan uses a different provider network):
 Anthem Vivity 30/40/500A HMO | Network: Vivity
 Anthem Classic 20/40/250A HMO | Network: California Care® HMO

Anthem | PPO Medical Plans
The Anthem Preferred Provider Organization (PPO) plans allow 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 in-network, a greater
percentage of the entire cost will be paid by the insurance plan. You may also obtain services using an out-of-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.

PPO Plan Options Available:
 Anthem Lumenos PPO HSA 2700/20 | Network: Prudent Buyer PPO
 Anthem Classic 1000/35/20 PPO | Network: Prudent Buyer PPO

Note about the HSA PPO Plan Option
The Health Savings Account (HSA) plan combines a high deductible health plan (HDHP) with a special, tax-qualified savings account.
When you establish an HSA banking account you may elect to make contributions into the account up to the IRS maximums:

HSA Contributions 2018 Annual IRS Employee
Contribution Maximum

Employee Only $3,450
Employee + 2 or More Dependents $6,850

Catch-Up Contribution (Ages 55+) $1,000

You may use your HSA funds to pay for current medical expenses or save toward future medical expenses on a tax-free basis. You
pay the full cost for most expenses (including the full cost for most prescription drugs) until you meet the calendar year deductible.
Once you meet the calendar year deductible (January through December), you will pay the cost of your medical expenses through
coinsurance.

Your account balance earns interest and the unused balance rolls over from year to year. The money is yours to keep even if you
leave Jewish Family Service of Los Angeles, no longer participate in a high deductible health plan (like the HSA Option), or retire. If
you are interested in the HSA PPO plan option, please contact the Human Resources Department for additional information.

Pharmacy Program

Covered drug lists can be found at www.anthem.com/formulary. You can search online to confirm if a prescription is covered
under the Open Formulary inclusive of Precertification and Step Therapy.

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