Page 9 - Optima Tax EE Guide 01-20 CA w Kaiser

Medical Plan Choices

Optima Tax Relief offers three medical options to provide appropriate
coverage to you and your family.
Kaiser | HMO Plan
With the Kaiser Permanente Health Maintenance Organization (HMO) plan, services must be obtained at a Kaiser
Permanente facility, except in the case of emergency. All of your care must be directed through your selected
doctor, but you can choose and change your doctor at any time, for any reason. Kaiser Permanente integrates all
elements of healthcare such as physicians, medical centers, pharmacy, and administration in one convenient
facility
Anthem | Basic PPO Plan
The Anthem PPO plan utilizes the Prudent Buyer Anthem PPO Network, however, you are not limited to the
physicians within the network. Staying in-network saves you money! You may 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.
Basic PPO • You are cost conscious and do not want to pay for the coverage you are not going to use
plan is best if: • You do not anticipate high cost procedures (hospitalizations, surgeries, MRIs, CT scans, etc.)
• You like the option of going to any provider you want
• You take medications that are on the Anthem-approved drug list

Anthem | Standard Network Only EPO
This Anthem Network Only EPO plan utilizes the vast Prudent Buyer Anthem PPO Network. You are encouraged to
choose a primary care physician (PCP) and direct your specialty care through your PCP. You will receive benefits
only if you use the doctors, clinics and hospitals belonging to the Prudent Buyer Anthem PPO Network, except in
the case of an emergency.
Standard • You do not mind using in-network (EPO) providers only
Network • You like having set copays when receiving medical and prescription services
Only EPO • You take medications that are on the Anthem-approved drug list
plan is best if:
• You are comfortable paying a slightly higher employee contribution

Anthem | Premier PPO
The Anthem PPO plans utilizes the Prudent Buyer Anthem PPO Network, however, you are not limited to the
physicians within the network. Staying in-network saves you money! You may obtain services using a non‐network
provider and you will be responsible for the difference between the covered amount and the actual charges. You
may also be responsible for filing claims.
Premier PPO • You like the option of going to any provider you want
plan is best if: • You may have existing medical conditions and would prefer to pay lower out-of-pocket costs
such as deductibles and copays when receiving medical and prescription services
• You take medications that are on the Anthem-approved drug list
• You are comfortable paying a higher employee contribution for premier benefits and
network access

Finding a Medical Provider

Kaiser: Visit www.kp.org. Anthem : visit www.anthem.com/ca.
Click Doctors and Locations Click Find a Doctor > You may log in or search as a Guest > If
searching as a Guest, refer to the following Plan/Network:
• Medical (Employer-Sponsored), then Blue Cross PPO (Prudent
Buyer) - Large Group

Employee Benefits 9