Page 5 - Tongle Benefits Guide 2018 - CA Final

BENEFITS

Medical Insurance

Anthem | HMO Medical Plan
With the Anthem Health Maintenance Organization (HMO) plan, you must choose a primary care physician (PCP) or medical group
within the ‘Blue Cross HMO (CACare) - Small Group’ 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 | PPO Medical Plans
The Anthem 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 ’Blue Cross
PPO (Prudent Buyer) - Small Group’ 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.

Anthem Gold HMO Anthem Gold PPO Anthem Platinum PPO
Plan Differences 25 / 20% / 5500 1,000 / 20% / 6000* 200 / 10% / 3000

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

In-Network Benefits ✓ ✓ ✓
Non-Network Benefits Emergency Only ✓ ✓

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

*The employee only premium is paid in full for the Anthem Gold HMO and Gold PPO 1,000 Deductible plan, premiums referenced
would be for dependent coverage. The Platinum PPO 200 Deductible plan is offered at a buy-up.

Finding a Medical Provider
Go to www.anthem.com/ca, click the Menu button, and go to the Find a Doctor link. Under the Search as a
Guest options, select Search by Selecting a Plan or Network. Select Medical, then your state, then the
appropriate plan network under Medical (Employer—Sponsored):

• Gold HMO 25 / 20% / 5500: Blue Cross HMO (CACare) - Small Group
• Gold PPO 1,000 / 20% / 6000: Blue Cross PPO (Prudent Buyer) - Small Group
• Platinum PPO 200 / 10% / 3000: Blue Cross PPO (Prudent Buyer) - Small Group

For further assistance, call Anthem’s member service at (855) 383-7248

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