Page 6 - Benefit Guide 2019.2020 - Final
P. 6
[EMPLOYEE BENEFITS]
EMPLOYEE BENEFITS
MEDICAL INSURANCE
ANTHEM BLUE CROSS | HMO PRIORITY SELECT NETWORK PLAN
With the Select Network Health Maintenance Organization (HMO) plan through Anthem Blue Cross, you must choose a Primary Care
Physician (PCP) or medical group within the Priority Select network for all of your covered family members. 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. This plan uses a smaller network of the most cost-effective providers to offer
lower per paycheck premiums. Please note that it is your responsibility to ensure that all family members choose providers from the Select
network.
ANTHEM BLUE CROSS | HMO FULL NETWORK PLAN
With the Anthem Blue Cross Health Maintenance Organization (HMO) plan, you must choose a primary care physician (PCP) or medical
group within the CaliforniaCare 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.
Although you are required to coordinate all your care through a doctor/medical group, you can change your PCP once a month by calling
member services or going online as a registered member.
ANTHEM BLUE CROSS | HSA PPO PLAN
With the HSA PPO plan through Anthem Blue Cross, you can pay for qualified healthcare expenses now and grow your savings for future
healthcare needs. This plan combines a High Deductible Health Plan (HDHP) with a special, tax-qualified Health Savings Account (HSA).
You can contribute tax-free money to your HSA up to IRS maximums. In addition, Total Vision will make contributions totaling $500
toward your health savings account. The money in your account is yours to pay for current healthcare expenses - or you can save for
future healthcare expenses. You have the freedom to choose your doctor without the requirement of selecting a PCP and you may self-
refer to specialists. You may use a network provider whose negotiated rates provide richer levels of benefits with claim forms filed by the
providers. 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 BLUE CROSS | PPO PLAN
The Anthem Blue Cross Preferred Provider Organization (PPO) plan allows you to direct your own care. If you receive care from a physician
who is a member of the network, a greater percentage of the entire cost will be paid by the insurance plan. However, you are not limited
to the physicians within the network and you may self-refer to specialists. If you obtain services using a non‐network provider, please note
that you will be responsible for the difference between the covered amount and the actual charges, and you may be responsible for filing
claims.
FINDING A MEDICAL PROVIDER
Go to www.anthem.com/ca or call (800) 888-8288 or the number on your ID card.
HMO Priority Select Network: Refer to the Priority Select HMO network.
HMO Full Network: Refer to the California Care HMO network.
PPO & HSA (CA): Refer to the Blue Cross PPO (Prudent Buyer) - Large Group network.
6
