Page 6 - First Presbyterian Church Benefit Guide

Medical Plan Choices

Anthem Blue Cross | HMO plans
With the Anthem Blue Cross Health Maintenance Organization (HMO) plans, you must choose a primary care physician
(PCP) or medical group within the Priority Select and Vivity network. The two HMO plans are named Classic HMO
20/40/250 Admit /125 OP with Be Active plans are the same benefit design (copays, labs/x-rays, prescriptions). The
main difference is the network of providers. Both have the “Be Active” component, which provides you healthy
lifestyle reimbursements that actually pays you in visa gift cards to make healthy decisions. You and your enrolled
members can earn up to $1200 in rewards and reimbursements. It's true that good health is its own reward. The “Be
Active” plan rewards you for taking part in employer-sponsored health and wellness programs.

 Priority Select HMO Network
This network is built around those medical groups demonstrating the most efficient practice patterns and hospital
referrals in selected Southern California counties: Los Angeles, Orange, Riverside, San Bernardino and San Diego. 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.

 Vivity HMO Network
Anthem and seven of the top-rated health systems in Southern California have joined together to create Vivity, a new
kind of HMO plan that was built to respect your busy life.
Members seeking specialist referrals enjoy the same flexible options as members of other Anthem HMOs, plus Physi-
cian Directed Access, which is available only through Vivity. And they move fast: for referrals, their goal is to provide
decisions within three business days; and they aim to provide specialty appointments within two weeks of referral
authorization.

• Cedars-Sinai Medical Center
• UCLA Health
• Northridge Hospital Medical Center
• Good Samaritan Hospital
• Torrance Memorial Medical Center
• Huntington Hospital
• PIH Health Hospital
• Community Hospital Long Beach
• Queen of the Valley Hospital

An example of how it works: A member assigned to Cedars-Sinai’s medical group could be referred to a specialist at
Torrance Memorial, or a member assigned to PIH Health’s medical group could be referred to a cardiologist at Hun-
tington Memorial. The referral is subject to the particular specialist having agreed to see members from other medi-
cal groups and the member’s primary care physician’s determination that the specialist visit is medically necessary.

Finding a Medical Provider
Go to www.anthem.com/ca or call (800) 888-8288.
• HMO: Refer to the Priority Select HMO network
• HMO: Refer to the Vivity HMO network

6 Employee Benefits