Page 5 - KNCH Benefits Guide 2019 v3

MEDICAL INSURANCE

ANTHEM BLUE CROSS | HMO CACARE (FULL NETWORK) MEDICAL PLAN
Available in CA Only
With the Anthem Blue Cross CaliforniaCare HMO plan, you must choose a Primary Care Physician (PCP) or Medical Group within
the Anthem CACARE Network for all of your covered family members. This plan offers the full Anthem HMO network of
physicians to provide you the greatest access within Anthem’s HMO 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. Please note that it is your responsibility to ensure that all family
members choose providers from the Anthem Blue Cross (CACARE) HMO Network—Large Group.

ANTHEM BLUE CROSS | EPO (EXCLUSIVE PPO) MEDICAL PLAN
Only Available in AZ, FL, NV & TX (Non-CA)
The Anthem Blue Cross EPO Plan allows you to direct your own care within the Anthem Blue Cross National Blue Card PPO
network of physicians, and you may self-refer to specialists. Note with this plan, if you receive care from a physician who is not
within the Anthem Blue Cross National Blue Card PPO network, you will be responsible for most if not all charges, except in the
case of an emergency. With this plan, there is very limited to no coverage for services rendered through non-network physicians
and facilities.

ANTHEM BLUE CROSS | PPO MEDICAL PLAN
Available in all states
The Anthem Blue Cross 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
Anthem Blue Cross Prudent Buyer PPO 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 BLUE CROSS | HSA PPO MEDICAL PLAN
Available in all states
The Health Savings Account (HSA) plan through Anthem Blue Cross combines a high deductible health plan (HDHP) with a
special, tax-qualified savings account. You may use your HSA funds to pay for current medical expenses or save toward future
medical expenses. Similar to the PPO plan, 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.

You may contribute into your HSA account up to IRS maximums:

2019 Annual IRS 2020 Annual IRS
Employee Contribution Maximum Employee Contribution Maximum

Employee $3,500 $3,550
Employee + Family $7,000 $7,100
Catch-up for Employees Over the Age of 55 $1,000 $1,000

Additional information about how the HSA Medical plan works is located on page 10 of this guide.

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