Page 7 - Sumitomo EE Guide 06-18.pub
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BENEFITS





         MEDICAL INSURANCE


         BLUE SHIELD | HMO
         California Residents Only
         With the Blue Shield Health Maintenance Organiza on (HMO) plan, you must choose a primary care physician (PCP) within the
         Access+ 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 authoriza on. 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  allows  you  to  receive  specialist  referrals  from  your  PCP  or  you  may  self‐refer  to  an  Access+  Specialist  within  your  PCP’s
         medical group for a higher copay.

         BLUE SHIELD | PPO MEDICAL PLAN
         California and Non-California Residents
         The  Blue  Shield  Preferred  Provider  Organiza on  (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
         network, a greater percentage of the en re 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.



                         LOCATING A MEDICAL PROVIDER

                         If you reside in California:                 If you reside outside of California:
                           HMO: Go to blueshieldca.com/networkhmo     Go to h p://provider.bcbs.com. Enter FTT in
                           PPO: Go to blueshieldca.com/networkppo      the “Your Plan” box
                           Call Member Services (888) 256‐1915        Call BlueCard Access (800) 810‐2583







         HEALTH ADVOCATE
         Health  Advocate  is  a  program  that  provides  you  with  experienced  help  when  dealing  with  benefit  related  issues.  Their  team
         includes highly trained registered nurses, backed by a staff of medical directors and administrative experts. When you call Health
         Advocate for assistance you are assigned a Personal Health Advocate who takes responsibility for helping you to resolve problems.

         Here are a few of the ways that they help:
           They help you get your claims and/or billing issues resolved
           They help you get answers to your medical questions about test results, treatment plans, and medications recommended by
            your doctor
           They work with our insurance carriers to help obtain appropriate approval for services when necessary
           They assist in communications between your doctors and the insurance companies
           They help you locate and contact the best doctors, dentists, and treatment facilities in your networks
           They share unbiased health information when you need to make an informed decision about your care



                        CONTACTING HEALTH ADVOCATE

                        Call (866) 695‐8622 or send an email to answers@healthadvocate.com







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