Page 6 - Humano EE Guide 06-20

Medical Plan Choices

Anthem Blue Cross | PPO Plans
The PPO plans require that you meet a calendar Your Access to Care
year deductible before Anthem Blue Cross starts Our plans are Preferred Provider Organization (PPO) plans
paying for certain services. Once the deductible and use Anthem Blue Cross’s “Blue Cross PPO (Prudent
has been met, most services will be covered at a Buyer)” network. PPO plans allow you to direct your own
coinsurance or a copay, For certain services, such care. You have the freedom to choose your doctor without
as office visits and urgent care, Anthem Blue Cross the requirement of selecting a PCP and you may self-refer to
has waived the deductible and cost sharing begins specialists. You may use a network provider whose
immediately. negotiated rates provide richer levels of benefits with claim
forms filed by the providers. You may also obtain services
There are 3 PPO options to choose from: using a non-network provider; however, you will be
• Bronze PPO responsible for the difference between the covered amount
• Gold PPO and the actual charges, and you may be responsible for filing
• Platinum PPO claims.

Finding a Medical Provider
Go to www.anthem.com/ca or call (855) 383-7248. Refer
to the “Blue Cross PPO (Prudent Buyer) - Small Group”
network when prompted.

Working Spouse Eligibility for Medical
Spouses and domestic partners who have other medical
coverage available to them through their employer are
not eligible to enroll in our plan. Upon enrolling for
your benefits in Ease, all associates will be required to
Educational Video sign-off on The Employee Affidavit, certifying that any
Health Insurance Terms spouse/domestic partner enrolling in the medical plan
http://video.burnhambenefits.com/terms is eligible.

Summary of Benefits and Coverage (SBC)
Health insurance issuers and group health plans are required to provide you with an easy-to-understand summary
about your health plan’s benefits and coverage, referred to as a Summary of Benefits and Coverage (SBC). This guide
is designed to help you understand the medical plan options offered to you by humano. Please refer to the SBC and
carrier contracts provided by Anthem Blue Cross for additional plan details.

6 Employee Benefits