Page 5 - 360 Behavioral Health Guide 2018-2019 Final

Medical Benefits

Anthem Blue Cross Anthem Blue Cross Kaiser Permanente
HMO Plan Differences Classic HMO (Select) Classic HMO (Traditional) HMO
CA Only CA Only CA Only

Providers In Network Only Select In Network Only Full In Network Only Kaiser
Limited Network Network Only Network
Employee Only Premiums $91.14 $156.08 $145.50
(per paycheck)
Employee Office Visit Copay $30 $30 $20

Access to Providers Managed by Your PCP Managed by Your PCP Managed by Your PCP
Primary Care Physician Required Required Required
Referral for Specialist Required Required Required

Anthem Blue Cross Anthem Blue Cross Anthem Blue Cross
PPO Plan Differences Classic PPO Solutions PPO PPO HSA
All Locations All Locations All Locations

Providers In and Out of Network In and Out of Network In and Out of Network

Employee Premiums $191.89 $120.59 $88.65
(per paycheck)
Employee Office Visits
In-Network $30/$40 Ded, 80% Ded, 80%
Non-Network Ded, 60% Ded, 60% Ded, 50%

Access to Providers Managed by You Managed by You Managed by You
Primary Care Physician Not Required Not Required Not Required
Referral for Specialist Not Required Not Required Not Required

Finding In-Network Medical Providers
 For Kaiser, go to www.kp.org or call (800) 464-4000
 For Anthem, go to www.anthem.com/find-doctor or call (800) 888-8222—see chart below for network
names

Plan Name Plan Network

Classic HMO 30/40/500 admit/250 OP Select HMO

Classic HMO 30/40/500 admit/250 OP Blue Cross HMO (CACare) - Large Group

Modified Classic PPO 500/30/20 Blue Cross PPO (Prudent Buyer) – Large Group

Modified Solution PPO 2500/20 Blue Cross PPO (Prudent Buyer) – Large Group

Anthem PPO HSA 2700/20 Blue Cross PPO (Prudent Buyer) – Large Group

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