Page 5 - Lake Avenue Church Benefits Guide 2018 5.22

Medical Benefits

Medical Insurance

Anthem Blue Cross | HMO plans
With the Anthem Blue Cross Health Maintenance Organization (HMO) plan, you must choose a primary care physician (PCP) or
medical group within the Select network. You have the choice of two HMO plans. For both, 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. Both HMO plans include a Chiropractic Care and Acupuncture
Rider Plan 10/30, meaning you have direct access to these specialist at a low cost of $10/visit, up to 30 visits a year.

• Base Plan - Value Deductible HMO 500/20/40/20% – Select HMO Network
This base plan, provides you the more affordable premium when I comes to your payroll deductions. When you get care,
you'll pay the full charges for covered services until you reach a set amount known as your deductible. After you reach
your deductible, you'll start paying less – a copay or a percentage of the charges (a coinsurance) for the rest of the year.
Full charges, copays, and coinsurance count toward your out-of-pocket maximum, which helps limit how much you pay
for care. After you reach your out-of-pocket maximum, you won't have to pay for most covered services for the rest of
the year.

• Buy-up Plan - Value HMO 20/40/250 3day/20% OP – Select HMO Network
You have to option buy-up and pay a nominal amount to enroll in the HMO plan without a deductible, meaning lower out
of pocket expenses as you use the plan.

Anthem Blue Cross | PPO Medical Plan
The Anthem Blue Cross Preferred Provider Organization (PPO) plan allows you to direct your own care. If you receive care from a
physician who is a member of the PPO network, a greater percentage of the entire cost will be paid by the insurance plan.
However, you are not limited to the physicians within the network and you may self-refer to specialists. If you obtain services using
a non‐network provider, please note that 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 Anthem Blue Cross Anthem Blue Cross
Plan Differences Value Ded HMO Value HMO PPO
(Base HMO) (Buy-up HMO)

Employee Premiums $ $ $$

Out-of-Pocket Costs $ $ $$
Cost Sharing Contribution, Copay, Contribution, Copay Contribution, Copay,
Deductible, Coinsurance Deductible, Coinsurance
Network Size   
In-Network Benefits ✓ ✓ ✓

Non-Network Benefits ✓
Access to Providers Managed by Your PCP Managed by Your PCP Managed by You
- Primary Care Physician Required Required Not Required
- Referral for Specialist Required Required Not Required

Finding In-Network Medical Providers
Go to www.anthem.com/ca or call (800) 888-8222.
• HMO: Select your state of residence
• Refer to the “Select HMO” plan/network when prompted
• PPO: Select your state of residence
• Refer to the “Blue Cross PPO (Prudent Buyer) - Large Group” plan/network when prompted 5