Page 5 - SBCEO Benefit Guide 19-20_FINAL

Medical Benefits 5

Medical Plan Options for Full-Time and Part-Time Employees
SBCEO provides health care benefits through SISC. These plans are designed to give you both choice and affordability.
PPO Plans

 Anthem 100-C $20 Classic PPO: #40461D
 Anthem 100/80 SB PBI PPO: #40482A
How the PPO Plans Work
 You have the freedom to choose any doctor you wish for your care, including specialists.
 When you access care from PPO providers, you receive richer levels of benefits and claim forms are filed by the
providers.
 You may also obtain care using out-of-network providers; however, you will be responsible for the difference between
the covered amount and the actual charges, and you may be responsible for filing claims.
 Coverage is available while traveling:
− In the United States: You can take advantage of in-network PPO benefits while traveling or temporarily living outside
your home state through the BlueCard Program. To locate BlueCard providers, call 800-810-2583.
− Outside the United States: Coverage outside the United States can be accessed through Blue Cross Blue Shield (BCBS)
Global Core. Please note that this coverage may differ from your PPO plan. For more information, call BCBS at
800-810-2583 (you may call collect at 804-673-1177) .

Online, Mobile and Phone Access

Manage your care online by registering at anthem.com/ca/sisc. You can locate network
providers, manage your claims, obtain health and wellness information and much more.
Once you’ve registered, download the Anthem Anywhere mobile app, available on the App Store and
Google Play, for on-the-go convenience. The app lets you manage your health plan, store your medical card
in your phone, search for providers, compare costs for health care procedures and more.

For customer service, call 800-322-5709.

Ambulatory Surgery Centers (ASCs)
SISC provides reference pricing for five common procedures that can be performed safely at an ASC at costs
significantly lower than at a hospital. The five procedures are Arthroscopy, Cataract Surgery, Colonoscopy, Upper GI
Endoscopy with Biopsy, and Upper GI Endoscopy without Biopsy. Provisions for exceptions include:
 If the physician provides clinical justification for using a hospital
 If a member lives more than 30 miles from an ASC
 If a procedure cannot be scheduled in a medically appropriately timely manner due to available ASCs not having capacity
 Emergencies