Page 4 - Avance Schools Benefit Guide 2019

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 Priority Select and 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: Priority Select HMO Network (Classic HMO 20/40/250 Admit /125 OP with Be Active)

“Be Active” provides you the more affordable premium when it comes to your payroll deductions and will actually pay you
in visa gift cards to make healthy decisions. You and your enrolled members can earn up to $1200 in rewards and
reimbursements. It's true that good health is its own reward. The “Be Active” plan rewards you for taking part in employer
-sponsored health and wellness programs. See page 5 of this brochure for more info.

• Buy-up Plan: Select HMO Network (Classic HMO 10/30/250 Admit/125 OP)

You have to option buy-up and pay a nominal amount to enroll in the HMO plan with a larger network of providers in the
“Select HMO” network. Since this plan offers more provider options, you will experience higher per paycheck premiums.

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 “Prudent Buyer 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.

Finding a Medical Provider

Go to www.anthem.com/ca or call (800) 888-8288.
• Base HMO: Priority Select HMO Network
• Buy-Up HMO: Select HMO Network
• PPO: Prudent Buyer PPO Network

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 Avance Schools. Please refer to the SBC and carrier contracts provided by
Anthem Blue Cross for additional plan details.

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