Page 5 - CHSI Benefit Guide 2019-2020

Medical Benefits

Anthem Blue Cross | HMO Medical Plan
With the Anthem Health Maintenance Organization (HMO) plan, you must choose a primary care physician (PCP) or medical
group within the Anthem Full HMO network (Blue Cross HMO (CACare) - Large Group). 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.

Anthem Blue Cross | HSA Medical Plan
With the HSA plan through Anthem Blue Cross, you can pay for qualified healthcare expenses now and grow your savings for
future healthcare needs. This plan combines a High Deductible Health Plan (HDHP) with a special, tax-qualified savings
account (HSA). You can contribute tax-free money to your HSA up to IRS maximums.

HSA IRS Maximums 2019
Employee $3,500
Family $7,000

Catch-Up for Employees Age 55+ Indexed for Inflation

The money in your account is yours to pay for current healthcare expenses - or you can save toward future healthcare
expenses. You have the freedom to choose your doctor without the requirement of selecting a PCP and you may self-refer to
specialists. You may use a network provider whose negotiated rates provide richer levels of benefits with claim forms filed
by the providers. You may also obtain services using a non-network provider; however, you will be responsible for the
difference between the covered amount and the actual charges and you may be responsible for filing claims. Additional
information on how the HSA plan works is located on page 8 of this guide.

Anthem Blue Cross | PPO Medical Plan

The Anthem Blue Cross Preferred Provider Organization (PPO) plan allows you to direct your own care. Similar to the HSA
plan, you are not limited to the physicians within the network and you may self-refer to specialists. If you receive care from a
physician who is a member of the network, a greater percentage of the entire cost will be paid by the insurance plan. You
may also obtain services using a non‐network provider; however, you will be responsible for the difference between the
covered amount and the actual charges and you may be responsible for filing claims.

Finding In-Network Medical Providers
Go to www.anthem.com/ca or call (866) 207-9878 for HSA or (800) 888-8288 for HMO and PPO.
• HMO: Select your state of residence
• Refer to the “Blue Cross HMO (CACare) - Large Group” plan/network when prompted
• PPO: Select your state of residence
• Refer to the “Blue Cross PPO (Prudent Buyer) - Large Group” plan/network when prompted
• HSA: Select your state of residence
• Refer to the “Lumenos Plans” plan/network when prompted

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 California Eye Specialists. Please refer to the SBC and carrier
contracts provided by Anthem Blue Cross for additional plan details.

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