Page 8 - ABC Company Burnham Sample Guide

Anthem Blue Cross | HMO Plan
With the HMO plan, you must choose a primary care physician (PCP) or medical group within the network. 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 | PPO Plan
The PPO plan requires that you meet a calendar year deductible PPO: Access to Care
before Anthem Blue Cross starts paying for certain services. Once The PPO and the HSA PPO plans are
the deductible has been met, most services will be covered at a Preferred Provider Organization (PPO) plans
coinsurance or a copay, For certain services, such as office visits and use Anthem Blue Cross’s [Network
and urgent care, Anthem Blue Cross has waived the deductible Name] network. PPO plans allow you to
and cost sharing begins immediately, direct your own care. You have the freedom
to choose your doctor without the
Anthem Blue Cross | HSA PPO Plan requirement of selecting a PCP and you may
With the [Plan Name] plan, you can pay for qualified healthcare self-refer to specialists. You may use a
expenses now and grow your savings for future healthcare network provider whose negotiated rates
needs. This plan combines a High Deductible Health Plan (HDHP) provide richer levels of benefits with claim
with a special, tax-qualified Health Savings Account (HSA). You forms filed by the providers. You may also
and the company can contribute tax-free money to your HSA up obtain services using a non-network
to IRS maximums. The money in your account is yours to pay for provider; however, you will be responsible
current healthcare expenses - or you can save toward future for the difference between the covered
healthcare expenses. More details about the HSA medical plan amount and the actual charges, and you
are located on page X. may be responsible for filing claims.

Finding a Medical Provider

Go to www.anthem.com/ca .
• HMO: Refer to the [Network Name] network
• PPO: Refer to the [Network Name] network
• HSA: Refer to the [Network Name] network

Educational Video
Health Insurance Terms
http://video.burnhambenefits.com/terms