Page 9 - SunWest EE Guide 09-19 CA

Medical Plan Choices

Anthem Blue Cross | HMO Plans
Two HMO options are available
With the HMO plans, 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.

HMO Plans: Access to Care
Our two HMO plans both have the same level of benefits as each other including copays, coinsurance, and out of
pocket maximums. However, these plans utilize different networks of providers and medical groups. It is
important for you to carefully review the providers, hospitals and medical groups within the Priority Select HMO
and California Care HMO networks to ensure you elect a plan that includes a PCP & medical group that is right for
you. You can request to change PCP’s and/or medical groups throughout the year. Changes can typically be made
the month following the request.

Anthem Blue Cross | PPO Plan PPO: Access to Care
The PPO plan requires that you meet a calendar year deductible The PPO and the HSA PPO plans are
before Anthem Blue Cross starts paying for certain services. Once Preferred Provider Organization (PPO) plans
the deductible has been met, most services will be covered at a and use Anthem Blue Cross’s Prudent Buyer
coinsurance or a copay, For certain services, such as office visits PPO network. PPO plans allow you to direct
and urgent care, Anthem Blue Cross has waived the deductible your own care. You have the freedom to
and cost sharing begins immediately. choose your doctor without the
requirement of selecting a PCP and you may
Anthem Blue Cross | HSA PPO Plan self-refer to specialists. You may use a
Two HSA PPO options are available network provider whose negotiated rates
With the HSA PPO plan, you can pay for qualified healthcare provide richer levels of benefits with claim
expenses now and grow your savings for future healthcare forms filed by the providers. You may also
needs. This plan combines a High Deductible Health Plan (HDHP) obtain services using a non-network
with a special, tax-qualified Health Savings Account (HSA). You provider; however, you will be responsible
and the company can contribute tax-free money to your HSA up for the difference between the covered
to IRS maximums. The money in your account is yours to pay for amount and the actual charges (which can
current healthcare expenses - or you can save toward future exceed the plan’s non-network out of pocket
healthcare expenses. More details about the HSA medical plan maximums), and you may be responsible for
are located on page 14. filing claims.

Finding a Network Medical Provider
Go to www.anthem.com/ca
 HMO Priority Select: Refer to the “Priority Select HMO” network
 HMO Full Network: Refer to the “California Care HMO” network
 PPO and HSA PPO: Refer to the “Prudent Buyer PPO” network

Employee Benefits 9