Employee Benefits Technician
Medical and Prescription Drugs
Anthem Blue Cross HMO Medical Plans:
An HMO plan’s primary objective is to offer you and your dependents quality coverage at a lower cost. If you select the Anthem HMO, you must choose a primary care physician (PCP) and medical group who will then coordinate your care through the carrier’s HMO network of physicians and hospitals, resulting in cost savings for you. Kaiser’s network is a unique model as the insurance company employs hospitals, doctors, and nurses which members would receive all treatment from, except in an emergency. This “closed” system offers high quality care and benefits at a low cost relative to other insurance companies.
- To be eligible for these plans, you must reside in the Blue Cross of California HMO service area.
- There are no deductibles and no claim forms to file.
- You must select a PCP from Blue Cross’ pre-approved list of healthcare providers.
- If you need specialist care, you’ll need a referral from your PCP.
- Each family member may choose his or her own Blue Cross HMO network PCP.
- Non-network benefits are not covered.
Member Services: (800) 825-5541
Blue Cross HMO California Care
Certificated Group # 57AMTA
Classified Group # 57AMTJ
Confidential & Management Group # 57AMTE
Blue Cross HMO Select
Certificated Group # 57AMTQ
Classified Group # 57AMTU
Confidential & Management Group # 57AMTY
Blue Cross HMO Priority Select
Certificated Group # 57AMTN
Classified Group # 57AMTS
Confidential & Management Group # 57AMTW
Anthem Blue Cross PPO Medical Plan:
A PPO plan offer members a variety of medical groups and physicians to choose from. Even more so, PPO plans are designed to provide members with choice and flexibility. By enrolling in the Anthem PPO plans, you will have access to in-network and out-of-network coverage allowing you to see any provider of your choice (out-of-network care will lead to higher out-of-pocket costs).
- You are not required to select a PCP.
- As a PPO member, you may use a PPO provider outside of the PPO plan network, but you will pay more out-of-pocket and may be responsible for filing claims. If you visit a non-network provider or health care facility, the plan will pay benefits only up to the “allowed amount,” which is based on a limited fee schedule. You will have to pay any charges above the allowed amount (in addition to your regular co-insurance
Blue Cross PPO
Certificated Group # 40777A
Classified Group # 40779A
Confidential & Management Group # 40778A
Kaiser Permanente HMO Medical Plan:
With the Kaiser Health Maintenance Organization (HMO) plan, services must be obtained at a Kaiser facility. Kaiser integrates all elements of healthcare such as physicians, medical centers, pharmacy and administration in one convenient facility.
Kaiser Permanente HMO Plan Highlights:
Kaiser Permanente HMO Plan Highlights:
- To be eligible for this plan, you must reside in the Kaiser Southern California service area.
- There is no deductible and no claim forms to file.
- Services are only covered when you use Kaiser providers and facilities, except in the case of emergency.
- Kaiser offers the convenience of doctors, pharmacies and labs under one roof.
- Kaiser does not require that you choose a primary care physician until after you enroll in the plan.
- Kaiser offers online tools, so you can email your doctor’s office, make appointments, refill prescriptions, and more.
Kaiser - www.kp.org
Member Services - (800) 464-4000
Certificated Group #234480-047ACN
Classified Group #234480-0047ALN
Confidential & Management Group #234480-0047AMN
American Specialty Health Plans of California ( Chiropractic) - (800) 678-9133
As a result of Health Care Reform, effective 10/1/10, preventive care benefits are covered at 100% under the Kaiser and Blue Shield medical plans (this does not apply to out-of-network services under the PPO plans). You may also contact your insurance carrier for specific questions Kaiser: 800-464-4000 or Blue Cross:800-825-5541