Anthem Blue Cross HMO
An HMO (Health Maintenance Organization) is a closed network plan with no out of network benefits. You are required to select a Primary Care Physician, or PCP, for yourself and each member of your family on the health plan. Unlike the Anthem PPO plans, where you do not need a referral to see a specialist, the HMO plan requires that all care be accessed through your PCP. You do not have to use the same PCP for each member. For instance, you may select a pediatrician for your children and a family physician for yourself, etc. Your PCP will be your contact for all your health needs and will refer you to specialists as needed or requested. Though this may represent less freedom than a PPO plan, the benefit level for the HMO plan is much higher, with no deductible and many services are offered without co-pay.
The Anthem HMO network of doctors is very strong in the Central Valley. If you are interested in the HMO option with Anthem and would like to find a PCP or find out if your doctor accepts HMO patients, please visit the Anthem website at anthem.com/ca and follow the “Find a Doctor” link. You can also contact HR&D for assistance. If you do not choose a PCP at the time of enrollment you will have one automatically assigned to you. You can change your PCP through Anthem customer service or the website at any time, but will need to confirm the PCP you are selecting is accepting new HMO patients.
Click here for the Anthem Blue Cross HMO Benefit Summary.
Anthem Blue Cross PPO Plan Options
A preferred provider organization (PPO) is a health plan that has contracts with a network of "preferred" providers from which you can choose. You do not need to select a PCP and you do not need referrals to see other providers in the network.
If you receive your care from a doctor in the preferred network you will only be responsible for your copayment for your visit. If you get health services from a doctor or hospital that is not in the preferred network (known as going "out-of-network") you will pay a higher amount. And, you will need to pay the doctor directly and file a claim with the PPO to get reimbursed.
$0 Deductible PPO
No deductible when using a PPO provider. Most services paid at 90%. $20 office visit co-pays (deductible waived)
$500 Deductible PPO
Member must first meet the $500 deductible ($1000 per family) and then the plan will pay 80% for most services. $35 office visit co-pays (deductible waived)
$1000 Deductible PPO
Member must first meet the $1000 deductible ($2000 per family) and then the plan will pay 80% for most services. $45 office visit co-pays (deductible waived)
$2500 High Deductible Health Plan
Member must first meet the $2500 deductible ($5000 per family) and then the plan will pay 90% for most services. Pharmacy is included in this plan so once the deductible has been met then the member pays pharmacy co-pays (listed on the benefit summary).
Health Savings Account
Employees enrolled in the County's $2500 PPO High Deductible Health Plan (HDHP) are eligible to open a Health Savings Account (HSA). Participation in the HDHP gives you the opportunity to take advantage of this tax-sheltered arrangement to pay the cost of routine medical expenses or to build a fund for future expenses and retirement. Under an HDHP all benefits, both medical and Rx, are subject to the deductible and you are responsible for all charges until this has been satisfied. However, these expenses can be paid with funds from an HSA account, creating a tax savings. Funds may be contributed to an account via pre-tax payroll deduction or directly with after tax dollars which can be deducted from your income when filing tax returns. The funds in an HSA build year over year and funds may be used to pay for any allowable expenses according to IRS guidelines, including dental and vision.
For more information on a Health Savings Account, please visit Sterling HSA’s website.