Let's take a look

We know picking a health plan is a big deal, so this guide makes it easier for you to understand your benefit options. We’ll explain how the plan works and give you other important details. That way you can enroll with confidence!

In this guide, you'll find:

  • The plan at a glance
  • Your healthcare basics
  • How to use your health plan
  • Dental and Vision benefits
  • Health and Wellness programs
  • Your privacy and rights

The plan at a glance

Here's a quick overview of the plan your employer is offering. (But remember, each of our plans may have different rules, so always check your plan details for more specific information.) To learn more plan basics, visit anthem.com/basics.

PPO Benefits

  • This plan covers services from almost any doctor or hospital.
  • You pay less if you use a doctor from the Preferred Provider Organizations (PPO) plan.
  • You pay more if you go to a doctor who's not part of the PPO plan.
  • You don't usually need a referral from your main doctor, also called a primary care doctor, to see a specialist.

Know your health care basics

Learn about the kinds of costs you'll share with your plan:

Overview of Benefits

You pay your deductible

This is a set amount that you pay before we start sharing in the cost of the covered health care you receive. If your plan has co-pays (flat fees such as $30 for each visit) along with a deductible, you only need to pay the copay for most doctor visits.

What happens after I pay my deductible?

You pay a co-pay or a percentage of the cost, also called co-insurance, each time you receive care for covered services, and then your plan covers the rest.

What's an out-of-pocket limit?

Each year, there’s a maximum amount you can pay out of your own pocket for covered services — that’s your out-of-pocket limit. Once you’ve reached that limit — it varies by plan — we cover the rest for covered services. If you visit doctors or hospitals that aren’t in your plan, you’ll still have out-of-pocket costs. With some plans, you still have co-pays even after you reach your out-of-pocket limit.

What about the money for the plan that gets taken out of my paycheck?

That’s what you pay for the plan. Think of it like a membership fee. It’s separate from what you pay when you get care.


Using your health plan

Here's how to get started with your plan and make the best of your benefits.

Choose a doctor in your plan

Avoid getting care from doctors outside of your plan; it will cost you more or your plan may not cover it at all. We’ve made it easy for you to find doctors in your plan. Visit anthem.com to look for a primary care doctor, hospitals, labs and other healthcare professionals in your plan.

Use your ID card

You’ll be a member after you complete enrollment and your benefits begin. Then, you’ll be able to use your ID card. Don’t forget, it’s always available on the Anthem Anywhere mobile app. It’s like your passport to care since you’ll need to show it whenever you go to the doctor.

Anthem.com

Once your benefits begin and you access your ID card, register on anthem.com or on the Anthem Anywhere mobile app to get personalized information about your wellness programs and health plan.

  • Find a doctor.
  • Estimate your costs, before you step into the doctor’s office.
  • Set up your communication preferences to receive important information electronically, instead of by mail.

Learn more at anthem.com/guidedtour.

Preventive care is covered at no extra cost

Preventive care from a doctor in your plan is covered at 100%. Getting these regular checkups, screenings and shots can help you stay healthy and catch problems early – when they’re easier to treat. So, talk to your doctor about what preventive care you may need to protect your health.

You’re covered when you travel

When you’re away from home and need care right away, you have access to care across the country. Plus, if you’re going out of the country, you have access to care abroad through the Blue Cross Blue Shield Global Core program.

Save emergency room visits for emergencies only

Knowing where to go for care saves you time and money. So if you have a real emergency, head straight to the ER or call 911. Otherwise, visit your regular doctor or an urgent care center for minor medical issues.

We’re here for you

When you become a member, you can get your questions answered in the way that works best for you.

Overview of Benefits


Dental and Vision benefits

When you enroll, you'll probably need to sign up separately for the benefits in this section.

Dental

Dental benefits not only protect your teeth, but can supports overall health, too. Some conditions like heart disease, for example, can have warning signs in the mouth and gums. Our dental plan gives you all the benefits you need for a healthy mouth and more.

Our dental plan offers:

  • Access to a large number of dentists in the plan.
  • An extra cleaning if you’re pregnant, have diabetes or another qualifying condition.
  • A benefit for a brush biopsy that can help diagnose oral cancer.
  • No out-of-pocket costs for cleanings, X-rays and other preventive care services when you see a dentist in the plan.
  • Online tools including a Dental Health Assessment, Dental Cost Estimator and Ask a Dental Hygienist.
  • Find a Dental Provider here.

Vision

With Blue View VisionSM, you have access to more than 36,000 doctors in more than 27,000 locations across the country, including convenient retail stores like LensCrafters®, Sears OpticalSM, Target Optical®, JCPenney® Optical and most Pearle Vision® stores. You can also order glasses and contacts online through Glasses.com, ContactsDirect, or 1-800-CONTACTS.

Enrolling in a vision plan helps you pay for:

  • Routine eye exams. Even if you can see well, regular eye exams are important to help keep your eyes healthy - and you can catch other health problems early.
  • Frames and either eyeglass lenses or contact lenses.
  • Find a Vision Provider here.
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