Anthem Blue Cross PPO

The Anthem Blue Cross Preferred Provider Organization (PPO) provides benefits when participants use an in-network or out-of-network provider. However, the levels of coverage are higher for in-network providers than for out-of-network providers.

For many services, members must meet the annual individual deductible before the Plan begins paying benefits. Please see Anthem PPO Premier Summary of Benefits document on the Benefits Compliance Information page for more information.

Services received out of network require you to submit a claim form for processing. You are responsible for paying any difference between the allowed customary and reasonable (C&R) amount and actual charges, in addition to your deductible and coinsurance. Some services may require pre-approval from Anthem Blue Cross. You are responsible for contacting Anthem Blue Cross to determine if potential services are covered or if they must be submitted for utilization review and approval by Anthem Blue Cross.

  • Choose practitioners inside or outside PPO network; cost-sharing is higher if out-of-network
  • No referral necessary from primary care physician for specialist services
  • Higher employee contribution
  • Annual deductible is $250 for individual, $750 for family
  • Higher co-pay
  • Out-of-pocket (in network) limit is $889 for individual

LiveHealth Online provides 24/7 access to U.S. board-certified physicians with an average of 15 years of experience from an Internet-connected device (e.g., computer, tablet, or mobile phone) for non-emergency medical assistance. Anthem members may consult a doctor through LiveHealth Online for free, a savings of $49 per use. Read more, sign up and download the app at livehealthonline.com.

We recommend that members watch the Anthem Prescription Drug Overview webinar, which provides information about the Anthem member portal, the Sydney app, pharmacy co-pays, prescription drug maintenance, CarelonRx mail orders, and obtaining authorization for specialty drugs. Review the presentation materials here.

You can find the Anthem PPO Drug Plan Formulary here.

You have more choices than just the emergency room (ER) that can save you time and out-of-pocket costs. The ER shouldn’t be your first stop — unless there’s a true emergency. While both urgent and emergency care situations are serious, urgent care is for medical symptoms, pain, or conditions that require immediate medical attention but are not severe or life-threatening and do not require use of a hospital or ER. Urgent care conditions include, but are not limited to: earache, sore throat, rash, sprained ankle, flu and fever not higher than 104°. So, what do you do when you need care right away, but it is not an emergency?

– Call Anthem’s 24/7 NurseLine at 800-977-0027

– Find an urgent care center by visiting anthem.com/ca

– Contact doctors through livehealthonline.com

Whether you’re traveling domestically or internationally, Anthem Blue Cross will grant you coverage in the event of a life- or limb-threatening medical emergency. If you are traveling and receive emergency services, remember to retain all your receipts and related documentation.

While traveling internationally, you will only have coverage for emergency care; in other words, services that are provided for the initial treatment of an unexpected acute illness, injury, or condition that would permanently endanger your health if not immediately treated. If emergency medical care is necessary, you should go to the nearest hospital and call Blue Cross Blue Shield Global Core at 1-800-810-2583 or call collect at 1-804-673-1177 if admitted to the hospital. Blue Cross Blue Shield Global Core requires immediate notification once admitted. You may need to pay up front in full for your care and file a claim for reimbursement by submitting an international claim form. Claims are processed based on the diagnosis. This policy may cover medically necessary emergency services that meet or exceed 35,000 USD. You can also contact Blue Cross Blue Shield Global Core to find the nearest hospital. 

For additional information about this benefit, please visit www.bcbsglobalcore.com.