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.

No referral is necessary from a primary care physician for services of in-network or out-of-network specialists. For many services, members must meet the annual individual deductible before the Plan begins paying benefits.

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 premiums
  • Annual deductible is $250 for individual, $750 for family
  • Higher co-pay
  • Out-of-pocket (in network) limit is $889 for individual

LiveHealth Online

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 and sign up at livehealthonline.com.

Pharmacy Benefit: IngenioRX Will Become CarelonRX

IngenioRX Effective January 1, 2023, IngenioRx, Anthem's pharmacy benefit manager, will join the Carelon family of companies and change its name to CarelonRx. A few important things about the change to CarelonRx:

  • This name change will not impact members’ benefits, coverage, or how they fill their medications. In addition to the mail and specialty pharmacies, members can continue to fill their prescriptions at any in-network retail pharmacy
  • Members will not need new prescriptions for existing medications they currently take.
  • There is no impact to member ID cards because of this name change. There is no mention of IngenioRx on these ID cards and the pharmacy information on the cards, including member service phone numbers and BIN and PCN numbers, is not changing.
  • Members will continue to access their pharmacy information through their secure member portal (e.g., anthem.com/ca), and via Sydney Health.

COVID-19 Vaccination Facts and Myths

Getting vaccinated is a critical part of the fight against COVID-19. Learn more about the vaccine and why it is so important to get vaccinated when it's your turn.


Medical Coverage While Traveling

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. If you need emergency services, it is important to contact Blue Cross Blue Shield Global Core at 1-800-810-2583 or call collect at 1-804-673-1177 if admitted to the hospital. For additional information about this benefit please visit www.bcbsglobalcore.com.  

Important Resources:

Blue Cross Global Core Program

Anthem Find Care Guide - U.S.

International Claim Form

 

Urgent Care

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.