Anthem Health Plans
What to Know
Medical coverage is administered through Anthem Blue Cross and includes coverage for important services such as preventive care, doctor’s office visits, hospitalization and prescription drugs.
Anthem Blue Cross PPO (All Campuses)
Your medical and behavioral health benefits are provided through the Anthem Blue Cross PPO (preferred provider organization) plan. All campuses, except UCSF, pay no monthly premiums for this coverage; UC pays the entire premium cost.
The Anthem PPO plan allows you to get care from any doctor, hospital or provider you want. But you’ll usually pay less out of pocket when you see a UC Health provider or one of the more than 60,000 providers in the statewide Anthem Blue Cross Prudent Buyer (PPO) network.
UCSF Pays Monthly Premium
For UC San Francisco residents and fellows, you will pay a small monthly cost to enroll yourself and any eligible dependents in the Anthem PPO plan.
Plan Highlights
The Anthem PPO plan features include:
No-cost in-network preventive care for you and all enrolled family members through UC Health centers and Anthem providers. There’s no deductible or out-of-pocket cost for preventive screenings and lab tests recommended by Anthem based on your age and gender.
Coverage for other types of care, including doctor’s office visits, hospitalization, behavioral health services and prescription drugs, when you see an Anthem provider. Each year, you have to meet an annual deductible ($100 for individual / $200 for family coverage) before the plan begins to share in the cost of covered services. There’s no deductible for services received at a UC Health center.
Behavioral health benefits for mental health services and substance abuse treatment. You and your covered family members can use behavioral health benefits for sessions with counselors, psychologists or psychiatrists to address issues such as:
- Depression and anxiety
- Alcohol or drug abuse
- Eating disorders
- Medication management
- Autism and pervasive developmental disorders
You’re protected for the worst-case scenario. The health plan protects your physical health, while the out-of-pocket maximum limits your financial liability for covered expenses.
- After you meet the out-of-pocket maximum ($1,000 for individual / $2,000 for family, which includes the deductible), Anthem pays 100% for most covered services, including prescription drugs, for the remainder of the benefit year.
- If you’re enrolled in family coverage, you must meet the family out-of-pocket maximum before Anthem will pay 100% of expenses.
- In-network expenses count toward the out-of-network out-of-pocket maximum, but out-of-network expenses do not count toward the in-network out-of-pocket maximum.
- Benefit year runs from July 1 through June 30 of each year.
What You Pay for Care Under the Anthem PPO Plan
What you pay for care depends on where you get care.
You’re protected by the out-of-pocket maximum, which is essentially a year-long safety net for the worst-case scenario. Once you reach the maximum, the plan pays 100% of covered services for the rest of the benefit year.
Tier 1: UC Health Center Providers
($350 maximum allowance for out-of-network providers)
$2,000 Family
- In addition to any deductible and coinsurance, you are responsible for any billed charge that exceeds Anthem’s maximum allowed amount for services provided by an out-of-network provider. For outpatient non-emergency services or surgery at an out-of-network facility or ambulatory surgical center, the maximum plan payment amount is $350 per day. For inpatient non-emergency services at an out-of-network facility, the maximum plan payment amount is $600 per day.
- In-network and out-of-network benefit-year deductibles are separate — what you pay toward one doesn’t count toward the other. UC Health Center deductibles apply to the Anthem PPO in-network deductible. The deductible and out-of-pocket maximum reset every year on July 1.
- Not all services provided during a preventive care visit are considered preventive health benefits. For more information about what services are covered, go to anthem.com/ca.
- An additional copayment of $250 applies if you do not receive preauthorization for non-network providers.
Tier 2: Anthem PPO Network Providers
($350 maximum allowance for out-of-network providers)
$200 Family
$2,000 Family
(waived if admitted)
- In addition to any deductible and coinsurance, you are responsible for any billed charge that exceeds Anthem’s maximum allowed amount for services provided by an out-of-network provider. For outpatient non-emergency services or surgery at an out-of-network facility or ambulatory surgical center, the maximum plan payment amount is $350 per day. For inpatient non-emergency services at an out-of-network facility, the maximum plan payment amount is $600 per day.
- In-network and out-of-network benefit-year deductibles are separate — what you pay toward one doesn’t count toward the other. UC Health Center deductibles apply to the Anthem PPO in-network deductible. The deductible and out-of-pocket maximum reset every year on July 1.
- Not all services provided during a preventive care visit are considered preventive health benefits. For more information about what services are covered, go to anthem.com/ca.
- An additional copayment of $250 applies if you do not receive preauthorization for non-network providers.
Tier 3: From an Out-of-Network Provider1
($350 maximum allowance for out-of-network providers)
$500 Family
$4,000Family
(waived if admitted)
- In addition to any deductible and coinsurance, you are responsible for any billed charge that exceeds Anthem’s maximum allowed amount for services provided by an out-of-network provider. For outpatient non-emergency services or surgery at an out-of-network facility or ambulatory surgical center, the maximum plan payment amount is $350 per day. For inpatient non-emergency services at an out-of-network facility, the maximum plan payment amount is $600 per day.
- In-network and out-of-network benefit-year deductibles are separate — what you pay toward one doesn’t count toward the other. UC Health Center deductibles apply to the Anthem PPO in-network deductible. The deductible and out-of-pocket maximum reset every year on July 1.
- Not all services provided during a preventive care visit are considered preventive health benefits. For more information about what services are covered, go to anthem.com/ca.
- An additional copayment of $250 applies if you do not receive preauthorization for non-network providers.
Anthem Health Guide
Personalized support for Anthem PPO members to:
- Find a doctor, hospital or pharmacy.
- Initiate prior authorization requests for medical services.
- Request referrals (when needed).
- Understand out-of-pocket costs.
- Check on the status of a claim and explain how a claim was processed.
- Get answers to questions about the medical, pharmacy and dental plans.
Anthem PPO members can call toll-free (833) 674-9256, Monday through Friday, 8 a.m. to 8 p.m.
Anthem Blue Cross HMO (UCSF, UCSD, UCR Only)
You must be a UC resident or clinical fellow at UC San Francisco, UC San Diego or UC Riverside to enroll in the Anthem Blue Cross HMO.
You choose a primary care physician (PCP) from a UC Health center or the Anthem Blue Cross HMO network, and your PCP coordinates all your care, including behavioral health.
Anthem HMO members who have questions before their effective date can call First Impressions toll-free at (888) 831-2238. Anthem HMO members can call Anthem at (833) 674-9257, Monday through Friday, 8 a.m. to 8 p.m.
All Anthem members can register with Anthem to:
- Check a medical or pharmacy claim status.
- Find an in-network doctor, hospital or pharmacy.
- Get mail order prescription fills and refills, and view drug pricing and the drug list.
Plan Highlights
- Except for emergencies, only care received from UC Health or Anthem HMO providers (also must be at Anthem HMO facilities) is covered at the in-network level.
- There’s no deductible. For most services, you pay a small copayment, and the plan pays the rest.
- If you have covered dependents living outside of California, you might want to consider the PPO, because the HMO typically doesn’t cover care received outside the HMO.
Choosing a Primary Care Physician
If you enroll in the Anthem HMO plan, you must choose an Anthem primary care physician (PCP) to coordinate your care.
Follow these steps:
- Visit anthem.com/ca, click on Find a Doctor under the Employers tab.
- Scroll to Search as a Guest by Selecting a Plan, and click Continue.
- Select Medical as the type of care you want and California for the State.
- Choose Medical (Employer-Sponsored) as the type of plan you want to search, and then choose Blue Cross HMO (CACare) – Large Group as the plan/network. Click Continue.
- Choose Doctor/Medical Professional for your selection. Then select Family/General Practice.
- Enter your ZIP code, and choose a distance preference, then click Search.
- Select a physician, and copy the 3- or 6-digit Primary Medical Group/Primary Care Physician code, located under the physician’s name.
- Call the customer service number on the back of your ID card, and give them your PCP information.
If you don’t select a PCP, you’ll automatically be assigned one. But you can change your PCP at any time.
What You Pay for Care Under the Anthem HMO Plan
You can choose to receive care from a UC Health Center or Anthem HMO doctors, hospitals and other providers. Except for emergencies, no care is covered from non-UC Health Center or Anthem HMO providers. UC pays the entire monthly premiums for the Anthem HMO.
UC Health and Anthem HMO Providers/Facilities Only
($350 maximum allowance for out-of-network providers)
$2,500 Family
* An additional copayment of $250 applies if you do not receive preauthorization for non-network providers.
ID Cards
Within 10 days of enrolling in coverage, you should receive an ID card from Anthem with the University of California logo. Show this ID card to your doctor and at the pharmacy the first time you get care or fill a prescription.
24/7 NurseLine
Get connected with a registered nurse who can help with medical issues. Call (800) 977-0027.
Available 24 hours a day, 365 days a year, Anthem 24/7 NurseLine takes the guesswork out of health problems. When you call, you get instant access to registered nurses who can help you deal with medical issues. Call (800) 700-9186 for immediate answers and reliable information about:
- Your symptoms
- Minor illnesses and injuries
- Medications and side effects
- Self-care home treatments
- When to go to your doctor and when to go to the emergency room
- Chronic conditions
- Medical tests
- Preventive care
- Self-help and support groups
- Wellness
ConditionCare
Caring for yourself when you have an ongoing health condition can be challenging. But managing your condition can lead to feeling better, visiting the doctor less frequently and spending less money out of your pocket.
To help people who are managing ongoing conditions live a healthier life, Anthem Blue Cross offers ConditionCare, which gives all Anthem members 24/7 access to a team of health professionals, including nurses, dietitians, pharmacists, social workers and others.
The ConditionCare team can answer your questions and provide advice about:
- Medications
- Eating healthier
- How to get more exercise
- How to quit smoking
- Pain management
- What your symptoms could mean
To sign up, call the number on the back of your Anthem ID card, and let them know you’re interested in the ConditionCare program. A nurse will ask a few questions to help identify your needs.
Provider Contact Information
Graduate Medical Education Office
Anthem Blue Cross
Group Number: 281636
PPO members: (833) 674-9256, Monday through Friday, 8 a.m. to 8 p.m. PT
HMO members: (833) 674-9257, Monday through Friday, 8 a.m. to 8 p.m. PT
First Impressions (for first-time PPO and HMO plan members): (888) 831-2238
Website
Mobile apps