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Frequently Asked Questions—Anthem PPO Medical and Pharmacy Plans

Enrollment and Eligibility

1. When is Open Enrollment?

Open Enrollment for Plan Year 2020-2021 occurs from 06/01/2020 – 06/30/2020.

2. How do I confirm my enrollment?

You may visit PlanSource to review your enrollment choices, change your plan, and confirm your address.

3. When can I make changes to my plan outside of Open Enrollment?

You may only make changes to your plan when you or your dependents have a qualifying life event. These events may include loss of other coverage, marriage, and births. Please contact your Graduate Medical Education office for answers to enrollment outside the Open Enrollment period.

4. When will I receive my ID card?

If you are not making any changes during Open Enrollment and are currently a member on the UC Resident & Fellows Plan, you will not receive a new ID card.

If you are a UC Davis Resident transitioning from Western Health Advantage and new to the Anthem plan, you will receive your ID card before the last week of June.

If you are a new Resident or Fellow on the Anthem plan, you will receive your ID card approximately 2 weeks after you complete your enrollment in PlanSource.

If you have questions after your effective date, please contact Anthem Health Guide at (833) 674-9256.

5. How can I access my ID card before I receive it in the mail?

You do not need to make this outreach unless your provider’s office or pharmacy has advised that you need this for your care before 07/01/2020. You can contact Customer Service 1 calendar week after you complete your enrollment in PlanSource. Please note: Customer Service may not be able to assist you if eligibility has not yet been received from PlanSource, and you may have to call back. You may contact Anthem Health Guide at (833) 674-9256.

Anthem Network Doctors

1. How do I find a doctor in the PPO network?

Find Care: UC Residents & Fellows PPO (after clicking on this link, please allow time for the tool to load until you see the page titled “Find Common Health Care Providers”).

If searching for a Primary Care physician, please enter your zip code first in the search bar; then, click on “Physicians & Medical Professionals”. After the search results are returned, click on “Specialty” and select “Family/General Practice, Internal Med”.

If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.

If you have questions after your effective date and are a PPO plan member, please contact Anthem Health Guide at (833) 674-9256.

Medical Plan Benefits

1. What is a deductible?

The calendar year amount that you must pay for covered services before you become entitled to receive benefit payments from the plan. Learn more about what counts towards your deductible.

2. Where can I find information about my plan benefits?

View the plan documents or read the 2020 Benefit Brochure.

If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.

If you have questions after your effective date, please contact Anthem Health Guide at (833) 674-9256.

3. What should I do in an emergency after I am enrolled in the plan?

Please call 911 or go to your nearest hospital. After your visit, if you receive bills that do not match your Explanation of Benefits issued by Anthem or they did not apply your insurance benefits to your bill, please contact Customer Service.

If you have questions, please contact Anthem Health Guide at (833) 674-9256.

4. What is my coverage for urgent care?

For the PPO plan, you will be responsible for a $15 copayment at in-network providers.

If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.

If you have questions after your effective date, please contact Anthem Health Guide at (833) 674-9256.

5. Is infertility treatment a covered benefit on any UC Resident & Fellows plan?

No. However, testing up to the determination of the diagnosis of infertility is covered. Anthem may ask for medical records from your provider for infertility testing claims to determine coverage upon receipt of a claim for infertility-related services.

If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.

If you have questions after your effective date, please contact Anthem Health Guide at (833) 674-9256.

6. What if I am new to Anthem and my current provider is not within Anthem’s network?

Transition Assistance may be considered in your case. Anthem may allow you to see your provider and apply in-network benefits for you to continue care with your current provider for a certain period.

If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.

If you have questions after your effective date, please contact Anthem Health Guide at (833) 674-9256.

Pharmacy Plan Benefits

1. Who is Anthem’s Pharmacy Benefit Manager?

The Pharmacy Benefit Manager for Anthem Blue Cross is IngenioRx, wholly-owned subsidiary.

2. How do I find a network pharmacy?

All the major pharmacy chains are within the network: UC Pharmacies, CVS (including CVS pharmacies inside of Target), Walgreens, Walmart, Safeway/Von’s, and Rite Aid. If you have any additional questions about whether a pharmacy is in your network, please contact the following teams:

If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.

If you have more questions after your effective date, please contact Anthem Health Guide at (833) 674-9256.

3. What will I have to pay for prescription drugs?

View the plan documents or read the 2020 Benefit Brochure.

If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.

If you have more questions after your effective date, please contact Anthem Health Guide at (833) 674-9256.

4. How do I determine what Tier my prescriptions fall under?

You may visit the formulary and search for your drug name and dosage via this URL: Anthem 4-Tier National formulary.

If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.

If you have more questions after your effective date, please contact Anthem Health Guide at (833) 674-9256.

5. What if my prescription drug requires a prior authorization?

Your physician will need to contact IngenioRx to provide medical information related to your prescription. This will need to occur after your effective date.

If you have questions, please contact Anthem Health Guide at (833) 674-9256.

6. What if I need to fill a prescription on my first day of coverage and I haven’t received my ID card?

You should wait until at least 2 weeks until after you complete your enrollment in Plan Source before contacting Anthem Customer Service. If your ID card has not arrived, please contact Customer Service. 

If you have questions, please contact Anthem Health Guide at (833) 674-9256.

7. What if I need to fill specialty medications?

You have two choices of pharmacies for specialty medications: a UC Medical Center pharmacy, or IngenioRx Specialty. You will be able to pick up medications at your UC Medical Center pharmacy. If you would like them delivered to your home, IngenioRx Specialty will be able to assist you after your effective date. You may contact IngenioRx Specialty at (833) 255-0645.

8. What if I would like my prescription filled via Home Delivery?

Please contact IngenioRx Home Delivery after your effective date by calling IngenioRx Home Delivery at (833) 236-6196.