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How the Plans Work

You can choose between two medical plans. Both plans cover services such as preventive care, doctors’ office visits, hospitalization and prescription drugs. However, there are important differences between them—both in your choice of providers and what you pay when you get care (your out-of-pocket costs).

  • Anthem Blue Cross HMO. You choose a primary care physician (PCP)—from a UC Medical Center (UCMC) or the Anthem Blue Cross HMO network—who coordinates all your care, including behavioral health. Except for emergencies, only care received from UCMC or Anthem HMO doctors and at 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 CA, you might want to consider the PPO because the HMO typically doesn’t cover care received outside the HMO.
  • Anthem Blue Cross PPO. Your medical and behavioral health benefits are provided through the Anthem Blue Cross PPO (preferred provider organization). A PPO plan allows you to get care from any doctor, hospital or other provider you want. But you’ll usually pay less out of pocket when you see a UC Medical Center (UCMC) provider or one of the more than 60,000 providers in the statewide Anthem Blue Cross Prudent Buyer (PPO) network. Other plan highlights:
    • No-cost in-network preventive care for you and all enrolled family members through UCMC and Anthem providers. There’s no deductible or out-of-pocket cost for screenings and lab tests recommended by Anthem based on your age and gender.
    • For other types of care, including doctors’ office visits, hospitalization, behavioral health services and prescription drugs, when you see an Anthem provider, you pay a deductible ($100 for self-coverage/$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 UCMC.
    • Your medical plan includes 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. The out-of-pocket maximum protects your finances by limiting your financial liability for covered expenses.
      • After you meet the out-of-pocket maximum amount ($1,000 for self-coverage/$2,000 for family—which includes the deductible), Anthem pays 100% for most covered services, including prescription drugs, for the remainder of the 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 meeting the out-of-network out-of-pocket maximum, but out-of-network expenses do not count toward meeting the in-network out-of-pocket maximum.

HMO Members: Choose 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:

  1. Visit anthem.com/ca, click on Find a Doctor under the Employers tab.
  2. Scroll to Search as a Guest, and click Continue. Select Through My Employer when asked how you get insurance.
  3. Select your state and Medical as the type of care you want. Select Blue Cross HMO (CACARE) – Large Group network.
  4. Select Doctor/Medical Professional, then Family/General Practice, Internal Medicine or specialty.
  5. Enter your ZIP code or city and state. Enter a doctor’s name or medical group name.
  6. Click Able to Serve as a Primary Care Physician (PCP) and then Search.
  7. On the Results page, click on your preferred desired doctor or medical group name. The 3- or 6-digit Primary Medical Group/ Primary Care Physician code is located under PCP ID/ENROLLMENT ID (PAPER/ONLINE).
  8. Once you've selected one, 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.