Choosing and using your plan - Your guide to open enrollment and making the most of your benefits - Harris-Stowe State University
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Choosing and
using your plan
Your guide to open enrollment and
making the most of your benefits
Harris Stowe State
University
Effective January 1st
2021
1
115324MUMENMUB Rev. 05/19
This guide is for information purposes only. You must enroll in a plan for your benefits to start.
It’s time to choose your plan
Your trusted health partner
Anthem is committed to being your trusted health care partner. We’re
developing the technology, solutions, programs and services that give
you greater access to care. We also work with doctors to make sure you
get affordable, quality health care.
Save this guide
You’ll find tips on how to make the most of your benefits and save
on health care costs throughout the year.
2 Choosing your plan
It’s time to choose your plan
Let’s get started
This is the perfect time to think about your health — where you are right now and where you want to
be tomorrow. It’s your opportunity to check out the benefits, programs and resources that can
support your health and well-being all year long.
This guide will help you understand our plans. It’s also full of tips, tools and resources that can help
you reach your health and wellness goals when you become a member. So keep it handy to make the
most of your benefits throughout the year.
Table of contents
Choosing your plan Using your plan
The basics explained .........................................................................4 How to use your plan ..................................................................... 36
Explore your plan options .................................................................5 Make the most of your pharmacy benefits ................................ 42
What you’ll pay when you get care .................................................6 Plan extras that support your health ......................................... 51
Your pharmacy benefits .................................................................40 The legal stuff we’re required to tell you ................................... 71
Dental benefits ................................................................................45
Vision benefits ................................................................................48
3 Choosing your plan
Anthem® Blue Cross and Blue Shield
Your Plan: Harris Stowe State University-Harris Stowe State University-Anthem Blue Access Choice PPO $0 / 0%
Your Network: Blue Access Choice
Cost if you use a
Cost if you use an In-
Covered Medical Benefits Non-Network
Network Provider
Provider
Overall Deductible $0 person / $1,000 person /
$0 family $2,000 family
Out-of-Pocket Limit $1,500 person / $3,000 person /
$3,000 family $6,000 family
The family deductible and out-of-pocket maximum are embedded meaning the cost shares of one family member will be applied
to both the individual deductible and individual out-of-pocket maximum; in addition, amounts for all covered family members
apply to both the family deductible and family out-of-pocket maximum. No one member will pay more than the individual
deductible and individual out-of-pocket maximum.
Preventive Care / Screening / Immunization No charge 30% coinsurance after
deductible is met
Doctor Home and Office Services
Primary Care Visit $20 copay per visit 30% coinsurance after
When Allergy injections are billed separately by network providers, the deductible is met
member is responsible for a $10 copay. When billed as part of an office
visit, there is no additional cost to the member for the injection.
Specialist Care Visit $40 copay per visit 30% coinsurance after
When Allergy injections are billed separately by network providers, the deductible is met
member is responsible for a $10 copay. When billed as part of an office
visit, there is no additional cost to the member for the injection.
Prenatal and Post-natal Care 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Other Practitioner Visits:
Retail Health Clinic $20 copay per visit 30% coinsurance after
deductible is met
Preferred On-line Visit $10 copay per visit 30% coinsurance after
Includes Mental/Behavioral Health and Substance Abuse deductible is met
4
Cost if you use a
Cost if you use an In-
Covered Medical Benefits Non-Network
Network Provider
Provider
Other Participating Provider On-line Visit $20 copay per visit 30% coinsurance after
Includes Mental/Behavioral Health and Substance Abuse deductible is met
Chiropractic Services 50% coinsurance Not covered
Coverage is limited to 26 visits per benefit period.
Other Services in an Office:
Allergy Testing 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Chemo/Radiation Therapy - PCP $20 copay per visit 30% coinsurance after
deductible is met
Chemo/Radiation Therapy - Specialist $40 copay per visit 30% coinsurance after
deductible is met
Dialysis/Hemodialysis $40 copay per visit 30% coinsurance after
deductible is met
Prescription Drugs - Dispensed in the office 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Diagnostic Services
Lab:
Office No charge 30% coinsurance after
deductible is met
Outpatient Hospital 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
X-Ray:
Office No charge 30% coinsurance after
deductible is met
Outpatient Hospital 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Advanced Diagnostic Imaging:
Office 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
5
Cost if you use a
Cost if you use an In-
Covered Medical Benefits Non-Network
Network Provider
Provider
Freestanding Radiology Center 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Outpatient Hospital 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Emergency and Urgent Care
Urgent Care $50 copay per visit 30% coinsurance after
When Allergy injections are billed separately by network providers, the deductible is met
member is responsible for a $10 copay. When billed as part of an office
visit, there is no additional cost to the member for the injection.
Emergency Room Facility Services $200 copay per visit Covered as In-Network
Copay waived if admitted.
Emergency Room Doctor and Other Services No charge Covered as In-Network
Ambulance 0% coinsurance after Covered as In-Network
deductible is met
Outpatient Mental/Behavioral Health and Substance Abuse
Doctor Office Visit $20 copay per visit 30% coinsurance after
deductible is met
Facility Visit:
Facility Fees 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Doctor Services 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Outpatient Surgery
Facility Fees:
Hospital 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Freestanding Surgical Center 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Doctor and Other Services:
6
Cost if you use a
Cost if you use an In-
Covered Medical Benefits Non-Network
Network Provider
Provider
Hospital 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Freestanding Surgical Center 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Hospital (Including Maternity, Mental / Behavioral Health, Substance
Abuse):
Facility Fees 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Human Organ and Tissue Transplants 0% coinsurance after 30% coinsurance after
Kidney and Cornea are treated the same as any other illness and subject deductible is met deductible is met
to the medical benefits.
Doctor and other services 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Recovery & Rehabilitation
Home Health Care 0% coinsurance after 30% coinsurance after
Coverage is limited to 100 visits per benefit period. Limits are combined for deductible is met deductible is met
all home health services.
Rehabilitation services:
Office $20 copay per visit 30% coinsurance after
Coverage for Occupational Rehabilitation services is limited to 40 visits deductible is met
per benefit period. Coverage for Physical Rehabilitation and Manipulation
Therapy services is limited to 40 visits per benefit period. Limit does not
apply to manipulation performed by a Chiropractor. Speech Therapy has
no visit limit. Benefit limit does not apply to Applied Behavioral Analysis.
Benefit limit does not apply when performed as part of Early Intervention.
Outpatient Hospital 0% coinsurance after 30% coinsurance after
Coverage for Occupational Rehabilitation services is limited to 40 visits deductible is met deductible is met
per benefit period. Coverage for Physical Rehabilitation and Manipulation
Therapy services is limited to 40 visits per benefit period. Limit does not
apply to manipulation performed by a Chiropractor. Speech Therapy has
no visit limit. Benefit limit does not apply to Applied Behavioral Analysis.
Benefit limit does not apply when performed as part of Early Intervention.
Cardiac rehabilitation
Office $40 copay per visit 30% coinsurance after
Coverage is limited to 36 visits per benefit period. deductible is met
7
Cost if you use a
Cost if you use an In-
Covered Medical Benefits Non-Network
Network Provider
Provider
Outpatient Hospital 0% coinsurance after 30% coinsurance after
Coverage is limited to 36 visits per benefit period. deductible is met deductible is met
Pulmonary rehabilitation $40 copay per visit 30% coinsurance after
Office deductible is met
Coverage is limited to 20 visits per benefit period.
Outpatient Hospital 0% coinsurance after 30% coinsurance after
Coverage is limited to 20 visits per benefit period. deductible is met deductible is met
Skilled Nursing Care (facility) 0% coinsurance after 30% coinsurance after
Coverage for Skilled Nursing, Outpatient Rehabilitation and Inpatient deductible is met deductible is met
Rehabilitation facility settings is limited to 150 days combined per benefit
period.
Hospice 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Durable Medical Equipment 50% coinsurance after 50% coinsurance after
deductible is met deductible is met
Prosthetic Devices 0% coinsurance after 30% coinsurance after
deductible is met deductible is met
Cost if you use a
Cost if you use an In-
Covered Prescription Drug Benefits Non-Network
Network Provider
Provider
Pharmacy Deductible Not applicable Not applicable
Pharmacy Out of Pocket Combined with medical Combined with medical
Prescription Drug Coverage
Essential Drug List
No coverage for non-formulary drugs.
Tier 1 - Typically Generic $10 copay per 50% coinsurance,
30 day supply (retail pharmacy). 90 day supply (home delivery). prescription, deductible deductible does not
does not apply (retail) apply (retail) and Not
and $20 copay per covered (home
prescription, deductible delivery)
8
Cost if you use a
Cost if you use an In-
Covered Prescription Drug Benefits Non-Network
Network Provider
Provider
does not apply (home
delivery)
Tier 2 – Typically Preferred Brand $25 copay per 50% coinsurance,
30 day supply (retail pharmacy). 90 day supply (home delivery). prescription, deductible deductible does not
does not apply (retail) apply (retail) and Not
and $50 copay per covered (home
prescription, deductible delivery)
does not apply (home
delivery)
Tier 3 - Typically Non-Preferred Brand $50 copay per 50% coinsurance,
30 day supply (retail pharmacy). 90 day supply (home delivery). prescription, deductible deductible does not
does not apply (retail) apply (retail) and Not
and $100 copay per covered (home
prescription, deductible delivery)
does not apply (home
delivery)
Tier 4 - Typically Specialty (brand and generic) 25% coinsurance up to 50% coinsurance,
30 day supply (retail pharmacy). 30 day supply (home delivery). $350 per prescription, deductible does not
deductible does not apply (retail) and Not
apply (retail and home covered (home
delivery) delivery)
Notes:
Dependent age: to end of the month in which the child attains age 26.
Members are encouraged to always obtain prior approval when using non-network providers. Precertification will help
the member know if the services are considered not medically necessary.
All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum
(excluding Non-Network Human Organ and Tissue Transplant (HOTT) Services).
No charge means no deductible/copayment/coinsurance up to the maximum allowable amount. 0% means no
coinsurance up to the maximum allowable amount. However, when choosing a Non-network provider, the member is
responsible for any balance due after the plan payment.
If your plan includes out-of-network benefits, In-network and out-of-network deductibles, copayments, coinsurance and
out-of-pocket maximum amounts are separate and do not accumulate toward each other.
If you have an office visit with your Primary Care Physician or Specialist at an Outpatient Facility (e.g., Hospital or
Ambulatory Surgical Facility), benefits for Covered Services will be paid under “Outpatient Facility Services” which is
generally coinsurance or coinsurance after your deductible is met.
This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary
does not reflect each and every benefit, exclusion and limitation which may apply to the coverage. For more details,
9
important limitations and exclusions, please review the formal Evidence of Coverage (EOC). If there is a difference
between this summary and the Evidence of Coverage (EOC), the Evidence of Coverage (EOC), will prevail.
10The basics explained
Before we dive into the plan details, it may be helpful to review some
health benefit basics.
What you pay and what your plan pays
Deductible Out-of-pocket
reached limit reached
What you pay
You pay your You and your Your plan pays
deductible plan share cost the cost
What we pay
This chart is only an example. Your actual cost share will depend on your plan, the service you
get and the doctor you choose. Check your plan details to see your actual share of the cost.
Words that are helpful to know
We can help you crack the code of health insurance lingo. Here are the meanings of some common terms:
Deductible: Copay: Coinsurance:
A set amount you pay each year A flat fee you pay for covered Once you’ve met your deductible,
for covered services before your services like doctor visits. you and your health plan share
plan starts to pay for covered the cost of covered health care
health care costs. services. The coinsurance is your
share of the costs, usually a
percent of the cost of care.
Your plan details show what
portion of the cost you’ll pay.
Out-of-pocket limit: Premium:
This is the most you have to pay The premium, also called a
out of your own pocket each year monthly payment, is what you
for covered services. This amount pay for the plan. It’s the money
may include your deductible and that comes out of your paycheck.
your percentage of the costs, Think of it like a membership fee
depending on your plan. And some that’s separate from what you
plans may still have you pay a pay when you get care.
copay at the time of service.
11 Choosing your planTake care of yourself
Use your preventive care benefits
Getting regular checkups and exams can help you stay healthy and catch problems early — when they’re easier to treat.
That’s why our health plans offer all the preventive care services and immunizations below — at no cost to you.1 As long as you see
a doctor or use a pharmacy or lab in the plan, you won’t have to pay anything for these services and immunizations. If you want to
visit a doctor or pharmacy outside the plan, you may have to pay out of pocket.
Not sure which services make sense for you? Talk to your doctor. He or she can help you figure out what you need.
Preventive vs. diagnostic care
What’s the difference? Preventive care helps protect you from getting sick. If your doctor recommends you have services even though
you have no symptoms, that’s preventive care. Diagnostic care is when you have symptoms and your doctor recommends services to
determine what’s causing those symptoms.
Adult preventive care
Preventive physical exams
Screening tests:
}}Alcohol misuse: related screening and behavioral counseling }}Hearing screening
}}Aortic aneurysm screening (men who have smoked) }}Height, weight and body mass index (BMI)
}}Behavioral counseling to promote a healthy diet }}HIV screening and counseling
}}Blood pressure }}Lung cancer screening for those ages 55-80 who have a
}}Bone density test to screen for osteoporosis history of smoking 30 packs per year and still smoke, or quit
}}Cholesterol and lipid (fat) level within the past 15 years3
}}Colorectal cancer, including fecal occult blood test, barium }}Obesity: related screening and counseling*
enema, flexible sigmoidoscopy, screening colonoscopy and }}Prostate cancer, including digital rectal exam and
related prep kit, and computed tomography (CT) prostate-specific antigen (PSA) test
colonography (as appropriate)3 }}Sexually transmitted infections: related screening
}}Depression screening and counseling
}}Hepatitis C virus (HCV) for people at high risk for infection and }}Tobacco use: related screening and behavioral counseling
a one-time screening for adults born between 1945 and 1965 }}Tuberculosis screening
}}Type 2 diabetes screening* }}Violence, interpersonal and domestic: related screening
}}Eye chart test for vision2 and counseling
Immunizations:
}}Diphtheria, tetanus and pertussis (whooping cough) }}Meningococcal (meningitis)
}}Hepatitis A and hepatitis B }}Pneumococcal (pneumonia)
}}Human papillomavirus (HPV) }}Varicella (chickenpox)
}}Influenza (flu) }}Zoster (shingles)
}}Measles, mumps and rubella (MMR)
Women’s preventive care:
}}Well-woman visits }}Counseling related to genetic testing for those with a
}}Breast cancer, including exam, mammogram, and genetic family history of ovarian or breast cancer
testing for BRCA 1 and BRCA 2 when certain criteria are met4 }}HPV screening
}}Breastfeeding: primary care intervention to promote }}Screening and counseling for interpersonal and
breastfeeding support, supplies and counseling5,6,7 domestic violence
}}Contraceptive (birth control) counseling }}Pregnancy screenings, including gestational diabetes,
}}Food and Drug Administration (FDA)-approved contraceptive hepatitis B, asymptomatic bacteriuria,
medical services, including sterilization, provided by a doctor Rh incompatibility, syphilis, HIV and depression6
}}Counseling related to chemoprevention for those with a high }}Pelvic exam and Pap test, including screening for
risk of breast cancer cervical cancer
These preventive care services are recommendations of the Affordable Care Act (ACA or health care reform law). They may not be right for every person, so ask your doctor what’s right for you.
This sheet is not a contract or policy with Anthem Blue Cross and Blue Shield. If there is any difference between this sheet and the group policy, the provisions of the group policy will rule. Please see
your combined Evidence of Coverage and Disclosure Form or Certificate for exclusions and limitations.
* CDC-recognized Diabetes Prevention programs are available for overweight or obese adults with abnormal blood glucose or who have abnormal CVD risk factors.
43199MUMENABS VPOD Rev. 9/18
12Child preventive care
Preventive physical exams
Screening tests:
}}Behavioral counseling to promote a healthy diet }}Lead testing
}}Blood pressure }}Newborn screening
}}Cervical dysplasia screening }}Screening and counseling for obesity
}}Cholesterol and lipid level }}Counseling for those ages 10–24 with fair skin about lowering
}}Depression screening their risk for skin cancer
}}Development and behavior screening }}Oral (dental health) assessment when done as part of a
}}Type 2 diabetes screening preventive care visit
}}Hearing screening }}Screening and counseling for sexually transmitted infections
}}Height, weight and BMI }}Tobacco use: related screening and behavioral counseling
}}Hemoglobin or hematocrit (blood count) }}Vision screening when done as part of a preventive care visit2
Immunizations:
}}Chickenpox }}MMR
}}Flu }}Pneumonia
}}Haemophilus influenza type b (Hib) }}Polio
}}Hepatitis A and hepatitis B }}Rotavirus
}}HPV }}Whooping cough
}}Meningitis
A word about pharmacy items
For 100% coverage of your over-the-counter (OTC) drugs Child preventive drugs and other pharmacy items —
and other pharmacy items listed here, you must: age appropriate:
}}Meet certain age requirements and other rules. }}Dental fluoride varnish to prevent the tooth decay of primary
}}Get prescriptions from plan providers and fill them at teeth for children ages 0-5
plan pharmacies. }}Fluoride supplements for children ages 6 months to
}}Have prescriptions, even for OTC items. 16 years old
Adult preventive drugs and other pharmacy items — Women’s preventive drugs and other pharmacy items —
age appropriate: age appropriate:
}}Aspirin use (81 mg and 325 mg) for the prevention of }}Contraceptives, including generic prescription drugs,
cardiovascular disease, preeclampsia and colorectal brand-name drugs with no generic equivalent and OTC
cancer by adults less than 70 years old. items like female condoms and spermicides6,8,9
}}Colonoscopy prep kit (generic or OTC only) when }}Low-dose aspirin (81 mg) for pregnant women who are at
prescribed for preventive colon screening increased risk of preeclampsia
}}Generic low to moderate dose statins for members that }}Folic acid for women ages 55 or younger who are planning
are 40-75 years and have 1 or more CVD risk factors and able to get pregnant
(dyslipidemia, diabetes, hypertension, or smoking) Breast cancer risk-reducing medications, such as tamoxifen
}}Tobacco-cessation products, including all FDA-approved and raloxifene, that follow the U.S. Preventive Services Task
brand and generic OTC and prescription products, for Force criteria3
those ages 18 and older
For a complete list of covered preventive drugs under the
Affordable Care Act, view the Preventive ACA Drug List flier
available at anthem.com/pharmacyinformation.
1 The range of preventive care services covered at no cost share when provided by plan doctors is designed to meet state and federal requirements. The Department of Health and Human Services decided which services to include for full coverage based on U.S. Preventive Services Task
Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by Health Resources and Services Administration (HRSA)
Guidelines. You may have additional coverage under your insurance policy. To learn more about what your plan covers, see your Certificate of Coverage or call the Member Services number on your ID card.
2 Some plans cover additional vision services. Please see your contract or Certificate of Coverage for details.
3 You may be required to get preapproval for these services.
4 Check your medical policy for details.
5 Breast pumps and supplies must be purchased from plan providers for 100% coverage. We recommend using plan durable medical equipment (DME) suppliers.
6 This benefit also applies to those younger than age 19.
7 Counseling services for breastfeeding (lactation) can be provided or supported by a plan doctor or hospital provider, such as a pediatrician, obstetrician/gynecologist or family medicine doctor, and hospitals with no member cost share (deductible, copay, coinsurance). Contact the
provider to see if such services are available.
8 A cost share may apply for other prescription contraceptives, based on your drug benefits.
9 Your cost share may be waived if your doctor decides that using the multisource brand is medically necessary.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to
anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri
(excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT
and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire,
Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service
area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by
Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue
1
Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.
3Skip the ER
When it’s not an emergency, get
quick care with these options
When you need care right away and your doctor isn’t available, the emergency room (ER) might be your first choice. But did you
know many ER visits are unnecessary? ERs aren’t the best choice in every situation, especially when you can save about $1,100
by going somewhere else when it’s not an emergency.1,2,3, And you probably won’t have to wait as long.
Here’s what to do when you need care fast
Step 1: Call your primary care doctor or 24/7 NurseLine
Your doctor can help you decide where to get care, whether it’s a visit to his or her office, going to the ER or
somewhere else. If your doctor isn’t available, you can call the 24/7 NurseLine at the number on the back of your
ID card to help you decide what to do.
Step 2: If it’s not an emergency, choose one of these options to save you time and money
Depending on your needs, you’ve got these choices:
Retail
health clinic — Usually in a major pharmacy or retail store where you can get basic health care services
from a health care professional.
Walk-in doctor’s office — No appointment is needed for routine care and common illnesses.
Urgent care center — For conditions that need care right away such as stitches, lab tests or X-rays.
LiveHealth Online — Have a video visit in minutes with a board-certified doctor 24/7 on your smartphone, tablet
or computer with a webcam. No appointment is needed. Just go to livehealthonline.com or download the free app
to register and get started.
These options are more convenient than the ER. They’re often open at night and on weekends, so you don’t have to
wait to get treated.
When to head to the ER Remember
When you think it’s a true emergency, If you go to the ER when it’s NOT an emergency, you
call 911 or go to the nearest ER. could be responsible for the full cost of treatment.
14
235433MUMENABS Rev. 3/18
See the other side for examples of when to go
to the ER or if you should consider other options.Where to get care3
Who usually provides care Estimated average costs2 When to go
Coughing up or vomiting blood
Emergency room
Symptoms feel life-threatening or disabling
Chest pain or severe shortness of breath
Doctors trained in For non-emergencies: Major injury or broken bones
emergency medicine $1,404 Sudden or unexplained loss of consciousness
Severe pain that cannot be controlled
If you’re pregnant and having labor pain
Allergic reactions (minor)
Retail health clinic
Bumps, cuts, scrapes, rashes
Burning with urination
Physician assistants or Burns (minor)
nurse practitioners
$72 Cold, cough and sore throat
Sinus pain and fever (minor)
Eye or ear pain or irritation
Shots
Walk-in doctor’s office Same as retail health clinic plus…
Asthma (mild)
Family practice doctors $124 Back pain
Nausea or diarrhea
Headache (minor)
Urgent care center Same as walk-in doctor’s office plus…
Animal bites
Doctors who treat conditions that
should be looked at right away
$143 Sprains and strains
Stitches
X-rays
Allergic reactions (minor)
LiveHealth Online
Headache (minor)
Nausea or diarrhea
Board-certified doctors $59 or less Cold, cough and sore throat
Sinus pain and fever (minor)
Eye or ear pain or irritation
Burning with urination
Need care fast?
Rather than waiting at the ER, you can save time by going to one of the quick care options shown above.
Be prepared
Get the right care. Whether that’s finding the right doctor, specialist, therapist or something else altogether.
Just use the Find a Doctor tool at anthem.com or call the Member Services number on your ID card and we’ll
guide you somewhere that’s part of your plan.
Find care near you whenever you need it. Download the Anthem Anywhere app to find an urgent care center,
retail health clinic or walk-in doctor’s office quickly and get driving directions. Just search for “Anthem Anywhere”
at the App Store® or Google Play.™
Money-saving tip
Visit hospitals and doctors that are in your plan. If you don’t,
you’ll often pay much more out of pocket for your care.
1 If you get care from a health professional or facility that is not in your health plan, you may have much higher out-of-pocket costs.
2 National averages of the total cost, not what members paid, based on Anthem members’ commercial paid claims from January 1, 2016 through December 31, 2016.
3 If you use the ER and it’s not a true emergency, your claim could be denied and you may be responsible for the full cost of your ER care.
LiveHealth Online is the trade name of Health Management Corporation, a separate company providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In
Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits
underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health
Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its
service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare
Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is
a registered trademark of Anthem Insurance Companies, Inc.
15NO-COST RESOURCES AND SOCIAL
SUPPORT TOOLS TO HELP NAVIGATE COVID-19
MENTAL HEALTH RESOURCE HUB
During this time, it’s normal if you want a little extra support to help you with the way you’re feeling.
Our partners at PsychHub are here to help you through social isolation, job loss and mental health
issues from the COVID-19 pandemic.
COVERAGE OPTIONS FOR DISPLACED EMPLOYEES
If you’ve been displaced from your job, you have coverage options available during this challenging
time. No matter what your budget or care needs are, the COVID-19 Coverage Option Hotline can help
support you. Call 1-888-832-2583 between 8:30 a.m. and 8 p.m. ET, Monday through Friday. Have your
current income level and ZIP ready, and a representative will assist you.
FIND LOCAL SOCIAL SUPPORT SERVICES
Right now, many people need help with food, housing, job training, transportation and social services.
Aunt Bertha, a social care network, can help you find free and reduced-cost programs providing
COVID-19 support and resources in your area.
SYDNEY CARE COVID-19 SUPPORT
We have created support tools to help you quickly understand your potential risk for COVID-19. The
Sydney Care mobile app’s new Coronavirus Assessment tool gives you a quick and easy way to assess
your symptoms and find a testing facility in your area. Sydney Care is free and available on your
mobile device through Google PlayTM or the App Store®, and works together with your Sydney Health
or Engage Wellbeing apps.
SYMPTOM ASSESSMENT
It’s normal to wonder about symptoms you may be experiencing. This tool asks you five simple
questions based on guidelines from the Centers for Disease Control and Prevention to help you
understand what your symptoms mean.
LOCATE A COVID-19 TESTING FACILITY
Not everyone needs to be tested for COVID-19. Testing is still mostly reserved for people who likely
have the disease. Priority is given to people displaying symptoms; anyone at high risk for
complications, as well as essential workers, particularly those in health care. If your doctor orders a
test for you, you can easily find your nearest test facility just by entering your state and county.
Sydney Health and Sydney Care are service marks of CareMarket Inc., ©2020. Sydney Care is offered through an arrangement with CareMarket, Inc.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana:
Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and
HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky
Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew
Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route
123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance
Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
16
123325MUBENABS Rev. 04/20Using your plan
How to use your plan
Once you’ve chosen a plan, explore how to make the most of your benefits. Here you’ll
learn simple ways to make using your plan easy. Plus, you’ll discover tools and resources
that can help you reach your health and wellness goals. With Anthem, supporting your
healthiest self is all part of the plan!
17 Using your planHow to use your plan
Use your ID card right from Register for online tools
your phone and resources
Introducing the Sydney Health mobile app. With Accessing your health plan on your mobile phone or
Sydney Health you can find everything you need to computer makes life so much easier. Register on the
know about your benefits – all in one place. You’ll Sydney Health mobile app and anthem.com to get
have a custom experience that’s based on your plan, personalized information about your health plan and
your specific health care needs and lots more. And more. You can:
you can quickly access your digital ID card to show it Quickly access your digital ID card.
to your doctor or pharmacy. You can even use
Sydney Health to track your health goals, find care,
Find a doctor and estimate your costs before
compare costs, and manage your claims. you go.
Look at your prescription drug benefits, check the
Have a question? Sydney Health acts like a personal price of a drug and find a pharmacy near you
health guide, answering your questions and that’s in your plan.
connecting you to the right resources at the right View your claims, see what’s covered and what
time. And you can use the chatbot to get answers you may owe for care.
quickly. Sydney Health makes it easier to get things
Get support managing your health conditions and
done, so you can spend more time focusing on your
tracking your goals.
health. Get started by downloading the Sydney
Health mobile app. Update your email and communication
preferences.
18 Using your planHow to use your plan
Find a doctor in your plan Schedule a checkup
The right doctor can make all the difference — and Preventive care, like regular checkups and
choosing one in your plan can save you money, too. screenings, can help you avoid health problems
So you’ll be happy to know your plan includes lots of down the road. Your plan covers these services
top-notch doctors. If you decide to get care from at little or no extra cost when you see a doctor
doctors outside the plan, it’ll cost you more and in your plan:
your care might not be covered at all. Yearly physicals
It’s easy to find a doctor in your plan. Simply use the Well-child visits
Find a Doctor tool on the Sydney Health mobile app Flu shot
or at anthem.com to search for doctors, hospitals,
labs and other health care professionals.
Routine shots
Screenings and tests
Check your plan details on the Sydney Health mobile
app or anthem.com to confirm what preventive care
is covered.
19 Using your planHow to use your plan
See a doctor from home
You can have a video visit with a doctor using your
mobile phone, tablet or computer with a webcam,
whether you’re at home, at work or on the go.
Doctors are available around the clock for advice,
treatment and prescriptions.1 Just go to
livehealthonline.com or download the LiveHealth
Online mobile app to get started.
Where to go for care when you need it now
When it’s an emergency, call 911 or head to the nearest emergency room.
But when you need nonemergency care right away:
Check to see if your primary care doctor can see you.
Search for nearby urgent care — and avoid costly emergency room
visits and long wait times.
See a doctor anytime using LiveHealth Online. It works on your mobile
phone, tablet or computer with a webcam.
Call the 24/7 NurseLine and get helpful advice from a registered nurse.
1 Online prescribing only when appropriate based on physician judgment.
LiveHealth Online is the trade name of Health Management Corporation.
20 Using your planYour pharmacy benefits
What your plan will cover How your pharmacy benefits work
It’s easy to get what you need, whether you take medicine You pay your deductible
every day or only once in a while.
Before a plan starts to help pay for medicine, you
Your pharmacy plan includes: may first pay a set amount out of your pocket. This is
One or more drugs lists. Be sure to check for your your deductible. You’ll want to check the plan details
medications – the brand-name drugs and the generics to see if it has a:
that are included in your plan. Pharmacy deductible: You first pay a set amount
— You can find out if the drug you take is included of drug costs out of your pocket and it’s separate
on the Essential 4-tier Drug List by visiting from a medical deductible. You have to pay your
anthem.com/abs/essentialdruglist. full pharmacy deductible before your plan starts
to share the cost of your medicine.
Combined deductible: You first pay a set
amount for both covered medical care and drug
costs out of your pocket.
No pharmacy deductible: Your plan helps pay
for medicine before you reach your deductible.
You and your plan share the costs
After you meet your deductible, your plan will share
the cost of medicine. Your options include plans with
different ways of sharing the cost:
Copays: You pay a set amount, or copay, for
medicine. Your copay will be based on which tier
the drug is on. See Save money with Tier 1 drugs
to learn more.
Coinsurance: You pay a certain percentage of
the drug’s cost, which can be different based on
the pharmacy you use.
21 Choosing your planYour pharmacy benefits
Save money with Tier 1 drugs
Prescription medicines or drugs are listed in groups called tiers. Your cost is based on which tier the drug
is in. Tiers 1 and 2 usually include low-cost and generic drugs. You’ll save the most money when you use
Tier 1 drugs.
Once you’re a member, you can check the price of a drug at different pharmacies at anthem.com and
see if there are lower-cost drugs.
Drug type Cost
Tier 1 Preferred generic $
Tier 2 Preferred brand name and newer, more expensive generic drugs $$
Tier 3 Nonpreferred brand name and generic drugs $$$
Tier 4 Preferred specialty drugs (brand name and generic) $$$$
Simple ways to save money on medicine
Find a pharmacy in your plan.
Talk to your doctor about generic medicines.
See if an over-the-counter option is available.
22 Choosing your planMake the most of your pharmacy benefits
You can manage your prescriptions and costs at anthem.com. Simply log in and explore the following ways to save:
1. Search the drug list. Find out if your drugs are
covered and which tier they’re in. Lower-cost
drugs and generics are usually in Tiers 1 and 2.
You’ll save the most money when you use
Tier 1 drugs.
2. Price a medication. See how much a medicine
costs. You can compare retail drug costs at local
pharmacies and see the price of generic
options. Results will include the cost of up to
a 90-day supply and home delivery pricing.
3. See if there are generic options. If you’re
taking a brand-name drug, you can find a list
of generic options that cost less, or ask
your doctor.
4. Choose a pharmacy that’s in your plan.
You have many retail pharmacies to choose from.
Use a pharmacy that is in your plan to get the
best price. To find a pharmacy in your plan, visit
anthem.com/pharmacyinformation/ networks
and choose your network list.
Your plan uses the National network list
of pharmacies.
Questions?
Call the Pharmacy Member Services phone number on your
member ID Card – we're available 24/7.
23 Using your planMail Service
Order Form
Mail this form to:
ppqssqrrsprrssqrprrrrssrsqqsqqqpppsrssppqsqpspqrrrpqrrsprrpqsrppq
IngenioRx Home Delivery
PO BOX 94467
PALATINE, IL 60094-4467
Member ID # (if not shown or if different from above)
Prescription Plan Sponsor or Company Name
Instructions:
Please use blue or black ink and print in capital letters. Fill in both sides of this form.
New Prescriptions – Mail your new prescriptions with this form. Number of New prescriptions:
Refills – Order by Web, phone, or write in Rx number(s) below. Number of Refill prescriptions:
TO RECEIVE YOUR ORDER SOONER request refills or new prescriptions online or by phone at the
website/phone number on your member ID card.
A Shipping Address. To ship to an address different from the one printed above, enter the changes here.
Last Name First Name MI Suffix (JR, SR)
Street Address Apt./Suite #
Use shipping address
for this order only.
City State ZIP Code
Daytime Phone #: - - Evening Phone #: - -
B Refills. To order mail service refills, enter your prescription number(s) here.
1) 2) 3) 4)
5) 6) 7) 8)
����������������������������������������������������
getting a new prescription, be sure to ask your doctor to write it for the maximum amount allowed by your
plan, usually a 90-day supply. Make sure your doctor SIGNS and DATES all new prescriptions. We want
to provide you with high quality medicines at the best possible price. In order to do this, we will substi-
tute equivalent generic medicines for brand name medicines whenever possible. If you do not want us to
����������������������������������������������������
section of this form.
We may package all of these prescriptions together unless you tell us not to.
24
©2018 All rights reserved. P13-NC Tell us about the people ordering prescriptions. If there are more than two people, please complete another form.
First person with a refill or new prescription. Spanish forms and labels
Suffix
(JR,SR)
Gender: M F Date of birth:
E-mail address: Date new prescription written:
Doctor’s last name Doctor’s first name Doctor’s phone #
Tell us about new health information for 1st person if never provided or if changed.
Allergies: None Aspirin Cephalosporin Codeine Erythromycin Peanuts Penicillin
Sulfa Other:
Medical conditions: Arthritis Asthma Diabetes Acid reflux Glaucoma Heart problem
High blood pressure High cholesterol Migraine Osteoporosis Prostate issues Thyroid
Other:
Second person with a refill or new prescription. Spanish forms and labels
Suffix
(JR,SR)
Gender: M F Date of birth:
E-mail address: Date new prescription written:
Doctor’s last name Doctor’s first name Doctor’s phone #
Tell us about new health information for 2nd person if never provided or if changed.
Allergies: None Aspirin Cephalosporin Codeine Erythromycin Peanuts Penicillin
Sulfa Other:
Medical conditions: Arthritis Asthma Diabetes Acid reflux Glaucoma Heart problem
High blood pressure High cholesterol Migraine Osteoporosis Prostate issues Thyroid
Other:
D Special instructions:
E How would you like to pay for this order? (If your copay is $0, you do not need to provide payment information.)
Electronic check. Pay from your bank account. (You must first register online or call Customer Care.)
Credit or debit card. (VISA®, MasterCard®, Discover®, or American Express®)
Use your card on file.
Use a new card or update your card’s expiration date.
Exp.
Date
Credit card holder signature/Date
Check or money order. Amount: $ .
Regular delivery is free and takes up to 5
• Make check/money order out to IngenioRx Home Delivery. days after your order is processed.
• W������������������������ If you want faster delivery, choose:
check or money order. 2nd business day ($17) Faster delivery
can only be
• If your check is returned, we will charge you up to $40. sent to a
Next business day ($23) street address,
not a PO Box
Payment for balance due and future orders: If you choose Expected processing time from receipt of this form:
electronic check or a credit or debit card, we will use it to pay • Refills: 1-2 days
for any balance due and for future orders unless you provide • New/renewed prescriptions: Within 5 days unless additional
another form of payment. information is needed from your doctor
(Charges subject to change)
Fill in this oval if you DO NOT want us to use this payment
method for future orders.
49-MOF 0316 INGENIORX
25Plan extras that support your health
Learn more by registering on the Sydney Health app or at anthem.com.
Your plan comes with great tools and programs to help you reach your health goals and save money on health
products and services. Plus, most of them come at no extra cost. Learn more by registering on the Sydney
Health app or at anthem.com.
Apps decide where to go for care and find providers in your
area. All you have to do is call 1-800-337-4770.
Introducing the Sydney Health mobile app. With
Case Management — If you’re coming home after
Sydney Health you can find everything you need to
surgery or have a serious health condition, a nurse
know about your benefits – all in one place. You’ll have
care manager can help answer your questions about
a custom experience that’s based on your plan, your
your follow-up care, medicines and treatment options,
specific health care needs and lots more. And you can
coordinate benefits for home therapy or medical
quickly access your digital ID card to show it to your
supplies, and find community resources to help you.
doctor or pharmacy. You can even use Sydney Health
Your nurse care manager will probably call you, but
to track your health goals, find care, compare costs,
you also can call the Member Services number on
and manage your claims.
your ID card.
Have a question? Sydney Health acts like a personal
ConditionCare — Get support from a dedicated
health guide, answering your questions and
nurse team to manage ongoing conditions like
connecting you to the right resources at the right
asthma, chronic obstructive pulmonary disorder
time. And you can use the chatbot to get answers
(COPD), diabetes, heart disease or heart failure.
quickly. Sydney Health makes it easier to get things
Work with dietitians, health educators and
done, so you can spend more time focusing on your
pharmacists who can help you learn about your
health. Get started by downloading the Sydney
condition and manage your health.
Health mobile app.
Future Moms — This program can help you take
Where to get care care of yourself and your baby before, during and
after pregnancy. You can talk to registered nurses
24/7 NurseLine — You can connect with a registered 24/7 about your pregnancy, newborn care and more.
nurse who’ll answer your health questions wherever Plus, you’ll have access to dietitians and social
you are — anytime, day or night. They can help you workers, as needed.
Want healthy advice?
Follow our Better Care Blog for helpful information about health
benefits, living healthy and the latest member news.
26 Using your planPlan extras that support your health
Learn more by registering on the Sydney Health app or at anthem.com.
LiveHealth Online — At home, at work or on the go,
you can have a video visit with a doctor using your
smartphone, tablet or computer with a webcam.
Doctors are available 24/7 for advice, treatment and
prescriptions if needed.* The cost is usually $59 or
less, depending on your health plan. Register at
livehealthonline.com.
* Online prescribing only when appropriate based on physician judgment. LiveHealth Online is the trade name of Health
Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross and Blue
Shield.
Healthy living
Anthem Health Rewards — Get rewarded for living
healthier every day. It can be as simple as getting
preventive care or taking a class on healthy eating.
You earn rewards when you complete the programs
and activities. Check with your Benefits Administrator
for more details.
27 Using your planSay hi to Sydney
Anthem’s new app is simple,
smart — and all about you
With Sydney, you can find everything you need to know about your Anthem
benefits -- personalized and all in one place. Sydney makes it easier to get
things done, so you can spend more time focused on your health.
Get started with Sydney
Download the app today!
Ready for you to use quickly, easily, Sydney acts like a personal health Get alerts, reminders and tips
seamlessly — with one-click access guide, answering your questions directly from Sydney. Get doctor
to benefits info, Member Services, and connecting you to the right suggestions based on your needs.
wellness resources and more. resources at the right time. And The more you use it, the more
you can use the chatbot to get Sydney can help you stay healthy
answers quickly. and save money.
With just one click, you can: Already using one of our apps?
Find care and check costs Get answers even faster with It’s easy to make the switch. Simply
Check all benefits our chatbot download the Sydney app and log in
View and use digital ID cards with your Anthem username and password.
See claims
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana:
Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO
Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain
Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health
Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin:
Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC).
Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
115993MUMENABS 06/19
28Shop smart – compare now, save later
Did you know doctors and hospitals may charge different amounts for the same services? As an Anthem member, you can
use the Estimate Your Cost tool on our app or website to compare costs based on your benefits. You can also use the tool
to find and compare quality of care information, so you know you’re getting the best care available.
Hospital 1 Hospital 2
Examples of procedures you can compare with the Estimate Your Cost tool
Bronchoscopy
$4,500 $7,900
(Average cost $6,200)
Chest CT scan
$700 $1,000
(Average cost $800)
Hip replacement
$31,600 $37,900
(Average cost $34,700)
Knee replacement
$31,700 $37,700
(Average cost $34,700)
Sample cost comparison*
Know your costs before you get care
For quick and easy cost comparison, use the Sydney app.
You can also go to anthem.com and log in to use the Estimate Your Cost tool.
Search for the procedure you need and the tool will guide you.
*These rates are national averages for the services listed. Your experience may be different depending on your specific plan, the services you receive and the health care provider.
Rates as of 2018.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to
anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In
Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO
Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem
Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and
Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of
network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies.
Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
11916ANMENABS VPOD Rev. 6/19 29You can also read
