About Anthem Blue Cross

Anthem Blue Cross offers the coverage and choices you – and your employees – want and need. You can select from a variety of plan types, including HMO, PPO, EPO, and HSA-compatible plans. Anthem’s smart tools help your employees make the most of your group health benefits. It’s easy to access your virtual ID card, connect to plan information, and more using the intuitive Anthem Anywhere mobile app.

Quick Plan Highlights

Here are some of our most popular (Carrier Name Health Plans) along with a high level snap shot of plan coverage and out of pocket costs. To view a complete list of ( Carrier Name coverage options) click Download Full Plan Details below to see the most current plan information.

Anthem Blue Cross Bronze EPO A

Network

Prudent Buyer - Small Group

Calendar Year Deductible*

$5,600 / $11,200¹ (combined Med/Pediatric dental ded) (applies to Max OOP)

Out-of-Pocket Max Ind/Fam

$7,350 / $14,700²

Dr. Office Visit (PCP)

$65 Copay (first 3 visits)8 - 60%

Urgent Care

60%

Emergency Room (copay waived if admitted)

$400 Copay - 60%

Anthem Blue Cross Bronze EPO A

Network

Prudent Buyer - Small Group

Calendar Year Deductible*

$5,600 / $11,200¹ (combined Med/Pediatric dental ded) (applies to Max OOP)

Out-of-Pocket Max Ind/Fam

$7,350 / $14,700²

Dr. Office Visit (PCP)

$65 Copay (first 3 visits)8 - 60%

Urgent Care

60%

Emergency Room (copay waived if admitted)

$400 Copay - 60%

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See Carriers

The CaliforniaChoice Employee benefits program lets your employees select health plans (HMO, PPO, HSA and more) from seven of California's top carriers while you determine how much your company will contribute. Click on any carrier below to view a sample of the health plans available to you and your team.

1) Family Deductible: For any given Member, cost share applies either after he/she meets their individual Deductible, or after the entire family Deductible is met. The family Deductible can be met by any combination of amounts from any Member; however, no one Member may contribute any more than his/her individual Deductible toward the family Deductible. 2) Family Out-of-Pocket Limit: For any given Member, the Out-of-Pocket limit is met either after he/she meets their individual Out-of-Pocket Limit, or after the entire family Out-of-Pocket Limit is met. The family Out-of-Pocket Limit can be met by any combination of amounts of any Member; however, no one Member may contribute any more than his/her individual Out-of-Pocket Limit toward the family 8) Office visits are per Member and combined for primary care physician, specialist, other provider, Retail Health Clinic Visit, Counseling (including Family Planning, Nutritional), Mental Health and Substance Abuse, and Telehealth. These Office Visits have a Copayment with deductible waived for in-network providers which applies to any combination of services for the first three visits during the Benefit Period. Starting with the fourth visit, you pay Deductible and Coinsurance instead of a Copayment. Always check the setting above to determining your payment responsibility for other services and Providers, if applicable. Benefits are based on the setting in which Covered Services are received. If the service is available (and you obtain the service) in a setting other than the one listed above, your Copayment /Coinsurance will be based on the setting in which you receive the service. Please see those settings to determine your cost share. 9) When you use an out-of-network provider, you will have higher cost sharing amounts to pay. Anthem’s payment is based on a maximum allowed amount (includes certain benefits with maximum payment limits) and an out-of-network provider can charge you for amounts in excess of the Maximum

Allowed Amount (there is an exception for Emergency Care received in California). In addition, only the maximum allowed amount for out of network services is applied towards your Out-of-Network deductible and out of pocket.

* All services are subject to the deductible unless otherwise stated.

Plans effective 7/1/2018