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Premier PPO
Anthem Blue Cross |
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Premier from Anthem Blue Cross...
  Anthem Blue Cross brings to market a new plan that fits the way you live. Whether you're self-employed, need coverage for your family, just left group coverage, or your job doesn't provide it, Anthem Blue Cross offers dependable individual health care plans that save you time
and make sense for the way you live.
Why do you need health coverage?
These days, a single day in the hospital can cost thousands of dollars. The financial risk you take without health coverage just isn't worth it. Not only does health coverage help you stay healthy, it also gives you added security, because you know you're protected against the high cost of unexpected medical bills.
Is the Premier Plan the right plan for you?
The Premier PPO plan is a great choice for families or for individuals looking for robust benefits for both routine and unexpected medical care.
Premier Preventive Care...
Preventive care is an important component of Premier plan coverage. An annual physical exam and certain preventive screenings are covered, before your deductible, once you've been on the plan for six months.
You also have the option of going to a HealthCheckSM Center which provides immediate coverage for annual preventive screenings. For more information about HealthCheckSM, go to anthem.com/healthcheck. |
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Prescription Drug Coverage... The cost of prescription drugs can be staggering so CoreGuard includes prescription drug coverage to help you manage those costs:
 Drug Formulary: This is a special list of prescription drugs the CoreGuard plan covers. Anthem has negotiated lower prices on these formulary drugs, so you'll save when your doctor prescribes from the Plan Formulary posted at www.wellpointnextrx.com/Formulary1.
Tier 1:These drugs have the lowest copay and include low-cost or preferred medications. This tier includes lower cost generic and brand-name drugs.
Tier 2: These drugs have a higher copay than those in Tier 1 and include preferred medications that are generally moderate in cost. They include higher cost generic and brand-name drugs. Specialty: These are typically high-cost, scientifically engineered drugs and are paid at a coinsurance level instead of copay.
Network Coverage...
With Anthem's extensive network of providers, chances are that your doctor is already part of their network. And all network providers have lower rates for their members. You'll have access to these lower rates (discounts) before and after meeting your deductible. The plans from Anthem Blue Cross also offer out-of-network coverage but you'll pay less when you choose an in-network provider. To view the list of network providers Click Here |
Premier Plan Highlights |
| Premier plan offers many benefits before the deductible and richer coverage as well for preventive care and prescription drugs. The lowest levels of coinsurance across all deductiubles gives Premier added value over other plans they offer. |
Features:
 Unlimited doctor office visits with predictable copays, before the deductible.
A broad range of preventive benefits help focus on keeping you healthy
Annual routine eye exam.
$7 million per member lifetime benefits.
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Things you should know:
1) Premier offers one of their highest levels of benefits so the premiums are typically more than their other plans
3) Maternity benefits are not included with this plan |
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 Customize your Premier Plan...
With Premier, you have some choice and flexibility to change the plan to better meet your needs. Premier offers a choice of:
Deductible: Premier Plan deductibles range from $1,000 to $6,000. You can usually lower your premium by choosing a higher deductible. Simply choose the deductible and premium combination that works best for you.
Other Optional Coverage: You can add more protection for you and your family by purchasing optional dental or life insurance. |
Dental Blue Plans for Individuals and Families... |
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Anthem Blue Cross now offers a selection of Stand Alone dental plans for individuals, families and for Seniors too. Dental Blue and Anthem Senior Dental PPO and HMO plans can be applied for as stand alone plans. With three Dental Blue plans to choose from, Anthem Blue Cross if confident you'll find the one that's right for you.
Applying for coverage is easy and fast. Anthem allows you to request any effective date to better meet your needs. Payment options include monthly billing via Credit/Debit Card or Monthly Checking Account Automatic Payment. Find out more about the new Dental Blue plans from Anthem Blue Cross Click for more information... |
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How to Enroll
Enrolling is easy. Submit your application online by clicking the "APPLY NOW" link below. If you have questions and would like an agent to contact you prior to applying then click on the Agent Assist link to the right or call us at 619.435.6700. |
To enroll, you must be:
- Age 64 3/4 or younger
- A permanent legal resident of California
- A U.S. resident for at least the lst 3 months
- The applicant's spouse or domestic partner, age 64 3/4 or younger
- The applicant's children (under 19 years of age), or the children (under 19 years of age) of the applicant's enrolling spouse or qualified partner or qualified domestic partner;
- The applicant's unmarried dependent children between the ages of 19 through 22 ("dependent" as defined by the Internal Revenue Service)
- Have questions? Then give us a call or complete the SALES ASSISTANCE form to the right. We will call you.
- Applying is easy - simply complete the application process online from the comfort of your home or office. Ready to Apply? Click Here...
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Anthem Blue Cross Premier PPO
Benefit Guide for California |
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Calendar Year Deductible |
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| Individual (In-network & Out-of-Network) |
$1,000 |
$1,500 |
$2,500 |
$3,500 |
$5,000 |
$6,000 |
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Family (In-network & Out-of-Network)
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$2,000 |
$3,000 |
$5,000 |
$7,000 |
$10,000 |
$12,000 |
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| In-Network Coinsurance |
25% |
Out-of-Pocket Maximum |
Add Your Chosen Deductible to the Amount Below
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| Individual |
In-network |
Out-of-Network |
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$4,500 |
$4,500 |
$4,500 |
$4,500 |
$4,500 |
$4,500 |
$7,500 |
$7,500 |
$7,500 |
$7,500 |
$7,500 |
$7,500 |
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| Family |
In-network |
Out-of-Network |
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$9,000 |
$9,000 |
$9,000 |
$9,000 |
$9,000 |
$9,000 |
$15,000 |
$15,000 |
$15,000 |
$15,000 |
$15,000 |
$15,000 |
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| How family deductibles and family out-of-pocket maximums work |
Once one family member reaches their individual deductible or out-of-pocket maximum, the remaining amount of the family deductible or out-of-pocket maximum needs to be met by one or more other family members. The family deductible or out-of-pocket maximum can be met by the family combined. |
| Plan Lifetime Maximum |
Plan pays up to $7 million per member for in-network and out-of-network services combined. |
| Covered Services |
Your Share of Costs (after deductible,unless waived) |
| Doctor's Office Visits |
In-Network |
Office Visit $30 copay for primary care physician; $50 Copay for specialist (deductible waived for both) |
| Out-of-Network |
50% Coinsurance |
Professional/Diagnostic Services
(X-ray, lab, anesthesia, surgeon, etc.) |
In-Network |
25% Coinsurance |
| Out-of-Network |
50% Coinsurance |
Inpatient Services
(overnight hospital/facility stays) |
In-Network |
25% Coinsurance |
| Out-of-Network |
50% Coinsurance |
Outpatient Services
(without overnight hospital/facility stays) |
In-Network |
25% Coinsurance |
| Out-of-Network |
50% Coinsurance
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| Emergency Room Services |
In-Network |
25% Coinsurance |
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Out-of-Network |
50% Coinsurance |
| Preventive Care Services |
In-Network |
HealthCheck Centers (immediate coverage): $25 Basic/$75 Premium (for ages 7 & older). For Members covered more than 6 months (deductible does not apply): Annual physical exam: $30 Copay, Routine mammogram, Pap and PSA tests: $30 Copay, Well-child through age 6: $30 Copay. Colorectal cancer screening: 25% Coinsurance (after deductible) |
| Out-of-Network |
50% Coinsurance. |
| Maternity |
Not Covered |
| Optional Coverage (additional cost) |
Dental, Life |
| Prescription Drug Coverage |
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| Retail Drugs (and Mail Order Drugs when available) |
In-Network |
Tier 1 (Lower cost Generic & Brand-name drugs): $15 Copay
$2,000 annual deductible per member applied before the following:
- Tier 2 (HIgher cost Generic & Brand-name drugs): $35 Copay
- Specialty: 25% Coinsurance up to a $2,500 Annual Out-of-Pocket Maximum (the most you'll have to pay), in-network only and in addition to $2,000 annual deductible
Non-formulary drugs: Not covered, discounts apply |
| Out-of-Network |
Not Covered |
| Other Covered Benefits include but are not limited to: |
Ambulance, Chiropractic Services, Home Health Care, Physical / Occupational Therapy, Urgent Care, Vision Exam |
Consider Other Anthem Blue Cross PPO Plan Links |
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Aetna
