Posted on February 22, 2024 by Steve Shorr — 4 Comments ↓

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- Blue Cross Removes UC Hospitals From EPO Health Plans
  
  UC Davis Medical Center, UC San Francisco Medical Center and Children’s Hospital, along with Benioff Children’s Hospital in Oakland are no longer part of their Pathway EPO network as January 1, 2022 Learn More - Insure Me Kevin.com
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Explanation of Blue Cross PPO – HMO, #Network, etc. options

from their official brochures.

HMO Network Comparison Guide 7/2023

Preferred Provider Organization (PPO)
Find a Participating Doctor or Hospital

PPO plans have large provider networks and give employees more choices than an HMO plan, but monthly premiums and deductibles are usually higher. No primary care physician (PCP) is needed. No referrals for other in-network doctors are required. Choosing doctors, hospitals and other covered medical services that are not in-network might cost employees more out-of-pocket. Prudent Buyer PPO network — Access to nearly 60,000 California doctors and specialists, and more than 330 hospitals

Select PPO

Select PPO plans give employees access to the same high-quality providers as a PPO, but usually the network is smaller. The monthly premiums and deductible options offer greater value than the standard PPO. No PCP Primary Care Physician is needed and no referrals for other in-network doctors are required. Access to more than 40,000 California doctors and specialists, and more than 300 hospitals

Note: Employers may choose only one PPO network. Flyer

Health Maintenance Organization (HMO)

HMO plans offer network provider choices similar to a PPO, but members must select an in-network primary care physician (PCP) to coordinate their care. Referrals are needed to see other doctors. The monthly premiums and out-of-pocket medical costs are generally lower than other plans. CaliforniaCare HMO network — Access to more than 42,000 California doctors and specialists, and more than 330 hospitals

Select HMO

Select HMO plans work like a standard HMO, but usually the network is smaller. The monthly premiums and out-of-pocket costs are generally lower than most other plans, offering greater value than the standard HMO. Members must select a primary care physician (PCP) to coordinate their care. Referrals are needed to see other doctors. Access to more than 26,000 California doctors and specialists, and nearly 250 hospitals Note: Employers may choose only one HMO network

Employers must select a network for each plan type. For example, the employer may offer employees plans available in the Select HMO network alongside the Prudent Buyer PPO network. Not all network options are available in every area. ^Anthem.com *

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How does it work if you want to #offer more than ONE Health plan?

Let’s take a look at the Employer Application

Choose what plans you want to offer from our Quote Engine and/or the Anthem/Blue Cross Guides

Contribution must be the same for all similarly situated Employee’s and Owners

Waiting periods to enroll must be the same for everyone.

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4 comments on “Blue Cross – Anthem – Employer Health Plans”

Steve Shorr says:

December 7, 2024 at 2:35 PM

https://players.brightcove.net/3639471564001/QBcqf6zgr_default/index.html?videoId=6158077265001
Video Balance Funding

Brad G says:

August 16, 2016 at 3:13 PM

Thanks for your efforts, you are top notch at what you do.
I was so amazed at how much you know about your industry, how efficient you are and how you handled all my needs with a smile and such a caring attitude!
You didn’t create any extra stress during one of the worst periods of my life.
Lots of blessings of success to you Steve and the strength to care about the people around you.

John C says:

March 16, 2016 at 5:46 PM

In terms of surgeries, do all surgeries usually require a prior authorization?
Could you provide us with hospitals in Los Angeles County that are in network with Anthem?

- Steve Shorr says:
  
  March 16, 2016 at 6:06 PM
  
  The simple answer on pre-authorization is yes. For details see a specimen policy by clicking on the link, page 132.
  Anthem’s Provider Finder
  We are sending you a list of 361 hospitals & facilities within 20 miles of San Pedro, CA