Blue Cross California Small Group Health Insurance
- Blue Cross / Anthem has long been one of the major health insurance carriers for California small group employers.
- This page is meant to help employers, employees, and families understand where Blue Cross may fit, how to review provider networks, and where to find plan documents when more detail is needed.
- The most important question is usually not just “What is the cheapest plan?” For many employers and employees, the better questions are:
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- Are my doctors in the network?
- Are my hospitals accepted?
- What happens if an employee lives outside the main service area?
- How does Blue Cross compare with Kaiser, Blue Shield, Health Net, or other California small group options?
- Get INSTANT Comparisons & Quotes
- Do you already have Blue Cross and need help on administering your plan?
- Provider and hospital access matters.
- Many visitors are really trying to answer a provider question. They may want to know whether a particular doctor, medical group, or hospital accepts a Blue Cross plan. Always verify directly with the carrier and the provider before enrolling, because networks can change and provider offices sometimes give incomplete answers.
- You may also want to review related provider and hospital pages on this website, including:
- Provider Finder and Network Help
- Plan documents and brochures:
- Carrier brochures, applications, benefit summaries, and enrollment guides are important, but they should not be the only thing an employer reviews.
- The official documents explain the details; a broker helps interpret how those details apply to your company, employees, doctors, and budget.
- Some documents may be hosted here for convenience.
- Others may link directly to Anthem / Blue Cross or other official sources. If a document is time-sensitive, always confirm that you are using the current version before making an enrollment decision.
- For employers:
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- A small group health plan decision usually involves more than the monthly premium.
- Employers should also think about employee contributions, waiting periods, dependent coverage, participation rules, Section 125 premium-only plan options, and whether employees are better served by a group plan or by individual coverage through Covered California.
- Related employer pages:
- For employees and families:
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- If your employer offers Blue Cross, compare the plan carefully before enrolling. Check your doctors, prescriptions, hospitals, deductible, copays, coinsurance, and out-of-pocket maximum. If you are also considering Covered California, Medicare, COBRA, or Medi-Cal, the rules can overlap and the right answer may depend on your household situation.
- Programs to enhance employee well-being
- Related individual coverage pages:
- Bottom line:
- Blue Cross may be a good fit for some California small groups, but it should be compared against the employer’s actual needs: doctors, hospitals, employee locations, prescriptions, budget, and administrative requirements.
- The brochures are useful, but the real value is knowing what to look for before you enroll.
Optional Deeper Details Below
The practical explanation is above. The section below includes supporting documents, background material, citations, examples, and technical details for readers who want more.
Networks & Provider Finder
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Resources
- (presenteeism) to help you in your business.
- Blue Card Out of State – Country Coverage
- Broker of Record Letter
- Tax Credits Small Business §45 R
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
- Select PPO Member Flyer Rev5.24 (PDF)
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
- HMO Network Comparison Guide Eff10.26 Rev9.26 (PDF)
- HMO Hospital Affiliation Guide Rev3.24 (PDF)
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 *
Network Comparison Guide 7/1/2023
Links – References
Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
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