Blue Cross Small Group

 Administration, FormsWellness,  Employer Portal & Renewal  Information & Tools

Anthem Employer #Portal Login

 

 

employer access manual

Documents #Forms

Forms Library

See also Easy Renew

Anthem Blue Cross Easy Renew & Forms

Easy  #Renew 

The newest Anthem plans are well-positioned for the changing market. The plans in this section are ACA-compliant, and offer all the essential health benefits (EHB) such as coverage for emergency care, hospital stays, maternity and newborn care, prescription drugs, preventive care and much more.

The section is clearly divided by year to make it easier for you to search. Here’s where you’ll find a detailed selection of plan information, renewal tools, documents, forms and much more.

 
BROKER ONLY 
Your Time Matters 

Explanation of Blue Cross PPO – HMO, #Network, etc. options

from their official brochures.

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 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 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.
 
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 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 *
 
 
 
Links – References 

Heal.com  – In Network House Calls  *
Live Health ONLINE ♦

Optional PCP Selection for PPO can help improve

employees’ health and lower costs

A strong relationship between your employees and a primary care physician (PCP) is important to promoting wellness, improving health and reducing costs. Optional PCP Selection lets your employees choose a PCP.

Optional PCP Selection helps members strengthen relationships with their doctors

We are moving from volume-based to value-based payment models, rewarding doctors when they improve patient health and affordability. That focus can be seen in our collaboration with doctors and in our payment innovation programs, like Enhanced Personal Health Care (EPHC), known nationally as Blue Distinction Total Care. Through the EPHC approach, members get the right level of care from the doctor that’s best for them, at the right time. It focuses on the quality of care doctors give, not the number of patients they see.

Why designate a PCP?

When members choose an EPHC doctor from their health plan as a PCP, they’re helping us help them. We can keep their doctors in the loop when they have an ER or hospital visit. We can reach out to that doctor about tests and services a member may need. We also can share other resources that will help doctors emphasize wellness with members. The goal is to have everyone work together so a member’s overall care makes the best sense. And when employees choose an EPHC doctor as their PCP, that doctor can more quickly take over the responsibility of coordinating the member’s care.

Encourage your employees to designate a PCP

Developing a relationship with a PCP is all about improving health care quality, outcomes and affordability. That’s why we’re encouraging members in open access plans to designate a PCP as part of the Optional PCP Selection on anthem.com/ca. They also can call customer service or have you, their employer, complete the selection through Employer Access.

Learn more

To know more about Optional PCP Selection, read our Frequently Asked Questions. And if you have any more questions or want to know if Optional PCP Selection is right for your company, talk to your account representative. Optional PCP Selection is not available to members who reside in Virginia or who wish to select a PCP in Virginia and is not planned for use in attribution outside of our core service area for the foreseeable future.

#Find a Anthem Blue Cross
Doctor, Hospital and other Providers
 

Anthem Blue Cross provider doctor search

Network Map

Check out this Q & A on finding Providers our webpage

Our webpage on Anthem Blue Cross  Provider List Definitions

Use this link to Enroll - So that we get compensated for helping you

Instructions - How to use Provider Search

you tube videos

 

EAP  Employee Assistance Program

Anthem’s Employee Assistance Program (EAP) provides quick and easy access to confidential counseling and referral services to help you deal with daily work and life challenges. It’s employer-sponsored, so it’s available at no cost to you, your dependents or household members.
EAP addresses a variety of issues, including:

  • Child care and parenting
  • Helping aging parents
  • Financial issues
  • Legal concerns
  • Work and career
  • Emotional well-being
  • Addiction and recovery
  • Wellness and prevention
  • Life events
  • Coping with stress and change
  • Relationship issues
  • Resources to support work/life
    balance
  • Dealing with traumatic events
As news of COVID-19 continues to evolve, you may find yourself growing increasingly concerned about dependent care, personal finances or even your family’s preparedness to whether the storm.  If so, rest assured you’re not alone. Remember, your Employee Assistance Program (EAP) is here to provide you and your household members support during challenging times.
Need support?  Reach out to the EAP today!

With your EAP you’ll have no-cost, confidential access to1:
Telephonic support.  Available 24/7 at 800-999-7222.  Talk to a counselor for in-the-moment support or a work/life specialist who can assist you in identifying resources to meet your individual needs.

  • Counseling visits.  Get a referral for in-office or LiveHealth Online video visits to manage stress, anxiety, and other issues.  Call 800-999-7222 for a referral.
  • Child and Eldercare resources.  Conduct your own search for local resources for full, part-time and back-up care at anthemeap.com (log in: My EAP CA.)
  • Financial consultations.  Meet telephonically with a certified financial professional who can discuss your short and longer term financial concerns.
  • Legal consultations. Speak to an attorney for a no cost consultation to discuss your legal questions.2
  • Website. At anthemeap.com (log in: My EAP CA) you’ll find tips, tools and resources for COVID-19, a critical event center, and more.

In accordance with federal, state law, and professional ethical standards.
Excludes benefit and employment matters. A per issue per 12 month period benefit.

Blue Cross

Wellness & Health Resources

When you use your health care services, there are some important things to know that could save you time and money, and keep you feeling your best. Here, on Blue Cross’s website you’ll learn about the best place to get care when you have a basic, urgent or emergency medical need. You’ll learn the best ways to prepare for your doctor’s appointment, and you can even get a personalized set of preventive care milestones with our Preventive Health Calendar.  Click here to get started
Anthem Whole Health Connection
Anthem – Time Well Spent Website   Time Well Spent® is a toolkit focused on building a healthier, more productive workforce.

Enter your census or securely send us an excel spreadsheet or a list of employees and get instant proposals for California

Enter your census and we will get right back to you with quotes

 

Schedule a Skype, Zoom, Phone or Face to Face meeting

 

Anthem Blue Cross
COVID Resource Center 

Coverage of COVID 19
Rev 8.2020

11.13.2020 Update  

Anthem Blue Cross FAQ COVID 19

10% premium discount for August 2020

More COVID FAQ's

Email us, if any links require a password

Get Instant Term Life Quote

get term life quotes

Life Insurance Buyers Guide

NAIC Life Insurance Buyers Guide

How much  life insurance you really need?

Video Insurance Unnecessary Cost?

Blue Cross Rx #Prescription Coverage & Information

 

Rx List   BC Website
Pharmacy Networks

Anthem Launches IngenioRx, New Pharmacy Benefits Manager   PBM
Anthem is establishing a new pharmacy benefits manager to be named IngenioRx.      IngenioRx will begin offering a full suite of PBM solutions starting in 2020, which coincides with the conclusion of the company’s current PBM contract.   FAQ’s

Drug Lists: The prescription drugs your plan covers
https://www.anthem.com/ca/ms/pharmacyinformation/home.html

Rx Choice Tiered Network
California
November 2020
https://file.anthem.com/RXCHTIERCA.pdf

 

FAQ – Does a Platinum plan  have a better formulary than the lower level plans?

See our main page on Rx  – Prescriptions

7 comments on “Administrative, Renewal & Wellness Tools

    • You can find your plan summary using this tool
      https://plan-summaries.anthem.com/sobdps/
      Your PPO plan uses the select drug list.
      Here is where Blue Cross shows all their various Rx lists
      https://www11.anthem.com/ca/pharmacyinformation/
      Small Group Select Drug List (Searchable) | (PDF)
      WOW, it’s not on the formulary!!!
      If my medicine isn’t on the drug list, what are my options?
      Here are a few things to think about:
      o If you want to take a drug that’s not on the drug list, you may have to pay the full cost for it.
      o You can also talk to your doctor or pharmacist to see if there’s another drug covered by your plan that will work just as well, or if generic or OTC drugs are an option. Only you and your doctor can decide what drugs are right for you.
      o You can search for generic drugs at anthem.com/ca. OTC drugs aren’t shown on the list.
      o If a drug you’re taking isn’t covered, your doctor can ask us to review the coverage. This process is called preapproval or prior authorization. Your doctor can get the process started by calling the Member Services number on the back of your member ID card or by downloading a prior authorization form from our website and submitting it.
      https://www.covermymeds.com/main/partners/anthem/
      CoverMyMeds is Anthem’s Preferred Method for Receiving ePA Requests
      If your request is approved, the amount you pay for the drug will depend on your plan’s benefit
      flomax not on formulary
      select drug list

      Reply
    • APPROVAL CRITERIA
      I. The individual must meet one of the following criteria to receive a non-formulary medication for formulary co-pay;
      A. Individual has previously tried and failed 2 (two) formulary products (when available):
      One of which has to be in the same specific drug class; the other product can be in a
      different drug class however it must have the same indication as the product requested.
      OR
      B. For combination products: Individual must try two formulary products:
      One of which must be in the same specific class as at least one ingredient in non-formulary combination product.
      OR
      C. For Non-Formulary antibiotics/ anti-virals/ anti-fungals, individual has previously tried and
      failed one formulary antibiotic/ anti-viral/ anti-fungal product within the same route of
      administration
      OR
      D. The individual has a documented drug interaction
      OR
      E. The individual has documented adverse drug experiences (side effects, adverse drug
      reaction)
      II. Any request for a Non-Formulary prescription medication that does not meet criteria in section I shall be subject to the normal medical necessity review. Source

      Reply
    • Alternatives to Flomax???
      https://www.medicalnewstoday.com/articles/319932.php
      Flomax, the branded version of the drug tamsulosin, is often prescribed to relieve the symptoms of BPH. benign prostatic hyperplasia
      Flomax can cost more than $200 per month and might not be entirely covered by insurance. Flomax may be no more effective than other alpha-blockers, but the manufacturing company spends more than $100 million marketing it to consumers, so it is often the only BPH drug many people know about.
      A generic form of Flomax, called doxazosin, may cost as little as $10 per month.
      doxazosin flomax generic

      Reply
    • If you appoint us as your agent, no extra charge, we can get you your billing summaries.

      You can sign up for the employer access site using the instructions above

Leave a Reply

Your email address will not be published.