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Documents #Forms
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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.
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Preferred Provider Organization (PPO)
Select PPO
Health Maintenance Organization (HMO)
Select HMO
Heal.com – In Network House Calls *
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Optional PCP Selection 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
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
- What to do when you receive a doctor bill VIDEO
- VIDEO When you're looking for health insurance in California, consider the quality of care provided by Anthem Blue Cross. The Anthem team knows the needs of growing families and offers an array of plans that offer affordable coverage for members of all ages.
- VIDEO What do do when you get a doctor's bill
- Live Health ONLINE - Tele Med with therapist VIDEO
- SYDNEY Overview VIDEO
- What is a provider network Video
- In & Out of Network - What's a network? HN Video
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
Need support? Reach out to the EAP today!
- anthemeap.com (log in: My EAP CA)
- Call 800-999-7222
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.
1 In accordance with federal, state law, and professional ethical standards.
2 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.
Live Health ONLINE Video
Live Health Online 1 page pdf on how it works
Live Health Online Video Motorcycle Rider
Live Health Online Demo Dr. Finklestein
LiveHealth Online 2 page pdf on costs, benefits vs seeing Urgent Care, PCP, ER and not going
Live Health Online Psychology 1 page pdf benefits
LiveHealth Online Psychiatry 1 page pdf psychiatrists available too.
Anthem Wellness Made Whole Video
Enter your census or securely send us an excel spreadsheet or a list of employees and get instant proposals for California
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Blue Cross #Underwriting Rules 2020
Anthem Blue Cross
COVID Resource Center
Coverage of COVID 19
Rev 8.2020
10% premium discount for August 2020
More COVID FAQ's
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- Tools - Calculator to help you figure out how much you should get
Life Insurance Buyers Guide
How much life insurance you really need?
- Life Screening Form
- Please complete & return and we'll search and consult for you.
- Or try this one from NAAIP.org
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Child, Related Pages & Site Map
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
Steve Shorr
Website Video #Introduction
Our webpages on our qualifications, reviews, testimonials, etc.
Our Webpage on Insurance Coverage for
COVID 19
Medicare Coverage for #SkilledNursing - 10153
Our Introductory You Tube VIDEO based on this manual
(Clinical Guidelines Explained so much better and in logical order!)
VIDEOs
- Medicare's VIDEO Nursing Home / Long-Term Care
- Our Webpage on Long Term Care
I have the Platinum PPO. Is Flomax or it’s generic Tamsulosin https://www.4flomax.com/ https://www.webmd.com/drugs/2/drug-4154/flomax-oral/details on the formulary?
What is the co pay?
Is CVS a participating pharmacy?
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
Insurance Companies are mandated to pay 85% of the premiums in claims. I guess Blue Cross figures if they pay too much for flomax, it will be way over that. https://healthlaw.healthreformquotes.com/medical-loss-ratio-mrl/
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
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.
https://medlineplus.gov/druginfo/meds/a693045.html
https://www.webmd.com/drugs/2/drug-3750-8060/doxazosin-oral/doxazosin-oral/details
https://www.mayoclinic.org/drugs-supplements/doxazosin-oral-route/description/drg-20063546
https://en.wikipedia.org/wiki/Doxazosin
How do we add new employees?
Here’s the Employee Enrollment form
Here’s a video to explain the forms, manuals and webpages.
Employee Enrollment Form
https://employers.healthreformquotes.com/companies-carriers/blue-cross-2/administrative-tools/employer-portal/
https://steveshorr.com/steveshorr/ab_1672_small_group_guaranteed_issue/Blue_Cross/2020/GroupAdminManual2020.pdf
https://employers.healthreformquotes.com/companies-carriers/blue-cross-2/administrative-tools/#comment-52415
https://employers.healthreformquotes.com/instant-proposal/
How do I take an employee who quit or I fired off the Insurance
Here’s a video to explain the steps of how to find forms and the specific change of information form
https://employers.healthreformquotes.com/cobra/cal-cobra/
https://employers.healthreformquotes.com/companies-carriers/blue-cross-2/administrative-tools/employer-portal/
https://steveshorr.com/steveshorr/ab_1672_small_group_guaranteed_issue/Blue_Cross/2020/GroupAdminManual2020.pdf
Quotit Forms – but they don’t have the one we need
https://www.quotit.net/eProIFP/webPages/applications/applications_group.asp?license_no=0596610
This Q & A https://employers.healthreformquotes.com/companies-carriers/blue-cross-2/administrative-tools/#comment-52413
where do I find the billing summary for our group-
what is the site for access?
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, here.
Our Webpage on Employer Portal