Anthem Blue Cross www.anthem.com/ca
As part of your RSCCD Employee Benefits you have access to 24/7 Nurseline with Anthem at no additional cost: (800) 977-0027
PPO Prudent Buyer Plan
Employees and eligible dependents may be treated by any physician, at any hospital, and have self-referral to specialists. The Plan will pay 90% of medically necessary expenses if the providers are part of the Prudent Buyer network. Physician visits co-pay (without procedures) are $20. The annual deductible is $300 per person/$900 for family (January thru December.)
Services performed by out of network providers are reimbursed at 60%, with an additional $500 deductible for hospital confinements.
HMO California Care Group
Each covered family member may select their own Primary Care Physician from the Blue Cross network of physician groups. There are no annual deductibles, and a nominal $15 co-payment for doctor's visits. Emergency room visits are covered at 100% after a $25 co-payment, for life-threatening emergencies only.
Specialty care is normally by referral only; however, Mental health counselors and chiropractors are self referral from the California Care directory.
Ready Access
There are two ways you may get special care without getting an OK from your medical group:
• "Direct Access"
• "Speedy Referral"
Not all medical groups take part in the Ready Access program. Contact the medical group listed on your medical card to verify participation.
Direct Access
You may be able to get some special care without an OK from your primary care doctor for:
• Allergy
• Dermatology
• Ear/Nose/Throat
If your medical group participates in the Direct Access program, you must still get your care from a doctor who works with your medical group
Speedy Referral
If you need special care, your primary care doctor may be able to refer you for it without getting an OK from your medical group first. Contact your primary care doctor to verify participation.
