Choosing and using your plan - Your guide to making the most of Anthem's resources and programs - Norfolk Healthcare Consortium
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Choosing and
using your plan
Your guide to making the most of
Anthem’s resources and programs
Norfolk Consortium
Effective January 1, 2022
115324MUMENMUB Rev. 05/19
This guide is for information purposes only. You must enroll in a plan for your benefits to start.
Welcome to 2022 Open Enrollment
Your medical and prescription plan will be covered by Anthem Blue
Cross and Blue Shield effective January 1, 2022. Anthem will
provide your pharmacy coverage with the support of their
pharmacy benefit manager, IngenioRx.
To help you navigate through the changes, we have partnered with
your employer to provide you with this booklet. The booklet
contains information about Anthem’s programs, tools and
resources.
Additional details of the plan offerings, eligibility requirements,
coverage, and fees are included in the separate Employee Benefits
Guide, available on the Norfolk Healthcare Consortium (NHC)
website. This year’s Open Enrollment page on the NHC website
contains videos, frequently asked questions, and a wealth of
information designed to assist you and your family in making
confident benefit choices that best meet your needs.
2 Choosing your plan
Table of Contents
Programs that support your health .......................................................4
Member Care Resources........................................................................7
Care While Traveling.............................................................................19
Anthem Special Offer Discounts.........................................................21
Making the most of your pharmacy benefits...................................23
How to use your plan...........................................................................24
Protecting your privacy.......................................................................37
3 Choosing your plan
Programs that support your health
For details, register on the Sydney Health mobile app or at anthem.com.
Your plan comes with great tools and programs to help you reach your health goals and save money on health
products and services that may come at no extra cost. For detailed information, register on the Sydney Health
mobile app or at anthem.com.
Apps Working for you:
Symptom Checker — Answer questions through
Discover a powerful and more personalized health the Sydney Health intuitive Symptom Checker. It
app. Access your benefits and wellness tools to uses the information you provide to narrow down
improve your overall health with the Sydney Health millions of medical data points and assess your
app. The mobile app works with you by guiding you to specific symptoms before you visit a doctor.
better overall health — and works for you by bringing
Virtual text visits — Sydney Health can link you
your benefits and health information together in one
directly to board-certified doctors for virtual text
convenient place. Sydney Health has everything you
visits at no extra cost.* During your appointment,
need to know about your benefits to make the most of
the doctor can evaluate your symptoms, discuss
them while taking care of your health.
your treatment options, and order prescriptions, if
you need them.
Working with you:
Virtual video visits — You can also use Sydney
Reminding you about important preventive Health to connect with a board-certified doctor
care needs. through video visits.
Planning and tracking your health goals, fitness,
and rewards.
Guiding you with insights based on your history
and changing health needs.
Empowering you with personalized tools to find and
compare healthcare providers and check costs.
Are you looking for healthy advice?
Follow our Better Care Blog (anthem.com/blog/) for helpful
information about health benefits, living healthy, and the latest
member news.
* Pricing based on $0 copay benefit eligibility offered through your plan.
4 Using your plan
Programs that support your health
For details, register on the Sydney Health mobile app or at anthem.com.
Anthem Skill — Our Anthem Skill for Alexa is a The Autism Spectrum Disorder Program —
voice-activated assistant for your health plan. Receive This program focuses on building a strong
answers to your healthcare questions — hands-free by support system for the entire family. A specialized
enabling the Anthem Skill. It works through any Alexa- team of clinicians will work with you to create a
enabled device, such as an Amazon Echo, or on your customized care plan, help coordinate care, and
mobile device using the Amazon Alexa app. connect you with resources in your community.
Call 844-269-0538.
Ask for your digital member ID card.
Access your health savings account (HSA) or health Cancer Resources — The Stronger Together
reimbursement account (HRA) balance, if you website is a great resource for anyone facing
have one. cancer. You will find tools and information that can
Check your progress toward meeting your medical help you make shared treatment decisions,
plan's deductible and out-of-pocket maximum. prepare for care or develop a care plan, manage
symptoms, and find caregiving support. Visit
Find out how close you are to reaching your dental cancerresources.anthem.com.
plan's deductible and annual maximum.
Refill, renew, and check the order status of any Case Management — If you’re coming home after
home delivery prescriptions. surgery or have a serious health condition, a nurse
care manager can help answer your questions about
If you do not have the Amazon Alexa app, download it
your follow-up care, medicines and treatment options,
from Google PlayTM or the App Store®.
coordinate benefits for home therapy or medical
supplies, and find community resources to help you.
Medical guidance Your nurse care manager will call you, but you also
can call the Member Services number on your ID card.
24/7 NurseLine — You can connect with a
Future Moms — This program can help you take care
registered nurse who will answer your health
of yourself and your baby before, during, and after
questions wherever you are — anytime, day or night.
pregnancy. You can talk to registered nurses 24/7
They can help you decide where to go for care and
about your pregnancy and newborn care. You also
find doctors and other healthcare professionals in
have access to dietitians and social workers, as
your area. Call 800-337-4770.
needed. The program includes breastfeeding support
through LiveHealth Online.
Anthem Health Guides — Highly trained Anthem
associates are like personal support guides who can
Shopper program for imaging services — The cost of
help you with all your healthcare needs. They can help
imaging services like X-rays, ultrasounds, MRIs,
you connect with the right resources, stay on top of
and CT scans can range from $300 to $3,000.* A
the screenings and tests you need, and find doctors.
higher price doesn’t always mean better care. If your
Reach a health guide by calling the number on your
doctor lets us know you need imaging, we will shop
member ID card. You also can go to anthem.com to
around to find the best value. You also can call us
send a secure email or chat with them online.
directly at 888-953-6703. If we find an option that
costs less, we will let you know. The choice of where
you go is always up to you.
*Source: AIM Specialty Health®, internal claims cost analysis.
5 Using your plan
Programs that support your health
For details, register on the Sydney Health mobile app or at anthem.com.
Total Health, Total You — This unique program offers
care tailored to your needs. It gives you the
personalized health support you need whenever you
need it most. You can count on Total Health, Total You
for extra guidance, support, and resources to put you
at ease.
Healthy living
Anthem Health Rewards — Earn rewards for living
healthier every day. It can be as simple as receiving
preventive care or taking a class on healthy eating.
You earn rewards when you complete the programs
and activities. Check with your Benefits Administrator
for details.
MyHealth Advantage — There is no cost for this service,
and it can help you stay healthy and save money. You will
receive reminders when you need to refill a prescription
or have a checkup, test, or exam. You will also receive a
personalized and confidential MyHealth Note in the mail
or on the Sydney Health mobile app if we see something
that might help you.
SpecialOffers — With SpecialOffers, you can receive
discounts on products and services that help promote
better health and well-being.
6 Using your plan
Total Health, Total You
The right people. The right
tools. The right answers.
The right time.
With Total Health, Total You, you get simple, personalized and relevant health support you need, when you need it most. From getting
quick answers to connecting you to a primary care nurse for guidance on the more complicated stuff, it’s care tailored to your needs.
It starts with a download Total Health, Total You: the personal touch you
Sydney: so much more than just a mobile health app deserve
Access your Total Health, Total You benefits with the Sydney Sometimes you just need one-on-one support when it comes
app. Find everything you need to know about the resources to your health care needs — big or small. That’s where our
available to you right through your smartphone. Sydney gives Health Guide comes in. Our health guides do more than just
you a simple, personal experience that’s all about you and your answer questions. Health guides give you the extra guidance,
health care needs. support and resources to put you at ease.
With the Sydney app, you can: For personalized and consultative support, just chat online or
See medical and pharmacy benefits all in one place. use your Sydney app to connect to a Health Guide who can
help you:
Pull up your member ID card.
Stay on top of your follow-up and preventive care reminders
Check spending to date.
and appointment-scheduling support.
Search for doctors and hospitals in your plan or find an Arrange care before or after a surgery or hospitalization.
urgent care center.
Find the right doctors, specialists or care facilities for you
Check reviews and compare costs for care.
and your family.
Plus, you can connect to your care team through click to chat Connect with the right benefits and programs for your
or call. health care needs, like nurse care manager support for
managing chronic conditions.
Download the Sydney app to see how easy it is to get things
done.
Always have us at your fingertips.
Download the Sydney app today!
Just search for Sydney in the App Store.
You can also call us at the number on the
back of your ID card.
7 See Total Health, Total You in action. Flip over for examples
on how this solution has worked for some members.
See your team in action
The Total Health, Total You team gives you the
personalized support you need.
Care management that goes the extra mile
Meet Kimberly and her Care Manager*
Kimberly is learning how to keep her rheumatoid arthritis in check. With the Sydney app, she
is able to tap into valuable resources all in one spot. The app helps her locate labs for her
infusions by location, search for covered insulin or locate primary care doctors in her area.
Plus, she gets support from her Care Manager, who connects with her doctor to ensure
she’s following her treatment plan. Kimberly can also count on timely messaging,
articles, tips, care alerts and notifications based on her claims and clinical data.
Support through a complicated surgery
Meet James and his Anthem Primary Nurse*
James is struggling after back surgery. So his Anthem Primary Nurse sets up in-home visits
with nurses and a physical therapist. During these visits, James mentions his appetite hasn’t
been the same since the surgery. His Anthem Primary Nurse contacts his doctor, who
prescribes medicine to increase James’ appetite. Plus, a dietitian who is part of James’
health care team at Anthem shows him how to get the calories he needs. With this
extra support, James is able to focus on healing instead of juggling appointments.
Care management that goes the extra mile
Meet Alice and her Health Guide*
Alice needs an MRI for her hip and has lots of questions. Where does she go first? How much
will it cost? Is it covered by her plan? Alice calls her Health Guide, who explains her benefits and
how she can use Estimate Your Cost on the Sydney app to find a highly-rated, but affordable
doctor. The Health Guide even schedules Alice’s MRI appointment.
* The people and situations in these examples aren’t real. They’re only used to show how the services work.
Sydney and Sydney Health are service marks of CareMarket, Inc.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to anthem.com/co/networkaccess. In Connecticut: Anthem
Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life
Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical
Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans
of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network
benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association.
Anthem is a registered trademark of Anthem Insurance Companies, Inc.
118623ANMENABS VPOD 9/19
8
A caring team to
help guide you
Anthem Health Guide is a concierge service for your
health and health care
Health care benefits can seem complicated or confusing at times. To make the most of your benefits, you need to understand them.
That is why you have a team of concierge-level customer service experts — ready to answer questions, advocate for your health and
explain how to use your benefits. You can call a health guide or chat from your mobile device using our Sydney Health app.
Anthem health guides are here to help
Health guides are team members hand-picked for their kindness and understanding, their ability to listen and find a solution, all
while also helping you feel less overwhelmed. They are experts at:
One-call resolution. Our guides use advanced technology to see your whole health care picture while talking to you or
advocating for you. They understand you are busy and may not have time for multiple conversations so they find the solution in
the first call. Health guides take a comprehensive and personal approach, not only to help with your immediate needs but also
anticipate future questions.
Advocating for you. Health guides bring knowledge and experience to help make sure you are receiving the care you need. They
will help break down barriers and eliminate “homework” for you, like calling providers about billing discrepancies, so you can
focus on your health. If you need help finding a provider, guides can match you with an in-network provider that suits your needs.
They can also help you save money by comparing costs for care at different hospitals and save on your prescription drugs, by
switching to generic from brand-name, if available.
Coordinating care for better health. Many people see more than one doctor. Health guides can connect you to health
professionals who will help coordinate with doctors and other members of your care team. They can remind you of important
preventive care, and even help schedule appointments for you, when possible. They also have in-depth knowledge about the
programs and preventive care services that are part of your benefits, and they work closely with nurses, health coaches and
social workers to provide support uniquely suited to you.
Anthem Health Guide is here to give you personalized help when you need it most. That way you can focus on what is most
important: your health.
Reach out to an Anthem Health Guide
Connect from your Anthem Blue Cross and Blue Shield Sydney Health
Sydney Care is offered through an arrangement with CareMarket, Inc. Sydney Health and Sydney Care are service marks of CareMarket Inc., ©2020. mobile app or by logging in at anthem.com. Then choose Customer
Support, then Contact Us
Health and wellness programs are not covered services under the health plan, but are additions; these programs’ features are not guaranteed under your health plan
certificate and could be discontinued at any time. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. Anthem Blue Cross and
Blue Shield, and its affiliate HealthKeepers, Inc., serving all of Virginiaexcept for the City of Fairfax, the Town of Vienna, and the area east of State Route 123, are
independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
40157VAMENBVA VPOD Rev. 05/20
9 Call us at 833-988-2030, Monday to Friday 8-8.
Sydney Health makes
healthcare easier
Access personalized health and wellness
information wherever you are
The Sydney Health mobile app is the one place to keep track
of your health and your benefits. With a few taps, you can
quickly access your plan details, Member Services, virtual
care, and wellness resources. Sydney Health stays one step
ahead — moving your health forward by building a world of
wellness around you.
Find Care Virtual Care
Search for doctors, hospitals, and Connect directly to care from the
other healthcare professionals in convenience of home. Assess your symptoms
your plan’s network and compare quickly using the Symptom Checker, then
costs. You can filter providers by what consult with a doctor through a video visit or
is most important to you such as text session. Download Sydney
gender, languages spoken, or location. Health today
Use the app anytime to:
My Health Dashboard Community Resources Find care and compare costs
Use My Health Dashboard to find This resource center helps you connect
See what’s covered and
news on health topics that interest with organizations offering free and
you, health and wellness tips, and reduced-cost programs to help with check claims
View and use digital ID cards
personalized action plans that can challenges such as food, transportation,
help you reach your goals. and child care.
Live Chat My Health Records
Find answers quickly with the Live Chat See a full picture of your family’s health
tool in Sydney Health. You can use the in one secure place. Use a single profile
interactive chat feature or talk to an to view, download, and share information
Anthem representative when you such as health histories and electronic Use your smartphone camera
have questions about your benefits or medical records directly from your to scan this QR code
need information. smartphone or computer.
Sydney Health is offered through an arrangement with CareMarket, Inc. Sydney and Sydney Health are trademarks of CareMarket, Inc.
Life and Disability products underwritten by Anthem Life Insurance Company. In Georgia: Life and Disability products are underwritten by Greater Georgia Life Insurance Company using the trade name Anthem Life. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky
Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky,
Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by
HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba
HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc.; HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia,
Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or administers PPO and indemnity
policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well
Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
116947MUMENABS VPOD BV Rev. 02/21MyHealth Advantage
We’re watching out for you!
It’s hard enough remembering birthdays, anniversaries and
all the big events in your life. Taking care of your health?
That’s easy to forget. But there’s a program that can help.
MyHealth Advantage connects your claims, doctor reports,
personal health history and other information for a bigger
picture of your health. If we see things you can act on to
help improve your health or save money, you’ll get a
MyHealth Note — a confidential health summary that includes:
Money-saving tips. For example: Can you switch from a
brand-name medicine to a lower-cost generic?
Reminders for checkups, tests and exams. We’ll keep
nudging you about scheduling preventive care.
Lists of recent claims. Share these with your doctors. Help is on the way — even if you didn’t know
General health tips. Are you at risk for diabetes or another you needed it!
condition? We can give you the warning signs.
Look for your MyHealth Note in your mailbox or read our
The program can help you keep health issues from developing “Suggestions” in your plan’s Secure Message Center
or becoming serious. And that means lower health care costs (website and mobile app).
down the road.
MyHealth Notes are mailed to you. Or you can read our
“Suggestions” on your iPhone or Android device by
downloading the Sydney app. With this app, you have the option
of getting personalized health messages on the go via the
Secure Message Center.
Anthem logo left
Health and wellness programs are not covered services under the health plan, but are additions; these programs’ features are not guaranteed under your health plan certificate and could be discontinued at any time.
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc., serving all of Virginia except for the City of Fairfax,
the Town of Vienna, and the area east of State Route 123, are independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MVASH1312A VPOD Rev. 12/18
1124/7 NurseLine
Giving you and your family access
to a registered nurse anytime
Your health is priceless. That is why it is so
A registered nurse can also:
important for you to be able to connect to
Help you find doctors, hospitals, and
the resources and expert guidance you need specialists in your area.
to keep you safe and healthy — day or night. Give you referrals to LiveHealth Online,
an option for care that allows you to have
24/7 NurseLine serves as your first line of a video visit with a board-certified doctor.
defense for unexpected health issues. You can Enroll you in health management
programs for certain health conditions.
call a trained, registered nurse to decide what
Remind you about scheduling important
to do about a fever, give you allergy relief tips, screenings and exams, including dental
or advise you where to go for care. A nurse is and vision checkups.
always available to help answer your questions. Provide guidance during natural
catastrophes and health outbreaks.
Offer links to health-related educational
videos or audio topics.
When you use 24/7 NurseLine, you also have
We understand the need for care to be access to Anthem’s other health and wellness
programs to help you achieve your personal
accessible. When you need guidance on wellness goals.
how to protect your health, we are here
to support you for any issue — big or
small. For help, call 24/7 NurseLine
at 800-337-4770.
LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing
telehealth services on behalf of Anthem Blue Cross and Blue Shield.
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. Anthem Blue
Cross and Blue Shield, and its affiliate HealthKeepers, Inc., serving all of Virginia except for the City of
12 Fairfax, the Town of Vienna, and the area east of State Route 123, are independent licensees of the Blue
Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
2000278VAMENBVA VPOD BV 01/21Autism doesn’t have
to be puzzling
We’ll help you figure it out
The Autism Spectrum Disorders (ASD) program — here for your family
When your child falls somewhere on the Autism Spectrum, you’ve got a team in your corner,
ready to help. Our Autism Spectrum Disorders (ASD) program is here for your whole family,
creating a strong care system. We’ll help you:
}} Strengthen the family unit and make it easier to understand how to use available care.
}} Guide your whole family through the health care system.
}} Use your benefits effectively to get the best outcomes.
What the ASD program can do for you
Community resources and family support Coordinated care
The ASD program team helps: ASD case managers help you:
}} Connect you to the resources and knowledge that }} Navigate the complex health care system.
build a strong foundation of care. }} Address unique challenges of your situation.
}} Tailor referrals and education to meet your }} Build a custom care plan for your child.
family’s needs.
}} Find available services and connect you to any missing care.
}} Give you and your family ongoing support
}} Link your child’s treatment providers together for
so you can overcome obstacles and add
new services. better collaboration.
}} Make it easier to reach your family’s lifestyle
and health goals.
Clinical review of Applied Behavior Analysis
We’ll help tackle the tough stuff:
}} A highly trained team of clinicians, experienced with families
touched by ASD, works hard to make sure your child gets the
right care from the right provider at the right time.
We can help
Call the ASD program team at 1-844-269-0538.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member
services or can be obtained by going to anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem
Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc.
RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In
Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of
New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of
Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network
benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well
Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.
2
110541ANMENABS VPOD 9/18Facing a health issue?
We can help.
A hospital stay or long-term health problem can turn your life
upside down. You may feel overwhelmed and not know where to get Your nurse care manager
help and support.
will probably call you
That’s why we have a team of registered nurses, supported by clinical experts, trained
to help during these stressful times. They’re called nurse care managers, and they’re But if you don’t pick up or if you want
your health care advocates. Their goal is to understand your needs from all angles to reach out to us about the
and help you get the best care possible. program, you can call the number on
Depending on your needs, a nurse care manager might help you: the back of your card and ask for
Case Management.
}} Find out more about your health issue and your treatment options.
}} T alk with your doctors and the rest of your health care team — and encourage
them to talk with each other.
}} eview your health plan to help you save money and get the most value
R
from your plan.
}} onnect with resources near you, like home care services and community
C
health programs.
}} Take steps to make healthy changes in your life.
14
21400VAMENBVA VPOD Rev. 04/18Nearly 9 out of 10 members
who use this service say
they’re “very satisfied” a d
This service doesn’t cost anything extra. would recommend the
Keep in mind that the nurse doesn’t provide hands-on care to you. It’s up to your program to another member.1
doctors and the rest of your health care team to do that. But the nurse can work with
you and your team to keep the focus where it belongs — helping you manage your
health and feel better. Here’s how it works:
}} Get started. In most cases, someone from this program contacts you directly.
You can also call the Customer Service number on your member ID card or the
health benefits team where you work. Ask to get in touch with the Case
Management team. Your nurse will call you and get to know you. You’ll talk about
your current health situation and how it affects you. But you’ll also talk about
your health goals — and how your nurse can help you reach them.
}} Stay in touch. Your nurse will call you regularly to see how you’re doing. You can
get support with any health issues. This is important because your needs may
change over time. You’ll also have your nurse’s direct phone number, so you can
call if any questions or problems come up.
}} Get better. If you don’t think you need help anymore, just let your nurse know.
You can stop participating at any time.
}} See us at home or the hospital. Sometimes we may offer to send a health
professional to your home, to help coordinate your care or connect you with
community resources that can support your recovery after a hospital stay.2
An extra helping hand is a phone call away. Call Customer Service at the phone
number on your ID card and ask for Case Management. To learn about other member
programs available to you, visit your health plan’s website.
1 2017 Clinical Satisfaction Study: Case Management Program.
2 Not available for all funding types. Varies by market and geographic area. 15
Health and wellness programs are not covered services under the health plan, but are additions; these programs’ features are not guaranteed under your health plan certificate and could be discontinued at any time.
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc., serving all of Virginia except for the City of Fairfax,
the Town of Vienna, and the area east of State Route 123, are independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.Meet your new health champion
Enhanced Personal Health Care doctors go above and beyond for you
Whether you go to the doctor rarely or often, you should find a primary care physician (PCP) you like and trust. Checking
out Enhanced Personal Health Care (EPHC) doctors is a great way to start your search. Enhanced Personal Health Care
professionals (including primary care doctors and other medical staff) have agreed to provide high-quality care and focus
on your whole health — not just your symptoms. In fact, Anthem members who choose an EPHC doctor are happier with their
doctors and their overall health.*
Your Enhanced Personal Health Care doctor has agreed to go above and beyond and:
Focus
}} on preventing illnesses and helping you get healthy faster and stay healthy longer.
Coordinate
}} your overall health care to avoid any gaps in care. This entails things like setting up appointments
with specialists to ensuring you’re following your prescription plan and getting the right tests and screenings regularly.
Help
}} you avoid unnecessary medical services and tests, saving you money and reducing stress.
Use
}} specialized health information to help them better coordinate and manage your care.
Be
}} available to you 24/7 through extended office hours, after-hours call coverage and sometimes even online.
Spend
}} extra time with you to get to know you and your health goals.
Contact
}} you when you’re due for a preventive exam or screening.
16
108075MUMENABS 06/18Choose the kind of professional who’s right for you
Family
}} practice/general practice — These doctors offer a
wide range of care, from check-ups to pregnancy care. This
type of doctor might be a good choice if you want to keep
all of your family members under the same doctor’s care.
A doctor who treats everyone in a family can sometimes
get a better view of each person’s health.
Internal
}} medicine — Internal medicine doctors mainly
treat adults and offer a range of care, including
preventive care. But they may have special knowledge
about certain health problems. So if you have a long-term
health problem, an internist who also focuses
on that particular problem may be a good fit for you.
Pediatricians
}} care for infants, children, and adolescents.
Nurse
}} practitioners and physician assistants aren’t
doctors, but they’ve had lots of training. They can do
many of the same things that doctors do.
Ready to find your Enhanced Personal Health Care doctor?
1. Log in or register at anthem.com.
2. Under Find a Doctor, enter your location and search distance.
Be sure to select the boxes for Able to serve as primary care
physician (PCP) and Enhanced Personal Health Care.
3. Choose Search and you’ll see a list of available doctors near you.
* AEPHC Patient Experience Survey Results. In 2015, 2,751 EPHC patient interviews were conducted across four distinct EPHC patient populations. 746 interviews for non-EPHC Group. Analyses conducted across patient experience domains to identify performance of EPHC providers
over time, and, comparative performance to non-EPHC providers.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem
Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates
administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc.
HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community
Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield
of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare
underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.
17BlueCard® Program
Take your benefits with you
With the BlueCard and Blue Cross Blue Shield Global ® ®
Core programs
Traveling?
What happens if you’re away from home and you need care right away? As
an Anthem Blue Cross Blue Shield (Anthem) member, you have access to
care across the country through the BlueCard® Program. This includes Here’s what you need to know:
95% of doctors and 96% of hospitals in the U.S.1 Before leaving the country, ask
Member Services if your
international benefits are different.
Ask for approval before getting care.
This is “precertification” and helps
How to access care across the U.S.: you find care covered by your plan.
To see if you need precertification,
call Member Services at the
number on your ID card.
Call 911 or go to the nearest hospital in an emergency.* Save money by seeing a BlueCard
program doctor or hospital. You
only pay your usual out-of-pocket
amounts (such as deductible, your
Go to anthem.com, log in and use the Find a Doctor tool to
search for a BlueCard Program doctor or hospital. percentage of costs or copay). If you
go to a doctor or hospital outside
the program, you’ll need to pay the
Use the Sydney Health mobile app to search for a BlueCard entire bill up front.
Program doctor or hospital. Get turn-by-turn directions to the Show your Anthem ID card so the
nearest doctor, urgent care center or hospital. doctor or hospital can check your
benefits and send us a claim for
processing.
Call Member Services at the number on your ID card. They
can help you find a doctor or hospital.
**You or a family member needs to call the Member Services number on your ID card within
24 hours (48 hours for members in Indiana) after going to the hospital or as soon as you can.
Remember to carry your ID card
The symbol shows you can get
care from BlueCard Program
doctors and hospitals.
18
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc., serving all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123, are
independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
58267VAMENBVA VPOD Rev. 3/20Blue Cross Blue Shield Global® Core Program
How to access care around the world
The Blue Cross Blue Shield Global Core Program gives you ®
benefits when you travel outside the U.S.
If you’re outside the U.S., you can use the Blue Cross Blue Shield Global®
Core Program. It gives you access to preferred doctors and hospitals in
190 countries and territories around the world.2
Download the Blue Cross
Blue Shield Global Core
app today
With the app, you can:
Need care outside the U.S.? Search for a doctor or hospital.
You can: Submit claims.
Get medical terms and phrases
for many symptoms translated —
Go straight to the nearest hospital in an emergency. and even use an audio feature to
play the translation.
Find a drug’s generic name, local
brand name and check whether
Go to bcbsglobalcore.com to search for a doctor or
hospital. it’s available.
Get information about how to find
and contact a U.S. embassy.
Use the Blue Cross Blue Shield Global Core app to find
a doctor or hospital.
Call the Blue Cross Blue Shield Global Core Service
Center 24/7 at 1-800-810-2583 (BLUE) or call collect at
1-804-673-1177. They can help you set up a doctor visit
or hospital stay.
Unless it’s an emergency, call the Global Core Service Center before getting care outside the U.S. Global Core will
work with the doctor and Anthem to approve and accept a Guarantee of Payment (GOP). What if you get care from a
doctor or hospital that has not accepted a GOP?
1. You will need to pay up front in full for your care.
2. Download an international claim form at bcbsglobalcore.com or get a form by calling Member Services at the
number on your ID card.
3. Fill out the claim form and send it with the original bills to the Blue Cross Blue Shield Global Core Service Center.
You can submit them through the mobile app, email or postal mail.
1 Blue Cross Blue Shield Association website, The Blue Cross Blue Shield System (accessed February 2020): bcbs.com/about-us/the-blue-cross-blue-shield-system.
2 GeoBlue® website, More than 20 years as a leader in international healthcare (accessed February 2020): about.geo-blue.com.
The Blue Cross Blue Shield Global Core program was formerly known as BlueCard Worldwide®.
Blue Cross, Blue Shield, the Blue Cross and Blue Shield symbols, BlueCard, BlueCard Worldwide, and Blue Cross Blue Shield Global are trademarks of the
Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies.
19Save money
with discounts
at anthem.com
As an Anthem member, you qualify for discounts on products and services that help promote better health and
well-being.* These discounts are available through SpecialOffers to help you save money while taking care
of your health.
Vision, hearing and dental
Glasses.com™ and 1-800-CONTACTS® — Shop for the Nations Hearing — Receive hearing screenings and
latest brand-name frames at a fraction of the cost for in-home service at no additional cost. All hearing aids
similar frames at other retailers. You are also entitled to start at $599 each.
an additional $20 off orders of $100 or more, free
shipping and free returns. Hearing Care Solutions — Digital instruments start at
$500, and a hearing exam is free. Hearing Care Solutions
EyeMed — Take 30% off a new pair of glasses, 20% off has 3,100 locations and eight manufacturers, and offers a
non-prescription sunglasses and 20% off all eyewear three-year warranty, batteries for two years and unlimited
accessories. visits for one year.
Premier LASIK — Save $800 on LASIK when you choose Amplifon — Take 25% off, plus an extra $50 off one
any “featured” Premier LASIK Network provider. Save 15% hearing aid; $125 off two.
with all other in-network providers.
ProClear™ Aligners — Take $1,200 off a set of custom
TruVision — Save up to 40% on LASIK eye surgery at more aligners. You can improve your smile without metal braces
than 1,000 locations. and time-consuming dental visits. Your order is 50% off
and comes with a free whitening kit.
20
MANSH1231A VPOD Rev. 06/20Fitness and health
Active&Fit Direct™ — Active&Fit Direct allows you to Jenny Craig® — Join this weight loss program for free.
choose from more than 11,000 participating fitness Jenny Craig provides you with everything you need, making
centers nationwide for $25 a month (plus a $25 it easier to reach your goals. You can save $200 in food, in
enrollment fee and applicable taxes). Offered through addition to free coaching, with minimum purchase. Save
American Specialty Health Fitness, Inc. an extra 5% off your full menu purchase. Details apply.
FitBit — Work toward your fitness goals with Fitbit trackers ChooseHealthy® — Discounts are available on
and smartwatches that go with your lifestyle and budget. acupuncture, chiropractic, massage, podiatry, physical
Save up to 22% on select Fitbit devices. therapy and nutritional services. You also have discounts
on fitness equipment, wearable trackers and health
Garmin — Take 20% off select Garmin wellness devices. products, such as vitamins and nutrition bars.
GlobalFit — Discounts apply on gym memberships, fitness
equipment, coaching and other services.
Family and home
23andMe — Take $40 off each Health + Ancestry kit. Save ASPCA Pet Insurance — Take 5% off pet insurance. You
20% on a 23andMe kit and learn about your wellness, can choose from three levels of care, including flexible
ancestry and more. deductibles and custom reimbursements.
Safe Beginnings® — Babyproof your home while saving WINFertility® — Save up to 40% on infertility treatment.
15% on everything from safety gates to outlet covers. WINFertility helps make quality treatment affordable.
Nationwide Pet Insurance — Receive an automatic 5% LifeMart® — Take advantage of great deals on beauty and
discount when you enroll through your company or skin care, diet plans, fitness club memberships and plans,
organization. Save up to 15% when you enroll personal care, spa services and yoga classes, sports gear
multiple pets. and vision care.
Medicine and treatment
SelfHelpWorks — Choose one of the online Living Allergy Control Products and National Allergy Supply —
programs and save 15% on coaching to help you lose Save up to 25% on select doctor-recommended products
weight, stop smoking, manage stress or diabetes, restore such as allergy-friendly bedding, air purifiers and filters,
sound sleep or face an alcohol problem. asthma products and more. Orders over $59 ship for free
by ground within the contiguous U.S.
Brevena — Enjoy a 41% discount on BREVENA® skin care
creams and balms for smooth, rejuvenated skin from face
to foot.
To find the discounts available to you, log in
Puritan’s Pride® — Choose from a large selection of
discounted vitamins, minerals and supplements from to anthem.com, choose Care and select
Puritan’s Pride. Discounts.
Your SpecialOffers discounts are part of our effort to support your personal health journey. Taking care of your health can
be easier with the savings offered through you r health plan.
* All discounts are subject to change without notice.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request
from member services or can be obtained by going to anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies,
Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance
Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services
for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New
Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc.
trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin
(BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance
Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a
registered trademark of Anthem Insurance Companies, Inc.
21Make the most of your pharmacy benefits
You can manage your prescriptions and costs at anthem.com. Log in and explore the following ways to save:
1. Search the drug list. Find out if your 6. Save time with home delivery. If you take
medications are covered and which tier they are medicines regularly or need them on a long-
in. Lower-cost brand-name drugs and generics term basis, you can save time with home
are usually in Tiers 1 and 2. You will save the delivery. You may also save money. You can
most money when you use Tier 1 drugs. receive a 90-day supply of your drugs delivered
to your door. Maintenance medicines can vary in
2. Price a medication. See how much a medicine amounts. Once you’re a member, visit
costs. You can compare retail drug costs at local anthem.com to sign up.
pharmacies and see the price of generic
options. Results will include the cost of up to 7. Receive a 90-day refill at a retail pharmacy.
a 90-day supply and home delivery pricing. You can receive up to a 90-day supply of any
covered medicine at a participating retail
3. Check if there are generic options. If you’re pharmacy. Maintenance medicines can vary
taking a brand-name drug, you can find a list in amounts.
of generic options that cost less, or ask
your doctor. 8. Save money on some non-covered medications.
If your prescription isn’t covered by your plan,
4. Most specialty drugs are covered if you need you may be able to receive a discount. Share
them. Specialty drugs are for people with serious your ID card at the pharmacy, and the available
health issues. They come in different forms, such discount will automatically be applied.
as pills or liquids. There are drugs that need to be
injected, inhaled, or infused. They often need
special storage and handling and may be given to
you by a doctor or nurse. If you have a complex
health condition that requires specialty drugs for
your treatment you can receive them through
IngenioRx Specialty Pharmacy. Call the Pharmacy
Member Services phone number on your ID card
for help.
5. Choose a pharmacy that’s in your plan. You
have many retail pharmacies from which to
choose. Use a pharmacy that is in your plan to
avoid paying full price. To find a pharmacy in
your plan, visit anthem.com/
pharmacyinformation/rxnetworks.html and
choose your network list. Your plan uses the
National Network list of pharmacies.
For more information, go to anthem.com/FAQs and select your state, then Pharmacy.
22 Using your planHow to use your plan
How to use your plan
Now that you've chosen a plan, you can explore how to make the most of your benefits.
This guide shows you simple ways to make using your plan easy. You will also discover
tools and resources that can help you reach your health and wellness goals.
23 Using your planHow to use your plan
Use your ID card from your phone Register for online tools
Quickly access your ID card on your phone by using and resources
the Sydney Health mobile app or logging in at
anthem.com. Your digital ID card works the same as Accessing your health plan on your mobile phone
a paper one. You can share it with your doctor or or computer makes it more convenient to manage
pharmacy by printing a copy anytime you need one, your plan. Register on the Sydney Health mobile
or emailing or faxing it from your computer or app and anthem.com to receive personalized
mobile device. You also can download your ID card information about your health plan. You can also:
for quicker access. Quickly access your digital ID card.
Assess your symptoms at no cost, and
get personalized information about a
diagnosis, including over-the-counter
medicine to take, and recovery time.
Text with a board-certified doctor at no
extra cost,1 discuss treatment options,
and order prescriptions.
Have a video chat with a doctor.
Find a doctor and estimate your costs
before you receive care.
Look at your prescription drug benefits,
check the price of a drug, and find
a pharmacy near you that’s in your
plan’s network.
View your claims, see what’s covered, and what
you may owe for care.
Find support managing your health conditions
and tracking your goals.
Update your email and communication
preferences.
1 Pricing based on $0 copay benefit eligibility offered through your plan.
24 Using your planHow to use your plan
Find a doctor in your plan Schedule a checkup
The right doctor can make all the difference. Preventive care, such as regular checkups and
Choosing a doctor who is in your plan’s network can screenings, can help you avoid health issues
save you money. Your plan includes a broad selection in the future. Your plan covers these services
of high-quality doctors. If you decide to receive care at little or no extra cost when you see a doctor
from doctors outside the plan’s network, it will cost in your plan’s network:
you more and your care might not be covered. Yearly physical
To find a doctor in your plan’s network, use the Well-child visits
Find Care tool Sydney Health mobile app or at Flu shot
anthem.com you can search for doctors, hospitals,
and other healthcare professionals. You can also use
Routine shots
the tool to search for high-quality, low-cost labs, like Screenings and tests
Quest Diagnostics, Labcorp, or others in your
Check your plan details on the Sydney Health
plan’s network.
mobile app or anthem.com/find-care to
confirm what preventive care is covered.
25 Using your planHow to use your plan
Access care from home in a way that
works for you
Assess your symptoms online at no cost. Answer
questions through the Sydney Health intuitive
Symptom Checker. It uses the information you
provide to narrow down millions of medical data
points and assess your specific symptoms before
you visit a doctor.
Text with a board-certified doctor at no extra
cost.1 Sydney Health can link you directly to
doctors for virtual text visits. During your
appointment, the doctor can evaluate your
symptoms, discuss your treatment options, and
order prescriptions, if you need them.
Have a video chat with a doctor. You can also use
Sydney Health to connect with a board-certified
doctor through video visits.
See a doctor from home. You can have a video
visit with a doctor using your mobile device or
computer, whether you’re at home, at the
workplace, or on the go. Doctors are available
around the clock for advice, treatment, and
prescriptions.1
Where to go for care when you need it now
When it is an emergency, call 911 or go to the nearest emergency room.
If you need nonemergency care right away:
Check to see if your primary care doctor can see you.
Search for nearby urgent care to avoid costly emergency room
visits and long wait times.
Call 24/7 NurseLine and receive helpful advice from a registered nurse.
1 Pricing based on $0 copay benefit eligibility offered through your plan.
26 Using your planYou can also read
