Under an HMO Plan, covered benefits are provided for no charge or for a fixed copayment. Your out-of-pocket costs will generally be much lower under an HMO Plan than under the PPO Plan. There are no claim forms to complete.

Yes, provided the doctor is an HMO doctor under the Plan you selected. Each family member is encouraged to select a personal physician.

Yes, under both of the HMO Plans you are allowed to change to another doctor at any time subject to the rules of the HMO selected.

Unless the HMO you selected referred you to a specialist, there are no benefits available if you use doctors outside of the HMO.

In view of the "affordability factor," parents can seek medical attention for their children as concerns arise. Each HMO has established a limit on the total amount of copayments that you would have to pay in any one year. The exact amount of this maximum copayment liability is shown in the HMO's "Evidence of Coverage" brochure.

Yes provided you make written application to the HMO within the prescribed time period.

Generally yes, subject to the established rules of the HMO. Each HMO has specific benefits for emergency services, within or outside the HMO enrollment/service area. Refer to the "Evidence of Coverage" brochure from your HMO for specific details.

You can go to any licensed doctor of your choice and be eligible for Plan benefits, and you are not restricted to a specific service area. That is why the PPO Plan is also referred to as the "freedom of choice plan." You will have less out-of-pocket costs when using the Anthem Blue Cross Prudent Buyer PPO network, called "Participating Providers." The Administrative Office can furnish you with a Prudent Buyer directory for an area where you live or work.

Yes provided you make written application to Anthem Blue Cross within the prescribed time period and meet other requirements.

Yes, provided the following two conditions are met: 1. You are admitted to the hospital, by a licensed doctor of medicine, and 2. The hospital meets the Plan's definition of a hospital.

Yes. The Plan requires that all non-emergency hospital stays be approved in advance. Refer to section titled "Medical Benefits Comparison: Anthem Blue Cross, Kaiser and UnitedHealthcare" for more details. When you use Participating Prudent Buyer Providers, this will be accomplished with no action required on your part.

Yes. In fact, for all non-emergency surgeries, the Plan encourages you to obtain a second opinion.

Yes. The Anthem Blue Cross Plan has contracted with select doctors and hospitals, who have agreed to provide medical care at reduced rates. These doctors and hospitals are referred to as a Preferred Provider Organization (PPO) under the Anthem Blue Cross Prudent Buyer Plan. For a complete explanation, refer to table of contents titled "Anthem Blue Cross Prudent Buyer Plan (PPO)".

All Plans, both HMOs and the PPO Plan, have specific exclusions concerning experimental and investigational procedures. Contact your benefit provider directly (Kaiser, UnitedHealthcare or Anthem Blue Cross) or MedExpert if you have any questions about a specific procedure.