Summary of Prudent Buyer Plan Features

Participating Providers are the key to using the Prudent Buyer Plan, with one of the largest networks in the state. The Participating Hospitals, Physicians, and other facilities included in the Prudent Buyer Plan Directories have signed Prudent Buyer Plan Participating Provider Agreements with Anthem Blue Cross of California. They have agreed to accept a reduced, pre-negotiated rate for services, which are covered by the Southern California IBEW-NECA Active Health Indemnity Plan. They will not bill you for any difference between the pre-negotiated rates for services covered by the Indemnity Plan. You are responsible only for your deductibles and copayment amounts, which are required by the Plan as explained above and in the sections, which follow.

Do not make any payment to your Prudent Buyer doctor, hospital, or other health care provider, except deductible amounts not yet met, until you receive the Explanation of Benefits (EOB) form from Anthem Blue Cross. This ensures that you receive the discounted rate for using a Prudent Buyer Participating Provider.

Participating providers also agree to handle the claims for Prudent Buyer members and send the bill directly to Anthem Blue Cross, eliminating this time-consuming and often confusing task. Anthem Blue Cross will apply their special discounts, pay the claim, and will provide you with a copy of the claim (Explanation of Benefits) showing what the Plan has paid, and the amount that is your responsibility.

As has always been the case with the Indemnity Plan, you have complete freedom of choice in where you obtain health care. However, it is to your financial advantage to use the Prudent Buyer Plan, as well as to the financial advantage of the Health Plan. In the rare instance where you may be unable to utilize a Participating Prudent Buyer Provider, please contact the Administrative Office for assistance.