Blue Cross PPO - HMO Network Definitions & Network Options
Blue Cross PPO – HMO Network Definitions & Network Options

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2017 HMO Network Guide   The HMO Network Guide allows you to view the participating medical groups/independent practice associations (PMGs/IPAs) that are part of the Anthem Blue Cross HMO (CaliforniaCare), Select HMO and Priority Select HMO networks. The guide is organized by county.

Product type

PPO — Allows members to go directly to any in-network provider. There is no need to choose a primary care physician (PCP) or get a referral to see other doctors.

HMO — Requires members to choose a PCP; a referral is required to see other doctors.

Health Savings Account (HSA) — A savings account for certain plans that members can fund with pretax dollars and use to pay for qualified health care expenses, including prescriptions. This is often used with a Consumer-Driven Health Plan.

Health Reimbursement Account (HRA) — Employer-funded plan to help pay for covered costs. This is used with a CDHP and requires the deductible first. This means members must pay a certain part of the in-network deductible — the upfront deductible — before using their HRA account. HRA funds cannot be used for the upfront deductible. Once the yearly in-network deductible is met, coverage under this plan begins.

Note: The HSA employer contribution, or the amount newly made available by the employer under an integrated HRA that may only be used for cost sharing, may be considered part of the AV calculation when the contribution is available and known to the issuer at the time the plan is purchased. Network(s) Note: At enrollment, the group can select only one PPO network option and/or only one HMO network option.

PPO network options

Prudent Buyer PPO Network — Access to nearly 60,000 California doctors and specialists, and more than 330 hospitals.

SELECT PPO Network — Access to more than 40,000 California doctors and specialists, and more than 300 hospitals.

 

HMO network options (Please refer to the rate guide for detailed network availability.)

CaliforniaCare HMO Network — Access to more than 40,000 California doctors and specialists, and more than 330 hospitals.

SELECT HMO Network — Access to more than 23,000 California doctors and specialists, and nearly 250 hospitals.

Priority SELECT HMO Network — Access to more than 7,500 California doctors and specialists, and more than 150 hospitals. Blue Cross Small Group Guide 2016 page 4

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