Following are your costs for many common treatments. For more details about these or other treatments that are not listed, go to Anthem or call Anthem Health Guide, toll-free, at (844) 437-0486, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific).
| In-Network | |
|---|---|
|
Medical/Behavioral Health Calendar-Year Deductible The deductible is the amount you pay before the plan begins to share in the cost for covered services. |
$100 per individual for only those services not covered by Medicare but covered by Anthem |
|
Medical/Behavioral Health Out-of-Pocket Maximum The out-of-pocket maximum is the most you’ll pay for covered health care services in a calendar year. |
Individual: $1,500 |
| Preventive Health Visits | No charge, no deductible |
|
Physician and Specialist Office Visits Outpatient X-ray, Pathology and Lab |
20% of Medicare allowed amount after Medicare first pays its share |
|
Virtual Care (LiveHealth Online) Sign up at livehealthonline.com |
$20 copayment per visit. Medical plan deductible does not apply. Copayment counts toward out-of-pocket maximum. |
| Outpatient Surgery in a Hospital or Ambulatory Surgical Center | 20% of Medicare allowed amount after Medicare first pays its share |
| Inpatient Non-Emergency Facility Services | 20% of Medicare allowed amount after Medicare first pays its share |
| ER Services | 20% of Medicare allowed amount after Medicare first pays its share |
| Ambulance for Emergency or Authorized Transport | 20% of Medicare allowed amount after Medicare first pays its share |
| Emergency Care Outside of California or the U.S. |
Access to providers for emergency and non-emergency care through the BlueCard® or Blue Cross Blue Shield Global Core network 20% of Anthem allowed amount |
A Note About Services
Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should always check ahead of time with your doctor, medical group, independent practice association, or clinic or call Anthem Health Guide to ensure that you can obtain the health care services that you need.
Privacy
Anthem Blue Cross protects the confidentiality and privacy of your personal and health information—including your name, address, telephone number, Social Security number and medical information. That’s why you are required to sign an Authorization of Release of Personal Health Information when you request health information for your spouse/same-sex domestic partner or dependents over age 18.
If you have questions about how Anthem protects your privacy and confidentiality, please Call Anthem Health Guide, toll-free, at (844) 437-0486, or view the privacy policy.