1. Open Enrollment 2017
Ready to choose your Anthem Blue Cross and Blue Shield benefits? We can point you in the right direction.
Open Enrollment 2016
Ready to choose your Anthem Blue Cross and Blue Shield benefits?
We can point you in the right direction.
51502MUMENABS Rev. 3/16

2. Agenda What’s new for 2017? Enrolling in your health plan
Using your health plan
Making things easier with tips and resources
Here’s an overview of what we’ll be covering.
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3. What’s new for 2017?
Medical and prescription drug plans are moving to Anthem Blue Cross and Blue Shield effective January 1
Dental plan is staying with Anthem
You will have 2 ID cards -
One Medical and Pharmacy
One Dental
<discuss plan changes>
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4. + + = How the PPO plan works
Annual deductible The amount you pay each year before the plan starts to pay for care.
Your percentage of the costs You pay a percentage of the costs for most other services, such as outpatient surgery, hospital care or tests.
Copay You pay a set amount for doctors’ visits and services from a doctor in the PPO plan.
Out-of-pocket maximum Once you pay the annual maximum for your percentage of the costs, the plan pays 100% of other covered expenses for that year.
Medical copays and deductibles are part of your out-of-pocket maximum
This plan offers the freedom to get care from any doctor; however, you’ll pay less when you get care from the Anthem PPO plan.
<enter plan details here>
How it works
You pay a copay for visits to a doctor in the plan, the deductible, and a percentage of the cost for all other care until you reach the out-of-pocket annual maximum.
You must meet a deductible before the plan starts to pay for care.

5. Key features Things to consider The PPO plan
Freedom to get care from any doctor.
You don’t need a referral to see a specialist.
If you seek care from a doctor who is not in the PPO plan, you’ll pay a higher percentage of the costs, as well as any amount over the maximum allowed amount.
With a PPO plan, you have freedom in choosing where to get care and you don’t need a referral to see a specialist.
You’ll want to consider, however, that if you get care from a doctor who is not in the plan, you’ll pay a greater percentage of costs.

6. KeyCare 25/650 Your plan Medical plan KeyCare Network – in Virginia
Doctors in your plan
KeyCare Network – in Virginia
BlueCard PPO National network
Benefits from doctors who aren’t in the plan
Out of network benefits apply;
balance billing may occur
Primary care doctor
Not required, but recommended
Specialist referrals
Not required
Here’s a quick summary of how each plan works.

7. Doctors not in your plan
Medical plan
KeyCare 25/650
Doctors in your plan
Doctors not in your plan
Deductible
Employee
$650
$780
Employee + 1
$1,300
$1,480
Employee + Family
Office visits
Doctor
$25 per visit
40% after ded
Specialist
$37.50 per visit
Your percentage of the costs
20% after ded
Out-of-pocket limit
$2,600
$5,200
$10,400
Prescription drugs
Retail
40% coinsurance Tier 1: $50 max; Tiers 2, 3, and 4: $100 max
Smart 90
40% coinsurance Tier 1: $125 max; Tiers 2, 3, and 4: $300 max
Home Delivery
$4,500 Individual/$9,000 Family
(separate from the Medical out of
pocket maximum)
Take a moment to review the details of your plan options.

8. Getting care at the right place can save you money.
Where to go for care
Medical plan
KeyCare 25/650
Doctors in your plan
Preventive care
No cost share
Primary Care Doctor visit
$25 copay
Specialist visit
$37.50 copay
LiveHealth Online sick visit*
$15 copay
Urgent care center visit
Emergency room visit
$65 copay
The difference between a doctor’s visit and preventive care is that you might schedule a doctor’s visit when you aren’t feeling well. Then the treatment you see from your doctor is diagnostic — trying to find the cause of existing symptoms and not preventive — trying to prevent symptoms before they start.
Sometimes you might need to see a specialist, a doctor who has specialized training in a certain field. Check your plan information to see if you need a referral from your regular doctor before visiting a specialist.
If you need treatment quickly or outside your doctor’s normal hours, knowing where to get that treatment can help save you money. So, if it’s not a medical emergency, try these other choices:
Retail health clinic — A clinic staffed by medical professionals who provide basic medical services to “walk-in” patients. Usually in a major pharmacy or retail store.
Walk-in doctor’s office — A doctor’s office that doesn’t require you to be an existing patient or have an appointment. Can handle routine care and common family illnesses.
Urgent care center — A group of doctors who treat conditions that should be looked at right away but aren’t as severe as emergencies. Can often do X-rays, lab tests and stitches.
Getting care at the right place can save you money.
* The LHO copay is for non-Behavioral health visits, LHO BH visits are at the standard BH $25 copay/visit.

9. Prescription drug plan
Save money
Ask your doctor if there’s a generic equivalent for the brand-name medications you’ve been taking.
After 2 fills of your maintenance medication at your local pharmacy, you will need to get your 90-day supply via Anthem mail order or a Smart 90 retail pharmacy
Smart 90 includes CVS, Target, Kroger, Safeway, Walmart, as well as Strategic Health Alliance (some independents)
It does not include Rite Aid or Walgreens
Save time
Refill your prescriptions online or over the phone.
Take advantage of home delivery.
Anthem’s pharmacy program includes over 64,000 retail pharmacies across the country, plus an easy home delivery option.
Anthem’s prescription drug plan includes 64,000 retail pharmacies in your plan across the country, plus a convenient home delivery program.
To save money, ask your doctor if there’s a generic equivalent for the brand-name medication you’re using or have been prescribed. If there is, you’ll pay a lot less.
And if you take maintenance medications, you can save even more by using home delivery. <You can get a 90-day supply of your medications mailed directly to your home for the cost of two 30-day supplies if you’d purchased them at a pharmacy.> <You can get a 90-day supply of your mediations mailed directly to your home for less money than if you’d purchased your medications at a pharmacy>
<explanation about specifics of plan>
Specialty Medications must be filled through ESI’s Specialty drug pharmacy, Accredo.

10. Dental Prime Dental Complete
Annual checkups are covered — at 100%, no deductible.
Easy access to any dentist or specialist.
Discounts with dentists in the plan.
Go to and use the Provider Finder to search for Dental Prime and Dental Complete participating providers
Dependents now covered until end of month turn 26
Good oral health affects overall physical health. In fact, more than 90% of all diseases that can impact your body produce signs and symptoms in your mouth.*
Anthem dental plans incorporate the very latest dental technology and offer incentives to encourage proper preventive care. You’re 100% covered for regular exams, cleanings and X-rays from a dentist in the plan. <And you can carryover unused benefits dollars from year to year.>
<explanation about specifics of plan>
*Academy of General Dentistry website: Importance of Oral Health to Overall Health (Reviewed: January 2012): knowyourteeth.com/infobites/abc/article/?abc=O&iid=320&aid=1289.

11. Dental Plan Anthem Dental Deductible $50/$150 Preventive Care
(Oral exams, teeth, cleanings)
100% of the allowable charge
Annual Benefit Maximum
$1,500 per member
Basic Care –
(Fillings - Amalgam)
80% of the allowable charge after deductible
Major Care – 12 month waiting period
(Crowns)
50% allowable charge
after deductible
Orthodontics – 12 month waiting period
(Braces)
50% of the allowable charge (deductible does not apply) $1,000 per member/lifetime
Take a moment to review the details of your plan options.

12. Enrolling in your Anthem plans
Open enrollment October 31 – November 18
Enrolling in your health plan

13. Tools to help you choose
Enrollment Guide Read this guide to help understand your plan
Open enrollment web page Easily access benefit details, medication lists and more - anytime, at work or at home.
Find a Doctor Search for local doctors, hospitals and health care professionals.
Interactive videos Learn more about your health plan options and how to effectively use them.
This presentation provides an overview of your options to get you started.
<When you’re ready to choose your health plan, visit <custom BRC URL> where you’ll find an advisor tool that will help you understand your choices, a digital version of your open enrollment book and more detailed plan information>
<When you’re ready to choose your health plan, visit anthem.com where you’ll find more detailed information, including the Estimate Your Cost and Find a Doctor tools, and helpful video tutorials.>
<if Open Enrollment Book is offered>
And be sure to review your Open Enrollment Book for an in-depth guide to your plan options.

14. Using your health plan
You’re choosing a plan to keep you or your family healthy. But there’s more to your health than going to the doctor. Once you join, here’s how we’ll help.

15. The benefits of registering at anthem.com
When you register online, you have great personalized tools to help you:
Search for doctors.
Check your claims.
Estimate your costs.
Review your medical benefits.
View your ID card.
Refill a prescription.
Once you’ve enrolled in your plan, you’ll receive an invitation to personalize your account on anthem.com.
You’ll be asked a sort series of questions aimed at helping you get the most out of your online experience and your benefits.
It’s important to register at anthem.com so you can access all of the great online tools. You can:
Find a doctor
Check your claims
Compare costs and quality of care ratings
View your temporary ID card
<Refill a prescription> and much more.
And if you complete a Health Assessment, you’ll see tips, news and alerts that relate to your specific health concerns.

16. Looking for a doctor? Finding one online is fast and easy.
Look up a doctor, pharmacy or urgent care center.
View doctor profiles and read patient reviews.
Get directions to health care facilities.
With Anthem’s Find a Doctor tool, you can search for a doctor or health care professional who’s near you and in your plan. You can search for doctors in eight categories and see what part of town they’re in.
You can even rank doctors based on quality ratings, the Blue Distinction National Centers of Excellence Program and the Blue Precision Specialty Physician Recognition Program. And when you’re on the go, use our app to search for doctors, hospitals and pharmacies from your mobile device.

17. Comparison shop for your care
With our Estimate Your Cost online tool, find out what a test, procedure or other type of care will cost before visiting a doctor.
See average costs for common procedures and services in almost 400 treatment categories, plus quality information for procedures done at a hospital.
Compare doctors and facilities based on cost and quality of care ratings for procedures.
By being informed, you can make the choice that’s right for you – and save money.
When you need a certain medical procedure, you can shop around for the best price. Our Estimate Your Cost tool, only available to our members who’ve registered online, helps you make educated decisions about where to get your health care. You’ll get a list of local doctors or hospitals in your plan who can perform the procedure that you need.
The tool even personalizes the results, including your copay, deductible and your percentage of the costs, so you can see what you would pay out of pocket. You’ll also see information about quality of care, length of stay and number of patients treated.
If you or your loved ones are facing major surgery or a serious medical condition, Anthem’s Blue Distinction Centers for specialized care offer quality outcomes and important peace of mind. These are the best of the best, and each Blue Distinction Center meets or exceeds rigorous, evidence-based criteria established in collaboration with expert physicians and medical organizations. Best of all — you don’t pay extra for access to a Blue Distinction Center. They’re part of your plan.
<if Blue Precision is provided>
And when it’s time to choose a specialist in cardiology, obstetrics/gynecology, endocrinology, rheumatology or pulmonary medicine, look for Anthem’s Blue Precision designation. This means the doctor meets the highest professional standards for quality care and controlling costs.

18. LiveHealth Online See a doctor or therapist at home
Have a private video visit with a doctor or therapist on your smartphone, tablet or computer with a webcam.
Choose from board-certified doctors and licensed therapists.
You can be at home or even on vacation.
Sign up at livehealthonline.com or download the app.
LiveHealth Online is a quick, easy way to see a doctor or therapist through a private video visit using your smartphone, tablet or computer. You can be at home even on vacation.
All you need to do is sign up at livehealthonline.com or download the free app to get started.
With LiveHealth Online, you can:
Have 24/7 access to doctors in about 10 minutes or less: Doctors can assess your condition and send prescriptions to your pharmacy, if needed.1 It's a great choice when your doctor isn't available for things like pinkeye, the flu, a cold, a sinus infection and more. Doctors typically charge $49 or less per visit, depending on your health plan.
See a licensed therapist. If you're anxious or having a tough time, talk with a therapist online. In most cases, you can make an appointment and see a therapist in four days or less.2 Appointments are available seven days a week and a 45-minute session usually costs about the same as an office therapy visit.
1 Prescription availability is defined by physician judgment and state regulations. LiveHealth Online is available in most states. Visit
the home page of livehealthonline.com to view the service map by state.
2 Appointments subject to availability of a therapist.
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.
Online counseling is not appropriate for all kinds of problems. If you are in crisis or have suicidal thoughts, it's important that you seek help immediately. Please call (National Suicide Prevention Lifeline) or 911 and ask for help. If your issue is an emergency, call 911 or go to your nearest emergency room. LiveHealth Online does not offer emergency services. .

19. 24/7 NurseLine Get health information instantly.
Talk with registered nurses.
Call 24 hours a day, toll-free.
The 24/7 NurseLine is available around the clock via a toll-free number, and provides registered nurses who will talk with you about your general health issues.
They can help you determine if you can treat your issue at home, if you need to make an appointment to see your doctor, or if you should head to urgent care or the emergency room.

20. Future Moms Get screenings and support during pregnancy.
Consult with nurse coaches.
Call 24 hours a day, toll- free.
Future Moms offers helpful tools and resources during your pregnancy, including:
A toll-free number that connects you to a nurse coach, 24/7
Your Pregnancy Week by Week book
Screening for risk of depression or early delivery
<Earn <up to $200> when you complete the Future Moms program>
And more

21. ConditionCare Get help and support following your care plan.
Consult with nurse coaches.
Better manage your health.
If you or a family member have certain conditions, ConditionCare nurse coaches can help you better manage your health and follow your doctor’s care plan. <You can earn <<$100> when you enroll><and><<$200> when you complete the program.>>
Specific conditions include:
Asthma: pediatric and adult
Diabetes: pediatric and adult
Chronic obstructive pulmonary disease (COPD)
Heart failure
Coronary artery disease
Cancer <if offered>
Vascular disease <if offered>
Musculoskeletal disease <if offered>
Low-back pain <if offered>

22. Discounts
Save money with stuff that’s good for you at our site, anthem.com.
Access healthy discounts on weight-loss programs, gym memberships, vitamins, glasses and much more.
Save money on things that are good for you. Get discounts on things like vision and hearing products or health and fitness services.
You can also save money on services and products for your family and home and some medicines and treatments.
To find discounts that are available to you, log in to anthem.com and select Discounts.

23. To Help With your Transition to Anthem
Open Mail Order Prescriptions
Will be transferred over from your current carrier to Anthems Home Delivery Pharmacy
Download the Anthem Anywhere App
Search for information about doctors in your area, have access to your ID card on your smartphone, look up cost estimates of medical services and/or prescriptions
Register on Anthem.com
As soon as you receive your ID card to access all of the tools available to help you get the most out of your plan.
This presentation provides an overview of your options to get you started.
When you’re ready to choose your health plan, visit <custom BRC URL> where you’ll find an advisor tool that will help you understand your choices, a digital version of your Open Enrollment Book and more detailed plan information
When you’re ready to choose your health plan, visit anthem.com where you’ll find more detailed information, including the Estimate Your Cost and Find a Doctor tools, and helpful video tutorials.
And be sure to review your Open Enrollment Guide for an in-depth guide to your plan options.

24. To Help With your Transition to Anthem
Transition of Care
Only applies if you will be using a Non-participating provider AND have one of the following situations:
You have just begun intensive medical treatment (e.g., newly diagnosed cancer, recent heart attack, chemotherapy, radiation therapy, or recent surgery). 
You are in your third trimester of pregnancy as of your new Anthem medical coverage effective date
Major surgery previously scheduled after 60 days of the date that your new Anthem medical coverage begins (e.g., heart transplant surgery)
Transition of care is not available for chronic medical conditions such as diabetes, allergies or asthma.
This presentation provides an overview of your options to get you started.
When you’re ready to choose your health plan, visit <custom BRC URL> where you’ll find an advisor tool that will help you understand your choices, a digital version of your Open Enrollment Book and more detailed plan information
When you’re ready to choose your health plan, visit anthem.com where you’ll find more detailed information, including the Estimate Your Cost and Find a Doctor tools, and helpful video tutorials.
And be sure to review your Open Enrollment Guide for an in-depth guide to your plan options.

25. if you have questions We’re here
Answers and information at your fingertips, by phone or online 24/7.
During Open Enrollment: Call -(866)
Monday – Friday: 8am to 6pm
or visit anthem.com
As of 1/1/17, please contact Anthem Member Services for assistance at
We’re here when you need us. Whether you have a question about your benefits, need a new ID card or want to find a new doctor, we’re available around the clock, seven days a week.
Call <(866)
> <insert customer service hours of operation> or visit anthem.com.

26. These policies have exclusions and limitations to benefits and terms under which the policy may be renewed or discontinued. For costs and complete details of the coverage, contact your Benefits Administrator or Anthem Blue Cross and Blue Shield.
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 Georgia: Anthem Blue Cross and Blue Shield is the trade name of Blue Cross and Blue Shield of Georgia, Inc. Independent licensee of the Blue Cross and Blue Shield Association. 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), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.