Indemnity PPO Medical Plan
This is a preferred provider organization (PPO) plan that combines a Health Reimbursement Account with comprehensive medical coverage. In addition to paying benefits when you and your family need medical care, this plan is designed to help prevent illness and promote wellness.
Refer to your plan’s Benefits Chart for coverage details.
Castlight Pricing Tool -Sign-on. Details here.
www.mycastlight.com/SCUFCW
Watch this two-minute video for a sneak peek of Castlight.
About the Plan’s Coverage
Start here to learn about the plan’s covered services, including preventive care, doctor’s visits, and hospital visits
The Indemnity PPO Medical Plan gives you:
- 100% coverage for preventive care services specified in the plan’s Preventive Care Guidelines when you use network providers.
- Comprehensive coverage for in-network office visits, specialists, urgent care, hospital care, outpatient services, and more.
- The freedom to choose the health care providers you want. However, if you choose an in-network doctor, hospital or other health care provider, you will have the lowest possible out-of-pocket expense.
The plan does not require you to coordinate your care through a primary care physician. Also, you do not need a referral to see a specialist.
Paying for Health Care
The plan’s Health Reimbursement Account helps you pay for the care you need. A deductible applies to most services; once met, you and the plan share costs through coinsurance.
Paying for Health Care
If you are in the Indemnity PPO Medical Plan, you automatically receive an annual contribution to your Health Reimbursement Account (HRA), which helps pay for eligible out-of-pocket expenses, including the deductible, your coinsurance, and prescription drug copayments (if you “opt-in” for copay reimbursements).
You can also earn extra HRA funding when you complete certain Healthy Activities.
The Fund uses your HRA balance on hand to pay for eligible health care expenses. When your HRA funds are depleted, you and the plan share costs, as follows:
- Deductible: Before the plan pays any benefits, you need to meet a calendar-year deductible for many services. (Remember, funds from your HRA can help to pay down your deductible.)
- Coinsurance: Once you meet the deductible, you and the plan each pay a percentage of the cost of your covered charges. Your share is called “coinsurance.”
- Covered charges are paid based on the plan’s allowed amount for a given service. If you use out-of-network providers, the provider’s charge may substantially exceed the allowed amount. You are responsible for any charges that exceed the allowed amount.
- You will pay less of your own money when you use an in-network provider (sometimes referred to as a PPO provider).
- When you visit an out-of-area or out-of-network provider, you generally will be responsible for all charges that exceed the allowed amount for a given service, and charges in excess of allowed amounts are not payable from HRA funds.
- Annual Medical Out-of-Pocket Maximum: This maximum protects you from catastrophic health care expenses. After you meet your deductible and the annual medical out-of-pocket maximum for in-network services in a calendar year, the plan will pay 100% of eligible medical expenses for the remainder of the calendar year.
Finding Network Providers
The plan uses one of California’s largest provider networks—the Anthem Blue Cross PPO (Prudent Buyer) network. It’s easy to find a provider, by phone or online
You will pay less of your own money when you visit an Anthem Blue Cross network provider. To find a provider, call 855-686-5613 or go to www.anthem.com/ca. When prompted to select a network, be sure to choose “Blue Cross PPO (Prudent Buyer) – Large Group.”