GA 2019 SG Guide
User Manual:
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YOUR TIME MATTERS.
So we’re making everything work harder for you.
�
New, more affordable plan designs for your clients
�
Simplified electronic process, from quoting through enrollment, for you
Small Group product guide I Effective January 1, 2019
This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of coverage, contact your Anthem representative.
* Non-ACA compliant plans may may not qualify for single bill when combined with other coverages.
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 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), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits
in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or
POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.
HELPING CHOOSE THE RIGHT PLAN FOR YOUR CLIENTS SHOULDN’T KEEP YOU UP AT NIGHT
Your clients want their employees to have the right plan for their needs, while balancing the cost. We get it. We created a wider range of plan
options with everything your clients and their employees need to make smarter health care choices, save time and manage costs. And our plans
work together – medical, pharmacy, dental, vision, life, disability and behavioral health. You and your clients should feel good with that choice.
� More plan choices to meet more budgets
� A lower cost of care because of the strength and quality of our
networks, so members can see doctors who deliver the most
effective, efficient care
� Expanded medical and pharmacy portfolios:
—ACA-compliant medical and pharmacy plans offering
a wide range of member cost share options
—Integrated Act Wise consumer-driven health plans
that manage the medical benefits and the
spending accounts
� A 5% discount on specialty premiums (dental, vision, life and
disability) when clients purchase dental for the first time along
with vision, life and/or disability
—Members get whole-person coverage. Because our products
are connected, doctors can work together behind the scenes
to see a person’s overall health, leading to earlier detection of
possible health issues
� Better health and engagement for members – our digital health
care platform integrates benefit information, clinical and claims
data, and other digital tools to create a more personalized
member experience
MAKING IT ALL EASIER. YOU SPOKE, WE LISTENED.
We know it hasn’t always been easy to work with us. From complicated and inconsistent processes to long implementation times, you’re
frustrated and we hear you. We’ve been working hard to invest in, and develop, market-leading tools and technology with one goal in mind:
to streamline, so you can save time and worry. The changes you’ll see:
� Reimagined Producer Tool-box where you can do it all—in one
place, no more going back and forth between portals
� Simplified quoting so you can easily show your clients the cost
of any combination of our medical, dental, vision, life and
disability coverage
� Online enrollment submission for your clients and their
employees that drastically reduces implementation times; no
more paperwork
� Full transparency on your clients’ status in the implementation
process – no more guessing games
� Integrated EmployerAccess makes it easier for you to perform
maintenance on all of your clients with a single sign-on
But we didn’t change everything. You will continue to enjoy the support from the service teams you know and trust. And we’ve made their jobs
easier with streamlined processes that are consistent across our company and technology that’s flexible so they can quickly answer your
questions. It’s the best of both worlds so you can rest easy.
PharmacyMedical Dental DisabilityLifeVision Behavioral Health
MAKING IT EASIER
FOR YOU AND YOUR CLIENTS
Your time should be focused on supporting your clients, consulting with them on the right health plan
for their unique needs. What if it could be easier? Instead of paperwork, what if you could focus on
building your business?
WELCOME TO A BETTER WAY.
>
Anthem Health Guide
This combination of customer service and health support offers members access to highly trained professionals (health guides) who
consult with them and provide comprehensive help. Backed by smart technology and analytics, guides are closely linked to health
professionals, such as nurses, health coaches, educators and social workers. Together, they can help members stay on top of their
heath, get more value from their benef ts and navigate the health care system more eff ciently. Members can call, request a scheduledii
call back, email or have an online chat on a computer or through our app.
LiveHealth Online
Through LiveHealth Online, members can have video visits 24/7 with board-certif ed doctors using a mobile device or computer withi
a webcam. Doctors can assess common health issues like f u or allergies. They provide a treatment plan and send prescriptions to al
pharmacy, if needed.1 Members can also talk with licensed therapists and psychiatrists. Therapists are usually available in four days
or less.2 And, Spanish-speaking doctors take appointments 7 a.m. to 11 p.m., seven days a week>using Cuidado Médico.
PayForward cash rewards program
This exclusive cash rewards program invites Anthem members to earn cash back with each qualif ed purchase when they shop ati
participating retailers. Once they register, members can link their PayForward account to an existing credit card and start earning
rewards from PayForward as well as from their own credit card rewards program. They can shop online, swipe their card at store
locations or buy and use an e-gift card. They can store rewards in an online account and use them to shop, share, give away to favorite
charities or even save for health care expenses.
SmartShopper rewards program
SmartShopper is a program that rewards members for using lower-cost, high-quality locations for certain health care services and
procedures. Because costs can vary by hundreds and even thousands of dollars, this program gives members a way to compare costs.
If they choose a lower-cost location, they not only get a cash reward, but they save on out-of-pocket costs. Members just register with
SmartShopper and go online or call to get help comparing costs and f nding a lower-cost location nearby. After their procedure isi
complete and the claim is paid, they’ll get a check in the mail in about four to six weeks.
If you'd like to know more contact your
Anthem broker.
For employer groups with 2-50 employees
Georgia
WHAT’S NEW IN 2019
Working together to make health care easier for
everyone, everywhere
ANTHEM AND YOU
1 in 3 Americans are covered by a Blue
Cross and Blue Shield plan1
More than 106 million employees
96% of hospitals in the U.S. are in
our plans
95% of providers in the U.S. are in
our plans
Local focus in 14 states
Our local networks offer access to 97% of
in-network doctors and 96% of in-network
hospitals.
When using network doctors employees
save big! And we reward our doctors for
the quality of care they give not the
number of patients they see. So
employees get more attention and
better care.
Benef ts that travel i
Employees have access to medically necessary
emergency and urgent care across the country, and
around the world, with the BlueCard® and Blue Cross
Blue Shield Global Core program.
1 Blue Cross and Blue Shield Association website: About Blue Cross and Blue Shield Association
(accessed May 2018): bcbs.com.
2
1 Not available on all plans.
2 Available for iOs 9 and above and for Android versions 6 and above.
Access at-a-glance account information through
My Summary1.
Log in with their fingerprint via
touch authentication2.
Quickly find providers or
urgent care centers.
Save their ID card to their phone or share, fax or
email an ID card directly to their provider.
Chat confidentially with our Member
Services team.
Receive push alerts when there are changes to
claims or other updates.
MOBILE ANTHEM
ANYWHERE APP
The Anthem Anywhere app is better and faster than
ever, making it easy for employees to manage their
care and coverage right from their smartphone.
With a quick tap, employees can:
PERSONALIZED,
EASY-TO-USE CARE
Our innovative approach helps provide one of the best
consumer experiences in the industry.
Enhanced Personal Health Care:
Team-based approach for personalized,
proactive, quality care.
LiveHealth Online: 24/7 doctor care, right
from a computer or mobile device.
Easy online tools: Employees can compare
provider costs and quality, review/rate
providers and get estimates on procedures.
Cancer Care Quality Program: Helps doctors
provide evidence-based care for employees
with fewer side effects
Quick care options: Helps employees
understand their options when they need care
right away.
3
Act Wise offers:
One-stop support from one implementation
team and one customer service number.
ACT WISE
CONSUMER-DRIVEN
HEALTH PLANS
Welcome to Anthem’s one team, one solution
consumer-driven health plan!
Act Wise makes it easier for your clients to administer
their health savings account because now Anthem
manages both the medical benef ts and the spendingi
accounts. We’re streamlining everything – for you, your
clients and even their employees.
One website and mobile app for employees to
review claims in real time and access benef ti
and account information.
Simple tools and messaging to help both
employers and employees understand their
coverage and manage their health benef tsi
and spending.
Easy set-up - whether it’s a new plan or a
renewal from another consumer-driven health
plan, it’s never been easier.
Check eligibility.
Request ID cards.
View Summary of Benefits.
View, pay and download bills.
View transaction history.
EMPLOYERACCESS
MANAGING BENEFITS
HAS NEVER BEEN EASIER
EmployerAccess is a simple and secure tool on
anthem.com that gives your clients everything they need
to manage benef ts easily and quickly - 24/7. i
They can:
Enroll and cancel employees
and dependents.
Change employee personal information.
To get started today, clients can sign
up at employer.anthem.com.
4
Why LiveHealth Online?
LIVEHEALTH ONLINE:
ACCESS TO CARE
ANYTIME, ANYWHERE
Convenience. Access to care right from
the home or off ce. i
Choice. Employees can select from a
range of doctors and therapists.
Cost. Depending on the health plan,
employees pay $49 or less per visit1 to see
a doctor, and visits with a therapist or
psychiatrist cost about the same as an
off ce therapy visit. i
Employees can use LiveHealth Online to have video
visits with board-certif ed doctors from a computer withi
a webcam or mobile device. In minutes, doctors can
address common health issues such as colds, allergies
and headaches. They’ll then assess conditions, provide a
treatment plan and send prescriptions to a pharmacy, if
needed. Spanish-speaking doctors are available by
appointment from 7 a.m. to 11 p.m., 7 days a week using
Cuidado Médico.
LiveHealth Online also has professionals available to
address mental health, allergies, wellness, and some
that specialize in kids’ health. Employees can see a
licensed therapist or board certif ed psychiatrist in justi
a few days.1
Employees can register at
livehealthonline.com or download the
free mobile app.
1 Appointments subject to availabiity of the mental health professional.
5
Within the United States
}
Outside of the United States
BLUECARD® MAKES
GETTING CARE EASY
ALMOST ANYWHERE
Employees take health care benef ts with them across thei
country and around the world.
The BlueCard® program gives employees access to
doctors and hospitals almost everywhere, giving them
peace of mind that they can f nd the health care provideri
they need no matter where they are in the world.
Employees have coverage for urgent and
emergency care. The Blue Cross Blue Shield
Global Core Program makes it easy for
employees to locate a preferred provider
through online tools and 24/7 Customer
Service. Program excludes Pathway network.
Our PPO plans also include coverage for
nonemergency care across the U.S. and while
traveling abroad.
Employees are covered for medically
necessary emergency and urgent care in all
50 states, whether care is needed in a rural
or urban area.
When you see a network provider there are:
No claims forms to complete
No payment upfront for medical services
except for the usual out-of-pocket
expenses.
Explanation of benef ts received from thei
employees’ plan.
6
Compare prices at different locations.
Choose from the list of lower-cost locations
and book the appointment.
Get cash back (in about 4-6 weeks), once the
procedure is complete and the claim is paid.
Here’s just some of the health services that qualify
for rewards:
Health service Reward
SMARTSHOPPER OFFERS
EMPLOYEES
CASH REWARDS
When employees shop smart for certain
health services, they’ll get rewarded
Prices for the same quality health services, like health
screenings and surgeries can vary by hundreds to
thousands of dollars depending on the location. With
SmartShopper, employees can get help f nding lower-costi
options when their doctor recommends a medical
procedure so they can save money and earn cash rewards!
Here’s all they need to do:
Register with SmartShopper by calling or
going to vitalssmartshopper.com.
Colonoscopy
Gallbladder removal
Up to $150
Up to $250
May not be available on all plans. Pathway plans are excluded.
Check with your Anthem representative for details.
PRESCRIPTION
DRUG PLANS
Searchable Drug Lists — Employees can log
in to anthem.com to connect to their benef t-i
specif c drug list and search up-to-datei
information.
Rx Choice Tiered Retail Pharmacy Network
— has two levels. Employees pay the standard
cost share at Level 1. In Level 2, they pay a
higher cost share.
Retail90 — Employees can get up to a 90-day
supply of drugs from participating local
pharmacies.
PreventiveRx Plus — Employees can get
certain drugs, used to treat and manage
conditions like asthma, diabetes, high
cholesterol and osteoporosis at a lower cost.
Preferred Generics — If a generic drug is
available and employees choose the brand
name drug, they’ll pay the Tier 1 cost share
plus the difference in cost.
Home Delivery Choice — Employees choose
how prescriptions are f lled for maintenancei
drugs, at their local or home delivery
pharmacy.
Web and Mobile Tools — Employees can price
medications, f nd a pharmacy and checki
prescription order status.
Specialty Drug Split Fill — prevents waste by
splitting f rst 30-day f ll of certain specialtyii
drugs into two 15-day supplies with member
copay prorated.
7
VISION AND DENTAL
BENEFITS FOR WHOLE-
PERSON HEALTH
Anthem Blue View VisionSM offers employees access to
one of the largest networks in the nation — along with
signif cant savings. i
1 Except when discounting of non-covered services is prohibited by state law.
2 Based on the Blue View Vision plan with $10 lens copay and $130 frame allowance for glasses, or
$130 contact lens allowance.
3 Applies to Anthem Dental Essential Choice members who are actively engaged in an Anthem Care
Management program for the following conditions: cancer, pregnancy, diabetes, certain heart
conditions, organ or bone marrow transplants, stroke, end stage renal disease (kidney disease), and
suppressed immune systems (HIV/AIDS).
38,000 doctors and 27,000 locations
40% off an additional pair of glasses from
providers in the plan1
63% average retail savings for Blue View
VisionSM members using network providers 2
Our Dental benef ts i offer employees easy access to a
large number of dentists. That includes discounts and
services to help them keep up their dental health and
prevent long-term problems.
127,000 dentists and 385,000 places to
get care
35% average discount on covered dental
services when using a dentist in the plan
Extra cleaning or periodontal maintenance for
employees in one of our medical care
management programs for certain conditions3
Retail and online partners
ADDED PROTECTION FOR
EMPLOYEES
Dedicated team of disability case managers,
nurses and health coaches.
Personalized claim support and stay-at-work
programs help those with disability claims get
back to work quickly and safely.
Resource Advisor offers counseling on
emotional, f nancial and legal concerns, andi
identity theft recovery.
Travel assistance with emergency medical
assistance covers employees when traveling
more than 100 miles from home.1
Benef ciary Companioni offers support for
handling estate details.
Disability claims processing time is 7.3 days
or less with 99.8% accuracy.
These benef ts can be offered on a voluntary basis toi
help your clients save on premium costs
Your clients can offer 100% employee-paid voluntary
dental, vision, life and disability plans. They pick the
plan design and their employees pay premiums at
affordable group rates.2
Life and disability benef ts are easy to add, easy toi
manage. Here's a sample of what's included:
1 Travel assistance available to clients with life benef ts. i
2 Minimum voluntary participation requirements: dental/vision = 5 enrollees, life/disability =
10 enrollees.
8
HELP EMPLOYEES BE
THEIR HEALTHY BEST
These resources help employees get support for
every life stage.
24/7 NurseLine
Round-the-clock answers to health questions
Help deciding where to go for care
Future Moms
Education and support during pregnancy
Assessments to help f nd risks i
Nurses on call for questions and follow-up
throughout pregnancy
Breastfeeding support through
LiveHealth Online
MyHealth Advantage
Claims reviewed for gaps in care and
health risks
Conf dential MyHealth Note sent toi
employees offering suggestions to
improve health
Condition Care
Support for employees with a
chronic condition
Personalized plan from a nurse coach and
team of specialists
Case Management
Proactive outreach to employees who are
hospitalized or have a serious illness
Support from a nurse care manager and
other health professionals
Health kits
Turnkey wellness campaigns focused on
important health topics.
Wellness calendar
A year of health education with monthly topics
that align with national health observances.
Workplace challenges
Fun wellness campaigns that motivate
employees to make simple, healthy changes.
Wellness on the Run
Monthly employer webinars that highlight the
latest workplace wellness tactics to help
motivate employees toward better health.
WORKPLACE WELLNESS
We’ll help your clients build a culture of health in their
workplace at no extra cost.
Time Well Spent® is our online communications toolkit
for workplace wellness campaigns. It includes step-by-
step guides and educational resources that can help
your clients build a wellness strategy. Go to
timewellspent.anthem.com to f nd: i
Healthy Workplace is a great online resource for
planning and evaluating a workplace strategy.
Your clients can just go to
anthem.com/healthyworkplace
9
HEALTHY WAYS TO
EARN REWARDS
Our plans offer lots of ways to support employees at
every stage and some provide incentives for taking
steps to stay healthy. Employees can earn up to $200 a
year in rewards with these programs available on
some plans. 1, 2, 3
1 Must be 18 years of age or older to qualify.
2 An employee and their covered spouse or partner can each earn up to $200 in rewards a year.
3 Excluded on Focus plans.
* Health Rewards card = A reloadable debit Mastercard® that's automaticaly credited when members earn
rewards. Rewards can be earned by a member and their covered spouse or partner. Must be 18 or older
to earn rewards.
Preventive Care Incentives
Get a preventive wellness exam and f u shot,l
get $100 on their Health Rewards Card*
Complete tobacco-free certif cation, get $50i
on their Health Rewards Card*
Complete online health risk assessment, get
$50 on their Health Rewards Card*
10
Vision and hearing
Fitness and health
Family and home
Medicine and treatment
*All discounts are subject to change without notice.
SPECIALOFFERS@
ANTHEMSM FOR
HEALTHY SAVINGS*
With SpecialOffers@AnthemSM, employees get discounts
on products and services that promote better health and
well-being. Here’s a peek at the perks:
See the discounts
Employees can log in to anthem.com and select
Discounts.
Jenny Craig®
GlobalFit™
FitBit
SelfHelp Works
1-800 CONTACTS®
Premier LASIK
Puritan’s Pride
Allergy Control products
WINFertility®
Safe Beginnings®
ASPCA Pet Health Insurance
Through our partnership with PayForward.
EMPLOYEES CAN EARN
CASH BACK WHEN
THEY SHOP
How does it work?
Employees can shop at 60,000 participating
retailers and earn 3 - 15% cash back with each
qualif ed purchase. They can shop online, swipei
their card or buy and use an e-gift card.
Is it free to join?
Yes! Employees just need to have an Anthem
medical plan.
How do employees sign up?
They can register at payforward.com, or
download the PayForward app from the App
Store or Google Play™.
Employees can use incentives to:
Spend any way they choose.
Save to a Health Wallet, PayForward
account or bank account.
Share with friends, family and charities.
For more details:
Check out payforward.com.
Contact your Anthem account representative.
11
LET’S DO THIS, TOGETHER
Medical plan grid
Dental plan grid
Vision plan grid
Life & Disability plan grid
Select the links below to view Anthem’s products for 2019.
As you view our portfolio, you’ll see all types of plan designs that are as unique and different as
your clients.
Choosing a health plan isn’t easy, but we want it to be. The plans you’re about to see have been
created to be easy for you to quote and administer and easy for your clients and their employees
to use.
YOUR TIME MATTERS.
So we’re making everything work harder for you.
�
New, more affordable plan designs for your clients
�
Simplified electronic process, from quoting through enrollment, for you
Small Group product guide I Effective January 1, 2019
This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of coverage, contact your Anthem representative.
* Non-ACA compliant plans may may not qualify for single bill when combined with other coverages.
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 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), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits
in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or
POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.
107469GABENBGA VPOD 05/18
