Anthem Blue Cross 2017 Individual and Family Plan Materials

For 2017, Anthem has announced product changes for the Individual market that offer value to members. Anthem has also release marketing materials that compare plans, rates for all regions of California, and the 4-Tier prescription drug formulary.

PPO plans transition to EPO Plans

For 2017, we have adjusted our product portfolio to include an exclusive provider organization (EPO) in most rating regions. Rating Regions 10 – 14 (Southern San Joaquin Valley counties) will continue to be offered PPO plans. Members on some 2016 PPO plans and all Tiered PPO plans in these areas will be transitioned to EPO plans effective 1/1/17 (unless they choose a different plan). Members will have access to our Pathway network of doctors and hospitals, but their EPO plan will not cover out-of-network benefits.

2017 Evidence of Coverage

The Evidence of Coverage will be updated to reflect the EPO network changes. In addition, there will be other updates. A few of the changes include.

• All EPO and PPO plan member will be assigned a Primary Care Physician
• Prior Authorization clarification for certain prescription drugs
• Specialty Pharmacy Program emphasizes that certain specialty drugs must be ordered through a Specialty Preferred Provider, which will deliver the drugs to the member’s home.
• Doctors can request that Anthem Blue Cross cover a drug no on the Prescription Drug List.
• Designated Pharmacy Providers must be used in order to get the Pharmacy Benefit of the Medical plan.
• Certain Allergy tests will not be covered
• Dental coverage is separate from medical coverage unless otherwise noted
• Gene Therapy will not be covered
• Gynecomastia will not be covered
• Residential Treatment Center definition has changed, but the member benefit will stay the same.

Anthem Blue Cross Covered California Health Plans

Anthem Blue Cross Health Plan Direct

Anthem Select 4-Tier Prescription Drug Formulary

2017 Anthem Blue Cross Rate by Region and Health Plan