Anthem FAQ
Anthem PPO and HMO Medical and Pharmacy Plans
Enrollment and Eligibility
When is Open Enrollment?
Open Enrollment for benefit year 2024–2025 occurs from May 1, 2024 through May 24, 2024.
How do I confirm my enrollment?
All residents and fellows, except those at UCI, can visit PlanSource to review your enrollment choices, change your plan, and confirm your address. UCI residents and fellows must reach out to your Graduate Medical Education office.
When can I make changes to my plan outside of Open Enrollment?
You can make changes to your plan only when you or your dependents have a qualifying life event. These events may include loss of other coverage, marriage and births. Please contact your Graduate Medical Education office if you have questions about enrollment outside the Open Enrollment period.
When will I receive my ID card?
If you are not making any changes during Open Enrollment and are currently a member on the UC Residents & Fellows plan, you will not receive a new ID card.
If you are a new resident or fellow on the Anthem plan, you will receive your ID card approximately two weeks after you complete your enrollment in PlanSource (UCI residents and fellows: Check with your GME office).
If you are already an Anthem member on the UC Residents & Fellows plan and electing to change your coverage during Open Enrollment, you will receive your new ID card with your updated plan information approximately two weeks after the close of Open Enrollment. Your pharmacy information will remain the same and your current ID card information should continue to work at the pharmacy until you receive your new ID card.
If you have questions after your effective date:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members (UCSF, UCSD, UCR only), please contact HMO Member Services at (833) 674-9257.
How can I access my ID card before I receive it in the mail?
You can contact customer service one calendar week after you complete your enrollment in PlanSource. Please note: Customer service may not be able to assist you if eligibility has not yet been received from PlanSource, and you may have to call back.
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members, please contact HMO Member Services at (833) 674-9257.
Plan Choice Options
1. What is the difference between a PPO and an HMO?
The UC Residents & Fellows PPO plan contracts with medical providers that include doctors and hospitals who are all in the same network. You’ll save additional money by using UC health centers. You don’t need a referral if you visit a doctor or facility in the network, including specialists, labs, imaging centers, and urgent care.
If you are a resident or fellow at UCSF, UCSD or UCR and choose an HMO, you’ll get your care and services from doctors, other health care providers, and hospitals only in your plan’s network. Care is generally limited to doctors in your assigned medical group. You are required to get referrals from your primary care physician to see specialists and other health care providers. Without a proper referral, your medical services may not be covered, which means you might have to pay more.
If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.
If you have questions after your effective date:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members (UCSF, UCSD, UCR only), please contact HMO Member Services at (833) 674-9257.
Anthem Network Doctors
How do I find a doctor in the PPO network?
Use the Find Care tool by clicking this UC Residents & Fellows PPO link. After clicking this link, please allow time for the tool to load; then enter your location and scroll down to “Search by Care Provider.”
If searching for a primary care physician, select the “Primary Care” box; a list of primary care providers near you will appear.
If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.
If you have questions after your effective date and are a PPO plan member, please contact Anthem Health Guide at (833) 674-9256.
How do I find a doctor in the HMO network (UCSF, UCSD, UCR only)?
Use the Find Care tool by clicking this UC Residents & Fellows HMO link. After clicking this link, please allow time for the tool to load; then enter your location and scroll down to “Search by Care Provider.”
If searching for a primary care physician, select the “Primary Care” box; a list of primary care providers near you will appear.
If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.
If you have questions after your effective date and are an HMO plan member, please contact HMO Member Services at (833) 674-9257.
Medical Plan Benefits
What is a deductible?
The calendar-year amount that you must pay for covered services before you become entitled to receive benefit payments from the plan. Learn more about what counts toward your deductible.
Where can I find information about my plan benefits?
View the plan documents or read the 2023 Benefits Brochure [PDF].
If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.
If you have questions after your effective date:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members, please contact HMO Member Services at (833) 674-9257.
What should I do in an emergency after I am enrolled in the plan?
Please call 911 or go to your nearest hospital. After your visit, if you receive bills that do not match your Explanation of Benefits issued by Anthem or they did not apply your insurance benefits to your bill:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members (UCSF, UCSD, UCR only), please contact HMO Member Services at (833) 674-9257.
What is my coverage for urgent care?
For the PPO plan, you will be responsible for a $15 copayment at in-network providers.
For the HMO plan, you will be responsible for a $10 copayment at in-network providers.
If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.
If you have questions after your effective date:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members (UCSF, UCSD, UCR only), please contact HMO Member Services at (833) 674-9257.
Is infertility treatment a covered benefit on any UC Residents & Fellows plan?
No. However, testing up to the determination of the diagnosis of infertility is covered. Upon receipt of a claim for infertility-related services, Anthem may ask for medical records from your provider to determine coverage.
If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.
If you have questions after your effective date:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members (UCSF, UCSD, UCR only), please contact HMO Member Services at (833) 674-9257.
What if I am new to Anthem and my current provider is not in Anthem’s network?
Transition assistance may be considered in your case. Anthem may allow you to see your provider and apply in-network benefits for you to continue care with your current provider for a certain period.
If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.
If you have questions after your effective date:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members (UCSF, UCSD, UCR only), please contact HMO Member Services at (833) 674-9257.
Pharmacy Plan Benefits
Who is Anthem’s pharmacy benefit manager?
The pharmacy benefit manager is Anthem Blue Cross.
How do I find a network pharmacy?
All the major pharmacy chains are in the network: UC Pharmacies, CVS (including CVS pharmacies inside of Target), Walgreens, Walmart, Safeway/Vons, and Rite Aid. If you have any additional questions about whether a pharmacy is in your network, please contact the following teams:
If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.
If you have questions after your effective date:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members (UCSF, UCSD, UCR only), please contact HMO Member Services at (833) 674-9257.
What will I have to pay for prescription drugs?
View the plan documents or read the 2023 Benefits Brochure [PDF].
If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.
If you have questions after your effective date:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members (UCSF, UCSD, UCR only), please contact HMO Member Services at (833) 674-9257.
How do I determine which tier my prescriptions fall under?
You can visit the formulary and search for your drug name and dosage via this link: Anthem 4-Tier National Drug List.
If you have more questions before your effective date, please contact Anthem First Impressions at (888) 831-2238.
If you have questions after your effective date:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members (UCSF, UCSD, UCR only), please contact HMO Member Services at (833) 674-9257.
What if my prescription drug requires a prior authorization?
Your physician will need to contact Anthem to provide medical information related to your prescription. This will need to occur after your effective date.
If you have more questions:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members (UCSF, UCSD, UCR only), please contact HMO Member Services at (833) 674-9257.
What if I need to fill a prescription on my first day of coverage and I haven’t received my ID card?
You should wait until at least two weeks after you complete your enrollment in PlanSource before contacting Anthem customer service. If your ID card has not arrived:
- PPO plan members, please contact Anthem Health Guide at (833) 674-9256.
- HMO plan members (UCSF, UCSD, UCR only), please contact HMO Member Services at (833) 674-9257.
What if I need to fill specialty medications?
You have two choices of pharmacies for specialty medications: a UC health center pharmacy or the Anthem specialty pharmacy. You will be able to pick up medications at your UC health center pharmacy. If you would like them delivered to your home, Anthem can assist you after your effective date. You can contact Anthem.
What if I would like my prescription filled via the Anthem mail service?
Log in to anthem.com/ca (select Pharmacy) to enroll your medications in home delivery
