Medical plans are offered through ASCIP
(Alliance of Schools for Cooperative Insurance Programs)
Medical Benefit Summary for all plans.pdf
HMO vs. PPO plans – what are the differences?
Deductible - the amount you pay each year before your plan starts to pay.
Copay - a flat fee you pay for covered services like doctor visits.
Coinsurance - your share of health plan costs (a percentage of total costs) after meeting your deductible.
Out-of-Pocket Maximum - the most you have to pay out-of-pocket each year for health care services. once this amount is reached, insurance will pick up 100% of any subsequent qualifying expenses.
Premium - The amount you pay to belong to a health plan.
In Network - Providers who have agreed to render services at a negotiated rate
Out of Network - Providers who have not agreed to provide services at the negotiated rate. Members can still see these providers, but may experience higher fees, balance billing for the difference between the charged fee and the negotiated rate as well as different deductible out of pocket maximum.
Who is SISC?
You may see SISC on many of the plan documents. ASCIP partners with SISC (Self Insured School of California) to administer its billing and eligibility functions for Anthem and Blue Shield HMO and PPO plans. This partnership ensures that ASCIP districts benefit from the negotiating leverage of the larger SISC pool while still having access to the local support and unique programs offered through ASCIP.
Anthem Blue Cross
- Anthem PPO Medical Plan 2023
- Anthem HMO Medical Plan 2023
VALUE ADDED SERVICES OFFERED IN PARTNERSHIP WITH SISC FOR ANTHEM MEMBERS
Employee Assistance Program (EAP)
The EAP is available to all eligible Anthem and Blue Shield participants and their household members. This benefit provides problem assessment, short-term counseling and referrals for problems like alcohol and substance abuse, marital and family difficulties, financial or legal troubles, and emotional distress. Access the EAP by calling 800-999-7222 or online at anthemEAP.com using the company code SISC.
This benefit provides all eligible Anthem and Blue Shield PPO and HMO members with access to doctors and pediatricians who can answer their health-related questions conveniently over the phone, or using online video. This program is available 24/7, 365 days a year including holidays. The service is secure, confidential and compliant with all medical privacy regulations. Online behavioral health visits are also available. Eligible members register by calling MDLIVE at 1-888-632-2738 or by going online at mdlive.com/sisc. Members will need to have their member ID number and the name, address and phone number of the covered member who needs medical assistance. There is a $5 per consultation fee for this service regardless of the plan’s office visit copay.
Free Generic Medications at Costco
Eligible Anthem and Blue Shield PPO and HMO members can fill their genetic medication prescriptions free of charge at Costco for up to a 30-day supply. The program excludes some narcotic pain and cough medications, but Costco membership is not a requirement to use this program. To find a Costco location, call 800-774-2678 (press 1) or go to Costco.com.
Cancer Treatment Centers of Excellence
The City of Hope in Duarte is a facility that has been recognized for its high performance in the area of cancer treatment. The program includes a variety of resources for patients with a cancer diagnosis:
• A comprehensive consultation with a specialized oncologist at the City of Hope who will review the patient’s imaging, confirm the diagnosis and recommend changes to the treatment plan as appropriate.
• Education on emerging clinical trials & genetic therapies.
• Access to nurses, social workers and other ongoing clinical support personnel with expertise specific to cancer patients.
• Care coordination with the home provider if the treatment is not rendered at the City of Hope.
• Travel benefits for patients who live out of the area.
• General assistance navigating the complex world of cancer treatment.
Eligible Anthem and Blue Shield PPO members can get started by a calling Health Design Plus at 877-220-3556.
Home-Based Physical Therapy
Hinge Health is a home-based physical therapy program available to Anthem and Blue Shield PPO enrollees who are struggling with chronic back, knee or hip pain. They provide a variety of resources designed to educate and encourage qualifying participants to complete their customized exercise therapy curriculum including interactive 1-on-1 coaching, wearable sensors, and even a tablet computer to track progress. On average users who follow the recommended course reduce their pain by 60% after 12 weeks. Contact Hinge Health at 855-902-2777 or go to hingehealth.com/sisc.
Protection When Traveling or Living Outside Your Home State
You and your enrolled dependents may access PPO benefits when you’re traveling or temporarily living outside your home state with the BlueCard program. The BlueCard also covers enrolled dependents, including students and family members, who temporarily reside outside your home state. To locate BlueCard providers, call BlueCard Access® at
1-800-810-BLUE (2583). BlueCard is not applicable to HMO plans or Medicare Supplement plans. Blue Cross Blue Shield (BCBS) Global Core—How Do I Access Medical Care in a Foreign Country?
• Before you leave, contact BCBS Global Care for coverage details. Coverage outside the United States may be different.
• Always carry your current member ID card.
• In an emergency, go directly to the nearest hospital.
• If you need to locate a doctor or hospital or need medical assistance services, call the Service Center for BCBS Global Core at 1-800-810-BLUE (2583) or call collect 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, in conjunction with a medical professional, will arrange a physician appointment or hospitalization, if necessary.
• If you need to be hospitalized, call the Service Center at the numbers listed above and the BCBS Company for pre-certification or pre-authorization. Refer to the phone number on the back of your member ID card to reach the BCBS Company.
• Call the Service Center at 1-800-810-2583 or collect at 1-804-673-1177 when you need inpatient care. In most cases, you should not need to pay upfront for inpatient care at participating BCBS Global Core hospitals except for the out-of-pocket expenses (non-covered services, deductible, co-payment and co-insurance) you normally pay. The hospital should submit your claim on your behalf.
• You will need to pay upfront for care received from a doctor and/or non-participating hospital. Then complete a Blue Cross Blue Shield Global Core international claim form and send it with the bills(s) to the Service Center (the address is on the form). International claim forms are available from, www.bcbsglobalcore.com, or the BCBS Global Core Service Center at 1-800-810-2583 or collect at 1-804-673-1177.
Claim Filing Information
• If Blue Cross Blue Shield Global Core arranged your hospitalization, the hospital will file the claim for you; you will need to pay the hospital for the out-of-pocket expenses you normally pay.
• For outpatient and doctor care or inpatient care not arranged through the Blue Cross Blue Shield Global Core center you will need to pay the healthcare provider and submit an international claim form with original bills to the Service Center.
• International claim forms are available from the Service Center or on-line at www.bcbsglobalcore.com.
To Learn More About Blue Cross Blue Shield Global Core:
• Call your Blue Cross Blue Shield Plan.
• Visit www.bcbsglobalcore.com
• Call the Blue Cross Blue Shield Global Core Service Center at 1-800-810-2583 or call collect at 1-804-673-1177.
Call the Blue Cross Blue Shield Global Core Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177 to locate doctors and hospitals or obtain medical assistance services when outside the United States
Kaiser Permanente Traditional HMO Plan