Frequently asked questions (FAQ) in New York

The only way you can have access to plan information from the online account is to ask the primary account holder, also known as subscriber, for access. Once the subscriber gives you access, you will be able to view plan level information (like Deductible) from the online account.

Once they’ve set up an account, they will be able to view, update and manage claims and benefit information as well as manage other features on your online account on your behalf.

Caregivers have access for one year. Each year access has to be set up again for security purposes. You can change access settings at any time.

The only way a caregiver can get access to a member’s plan information is to ask the primary account holder, also known as subscriber, for access. Once the subscriber gives you caregiver access, you will be able to view, update and manage online account information on their behalf. You can also contact Customer Service using the number on the back of the member’s ID card for help.

If you are the health care power of attorney and need to access online account information for a member, you will need to contact Customer Service using the number on the back of the member’s ID card for help.

If you are a guardian caregiver and need to access online account information for an underage member, you will need to contact Customer Service using the number on the back of the member’s ID card for help.

The healthcare system can be hard to figure out. It can be especially hard if we have trouble speaking English or we don't understand American culture very well. But don't give up! Here are some ways to help put you at ease and make your doctor visits a positive experience. Choose a doctor who speaks your language if you do not speak or understand English. It is important that you understand what your doctor and the office staff tell you. It is also important to find health care workers who speak your language or can understand your culture and beliefs.

How to Find a Doctor Who Speaks Your Language
 

When you use our “Find Care” web site, you can find out if a doctor’s office speaks your language. When you call the office to set up an appointment, confirm they have someone who can speak in your language. Many of our doctors also have special training to assist patients with special beliefs and customs, or who speak limited English. 
 

Ask for a trained interpreter. Try not to use your family or friends to translate. Your family members, especially a child, may miss something important that the doctor says. They also may not tell the doctor everything you say. So, if you need language help, ask if the doctor can have an interpreter there. 
 

Write down your questions. Rehearse what you are going to say to the doctor. If going to an English-speaking doctor is new to you, practice what you are going to say with someone who has been to a doctor before. Every time you talk with a doctor, nurse, or pharmacist, remember to ask three questions:

• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?

Bring a list of all your medications. Put the medicines you take in a bag or shoe box so you can show them to the doctor. Bring everything, even the over-the-counter medicines. This way your doctor can see what you're taking without having to tell him. It will help the doctor know what medicines to best prescribe for you.  

Don't be upset if the doctor speaks or looks only at you or if the doctor doesn't speak to or ask about your family. Many American-trained doctors talk only to the patient. If the patient does not speak English, then the doctor will talk directly to the patient’s interpreter. In the United States, some doctors are very businesslike and blunt. Being direct, though, doesn't mean the doctor doesn't care. It’s just a different way of working. 

Some doctors will only focus on your health and only on the part of your body that has problems. They don't tend to spend a lot of time talking about your family. If you have family problems that keep you from following the doctor’s treatment, be sure to tell the doctor, so you can work out other solutions. 

Tell the doctor if you have also been using a non-medical healer, such as an herbiera, curandera, or bruja. Some of their treatments may conflict with your doctor’s treatments and drugs and cause you harm. Remember the doctor is only concerned with your health and what you tell your doctor is only between you and the doctor. 

Ask your doctor to repeat or explain anything you do not understand. It is your right to ask questions if you need more answers. Doctors are busy people, but they will take the time to explain things to you if you ask. If you do not understand what your doctor or health-care provider tells you, ask him or her to tell you again. They want to be sure that you know what your treatment is, and that you follow the course of treatment they put you on. Your good health is their goal too! 

Tell your doctor if you think you will have problems following the doctor’s treatment. Maybe your family always eats certain foods that are not part of the doctor’s diet suggestions. Maybe you work during the day and do not have time to get the test your doctor wants you to have.

No. We use this kind of information to help us understand how to communicate better with you and our other members. When possible, we do our best to have materials available in languages other than English - or translate them. This information will not be used for eligibility or insurability.

It’s important to have what you need to use your health plan. You deserve simple, straight-forward plan details, no matter what language you speak.

• Just call the service number on your ID card.
• Customer Service will set up a conference call for you with an interpreter.
• He or she will help you understand your plan, and translate printed plan materials over the phone, if needed.
• This is a free service that’s available during business hours.
• Your native language or ethnic background does not impact getting quality service or coverage from us.
• For Speech or Hearing-Impaired Members, just call 711 for TTY/TDD services. A special operator will contact Anthem to help with your needs.

In order to access the myStrength website, you will need to have Internet Explorer 8 (IE8) or newer. If you have IE7 (or IE8 in compatibility mode for IE7), you can:

• Change/update your browser to IE8 or newer to navigate to and on the myStrength website.
  • Change your compatibility settings in IE8.
    In IE8, please click on the "Tools" menu and choose "Compatibility View Settings".
  • Please UNCHECK the selection for "Display all websites in Compatibility View" if it was checked (this setting must be unchecked in order for you to be able to view the myStrength page).
• If the above options do not work, please try accessing the myStrength website using Chrome as your browser.

Your household members may have trouble logging in when the member through their employer group has both Behavioral Health Resource and Employer Assistance Program (EAP). When members have both of these programs, household members should use the EAP website to access myStrength. For household members’ first visit to the myStrength site, s/he should call customer service at 800-865-1044 for assistance with the referral form to set up his/her access.

If you are logging onto the health plan’s website and don’t see the myStrength link on the homepage, please look on the middle of the page. You may need to scroll down to view the link.

Log in to find your claims. You’ll see a status for each claim, saying what stage of the claims process it is in.

Please contact customer service by calling the telephone number on the back of your member identification card.
 

Customer service can also guide you through a variety of programs and services we offer to support breastfeeding mothers.

COBRA is a federal law that enables employees and their covered dependents to maintain their group health coverage for 18, 29 or 36 months after becoming ineligible for regular group coverage. The COBRA law does not apply to group health plans maintained by a small employer (normally fewer than 20 employees on a typical business day).

Under normal circumstances, a qualified employee leaves employment can "elect coverage" under COBRA to continue in their company's health plan for up to 18 months, provided they pay the full premium, and payment is received on time. For COBRA qualifying events affecting a spouse or dependent children, such as separation, divorce, death, or children leaving the plan due to age, the election period is up to 36 months. Individuals determined to be disabled by the Social Security Administration may extend their group benefits to 29 months if the Social Security administration determines that their disability date (first day the disability began) occurred within the first 60 days of their COBRA coverage.

To help you better understand your benefits, you can access your Evidence of Coverage. Simply Login to your secure account and view your plan documents. Your Evidence of Coverage or Member Certificate Booklet will provide information on these important topics:

• Accessing health care for different types of services
• Coverage while traveling
• When to obtain emergency care and when to use 911 services
• How to file a claim
• How to voice a complaint or appeal a decision, including the right to independent external appeal
• How to resolve a concern you are having with Anthem
• Understanding your Pharmacy Benefit Program
• Covered benefits and exclusions
• Your copayments and other cost sharing information that you are responsible for
• How to obtain information about doctors who participate in our network
• How we evaluate new technology for inclusion as a covered benefit

When you applied for coverage with us, you were asked to provide information about any additional health insurance you or your covered dependents may have. We will use the information you provided to work with your other health plan to help ensure you receive the benefits you are entitled to while avoiding overpayment by either carrier. This process is called Coordination of Benefits. Log in or Register today to learn more!

Once you're logged in, you can find a good amount of info on your claims or benefits by selecting the Claims or Benefits items in the menu. You can also find some basic info by looking on the back of your ID card.

If you don't find answers to your questions, please call Member Services at the number listed on your ID Card.

How is my HRA funded?

Your employer makes an annual, upfront deposit to your Health Reimbursement Account (HRA). The amount of your annual allocation depends upon your employer, and whether you have individual or family coverage. You also have the opportunity to earn additional dollars for your HRA by taking certain steps to improve your health.

Does MyIncentive Account cost me anything?

No. It's being offered and funded by your employer to encourage healthy habits and to help you meet health care expenses.

Will I get taxed on this money?

No, funds in your account do not count as taxable income.

I still have questions. Who can I call?

Our customer service representatives will be happy to help answer them all. Just call the number on the back of your member identification card.

An EOB shows how your benefits work - what we paid, how much you'll need to pay, etc. If you didn't get one, it could be:

1. You may not need to pay anything. If a service is covered fully by your benefits (or you paid a copay and that's all you owe), we will not send you an EOB. We only send one when there's action you need to take.
   
   
2. We may not have gotten your claim yet.

What's the best, quickest way to solve this?

Log in to anthembluecross.com and click the Claims tab. If your claim isn't there or you still have questions, click Customer Support and choose how you'd prefer to contact us. Or call the Member Services number on your member ID Card.
 

How can I stop getting EOBs in the mail?

It's easy to stop getting EOBs by mail - and only get them by email. Just log in to anthembluecross.com and click on the Profile tab, then select Email Preferences toward the top of the page. Scroll down to choose the way you'd prefer to get your EOBs.

Generally, individuals become eligible to enroll in Medicare when they reach age 65, are disabled and have been receiving Social Security Disability Income (SSDI) checks for 24 months, or have a diagnosis of either end-stage renal disease or ALS (Lou Gehrig’s Disease).
 

While the law allows people to maintain their group health coverage and coordinate it with Medicare, anyone covered by a group plan who is planning on enrolling in Medicare should check their group plan's eligibility rules to find out their plan’s rules regarding Medicare enrollment, and to determine which insurance is primary (pays first), and which is secondary. Watch the relevant dates carefully, and beware that eligible individuals only have 80 days to enroll in Medicare Part B after their group health benefits end, or face paying a higher Part B premium as penalty.

Yes. You get discounts through our SpecialOffers program - just for being a member. It's easy. Log in and visit our Discounts page.

You get discounts through our SpecialOffers program - just for being a member. It's easy. Log in and visit our Discounts page.

Consumer-driven health plan (CDHP) is a high-deductible plan that also includes a tax-free health savings account (HSA), health incentive account (HIA) or health reimbursement account (HRA). You may put tax-free money into your account, or your employer might put money in - sometimes as a reward for steps you’ve taken for better health, depending on your plan. Then you use that money for your share of care costs, like your deductible or coinsurance.
 

It’s called consumer-driven because it puts you in the driver’s seat of your health and health care spending. With your checkups and preventive care likely covered at 100%, and tools to help you stay healthy and shop around for quality care at more reasonable costs - you might be able to cover all your costs with the money in your account.

Health Savings Account (HSA) plan is a high-deductible plan that also includes a tax-free HSA. You can put tax-free money into it. Then use that money for your share of care costs, like your deductible or coinsurance. You can see all of the types of costs you can cover with money in your HSA. But remember that only cost your plan covers will go toward paying down your deductible.
 

It gives you the flexibility of a PPO - you can often go to doctors in and out of your network, though you’ll get better rates with in-network doctors. HSA plans tend to have lower monthly premiums than similar PPOs, and sometimes even HMOs.
 

It’s sometimes called a consumer-driven health plan (CDHP) because you’re in more control of your care spending at first. With your checkups and preventive care likely covered at 100%, and tools to help you stay healthy and shop around for quality care at more reasonable costs - you might be able to cover all your costs with the money in your account.

You (or sometimes your employer) can put tax-free money into your health savings account (HSA). Then you use that money to pay for your share of care costs, like your deductible or coinsurance. Some people cover for all their care costs with their HSA dollars - since your checkups and other preventive care are already covered at 100%. Also, your plan comes with tools to help you find quality care at a lower cost.
 

If you still have money left in your account, it stays in there for next year and beyond. And you can also take it with you if you change health plans. View IRS rules on paying costs with money in your HSA.

A health incentive account (HIA) is a health account set up by your employer health plan. You earn dollars in your account when you take certain steps to improve your health. You use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money, it stays in there next year as long as you’re still at the same job.

Your employer puts money into your health incentive account (HIA) when you take certain steps to improve your health. You use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money, it stays in there next year as long as you’re still at the same job.

Yes. The three main types of FSAs are:
 

1. Health care FSA for qualified medical, dental, vision or other health care costs, including insurance deductibles, co-payments, and co-insurance.
   
   
2. Dependent care FSA for child, elder or other dependent care.
   
   
3. Limited purpose FSA for qualified dental and vision care costs only when combined with a Health Savings Account (HSA) or a Health Reimbursement Account (HRA).

To be eligible for an FSA, your employer must offer it. You don’t have to participate in your employer’s health plan. You must elect to participate in the FSA during your employer's open enrollment.
 

For a Dependent Care Flexible Spending Account (DCA), you must have children under the age of 13 (if divorced, you must be the custodial parent) or you must claim an adult dependent on your tax return who’s physically or mentally unable to care for themselves.

Yes, you’ll need to elect to participate in an FSA each plan year during your employer's open enrollment.

Qualified individuals must meet one of the following criteria: children under the age of 13 or any adult you can claim as a dependent on your tax return who is physically or mentally unable to care for themselves.
 

For more information, view IRS Publication 503. 

To qualify for a DCA, you must be the custodial parent, even if you don’t claim your child as a tax dependent.
 

For more information, view IRS Publication. 

Typically anyone whose employer offers a DCA can participate. As a rule, your DCA can only cover expenses incurred during work hours. Ask your employer’s benefits team to verify eligibility.
 

For more information, view IRS Publication. 

To qualify, dependent care must be essential for you and a spouse (if applicable) to work, look for work or attend school full-time. Typical eligible expenses include:

• Before and after school care programs
• Preschool or nursery school
• Extended day programs and summer day camp
• Babysitter (in or out of your home)
• Nanny and au pair services
• Daycare and eldercare facilities

Expenses not related directly to care of the dependent (i.e., tuition, food, etc.) aren’t eligible. Examples include:

• Educational expenses (summer school and tutoring)
• Tuition for kindergarten and above
• Overnight camp
• Field trip expenses and fees
• Housekeeping services
• Dependent care expenses incurred if your spouse doesn’t work, unless your spouse is a full-time student or is disabled

The work-related expense test is the standard the Internal Revenue Service uses to determine if expenses are work related for a DCA. An expense isn’t considered work related just because you had it while you were working. Expenses are considered work related only if both of the following are true:

• They allow you (and your spouse if filing jointly) to work or look for work.
• They’re for a qualifying person’s care.

For more information, view IRS Publication 503.

Contribution maximums are defined by the U.S. Department of the Treasury and the Internal Revenue Service and may increase for inflation annually. Visit www.irs.gov for the most current maximum amounts. 

Your spouse can also contribute up to the annual contribution maximum to their separate FSA.  Visit www.irs.gov for the most current maximum amounts. 

The entire amount you’ve elected to put into your FSA is available on day one of your plan, even if you’re contributing a portion each month. You can use your funds by logging into your FSA administrator’s website or by using your FSA debit card, if you’ve been provided one.

Your employer determines how your plan works. Employers can elect to offer a carryover. Carryover is a dollar amount (up to the Internal Revenue Service limit) of unused funds to use your new plan year. Any balance after that is forfeited to your employer. A grace period is extra days to incur new expenses and use funds after the plan year ends. Employers can’t have both; they must only select one option. After that, any unused balance for the previous year goes back to your employer. Check your plan documents for what is allowed by your employer.

The run-out period is the time limit for submitting receipts for expenses incurred during the plan year. Check your plan documents for the run-out period allowed by your employer.

No.

No.

Internal Revenue Service guidelines state that you can’t have both an HSA and a FSA. During open enrollment, if you elect an HSA plan, you may not re-enroll in an FSA. If your employer offers a Limited Purpose FSA, you may enroll in it.

Visit www.irs.gov for the most current maximum amounts.

No. The combined DCA contributions can’t total more than the Internal Revenue Service maximum per plan year, per household.

Your DCA withholdings are reported on your W-2.

By logging onto your administrator’s member portal.

By logging onto your administrator’s member portal.

You must submit documentation. It can be an itemized receipt, invoice, explanation of benefits or other, but must include the patient’s name, name of the provider/pharmacy, the service/item purchased, date of the service/transaction and dollar amount.

When you use your FSA debit card, sometimes you may get an email or letter that asks you to “substantiate” a charge or claim. That just means supporting documentation is needed to make sure your FSA funds were used for eligible expenses.

You can submit a claim to your FSA that occurred anytime within the plan year up until the run-out period. Any claims submitted after the run-out date won’t be approved.

You can only enroll and set how much you’re putting into it during your employer’s open enrollment period. However, if you have a change in your life such as getting married or divorced, a new child, moving, etc., contact your company’s human resources department. You may qualify for a special enrollment period, and you’ll be able to make changes to your FSA.

Your employer decides if your FSA has a run-out period. During a run-out period, you can submit a claim for expenses from the FSA plan year. Unused funds will be forfeited. Contact your employer for details.

Each FSA administrator is different. However, many offer an FSA debit card, a paper form for reimbursement, or a member portal for electronic reimbursement requests.

Reimbursements can be requested when a qualified expense is incurred during the plan year and before the end of the FSA run-out period (or grace period if applicable).

FSA plans typically include a time past the plan year for reimbursement requests for expenses during the plan year (known as a run-out period) or expenses up to the end of the extension (known as a grace period). Contact your employer for details.

The deadline for using DCA funds is the last day of the plan year.

Elections for DCA are made during open enrollment and can’t be changed unless you experience a qualifying life event. Contact your employer for details.

Once we receive enrollment data from a state health insurance exchange marketplace, we process the information as quickly as possible and mail a payment letter to you as the customer. This payment letter serves as your receipt of enrollment. When everything works smoothly, this should only take about 10 days. However, sometimes processing the data can take time, especially if we need to go back and make sure any of the information is correct. There can also be issues with the initial application that keeps us from being able to process it, which will need to be corrected at your state’s health insurance exchange marketplace. If you’ve been waiting longer than a couple of weeks to receive your letter, you will want to check on the status of your application - either with us or with the health insurance exchange marketplace. Click on the Contact Us tab to speak with an Anthem representative.

You should receive your ID card within about 10 days of paying your first premium. If you need care and you haven’t gotten your ID card yet, ask your doctor to call us to confirm your benefits -and to make sure they’re in your health plan network.

Yes, if you have individual or family coverage. You can make your initial premium payment securely through our website.

Call us at the number on the back of your Anthem ID card. There is a grace period to help you avoid having your coverage canceled. If you pass the grace period, your policy is canceled from the date you stopped paying. Any claims you had during that time will be denied and you will be responsible for full payment of the health care services you received. You can re-enroll during the next yearly open enrollment.

Log in and go to your profile. You can change your preferences for how we communicate with you.

Once you receive your payment letter, it will share directions for you to pay the first month’s premium. Payment of the first monthly premium is required to start the policy according to the details shared in your letter. You must take this step to activate your policy before your health insurance identification cards (ID cards) can be mailed.

If you’re the primary person on your policy, you can view your info as well as some of your dependents’. When dependents are over 18, we have certain privacy rules in place that may restrict your access. But you can always change that by having that dependent log into their own profile and change who can view their info.

When your prescriber gives you a prescription for a drug, take it to a pharmacy in your network. Show your member ID card so the pharmacist can access your benefits. If you have medications that you take regularly, you may be able to have them conveniently and securely shipped to a location of your choice. 

By law you’re allowed to keep your group health benefits even when you’re eligible for Medicare. Some plans work well with Medicare benefits, or there may be reasons to keep your other coverage. Send us a quick message by logging in and going to your message center. Or you can call us at the number on your ID card.
 

Reminder: If your group benefits end and you’re eligible to enroll in Medicare Part B, do it within 80 days after your group health benefits end - or you could pay more.

Typically, if you are the subscriber continuing with the same employer, and you move outside of the area we serve, if your place of employment is not located within the service area, your coverage and your dependents' coverage terminates as of your moving date. Potentially, your coverage may be picked up by the local Blue Plan (visit bcbs.com for details). If you are a covered dependent and you move out of the service area, you may still be eligible for coverage. Check your contract or Certificate for more information.

Check with your employer, as well as your contract or Certificate for more information. There is a federal law known as COBRA which might apply. If COBRA applies to you, you have an opportunity to remain covered under your employer's coverage for some period of time, provided you pay the full amount of your premium. You may also be eligible to convert to an individual policy of coverage offered by Anthem. This is typically known as a "conversion privilege".

Note: If a service was authorized by us before termination, but is not rendered until after your coverage ends, Anthem is not responsible for paying benefits for such services.

Check your contract or Certificate for more information. There are several possibilities:

• If you are eligible under a federal law known as COBRA, you may have an opportunity to remain covered under your employer's coverage for some period of time, provided you pay the full amount of your premium.
• Your employer may offer retiree coverage.
• You may have the opportunity to convert to an individual policy offered by Anthem.
• You may have the opportunity to continue coverage under your group coverage.

Contact your employer or Customer Care for more information and for eligibility guidelines that apply to you.

If you are the employee through whom you and your dependents are receiving benefits, you will need to check your contract or Certificate and talk to your employer for more information. If a covered dependent becomes disabled, coverage for that dependent may continue while your coverage is in force until the dependent is Medicare eligible. Contact your employer or Customer Care for more information and for eligibility guidelines that apply.

Typically, if your spouse was covered under your health benefit plan, he/she would cease being eligible for coverage through your contract upon the divorce. However, because of a federal law known as COBRA which might apply, your former spouse may be able to retain independent coverage under your employer's coverage for some period of time, provided he or she pays the full amount of their premium. He or she might also be able to obtain coverage through his/her employer, through other affiliations, or purchase individual coverage. He or she may also be eligible to convert to an individual policy of coverage offered by Anthem.
 

If new coverage is obtained within certain time frames, waiting periods and medical underwriting might not apply. Contact your employer, your Certificate or Customer Care for more information and for any guidelines that apply.

Check your contract or Certificate. If you are covered through an HMO benefit design, pre-existing conditions will be covered. In other types of product designs, it will depend on what your contract says, and whether or not you were covered by another contract prior to being covered through your current contract. Contact Customer Care for more information and for guidelines that apply to you.

In general, the following treatments and services must be pre-certified. This is not a comprehensive list and coverage and/or precertification requirements may vary depending on your plan.
 

• Advanced Imaging (CT, MRA/MRI, PET)
• Air/Water Ambulance (non-emergency)
• Bariatric/Gastric Surgeries
• Cardiology - Cardiovascular Services and Imaging
• Endoscopies
• Enteral/Parenteral Nutrition
• Genetic Testing
• Hearing and Speech Devices
• Home Health Care
• Hyperbaric Oxygen Therapy
• Hysterectomies
• Inpatient Admissions/Services
• Infertility Treatments
• Joint Surgeries/Procedures
• Medical Oncology Drugs
• Orthotics/Prosthetics
• Out of Network Referrals/Services
• Pain Management Procedures/Injections
• Physical/Occupational/Speech Therapy
• Potential Cosmetic/Reconstructive Procedures
• Private Duty/Skilled Nursing (home setting)
• Radiation Therapy
• Select Durable Medical Equipment (DME)
• Select Injectable Therapy
• Select Mental Health/Substance Abuse Services
• Select Surgical Procedures
• Sleep Studies/Therapy
• Spinal Surgeries/Procedures
• Transplants

You can also check to see what services might require a precertification by calling Member Services at the number listed on the back of your member identification card. To find out more about how to request precertification review you can contact Member Services at the number listed on the back of your member identification card.

Please check your plan for details about covered benefits, copayments, coinsurance, deductibles, and exclusions or call member services for help with your questions.

Precertification is a required review of a service, treatment or admission for a benefit coverage determination which is done before the service or treatment begins or admission date. Certain services require precertification in order for you to get benefits. Precertification includes a review to decide whether the service, treatment or admission is considered medically necessary or is experimental/ investigational under the terms of your plan.

A Consumer-Driven Health Plan (CDHP) is a high-deductible plan that also includes a tax-free Health Savings Account (HSA) or Health Reimbursement Account (HRA). Depending on your plan, you may put tax-free money into your account, or your employer might put money in, for example, as a reward for steps you’ve taken toward better health. Then, you use that money for your share of care costs, such as your deductible or coinsurance.
 

It’s called “consumer-driven” because it puts you in the driver’s seat of your health and health care spending. With your check-ups and preventive care likely covered at 100 percent by your plan, as well as tools to help you stay healthy and the ability to shop around for quality care at more reasonable costs, you might be able to use your CDHP to cover most if not all your health care costs.

You’re eligible to have both only if the FSA has been defined as a Limited Purpose FSA, which may be limited to dental and/or vision services.

Your HSA is funded by your own pre-tax contributions, up to a certain annual limit. You may also contribute post-tax money to your HSA. Others (including your employer) may contribute to your account as well. The total of all contributions cannot exceed the maximums defined by the U.S. Department of the Treasury and the Internal Revenue Service.

The easiest way is through pre-tax payroll deductions, if allowed by your employer. However, you may also contribute directly to your HSA post-tax by following your bank’s defined contribution process.

Contribution maximums are defined by the U.S. Department of the Treasury and the Internal Revenue Service and may increase for inflation annually. Go to www.irs.gov for the most current maximum amounts.

An HSA is a bank account you can use to pay for health expenses. You or your employer can put tax-free money into your HSA, and you’ll use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money in your HSA, it carries over into the next year and beyond. You can also take funds with you if you change health plans. Visit qme.anthem.com/ny for more information.

Qualified medical expenses include medical, dental, vision and prescription expenses. Visit this website for more information: qme.anthem.com/ny

Yes, FSA funds can be used for over-the-counter medicines without a prescription. Visit this website for more information: qme.anthem.com/ny

Preapproval (also known as precertification, prior authorization, or preauthorization) is the process used to confirm if a proposed service or procedure is medically necessary. If you have a question, call the customer service number on your member ID card.

Not sure if a medication is covered? Search your plan’s drug list or call the customer service number on your member ID card

If you are pregnant and choose to breastfeed your newborn, we want to ensure you have the information, tools and support you need to be successful.

Many benefit plans offer pregnant women access to personal use, standard, double electric breast pumps through many of our contracted equipment suppliers at no cost to them. It is always important to check your member benefits to confirm coverage of a breast pump.

We want to make sure the process to access a breast pump is simple for you. If you are currently pregnant, we encourage you to talk with your physician and confirm your intention to breastfeed. Then, you may want to contact any of the following nationally contracted equipment providers to order your breast pump, or you may also call one of our many other contracted equipment providers.

Though there are many quality options available, you may have a particular brand in mind to meet your needs. Please be aware that the brands available from each equipment provider may vary. If you are not able to secure an order for the brand of your choice, please call the customer service number on the back of your member identification card to obtain assistance.

When contacting equipment providers please have your Anthem Member Identification number available, as well as your physician contact information. Some of the nationally contracted equipment (DME) providers are below:

Edge Park

www.edgepark.com 

800-321-0591 (phone)

330-425-4355 (fax)

Monday-Friday, 8 a.m. to 9 p.m.

Saturday, 9 a.m. to 3 p.m.

Byram

https://breastpumps.byramhealthcare.com 

877-773-1972 (phone)

800-521-6291 (fax)

Monday-Friday, 8 a.m. to 6 p.m.

Medline Industries, Inc.

https://insured.amedadirect.com 

877-791-0064 (phone)

337-628-2240 (fax)

It is always important to check your member benefits to confirm coverage of a breast pump. A breast pump is considered Durable Medical Equipment.

How is my HIA funded?

Your HIA is funded when you earn rewards for taking certain steps to improve your health. Check your Plan Summary for more information about earning rewards.
 

What type of services may I pay for with my HIA funds?

You can use the money in your HIA to pay for health care services covered by the Lumenos plan, such as doctor’s office visits, prescription drugs, and lab tests. Check your Plan Summary for more information on covered services.
 

What is traditional health coverage?

Similar to a PPO or HMO plan, after you meet your deductible, you pay coinsurance (a percentage of the provider’s charges) when you visit a network provider. You’ll pay more if you visit an out-of-network provider. Check your Plan Summary for more information on coinsurance amounts.
 

How do I check my health account balance?

It’s easy. First register then log on at anthembluecross.com. You can keep track of your account activity and balance and get details on your medical claims. You’ll also receive a monthly statement with your account balance, account activity, medical and prescription claim history and important messages about how you may be able to improve your health or save money.
 

Can I roll over all the money in my HIA at the end of each plan year?

Yes. Whatever you don’t spend on covered services will roll over to the next year, as long as you remain enrolled in the Lumenos HIA plan. You can use roll-over funds to help pay future out-of-pocket expenses.

If I leave this Lumenos plan, what happens to my HIA funds?

You cannot take your HIA funds with you if you leave the plan or your employer. The funds in your HIA stay with the health plan.

You will need to reach out to your benefit administrator through your employer in order to update these records on file.  If you have coverage direct with us, you can complete the coverage change form found in the forms library after you log in. If you have questions, please call us at the number listed on your ID card.

Consumer-driven health plan (CDHP) is a high-deductible plan that also includes a tax-free health savings account (HSA), health incentive account (HIA) or health reimbursement account (HRA). You may put tax-free money into your account, or your employer might put money in - sometimes as a reward for steps you’ve taken for better health, depending on your plan. Then you use that money for your share of care costs, like your deductible or coinsurance.

It’s called consumer-driven because it puts you in the driver’s seat of your health and health care spending. With your checkups and preventive care likely covered at 100%, and tools to help you stay healthy and shop around for quality care at more reasonable costs - you might be able to cover all your costs with the money in your account.

Health Savings Account (HSA) plan is a high-deductible plan that also includes a tax-free HSA. You can put tax-free money into it. Then use that money for your share of care costs, like your deductible or coinsurance. You can see all of the types of costs you can cover with money in your HSA. But remember that only cost your plan covers will go toward paying down your deductible.

It gives you the flexibility of a PPO - you can often go to doctors in and out of your network, though you’ll get better rates with in-network doctors. HSA plans tend to have lower monthly premiums than similar PPOs, and sometimes even HMOs.

It’s sometimes called a consumer-driven health plan (CDHP) because you’re in more control of your care spending at first. With your checkups and preventive care likely covered at 100%, and tools to help you stay healthy and shop around for quality care at more reasonable costs - you might be able to cover all your costs with the money in your account.

You (or sometimes your employer) can put tax-free money into your health savings account (HSA). Then you use that money to pay for your share of care costs, like your deductible or coinsurance. Some people cover for all their care costs with their HSA dollars - since your checkups and other preventive care are already covered at 100%. Also, your plan comes with tools to help you find quality care at a lower cost.

If you still have money left in your account, it stays in there for next year and beyond. And you can also take it with you if you change health plans. View IRS rules on paying costs with money in your HSA.

A health incentive account (HIA) is a health account set up by your employer health plan. You earn dollars in your account when you take certain steps to improve your health. You use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money, it stays in there next year as long as you’re still at the same job.

Your employer puts money into your health incentive account (HIA) when you take certain steps to improve your health. You use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money, it stays in there next year as long as you’re still at the same job.

Yes. The three main types of FSAs are:

1. Health care FSA for qualified medical, dental, vision or other health care costs, including insurance deductibles, co-payments, and co-insurance.
2. Dependent care FSA for child, elder or other dependent care.
3. Limited purpose FSA for qualified dental and vision care costs only when combined with a Health Savings Account (HSA) or a Health Reimbursement Account (HRA).

To be eligible for an FSA, your employer must offer it. You don’t have to participate in your employer’s health plan. You must elect to participate in the FSA during your employer's open enrollment.

For a Dependent Care Flexible Spending Account (DCA), you must have children under the age of 13 (if divorced, you must be the custodial parent) or you must claim an adult dependent on your tax return who’s physically or mentally unable to care for themselves.

Yes, you’ll need to elect to participate in an FSA each plan year during your employer's open enrollment.

Qualified individuals must meet one of the following criteria: children under the age of 13 or any adult you can claim as a dependent on your tax return who is physically or mentally unable to care for themselves.

For more information, view IRS Publication 503.

To qualify for a DCA, you must be the custodial parent, even if you don’t claim your child as a tax dependent.

For more information, view IRS Publication 503.

Typically, anyone whose employer offers a DCA can participate. As a rule, your DCA can only cover expenses incurred during work hours. Ask your employer’s benefits team to verify eligibility.

For more information, view IRS Publication 503.

To qualify, dependent care must be essential for you and a spouse (if applicable) to work, look for work or attend school full-time. Typical eligible expenses include:

• Before and after school care programs
• Preschool or nursery school
• Extended day programs and summer day camp
• Babysitter (in or out of your home)
• Nanny and au pair services
• Daycare and eldercare facilities

Expenses not related directly to care of the dependent (i.e., tuition, food, etc.) aren’t eligible. Examples include:

• Educational expenses (summer school and tutoring)
• Tuition for kindergarten and above
• Overnight camp
• Field trip expenses and fees
• Housekeeping services
• Dependent care expenses incurred if your spouse doesn’t work, unless your spouse is a full-time student or is disabled

The work-related expense test is the standard the Internal Revenue Service uses to determine if expenses are work related for a DCA. An expense isn’t considered work related just because you had it while you were working. Expenses are considered work related only if both of the following are true:

• They allow you (and your spouse if filing jointly) to work or look for work.
• They’re for a qualifying person’s care.

For more information, view IRS Publication 503.

Contribution maximums are defined by the U.S. Department of the Treasury and the Internal Revenue Service and may increase for inflation annually. Visit www.irs.gov for the most current maximum amounts.

Your spouse can also contribute up to the annual contribution maximum to their separate FSA. Visit www.irs.gov for the most current maximum amounts.

The entire amount you’ve elected to put into your FSA is available on day one of your plan, even if you’re contributing a portion each month. You can use your funds by logging into your FSA administrator’s website or by using your FSA debit card, if you’ve been provided one.

Your employer determines how your plan works. Employers can elect to offer a carryover. Carryover is a dollar amount (up to the Internal Revenue Service limit) of unused funds to use your new plan year. Any balance after that is forfeited to your employer. A grace period is extra days to incur new expenses and use funds after the plan year ends. Employers can’t have both; they must only select one option. After that, any unused balance for the previous year goes back to your employer. Check your plan documents for what is allowed by your employer.

The run-out period is the time limit for submitting receipts for expenses incurred during the plan year. Check your plan documents for the run-out period allowed by your employer.

No.

No.

Internal Revenue Service guidelines state that you can’t have both an HSA and a FSA. During open enrollment, if you elect an HSA plan, you may not re-enroll in an FSA. If your employer offers a Limited Purpose FSA, you may enroll in it.

Visit www.irs.gov for the most current maximum amounts.

No. The combined DCA contributions can’t total more than the Internal Revenue Service maximum per plan year, per household.

Your DCA withholdings are reported on your W-2.

By logging onto your administrator’s member portal.

By logging onto your administrator’s member portal.

You must submit documentation. It can be an itemized receipt, invoice, explanation of benefits or other, but must include the patient’s name, name of the provider/pharmacy, the service/item purchased, date of the service/transaction and dollar amount.

When you use your FSA debit card, sometimes you may get an email or letter that asks you to “substantiate” a charge or claim. That just means supporting documentation is needed to make sure your FSA funds were used for eligible expenses.

You can submit a claim to your FSA that occurred anytime within the plan year up until the run-out period. Any claims submitted after the run-out date won’t be approved.

You can only enroll and set how much you’re putting into it during your employer’s open enrollment period. However, if you have a change in your life such as getting married or divorced, a new child, moving, etc., contact your company’s human resources department. You may qualify for a special enrollment period and you’ll be able to make changes to your FSA.

Your employer decides if your FSA has a run-out period. During a run-out period, you can submit a claim for expenses from the FSA plan year. Unused funds will be forfeited. Contact your employer for details.

Each FSA administrator is different. However, many offer an FSA debit card, a paper form for reimbursement or a member portal for electronic reimbursement requests.

Reimbursements can be requested when a qualified expense is incurred during the plan year and before the end of the FSA run-out period (or grace period if applicable).

FSA plans typically include a time past the plan year for reimbursement requests for expenses during the plan year (known as a run-out period) or expenses up to the end of the extension (known as a grace period). Contact your employer for details.

The deadline for using DCA funds is the last day of the plan year.

Elections for DCA are made during open enrollment and can’t be changed unless you experience a qualifying life event. Contact your employer for details.

Once we receive enrollment data from a state health insurance exchange marketplace, we process the information as quickly as possible and mail a payment letter to you as the customer. This payment letter serves as your receipt of enrollment. When everything works smoothly, this should only take about 10 days. However, sometimes processing the data can take time, especially if we need to go back and make sure any of the information is correct. There can also be issues with the initial application that keeps us from being able to process it, which will need to be corrected at your state’s health insurance exchange marketplace. If you’ve been waiting longer than a couple of weeks to receive your letter, you will want to check on the status of your application - either with us or with the health insurance exchange marketplace. Click on the Contact Us tab to speak with an Anthem representative.

You should receive your ID card within about 10 days of paying your first premium. If you need care and you haven’t gotten your ID card yet, ask your doctor to call us to confirm your benefits -and to make sure they’re in your health plan network.

Yes, if you have individual or family coverage. You can make your initial premium payment securely through our website.

Call us at the number on the back of your Anthem ID card. There is a grace period to help you avoid having your coverage canceled. If you pass the grace period, your policy is canceled from the date you stopped paying. Any claims you had during that time will be denied and you will be responsible for full payment of the health care services you received. You can re-enroll during the next yearly open enrollment.

Log in and go to your profile. You can change your preferences for how we communicate with you.

Once you receive your payment letter, it will share directions for you to pay the first month’s premium. Payment of the first monthly premium is required to start the policy according to the details shared in your letter. You must take this step to activate your policy before your health insurance identification cards (ID cards) can be mailed.

If you’re the primary person on your policy, you can view your info as well as some of your dependents’. When dependents are over 18, we have certain privacy rules in place that may restrict your access. But you can always change that by having that dependent log into their own profile and change who can view their info.

Log in and send us a message through your Message Center.

A Consumer-Driven Health Plan (CDHP) is a high-deductible plan that also includes a tax-free Health Savings Account (HSA) or Health Reimbursement Account (HRA). Depending on your plan, you may put tax-free money into your account, or your employer might put money in, for example, as a reward for steps you’ve taken toward better health. Then, you use that money for your share of care costs, such as your deductible or coinsurance.

It’s called "consumer-driven" because it puts you in the driver’s seat of your health and health care spending. With your check-ups and preventive care likely covered at 100 percent by your plan, as well as tools to help you stay healthy and the ability to shop around for quality care at more reasonable costs, you might be able to use your CDHP to cover most if not all your health care costs.

Qualified medical expenses include medical, dental, vision and prescription expenses. Visit this website for more information:
 

qme.anthem.com/ny 

Yes, FSA funds can be used for over-the-counter medicines without a prescription. Visit this website for more information:
 

qme.anthem.com/ny 

Check your contract or Certificate for details. In most contracts, newborns are covered for their first 31 days of life automatically. Typically, you must enroll your newborn within 31 days from the date of the child's birth to continue coverage without interruption beyond the 31st day. Unless your contract or Certificate states otherwise, a newborn child of a dependent son or daughter does not qualify as a dependent under your coverage.

Check your contract or Certificate for details. In most contracts, adopted children are automatically covered for 31 days from the date of placement or adoption, whichever is earlier. Typically, you must enroll your adopted child within 31 days from the date of the child's placement with you or date of adoption, whichever is earlier to continue coverage without interruption beyond the 31st day. Unless your contract or Certificate states otherwise, an adopted child of a dependent son or daughter does not qualify as a dependent under your coverage.

Check your contract or Certificate. Typically, you need to contact us directly, or via your group if applicable, within 31 days of the event giving rise to the change. Requests for changes in eligibility need to be in writing.

Call Customer Support during normal business hours and request a Change of Eligibility Form. Customer Support numbers can be found on your insurance ID card and are specific to your account and plan.

Note that at any time we discover a person's ineligibility, we may cancel their coverage immediately, and recover from you the costs of any benefits paid on behalf of such person during the period of ineligibility.

Check your contract or Certificate. If a court order requires that you provide coverage for a child who is out-of-state, you must notify us of the court order within 31 days of its receipt, in order for coverage to be effective.

If you are covered through an HMO benefit design and your child is going to college outside of our service area, there may be special circumstances under which your child may be eligible for coverage other than emergency or urgent care benefits. If you are covered through a benefit design other than an HMO product, benefits may be covered for your child who is outside of our service area.

Children inside the service area are typically eligible for coverage, provided they meet the definition of "dependent" under your contract or Certificate. Contact Customer Service for more information and for eligibility guidelines that apply.

For plan years beginning on or after September 23, 2010, it has been our policy that children can remain on their parent's health plan until the end of the month they turn 26. Some self-insured plans or state mandates require us to administer to a different time period or age.

We always recommend that you check your plan specifics. Additionally, a dependent is defined as a child of the subscriber or participant who is under the age of 26. Financial dependency on or residency with the subscriber or participant is not required. Additionally, there is no requirement to be unmarried, student, employed or any combination of these factors.

Plans are also required to provide access to coverage regardless of a dependent's eligibility for other coverage, except for grandfathered group plans prior to 2014. For these grandfathered plans, groups may choose to exclude coverage for children under a parent's policy if they are eligible for their own employer sponsored coverage. For states or plans that cover other children (i.e., step children, children of domestic partners, etc.), that definition will not change.

Check your contract or Certificate. Typically, eligibility will be continued past the standard age limits specified in your contract or Certificate only for those already enrolled, unmarried children who cannot work to support themselves due to certain mental or physical disabilities. These children must be allowed as federal tax exemptions for the subscriber or the subscriber's spouse.

Under many health benefit plans, the disability must have started prior to the end of the period for which they would have otherwise been eligible under your coverage. We must be notified of the disability within 31 days after the child would normally have become ineligible, and we have the right to determine whether the child's condition meets our criteria for being covered under the coverage beyond the normal end date.

From time to time, you may be asked to submit proof of continued disability. Failure to provide that information could result in termination of the child's coverage.

Check your contract or Certificate for a definition of "dependent". If you are covered through an HMO benefit design and your child is going to college outside of our service area, there may be special circumstances under which your child may be eligible for coverage other than emergency or urgent care benefits. If you are covered through a benefit design other than an HMO product, benefits may be covered for your child who is outside of our service area. Children inside the service area are typically eligible for coverage, provided they meet the definition of "dependent" under your contract or Certificate. Contact Customer Care for more information and for eligibility guidelines that apply.

Once you're logged in, you can quickly view your benefit or claim information for you and potentially for your dependents on the policy. Dependents who are 18 years or older can adjust their settings in their profile online at any time and may or may not allow you to view their information online. A dependent can be a spouse, partner or child who is covered on the primary health insurance policy.

First log into your secure site. Once logged in, click Find Care and answer the required questions to complete your search.

Log into your secure account and go to Find Care If you are doing a search when you are not logged into your secure account, please be sure that you are double checking to make sure that the doctor or facility is in network before scheduling an appointment. If you need further help, please read on

Doctors, hospitals, facilities (such as labs) and other professionals who give health care services may have a contract with us. If they do, they're in our network - also called in-network providers. That means they've shown they provide quality care and they accept our payment rates when our members go to them for care. If they don't have a contract with us, they're outside of our network - or out of network providers.

Many of our networks are made up of providers who meet high quality standards. Network providers are responsible for getting any needed preauthorization (approval) of your care. They also file your claim for you and will seek payment from us for covered services. When you see network providers, you only have to pay the copays, deductibles and coinsurance required by hour health plan.
 

If you get treatment from a provider outside the network, you may be responsible for getting preauthorization for a proposed service. You could have to pay more for services done outside of your network. Check your plan document (your contract, Evidence of Coverage, Summary of Benefits, Certificate of Coverage, or Member Handbook, etc.) for details.

If you have questions or to check if your treatment needs preauthorization, call the Member Services number listed on the back of your ID card.

Yes, although it does not make the most of your benefits and may end up costing you more. Check your plan document (your contract, Evidence of Coverage, Summary of Benefits, Certificate of Coverage, or Member Handbook, etc.) to learn more.
 

NOTICE: There are hospitals, health care facilities, physicians or other health care providers who are not included in every plan network. Your financial responsibilities for payment of covered services may differ if you use a network provider or a non-network provider. Please refer to the online Find Care tool to determine if a particular provider is in the network or contact customer service for assistance.

You could ask your doctor to call us and apply to join the network. Until your doctor becomes a provider in the network, changing to a network doctor will help you pay less and make the most of your benefits.

The following definitions are for the Behavior Health Types:
 

Applied Behavior Analyst - specializes in analyzing overt (publicly observable) behavior, use procedures based on operant procedures.
 

Behavior/Substance Abuse - Facilities specializing in mental health and substance abuse.

Board Cert Assistant Behavior Analyst - Specializes in analyzing behavior, looking at environmental and biological factors, and using behavior change principles to address specific needs. A Board-Certified Behavioral Analyst (BCaBA, BCBA, BCBA-D) is a provider who is certified by the Behavior Analyst Certification Board (BACB).
 

Hospital Psychiatry - A specialized behavioral health services unit within as General Hospital that provides 24-hour acute inpatient care for the evaluation and treatment of mental health or chemical dependency disorders under the supervision of physicians and nurses.

Marriage and Family Therapists - A practice specialty that uses counseling and other psychotherapeutic techniques with individuals, couples, families, and groups to treat a variety of life problems. These may include mental and emotional disorders and/or alcohol and other drug problems.
 

Nurse Practitioners, Nurses - Nurse practitioners and nurses with special training and experience in the prevention, diagnosis, and management of problematic behaviors.
 

Other - Other service providers not listed, such as state agencies.
 

Pediatrics (Children) - Specialists in the diagnosis and treatment of the diseases of infants, children, and adolescents.

Professional Counselors - Specialists who provide professional counseling services involving psychotherapy, human development, learning theory, and group dynamics to individuals, couples, and families.
 

Psychiatry - Physicians who have medical training which enables them to understand the complex relationship between emotional illness and other medical illnesses.
 

Psychiatrists specialize in the diagnosis and treatment of mental and emotional illness and alcohol and other drug problems, including detoxification and rehabilitation by using a combination of counseling, psychotherapy, and medications.
 

Psychologists - A practice specialty that uses psychotherapeutic techniques with individuals, couples, families, and groups to diagnose and treat mental and emotional disorders and/or alcohol and other drug problems. Develops, administers, and interprets tests of mental abilities, aptitudes, interest, personality characteristics and motivations to aid in the assessment and diagnostic process.
 

Social Workers - Specialists trained

The following definitions are for the Dental Provider Types:
 

Dental Group Practice - A group of dental service providers, who are practicing in one location to study, manage and treat of diseases and conditions affecting the mouth, jaws, teeth and supporting tissues.
 

Behavior/Substance Abuse - Facilities specializing in mental health and substance abuse.
 

Endodontics - The branch of dentistry dealing with the cause, diagnosis, prevention, and treatment of diseases of the dental pulp, usually by removal of the nerve and other tissue of the pulp cavity and its replacement with suitable filling material, such as a root canal.
 

General Practice Dentistry - Nonspecialized dental practice which is concerned with providing primary and continuing dental care.
 

Oral Surgery - Diagnosis and treatment requiring an extraction or other form of oral surgery.
 

Orthodontics - the branch of dentistry concerned with preventing or correcting irregularities of the teeth.
 

Pediatric Dentistry - the goal of pediatric dentistry is to teach children the importance of oral hygiene, how to take care of their teeth and to help children feel comfortable about visiting the dentist.
 

Periodontics - the branch of dentistry dealing with the study and treatment of diseases of the periodontium (the bone, connective tissue, and gum surrounding and supporting a tooth).
 

Prosthodontics - the branch of dentistry that deals with the restoration and maintenance of oral function by the replacement of missing teeth and other oral structures by artificial devices.

The following definitions are for the Doctor & Other Health Professional Types:
 

Acupuncture - Acupuncture is a Chinese medical practice or procedure that treats illness or provides local anesthesia by the insertion of needles at specified sites of the body.
 

Allergy/Immunology - Specialists in the diagnosis and treatment of hypersensitive states resulting from exposure to a particular allergen and diseases of the immune system. Sub-Specialties include: "Allergy", "Allergy/Immunology", "Immunology", "Pediatric Allergy", "Pediatric Immunology".
 

Anesthesiology - Specialists in the relief of pain during surgery and childbirth, and control of pain due to various causes.  Sub-Specialties include: "Anesthesiology", "Anesthesiology Critical Care Medicine", "Anesthesiology Pain Center", "Hospital Based Physician-Anesthesiology", "Nurse Anesthetist", "Pediatric Anesthesiology".
 

Audiologists - Studies hearing disorders, including evaluation of hearing function and rehabilitation of patients with hearing impairments.
 

Cardiology - Specialists in the study of the structure, function, and diseases of the heart.
Sub-Specialties include: "Cardiac Electrophysiology", "Cardiology", "Cardiothoracic Surgery", "Cardiovascular Disease", "Echocardiography", "Hospital Based Physician-Cardiology", "Interventional Cardiology", "Licensed Perfusionist", "Nuclear Cardiology", "Pediatric Cardiology".
 

Chiropractic - Specialists in the non-drug treatment of musculoskeletal problems, including joint sprains and disk injuries.  Sub-Specialties include: "Chiropractor", "Chiropractor - Neurology", "Chiropractor - Occupational Medicine", "Chiropractor - Radiology", "Chiropractor - Sports Physician".
 

Colon/Rectal Specialists - Specialists in the treatment of disorders of the large intestine and rectum.  Sub-Specialties include: "Anorectal Surgery", "Colon/Rectal Surgery", "Proctology".
 

Critical Care Medicine - Specialists in the care for critically ill patient in intensive care unit.  Sub-Specialties include: "Internal Medicine Critical Care Medicine", "Neurological Surgery Critical Care Medicine", "Surgical Critical Care".
 

Dental - The study, management and treatment of diseases and conditions affecting the mouth, jaws, teeth and supporting tissues.  Sub-Specialties include: Prosthodontics.
 

Dermatology - Specialists in the diagnosis and treatment of diseases of the skin.  Sub-Specialties include: "Dermatology - Dermatological Surgery", "Dermatology Immunology/Diagnostic Laboratory Immunology", "Pediatric Dermatology".
 

Dieticians/Nutritionists - Special

The following definitions are for the Hospitals And Facilities Types:
 

Extended Care, Hospice, Skilled Nursing - Facilities designed for those who need assistance with day-to-day activities or medical needs (extended care facility), those who require a higher level of medical care monitored by nurses and other medical personnel (skilled nursing facility) or those who are facing life-limiting illnesses and no longer respond to cure-oriented treatments (hospice). Sub-Specialties include: "Agency - Nursing Care", "Chronic Care Facility", "Extended Care Facility", "Family Medicine Hospice and Palliative", "Hospice", "Hospice and Palliative Medicine", "Hospice Care, Community Based", "Hospice, Inpatient", "Internal Medicine-Hospice & Palliative Medicine", "Limited Care Facility", "Long Term Acute Care Hospital", "Long Term Care Hospital", "Nursing Home", "Skilled Nursing Facility".
 

Alternate Care Facility - Facility for the diagnosis and treatment of illnesses and injuries with the use of electromagnetic radiation, ultrasonics, and other forms of radiant energy. Sub-Specialties include: "Radiology Center".
 

Behavioral/Substance Abuse - Facilities specializing in mental health and substance abuse. Sub-Specialties include: "Behavioral Health Center", "Behavioral Health/Substance Abuse Facility", "Behavioral Health Facility", "Eating Disorder Facility", "Partial Day Intensive Outpatient", "Partial Day Outpatient", "Partial Day Psychiatric & Substance Abuse", "Psychiatric-General Hospital", "Rehabilitation, Comprehensive Outpatient Facility", "Residential Treatment", "Substance Abuse Disorder Rehabilitation Facility - Substance Abuse Treatment, Children", "Substance Abuse Facility",
 

Clinics - Facilities that provide management and treatment of patients with minor complaints or illnesses. Services may include primary care, dental, family planning and/or well child services. Sub-Specialties include: "Cardiology Center", "Clinic/Center - Federally Qualified Health Center (FQHC)", "Clinic/Center - Infusion Therapy", "Clinic/Center - Methadone", "Clinic/Center - Occupational Medicine", "Clinic/Center - Oncology, Radiation", "Clinic/Center - VA", "Community Mental Health", "Community Health Clinic", "Coronary Services Center", "Diabetic Education Center", "FED QUAL HLTH CLIN", "Kidney Disease Treatment", "Lithotripsy Provider", "Nursing School Clinic", "RES TRTMT CNTR".
 

General/Acute Care Hospital - Institutions offering residential, investigatory, and/or therapeutic care regarded as too complex or specialized for provision as home-care services. Services may be on an inpatient or out-patient basis. Sub-Specialties include: "Acute Care Hospital", "Children's Hospital", "Christian Science Sanitoria-Hospital", "General Acute Care Hospital - Critical Access", "General Acute Care Hospital - Rural", "General Acute Care Hospital - Women", "Indian Health Svcs/Public Health Svcs ( IHS/PHS ) Hosp", "Intensive Care Hospital", "Veterans Hospital".
 

Other - Other service providers not listed, such as state agencies. Sub-Specialties include: "Ambulatory Infusion Ctr", "Anesthesiology Pain Ctr", "Bariatrics", "Birthing Center", "Clinic/Center - Pain", "Clinic/Center - Radiology, Mobile", "Clinic/Center - Radiology, Mobile Mammography", "Clinic/Center - Student Health", "Freestanding ER", "Hematology Center", "Hemodialysis", "HOME INFUSION THERAPY", "Home IV (Facility)", "Hyperbaric Facility", "Military Hospital", "MRI Facility", "Naprapathy", "Native American Clinic", "OUTPAT C/D SVCS", "Pain Management Centers", "Sleep Disorders Center", "Special Hospital", "Specialized Facility", "Transitional

A primary care physician (PCP) is your main doctor. Always try to go to your PCP first for health concerns or questions.

Your PCP coordinates any other care you need, such as a visit to a specialist or a hospital stay. You may need to contact your PCP to get an OK (prior authorization) before you get certain services.
 

Most PCPs are family or general practitioners, internists, or pediatricians. These types of doctors have gone to school to learn about all areas of health. That way, they can get a strong, overall picture of your health.
 

Not all health plans require you to have a PCP. Check your plan document (your contract, Evidence of Coverage, Summary of Benefits, Certificate of Coverage, or Member Handbook, etc.) for details.

The following definitions are for the Vision Types:
 

Ophthalmology - Vision providers who specialize in the diagnosis and treatment of diseases and disorders of the eye. Sub-Specialties include: "Neuro-Ophthalmology", "Ophthalmology", "Ophthalmology, Otology, Laryngology, Rhinology (Osteopaths only)", "Ophthalmic Plastic".
 

Optician - Optician a person who makes or sells eyeglasses and, usually, contact lenses, for remedying defects of vision in accordance with the prescriptions of ophthalmologists and optometrists.
 

Optometrist - Vision Therapy - Vision therapy is a type of physical therapy for the eyes and brain, a highly effective non-surgical treatment for common problems.
 

Optometry - the practice or profession of examining the eyes, by means of suitable instruments or appliances, for defects in vision and eye disorders in order to prescribe corrective lenses or other appropriate treatment.
 

Vision Facility - Eyewear suppliers or optical stores, such as Pearle Vision® or Sears Optical. Sub-Specialties include: "Eyewear Supplier", "Optical Store".

In emergencies, call 9-1-1 or go to the nearest hospital - you don’t need an OK from us or your PCP. But be careful not to use the emergency room unless it really is an emergency.
 

If it’s not an emergency, you can see a doctor right away online, using your phone or computer at livehealthonline.com. Depending on your plan, it’s likely about the same cost as your doctor.
 

You can also use our Find Care tool to look for an urgent care center - or a clinic in a retail shopping store. You can usually walk in without an appointment needed. And they can handle lots of urgent health issues like a flu or cold, allergies, prescribing medication, even small fractures, and X-rays.

You may need to contact your Primary Care Physician (PCP) to get an OK (prior authorization) before you get certain services, including behavioral health services. Your PCP will work with you to decide if you need to see a specialist. If so, your PCP will refer you to a network specialist. If you have to refer yourself to a specialist, you can search for a network specialist in our online directory. Check your plan document (your contract, Evidence of Coverage, Summary of Benefits, Certificate of Coverage, or Member Handbook, etc.) for details.

If your primary doctor can’t see you that day or the next, you should find an urgent care clinic nearby. Under Find Care, select Find Urgent Care for one in your network.

It can take up to 10 business days or two weeks.

Call them. They should always have someone available, or a recorded message to help you get the care you need.

Get a full list of the types of doctors, hospitals, and other health care providers. Log in to and choose Find Care.

Simply enter the number into the Find Care search bar and hit enter.

To provide transparency in healthcare costs, we have partnered with Fair Health Consumer to provide cost estimates and reimbursement rates for out-of-network services in your area.

Call 911 or go to the closest emergency room anytime you have a life-threatening emergency. If you’re not sure it’s an emergency, call your doctor’s office for advice.

A guide to whether it’s an emergency is if your symptoms are so severe that you believe not getting medical care right away could place your or someone else’s health (or the health of an unborn child) at risk OR cause major harm to a body function or part.

Examples of an emergency include when someone:

• May die
• Has chest pains
• Cannot breathe or is choking
• Has passed out or is having a seizure
• Is sick from poisoning or a drug overdose
• Has a broken bone
• Is bleeding a lot
• Has been attacked
• Is about to deliver a baby
• Has a serious injury
• Has a severe burn
• Has a severe allergic reaction or has an animal bite
• Has trouble controlling behavior and without treatment is dangerous to self or others

If you feel you’re having an emergency, you don’t need an OK from us or your PCP to get care.

An urgent medical condition is not an emergency but needs medical care within 24 to 48 hours.

Here are some examples of urgent medical conditions:

• Earaches
• Fever
• Stomach pain
• Vomiting
• Minor burns
• Sprains

Yes. You are covered for emergency or urgent care even if you are outside of our service area. It's helpful if you find the hospital and urgent/walk-in center nearest your home and call to ask if they have a contract with your health plan. (Do this before an emergency or urgent situation arises.)

Go to the nearest health care facility. Call your doctor or us within 24 hours, or as soon as you can. When your care is done, you will need to pay the bill. (You may want to use a credit card. The credit card company will automatically transfer the foreign currency into American dollars for you.) Keep all your receipts.

When you get home, call us at the number on the back of your member ID card or stop by your employer's personnel office and ask for a claim form. Fill out the claim form and submit it with your receipts to our address on the form. (The amount submitted must be in American dollars). We will pay you back based on your health plan benefits.

Please contact customer service by calling the telephone number on the back of your member identification card.
 

Customer service can also guide you through a variety of programs and services we offer to support breastfeeding mothers.

A Health Risk Assessment is a helpful resource to understand your health risks and help provide you with actionable steps you can take on improving your health. Visit our Health & Wellness section of our website for more information.

Eligible members have a total of $200 per family to use towards reimbursement for any fitness clubs or exercise centers of their choosing in their eligible coverage year. Family members must be eligible under the member’s benefit coverage.

You are eligible for the ExerciseRewards benefits for fitness club and exercise center services incurred during your eligible coverage year (please note, that this may not necessarily be the calendar year).

In order to receive reimbursement, you must submit a receipt to show that you have paid for the fitness center membership. Members can submit receipts at any time during the eligible coverage year or up to 3 months after the eligible coverage year is completed, but reimbursements will only be provided for incurred services.

As long as the membership timeframe is part of your eligible coverage year, reimbursement for incurred months in your covered eligible coverage year can be reimbursed. Please note, that you must provide a receipt that shows the timeframe covered by the fitness center membership.

If you have other eligible members under your plan, they can also submit claims for reimbursement for membership at a fitness club or exercise center; however, please note that the total maximum amount allotted for the family benefit is $200, so any claims over that amount will not be reimbursed. Eligible covered members are those members with active coverage who are 18 years of age or older.

Paid receipts must be submitted with a completed claim form and a copy of the fitness club or exercise center agreement. Claim forms can be downloaded off of the ExerciseRewards website at ExerciseRewards.com or they can be requested through the ExerciseRewards customer service area at 877-330-2746. Members can expect to receive their reimbursement within approximately 30 days of submission, as long as it is within the guidelines of the established reimbursement dates (i.e., after services are incurred – see question on “How will I be reimbursed” for further details).

You have 3 months to submit claims after your contract year has expired, as long as the services rendered were within your eligible coverage year.

You can call ASH ExerciseRewards^TM directly for any customer service questions at 877-330-2746, or you can click on the attached link ExerciseRewards^TM to access the ExerciseRewards^TMwebsite, where you will find additional information on the ASH ExerciseRewards^TM program.

It is always important to check your member benefits to confirm coverage of a breast pump. A breast pump is considered Durable Medical Equipment.

Certain health plans that were in effect prior to March 23, 2010, may be "grandfathered health plans" under the Patient Protection and Affordable Care Act. If your plan is grandfathered, then your plan will include some consumer protections from the Affordable Care Act, but may not include other protections that apply to non-grandfathered health plans. If your plan is a grandfathered health plan, notice indicating that fact will be contained in your Certificate Booklet or your group's summary plan description.

Please click here to select your State and review your Medical Policies.

Please go to anthembluecross.com/privacy for information about our policies and procedures for the collection, use and disclosure of your protected health information (PHI). This includes, but not limited to information about routine notification of privacy practices, use of authorization, your access to medical records, protection of verbal, written and electronic information, information for employers, and more.

As a member, you have rights and responsibilities when receiving healthcare. As your healthcare partner, we want to make sure your rights are respected, while providing your health benefits. That means giving you access to our network of doctors and healthcare professionals, who help you make the best decisions for your health.
 

You have the right to:

• Speak freely and privately with your doctors and other healthcare professionals about healthcare options and treatment needed for your condition, no matter what the cost or whether it is covered under your plan.
• Work with your doctors and other healthcare professionals to make choices about your healthcare.
• Be treated with respect and dignity.
• Expect us to keep your personal health information private by following our privacy policies and state and Federal laws.
• Receive information you need to fully engage with your health plan and also share feedback. This includes:
  • Our company and services.
  • Our network of doctors and other healthcare professionals.
  • Your rights and responsibilities.
  • The way your health plan works.
• Make a complaint or file an appeal about:
  • Your health plan and any care you receive.
    
  • Any covered service or benefit decision that your health plan makes.
• Say no to care, for any condition, sickness, or disease without it having an effect on any care you may receive in the future. This includes asking your doctors and other healthcare professionals to tell you how that may affect your health now and in the future.
• Get the most up-to-date information from a doctor about the cause of your illness, your treatment, and what may result from it. You can ask for help if you do not understand this information.
   

You have the responsibility to:

• Read all information about your medical benefits under the Plan and ask for help if you have questions.
• Follow all medical Plan rules and policies.
• Choose a Network primary care physician, also called a PCP, if your health Plan requires it.
• Treat all healthcare professionals and staff with respect.
• Keep all scheduled appointments. Call your doctor’s office if you may be late or need to cancel.
• Understand your health challenges as well as you can, and work with your doctors and other healthcare professionals to create an agreed upon treatment plan.
• Inform your doctors and other healthcare professionals if you don’t understand the type of care and your actions that they’re recommending.
• Follow the treatment plan that you have agreed upon with your doctors and other healthcare professionals.
• Share the information needed with us, your doctors, and other healthcare professionals to help you get the best possible care. This may include information about other health insurance benefits you have in addition to your coverage with us.
• Inform Member Services if you have any changes to your name, address, or family members covered under your Plan.

If you would like more information, have comments, or would like to contact us, please go to anthem.com and select Contact Us. Or call the Member Services number on your ID card.
 

We are here to provide high-quality benefits and service to our members. Benefits and coverage for services given under the Plan are overseen by your Certificate of Coverage, Member Handbook or Schedule of Benefits and not by this Member Rights and Responsibilities statement.
 

Effective Date: 5/2011; Revised 2/2013, 1/2015, 4/021; Reviewed annually with last review 3/2023
 

A02146MUMENABS

To provide transparency in healthcare costs, we have partnered with Fair Health Consumer to provide cost estimates and reimbursement rates for out-of-network services in your area.

Do I need any special hardware or software to sign up for Auto Bill Pay payment service?

No special hardware or software is required to use this service. You will only need Web access and your browser. Please note that some older browsers use 40-bit encryption. For the highest level of security available, we suggest you use 128-bit encryption to access the site. Please visit your service provider’s web site or contact your service provider for more information on 128-bit encryption.

What if I forget my password?

For security reasons, we ask that you set a new password.

How am I billed for Auto Bill Pay payment service?

There is no cost for enrolling in and using Auto Bill Pay payment site. See the service Terms and Conditions for complete details.

How do I cancel my Auto Bill Pay payment service?

You can cancel the service yourself by de-enrolling your account in from the Change Profile page. If you need assistance, please call your customer care department. You can find the phone number on the back of your identification card.

If an account is in a name other than my own, can I still sign up for Auto Bill Pay payment service?

Yes, but please be sure to use the correct account number as it appears on the monthly paper bill.

What is my account number to sign up for service?

Your account number is your Member ID or Summary Bill number (if you are billed for multiple accounts on one invoice), please refer to your current invoice for this information.

Will I receive a reminder that I have an Auto Bill Pay ready for viewing and paying?

At this time, we will not be sending invoice reminders via email.

Can I turn off my paper invoices?

We have plans for future enhancements to include paperless invoicing.

When is the money for the payment drawn from my payment account?

The funds for the payment are debited from your account on the scheduled payment date which can be as soon as the same day payment is submitted. Keep in mind that you should always have funds available to cover the payment on that date.

How far in advance of the due date should I schedule my payments?

We suggest you schedule your payment for at least 3 business days before the actual payment due date.

I recently signed up for an automatic payment option but do not see this option online. Why not?

If you are currently on a recurring payment option such as checking deduction or you recently signed up for a recurring payment option, the information presented in web pay may not be updated to reflect your current payment option. It could take up to 30 days to reflect a change to a recurring payment option.

Can I enroll in Monthly Automatic Checking Deduction on Auto Bill Pay?

You can download the form to sign up for Monthly Automatic Checking Deduction. Please follow the directions on the form for submission.

The amount shown on the website seems incorrect. What should I do?

The amount displayed on the website should reflect your current invoice. If you have made changes to your coverage, it may take up to 30 days to reflect online. Please contact Auto Bill Pay customer care department if you have questions. You can find the phone number on the back of your identification card.

How can I confirm that a payment has been made?

After the payment date, check the status.

Yes. The Food and Drug Administration (FDA) will not approve a generic drug unless it’s A-rated ("therapeutically equivalent"). It must be identical to the brand-name version — same active ingredients, dosage and strength and medical effect.

Depending on their plan design, members can help control the amount they pay for their prescriptions by requesting that their prescriber prescribe generic medications. Generic medications don't compromise the quality of your care.

Your prescriber and pharmacist are the best sources of information about generic medications. Simply ask one of them if your prescription can be filled with an equivalent generic medication.

If your current prescription medication is not a generic, call your prescriber and ask if it's appropriate for you to switch to a lower-cost generic drug. The decision is up to you and your prescriber.

You may request that your prescriber prescribe the brand-name drug even when a generic version is available. However, you may have to pay the difference in cost between the generic and brand-name drug, plus the co-payment.

Brand-name drugs are usually available from only one manufacturer and may have patent protection. When a drug company develops a new drug, they're the only ones allowed to make and sell it under their “brand name.” At some point, other companies are allowed to start making "generic" versions. Generic drugs are required by law to have the same active ingredients as their brand-name counterparts but are normally only available after the patent expires on a brand-name drug. People using generic over brand-name medications can typically save money.
 

Some plans require you to use a generic version when there is one, or you may need to pay a higher copay or coinsurance. Check your plan details to see how your plan works.

A drug list/formulary is a list of prescription drugs that we cover. This list is made up of hundreds of generic and brand-name drugs approved by the U.S. Food and Drug Administration (FDA). We update the drug list/formulary several times a year. Our drug list/formulary decisions are based first on quality data, instead of cost.

Prescriptions for certain drugs (or the prescribed quantity of a drug) may require “prior authorization” from a health benefits plan before they can be filled. Some drugs require prior authorization because they may not be appropriate for every member or may cause side effects. Prior authorization helps promote appropriate utilization and enforcement guidelines for prescription drug coverage.
 

“Step therapy” involves prescribing medication only after a “first line” drug is tried. In instances in which one of these medications is not effective and/or appropriate for a particular member, the step therapy requirements allow the prescriber to then prescribe a different medication.

When your prescriber gives you a prescription for a drug, take it to a pharmacy in your network. Show your member ID card so the pharmacist can access your benefits. If you have medications that you take regularly, you may be able to have them conveniently and securely shipped to a location of your choice.

Most plans have different coverage levels for drugs based on whether they're generic or brand-name — or other factors. Those on higher "tiers" may require you to pay more in coinsurance.

Our medication list (sometimes called a formulary) allows you and your doctor to choose from a wide variety of prescription drugs. Please talk with your doctor about prescribing a drug that is on the medication list. If a drug is selected that is not on the medication list, you will be responsible for the full cost of the drug. You can also talk to your doctor about making a request to CarelonRx for an exception review of a drug not on the medication list.

From your secure online account, select Pharmacy from the main navigation. There you'll find links for the specialty pharmacy.

Normally, a generic drug can be introduced to the market only after the patent has expired on its brand-name counterpart and can be offered by more than one manufacturer. Using generic medications may save you money.

Supported Mobile Operating Systems

• Mobile iOS 15 series
• Mobile iOS 14 series
• Android 10, 11, 12

Supported Desktop Operating Systems

• Windows 10
• OS X 10
• Chrome OS
   

Web Browsers
 

We recommend that you always use the current version of your browser and have the latest security updates to make sure that our web pages display quickly. Members using an unsupported operating system or device will not be able to access our site unless they upgrade. Members may also get an alert suggesting they upgrade to a newer operating system for best results.

Please note we no longer support Internet Explorer 11.
 

Supported Desktop Browsers

• Google Chrome 98 & 99
• Microsoft Edge 98 & 99
• Safari 15 Series
• Mozilla Firefox 98
   

Supported Mobile Browsers

• Safari 14 & 15 series
• Chrome Mobile 98 & 99
• Samsung Browser 16 series
   

Supported Apple Devices

• iPhone 11
• iPhone 12 Pro Max
• iPhone XR
• iPhone 12
• iPhone 12 Pro
• iPhone 13 Pro Max
• iPhone 11 Pro Max
• iPhone 13 Pro
• iPhone 11 Pro 
   

Supported Non-Apple Devices

• Samsung Galaxy S21 Series
• Samsung Galaxy S10 Series
• Samsung Galaxy S20 Series
• Samsung Galaxy S9 Series
• Samsung Galaxy Note 20 Ultra
• Samsung Galaxy Note 9
• Samsung Galaxy Note 10+

If pages are showing up blank, or not displaying information properly, or you click a link and nothing happens, your browser could be set up to block cookies or pop-up windows, causing our website to not display correctly. Please disable all pop-up blockers and change your browser's privacy setting to allow 3rd party cookies; then close your browser, reopen it, and try again. Additionally, if you click a link on a web page before the page is loaded, the link may not be active. Please let an entire page load before clicking any links.