Group number: D49307
Website: Anthem Blue Cross Blue Shield
Plan Anniversary Date: February 1
Deductible - plan year based
For medical claims questions, call Anthem at 1-855-330-1214
INFORMATION FOR NEW HIRES
Medical coverage is available to all full-time employees (30+ hours per week).
ALL eligible employees MUST complete the Anthem Application showing your election or waiver of coverage.
Initial Enrollment Period: 90 days from date of hire.
Effective Date: 90 days from date of hire.
Termination/Loss of Coverage (LOC): Last day of month.
Cost of Coverage to Employee
Your employer will pay 85% of your employee only monthly premium.
Adding Dependents – Eligible dependents may be added at the employee’s expense.
The rate would be calculated using the same age-based plan rate chart.
YOUR MEDICAL PLAN
Anthem Gold PPO DED 3400/MOOP 4250 w/HSA
Contract Code: 8F2Y
Summary of Benefit Coverage
Plan Rate Chart
HSA Information
Please review the following:
Anthem Preventive Care Benefits
Marketplace Notification
All eligible employees MUST complete the enrollment form below, showing your election or waiver of coverage.
This application is for medical insurance only; disregard the Dental, Vision and Life Insurance sections.
Please note that once you make your choice, changes cannot be made until the next open enrollment period, at the end of the plan year, unless you have a material change in your personal circumstances.
Collection of Premiums
Premiums are collected bi-weekly, on a pre-tax basis with the prior month’s 2 payrolls (start up adjustments may apply). If there is a third pay period in the month, no premium is collected, but prior adjustments may be made.
Portability
If your employment is terminated, your benefits may be continued under State Continuation. Contact Outstaffing for more information.
If you have other questions, you can call Outstaffing at 1-888-OUTSTAFF (1-888-688-7823).
INTRODUCING "SYDNEY": ANTHEM'S NEW APP
Anthem has a new app that will make your health care experience easier. It’s called Sydney Health. Sydney Health makes it easy to register, find doctors near you, get important information about benefits and claims, track your progress toward health goals and more! You can even get your member ID car right from Sydney! You can download the Sydney Health App in the Google Play Store or the Apple App Store.
AFTER YOU HAVE ENROLLED
- Watch the Mail: Your Medical ID cards will be mailed directly to your home address.
- To maximize your benefit, we recommend that you register online.
- Once your plan is effective, take your plan and ID card on the go!
Questions? Call Anthem Member Services at (855) 330-1214.