Actives – Anthem Blue Cross PPO Plan

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Dental Benefits are provided through Delta Dental.

Vision Benefits are provided through VSP.
Employee Assistance Benefits are provided through Beat It! EAP.

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Frequently Asked Questions

Why did the Trust Fund elect to move to a self-funded program?
On an annual basis, the Board of Trustees evaluate the renewals received from our vendor partners to determine market competitiveness.  This past renewal was unacceptable and the Board of Trustees decided to market the program.  After reviewing all the opportunities, the Board of Trustees decided to move to a self-funded program which provides the Board of Trustees important financial data to ensure the long term viability of the Health & Welfare program.

What is the Prudent Buyer Network?
The Prudent Buyer Network is a Preferred Provider Organization (PPO) that is owned and operated by Anthem Blue Cross of California.  The Prudent Buyer Network (PPO Providers) is an organization that operates under contract with the Administrator to provide hospital, medical and surgical services at agreed upon allowances.  Prudent Buyer providers are located in California.

What allowances are provided by the Prudent Buyer Network (PPO)?
Prudent Buyer Allowances is the dollar amount allowed for each particular type of medical service by Prudent Buyer Providers. Prudent Buyer providers        (PPO) have agreed to accept the allowance as full payment for service for Self Funded PPO Plan members, although they will often list a higher fee.

What is UCR?
Usual Customary and Reasonable (UCR) is a range of fees which are usually charged and received for the given treatment by doctors of similar training within the appropriate geographic area.

What is my “lifetime maximum” for benefits and what is meant by the plan will restore an additional $1,500 per year?
The lifetime maximum is the total, “lifetime” amount of available benefits for you under the program. Each of your dependents have their own “lifetime” maximum. The restoration benefit is an amount of $1,500 per year which will be added back (restored) each year you are covered under the plan.

What is considered to be a routine physical?
On an annual basis, you may seek the services of your provider to conduct a routine physical. A routine physical is a periodic comprehensive preventive medicine reevaluation and management of an individual.

The eligible reimbursed expenses will vary depending on the age, gender, history, examination, risk factor reduction interventions and ordering of appropriate immunizations, laboratory/diagnostic procedures.

Please explain the value of using the prescription mail order program.
For 2 times the retail co-pay, you receive 3 times the medication by using the Mail Order Service available through SavRX. It is common to use these services for ongoing needed medications.  Please contact SavRX directly at 866-233-IBEW for any questions regarding your prescription drug plan.

How are claims processed through the Prudent Buyer Network and then processed by our Administrator, United Administrative Services (UAS)?
Your Administrator, United Administrative Services (UAS), has been approved by Anthem Blue Cross of California (Prudent Buyer Network) to process claims utilizing the Prudent Buyer Network (PPO) discounts.  After seeking services through a Prudent Buyer (PPO) network, your provider will send all necessary paperwork to Prudent Buyer (PPO), who will in turn work with UAS to provide the specifics of reimbursement. UAS will process the claim and send an explanation of benefits on how the claim was processed.

Please contact United Administrative Services directly at (408) 288-4400 should you have any questions on your claim. Anthem Blue Cross cannot answer questions about your specific claim.

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