City of San Jose, California moves to Medicare Advantage plan under Anthem Blue Cross

Category: Medicare

Effective January 1, 2020, the City of San Jose, CA will offer an Anthem Medicare Preferred (PPO) and a Senior Secure (HMO) Medicare Advantage plan. 

 

Providers may call Provider Services at 1-833-848-8730 for eligibility, prior authorization (PA) requirements and any questions about the City of San Jose member benefits or coverage.

 

Detailed PA requirements are also available to contracted providers by accessing the provider self-service tool via the Availity Portal.

 

Providers will follow their normal claim filing procedures for City of San Jose member claims.

 

Anthem Medicare Preferred (PPO) plan:

Anthem will provide medical benefits for the City of San Jose retirees through the Local Preferred Provider Organization (LPPO) product under Anthem. The plan includes the National Access Plus benefit, which allows members to receive services from any provider, as long as the provider is eligible to receive payments from Medicare.

 

Non-contracted providers may continue treating City of San Jose members and will be reimbursed at 100% of Medicare’s allowed amount for covered services, less any member cost share. 

 

City of San Jose members’ copay or coinsurance percentage will be the same whether their provider is in- or out-of-network. Locally or nationwide, doctors or hospitals, in- or out-of-network — the member’s cost share doesn’t change.

 

The Medicare Advantage Part D (MAPD) plan offers the same hospital and medical benefits that Medicare covers and also covers additional benefits that Medicare does not, such as an annual routine physical exam, hearing, vision, chiropractic care, acupuncture, LiveHealth Online® and SilverSneakers®.

 

The prefix on Medicare Advantage PPO ID cards is MBL. 

 

Senior Secure (HMO) Medicare Advantage plan:

Retirees with Medicare Parts A and B, or Part B only who reside in select California counties are eligible to enroll in the Senior Secure (HMO) Medicare Advantage plan. The MAPD plan offers the same hospital and medical benefits that Medicare covers and also covers additional benefits that Medicare does not, such as an annual routine physical exam, hearing, vision, chiropractic care, acupuncture, LiveHealth Online® and SilverSneakers®.

 

The prefix on Medicare Advantage HMO ID cards is MHG.

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