The City of Atlanta offers two high-deductible and two traditional Medical Plan options.
Each of the plans cover 100% of in-network preventive care, even before you meet the deductible. Each of the plans also provide prescription drugs according to a tiered coverage system. You will pay the least for prescriptions when you choose generics and/or use the mail order service.
This year, consider the two high-deductible plans. Though the deductible is higher than in a traditional plan, the paycheck contribution is significantly lower. This means your out-of-pocket costs for the year might be less than what you would pay under a traditional plan option.
The Anthem BCBS HDHP Blue Open Access Plan with Health Savings Account (HSA) is called a “high-deductible” plan because the initial deductible is higher than under the traditional plans. In return, however, you pay a lower premium.
Under the Anthem BCBS HDHP plan, you may receive care from either in-network or out-of-network providers. No gatekeeper or primary care referral is required for specialist visits when you use in-network providers.
To receive the highest level of reimbursement (80%), you should obtain services inside the nationwide network. You will receive a lower level of reimbursement for out-of-network care (60%) and pay more of the costs.
The Anthem BCBS HDHP plan allows you to participate in a Health Savings Account (HSA), which can help you meet the deductible and save for future healthcare expenses.
The Kaiser HMO HDHP is called a “high-deductible” plan because the initial deductible is higher than under the traditional plans. In return, however, you pay a lower premium.
Under the Kaiser HMO HDHP, only in-network care is covered (90% after deductible).
The Kaiser HMO HDHP allows you to participate in a Health Savings Account (HSA), which can help you meet the deductible and save for future healthcare expenses.
The Anthem BCBS POS Blue Open Access Plan offers in- and out-of-network coverage. No gatekeeper or primary care referral is required for specialist visits when you use nationwide in-network providers.
Services that do not require a Primary Care Provider (PCP) referral include:
For in-network services, your PCP or specialist will be responsible for ensuring that any surgical procedures or inpatient admissions obtain the necessary prior authorization from Anthem BCBS.
The Kaiser HMO covers in-network services only. If you go out-of-network, the plan will not cover that care.
When you join Kaiser Permanente, you pick a Primary Care Physician (PCP) within the Kaiser network. You may choose a physician in family medicine, general practice, adult medicine, or pediatrics/adolescent medicine as a personal physician. If you do not choose a PCP during enrollment, one will be assigned to you.
You may self-refer for Mental Health/Chemical Dependency, Dermatology and OB/GYN care. All other specialty care services require prior authorization from your PCP.
No referral is required for specialty services available at Kaiser Permanente Medical Centers. A referral is required for specialty care outside of a Kaiser Permanente Medical Center.
Currently, Kaiser Permanente has 26 conveniently located medical centers throughout metro Atlanta. For a listing of the providers covered under the Kaiser Permanente plan, please visit www.kp.org.
There is one number to call to make or cancel appointments, speak with an advice nurse, or access after-hours urgent care — regardless of which Kaiser Permanente Medical Center you use. Call the Health Line at 404-365-0966 locally or 800-611-1811 long distance.
To schedule or cancel appointments, you may call Monday through Friday from 7 a.m. to 7 p.m. The Health Line is open so you can speak with an advice nurse 24 hours, seven days a week. You also may schedule and cancel appointments yourself by logging into www.kp.org.
