Medical Plan Options

The Anthem BCBS HDHP with HSA plan, offered by Anthem Blue Cross Blue Shield, 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. To receive the highest level of reimbursement (80%), you should obtain services in-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.

Read more about HSAs »

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.

Read more about HSAs »

The Anthem BCBS Gatekeeper POS Plan offers in- and out-of-network coverage, coordinated by a Primary Care Physician (PCP). A PCP is a doctor who specializes in family or general practice, internal medicine or pediatrics and who participates in the BCBS Option network. Blue Cross Blue Shield of Georgia (BCBS) will designate a PCP for you if you do not elect one during enrollment. You may change your PCP by notifying BCBS of Georgia.

Services that do not require a PCP referral include:

• OB/GYN services for the treatment of an obstetrical or gynecological-related condition.
• Covered vision care services from a network ophthalmologist or optometrist. (Routine vision services may not be covered under your policy. Call customer service at 1-800-368-0766 with questions.)
• Dermatological care for skin-related conditions.
• Mental Health or Substance Abuse Benefits. (You may contact BCBS of Georgia Behavioral Health directly at 1-800-368-0766 without contacting your PCP.)

Your PCP must coordinate most in-network services. For in-network services, your PCP (or the specialist to whom you were referred by your PCP) will be responsible for ensuring that any surgical procedures or inpatient admissions obtain the necessary prior authorization from BCBS of Georgia.

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.

Specialty Care

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.

Customer Service and Health Line

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 1-800-611-1811 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.