Anthem’s New Network

[Pages:4]Pathway Essentials ? Quick Reference Guide Anthem's New Network

Pathway Essentials is an Affordable Care Act (ACA) plan sold via the Individual marketplace in 45 of 92 Indiana counties, with an exclusive arrangement with five in/out-patient facilities.

Please verify eligibility and benefits via Availity as individuals can choose to be a part of an HMO or POS* plan within the Pathway Essentials network and prefixes share multiple product options. Please see grid on Page 2

for more details. *POS only sold in Lake, La Porte and Porter counties

HMO

Health Maintenance Organization (HMO) offers care and services from doctors, other health care providers or hospitals only in the plan network

POS

Point of Service (POS) offers lower costs if doctors, health care

providers and hospitals in the plan's network are used. Think of it as an

HMO and PPO "hybrid"

Care is generally limited to doctors in the HMO's network

Typically offers lower monthly payments and out of pocket costs

No out of network coverage. Includes coverage of non-network benefits only for Urgent and Emergent authorized services. Members are responsible for 100% of non-Urgent & ER related costs

No PCP required Referrals are not required but please

refer as a courtesy to participating Pathway Essentials

Ancillary/Facility/Physician/Providers to minimize member's out of pocket expense

Out of network care is allowed, but staying in the plan's network is far

less expensive Offers the freedom to use out of network doctors and providers, but the out of pocket cost is higher than an in network doctor or provider Includes non-network benefits with

higher costs shares including deductible, coinsurance and copays

No PCP required Referrals are not required but please

refer as a courtesy to participating Pathway Essentials

Ancillary/Facility/Physician/Providers to minimize member's out of pocket

expense

Customer Service contact information:

Please refer to the back of the member's ID card for the Provider Services phone number.

Claim Mailing Address:

Anthem Blue Cross Blue Shield PO Box 105187

Atlanta, GA 30348-5187

Information as of February 2022 INBCBS-CM-003952-22-B August 2022

2022 Plan Name Anthem Bronze Pathway Essentials 5500 Anthem Bronze Pathway Essentials 5500 Anthem Bronze Pathway Essentials 5500 AI Anthem Bronze Pathway Essentials 6550 Anthem Bronze Pathway Essentials 6550 Anthem Bronze Pathway Essentials 6550 AI Anthem Bronze Pathway Essentials 8700 Anthem Bronze Pathway Essentials 8700 Anthem Bronze Pathway Essentials 8700 AI Anthem Bronze Pathway Essentials POS 5000 Anthem Bronze Pathway Essentials POS 5000 Anthem Bronze Pathway Essentials POS 5000 AI Anthem Gold Pathway Essentials 2200 Anthem Gold Pathway Essentials 2200 Anthem Gold Pathway Essentials 2200 AI Anthem Gold Pathway Essentials 2700 Anthem Gold Pathway Essentials 2700 Anthem Gold Pathway Essentials 2700 AI Anthem Silver Pathway Essentials 4000 Anthem Silver Pathway Essentials 4000 Anthem Silver Pathway Essentials 4000 AI Anthem Silver Pathway Essentials 4000 S04 Anthem Silver Pathway Essentials 4000 S05 Anthem Silver Pathway Essentials 4000 S06 Anthem Silver Pathway Essentials 5500 Anthem Silver Pathway Essentials 5500 Anthem Silver Pathway Essentials 5500 AI Anthem Silver Pathway Essentials 5500 S04 Anthem Silver Pathway Essentials 5500 S05 Anthem Silver Pathway Essentials 5500 S06 Anthem Silver Pathway Essentials 6000 Anthem Silver Pathway Essentials 6000 Anthem Silver Pathway Essentials 6000 AI Anthem Silver Pathway Essentials 6000 S04 Anthem Silver Pathway Essentials 6000 S05 Anthem Silver Pathway Essentials 6000 S06 Anthem Silver Pathway Essentials 6550 Anthem Silver Pathway Essentials 6550 Anthem Silver Pathway Essentials 6550 AI Anthem Silver Pathway Essentials 6550 S04 Anthem Silver Pathway Essentials 6550 S05 Anthem Silver Pathway Essentials 6550 S06

Information as of February 2022

Prod Type HMO HMO HMO HMO HMO HMO HMO HMO HMO POS POS POS HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

Prefix E7E K5N E7E E7E K5N E7E E7E K5N E7E S8P X6K S8P E7E K5N E7E E7E K5N E7E E7E K5N E7E E7E E7E E7E E7E K5N E7E E7E E7E E7E E7E K5N E7E E7E E7E E7E E7E K5N E7E E7E E7E E7E

Sample Member ID Card

All member ID cards will say Pathway Essentials on the front

Availity will always be your source of truth for plan, eligibility and benefit information

Referrals: Pathway Essentials plans are open access

Referrals are not required but please refer as a courtesy to participating Pathway Essentials

Ancillary/Facility/Physician/Providers to minimize members out of pocket expense

In Network Pathway Essentials Facility Providers

Methodist Hospitals (Gary & Merrillville) Memorial Hospital (South Bend) Union Hospital

Franciscan-Beacon La Porte Indiana University Health

Information as of February 2022

Please refer to our online directory for participating Ancillary and Professional physician/providers:

Pre-certification/UM

HMO

POS

In Network Provider - Provider must In Network Provider - Provider must

get precertification when required. get precertification when required.

Out of Network Provider - Member has no benefit coverage unless: The

member gets approval to use a nonnetwork provider before the service is

given or the member requires an emergency care admission*.

Blue Card Provider - Member has no benefit coverage unless: The member

gets approval to use the provider before the service is given or the member requires an emergency care admission*. Blue Card Providers must obtain precertification for all Inpatient

admissions.

*ER admissions require the provider or member to call us within 48 hours.

Please utilize Interactive Care Reviewer (ICR) on Availity for full Pre-

certification/UM requirements.

Out of Network Provider - Member must get pre-certification when

required. Member may be financially responsible for charges/costs related

to the service and/or setting in whole or in part if the service and/or setting is found not to be medically

necessary.

Blue Card Provider -Member must get pre-certification when required.

Member may be financially responsible for charges/costs related

to the service and/or setting in whole or in part if the service and/or setting is found not to be medically necessary. Blue Card Providers must

obtain precertification for all Inpatient admissions.

Pre-certification is not required to receive emergency care. ER

admissions do require the provider or member to call us within 48 hours.

Please utilize Interactive Care Reviewer (ICR) on Availity for full Pre-certification/UM requirements.

Anthem Blue Cross and Blue Shield is the trade name of: InColorado: Rocky Mountain Hospitaland Medical Service, Inc. HMOproducts underwritten by HMO Colorado, Inc. InConnecticut: Anthem HealthPlans, Inc. InIndiana: Anthem Insurance Companies, Inc. InKentucky: Anthem HealthPlans of Kentucky, Inc. InMaine: Anthem Health Plans of Maine, Inc. InMissouri (excluding 30 counties in the Kansas City area): RightCHOICE? Managed Care, Inc. (RIT), Healthy Alliance? LifeInsuranceCompany (HALIC), and HMO Missouri, Inc. RIT and certainaffiliates administernon-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RITand certain affiliates only provideadministrativeservices forself-fundedplans and do not underwrite benefits. InNevada: Rocky MountainHospitaland Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dbaHMO Nevada. InNew Hampshire: Anthem HealthPlans of New Hampshire, Inc.HMO plans are administered by Anthem Health Plans of NewHampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. InOhio: Community InsuranceCompany. InVirginia: Anthem Health Plansof Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its serviceareais al of Virginia except fortheCity of Fairfax,theTown of Vienna, and thearea east of StateRoute123. InWisconsin: Blue Cross Blue Shield of Wisconsin(BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services InsuranceCorporation (Compcare), which underwrites or administers the HMO policies; and Compcareand BCBSWi colectively, whichunderwrite or administer the POS policies. Independent licensees of theBlue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

Information as of February 2022

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