BlueAdvantage HMO Plan
A personal doctor. A plan for your routine health care as well as the unexpected — without complicated paperwork or hassles. Quality, affordability and ease of use are what you’ll find with our BlueAdvantage HMO plan.
PCP/PMG Coordinated Care.
When you enroll, you choose a primary care physician (PCP) or primary medical group (PMG) from the HMO Nevada provider network
of internists, pediatricians and family practice doctors. Your PCP/PMG provides all preventive care and routine treatment, coordinates non-emergency hospital care, and can assist with referrals. Your PCP/PMG plays an essential role in the overall coordination of your health care by ensuring consistency and quality of care, which helps to keep your plan affordable and easy to use.
Convenient Copayment Plan Design. You pay a flat amount for most types of care such as doctor office visits. After your copayment is paid, most services are covered at 100 percent, so you don’t have to worry about meeting deductibles or being surprised with medical bills. When you visit your PCP/PMG or an in-network specialist, the doctor will also file claims and submit other paperwork for you.
Referral-free Access to Any In-network Physician Specialist. With our new open access policy, you may visit any in-network physician specialist simply by scheduling an appointment. While you’re not required to visit your PCP/PMG for a referral, we believe your PCP/PMG is an important source of health care information. For the best possible coordination of care, we encourage you to use your PCP/PMG for the overall coordination and consistency of your care, as well as for referral guidance.
Although members are not required to obtain a referral for in-network physician specialist visits, preauthorization is required for some services and procedures. Please see our Referrals and Preauthorization FAQ
for more information.
Worldwide Emergency Care. BlueAdvantage HMO covers you anytime, anywhere, for emergency care. Simply call 911 or go immediately to the nearest emergency facility. You will be responsible for your emergency room copayment, which will be waived if you are admitted to the facility.
Urgent Care. Benefits are provided for visits to urgent care centers, clinics or other facilities for non-emergency, after-hours medical conditions. Urgent care is a convenient alternative when your physician’s office is closed and you need prompt medical attention. Choosing an urgent care facility when appropriate, instead of an emergency room, usually reduces your out-of-pocket expenses.
Away from Home CareSM
. When you travel, your health care coverage goes with you. For trips under 90 days, you have access to doctors and hospitals almost everywhere, should your condition require attention before you return home. Call 800-810-BLUE toll free, or locate a doctor or specialist at www.bcbs.com
Guest Membership. Courtesy membership is offered when you are residing outside your HMO Nevada service area for 90 days or more. Some states are not included in the program. To apply, call 800-827-6422 toll free.
Benefits: BlueAdvantage HMO Plan
Following is a partial listing of the plan benefits:
| Physician office services and consultations |
| Preventive care services, including routine gynecological exams and mammograms, prostate cancer screenings, well-baby/well-child care and immunizations for children, and routine eye examinations performed once every 24 months by a network provider |
| Maternity and newborn care, including diagnosis, care during pregnancy and delivery services |
| Prescription drugs from nearly all independent and chain-store pharmacies in the state, plus economical mail-order drugs, where available |
| Hospital treatment and inpatient/outpatient surgery |
| Laboratory and X-ray services |
| Urgent and emergency care and ambulance services |
| Many family planning services, including oral and injectable contraceptives, contraceptive devices, and sterilization |
| Physical, occupational and speech therapies |
| Behavioral/mental health care with alcohol/chemical dependency rehabilitation treatment services |
| Home health aide, nursing and therapy services, and hospice care |
Features: BlueAdvantage HMO Plan
In addition to basic health plan benefits such as preventive care, urgent and emergency care, and coverage for hospital treatment and surgery, BlueAdvantage HMO offers Anthem Healthy SolutionsSM to educate and guide you toward better health.
| Prevention education programs encourage you to have important health screenings and immunizations, and to visit your doctor regularly to prevent illness. Maternity wellness programs are also offered. |
| Disease management programs are offered for asthma, diabetes, coronary artery disease, congestive heart failure and end-stage kidney disease. BlueAdvantage HMO also offers a high-risk maternity program for those mothers needing extra guidance. Participation is voluntary and confidential. Call 877-236-7486 toll free for more information. |
| MyAnthem™. This personalized secure member website offers easy, streamlined access to self-service tools and information. Log in and enjoy one-click access to claims and benefits information; search the online provider directory for a doctor or pharmacy; view health and wellness information; use the Healthcare Advisor™ tool to learn about a medical condition and compare hospitals; view drug interactions, drug side effects and more with the PharmaAdvisor™.|
| MyHealth@Anthem and MiSalud@Anthem. These award-winning online health and wellness information resources feature WebMD Personal Health Manager – personalized and interactive tools to help members assess and manage their health, make informed health care decisions and promote healthier lifestyle choices. |
| SpecialOffers@Anthem. This site offers convenience and savings on retail products and services. Shop for a personalized weight-loss program; nutrition and alternative wellness products; vitamins; homeopathic and herbal remedies; laser vision correction and contact lenses; smoking cessation products; baby, toddler and maternity products; fitness club membership and fitness equipment; and much more! |
For more information about HMO Nevada’s group health plans, contact a Group Sales representative at 775-448-4000 for northern Nevada, or 702-228-2583 for southern Nevada.
The Strength and Security of Blue.
BlueAdvantage HMO is brought to you by HMO Nevada, a subsidiary of Anthem Blue Cross and Blue Shield. With $16 billion in revenue and more than 12 million plan members across the country, Anthem is proud to carry on the tradition of bringing you the health plans you prefer from a company you can count on.
As the only licensed Blue Cross and Blue Shield health care benefits insurer in Nevada, Anthem Blue Cross and Blue Shield offers the strength and security that comes with being one of the largest, most-experienced health insurance organizations in the nation. Nearly one in three Americans enjoys the benefits of coverage from Blue Cross and Blue Shield plans.