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360° Health®
A total-health solution that surrounds everyone with the help they need to live healthier, feel better and save money doing it.

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Anthem Blue Cross : Select HMO Plan

Select HMO Plan

PW_A116600
Great coverage with lower monthly premiums.
If you’re looking to save the most on HMO coverage, Select HMO offers you:  
No medical deductible. Benefits are immediate with copays for doctor visits that are designed to be affordable.
An exclusive HMO provider network allows you to choose from nearly 22,000 doctors in 22 California counties.
Maternity benefits, which support growing families.
Brand-name and generic prescription drug coverage with an affordable $10 copay on generic drugs.
Emergency coverage that travels with you. If you travel out of state, you’ll be covered in case of an emergency.
 
For extra security, we offer dental and life insurance plans that you can add to your medical coverage. 
 
If you have questions:  
Call 1-800-777-6000, Monday – Friday, 8:00 a.m. – 6:30 p.m. (PST) to speak to a licensed agent
Complete an Information Request Form
Or contact your local Anthem Blue Cross agent
Click here for our Select HMO brochure
 
 
Benefits-at-a-glance for the Select HMO plan

Plan Benefits 
Select HMO 
HMO Saver 
Individual HMO 
In-Select Network1 
In-Network 
In-Network 
Annual Deductible 
$0  
$1,500 per member
Inpatient / Outpatient Hospital Services
and Ambulatory Surgical Centers  
$0  
Annual Out-Of-Pocket Limit 
(in addition to deductible, if any) 
Individual 
$3,000 per member  
$1,500 per member  
$3,000 per member  
Family 
Each family member has an individual out-of-pocket limit. Once 2 members each reach the limit, the maximum is satisfied for the entire family  
Each family member has an individual out-of-pocket limit. Once 2 members each reach
the limit, the maximum is satisfied
for the entire family  
Each family member has an individual out-of-pocket limit Once 2 members each reach
the limit, the maximum is satisfied
for the entire family  
Lifetime Maximum
(the plan will pay up to this amount) 
Unlimited  
unlimited  
unlimited  
       
Covered Services  
The amounts shown are your share of costs after any deductible 
In-Select Network1 
In-Network 
In-Network 
Doctors’ Office Visits 
$25 copay  
$10 copay per visit  
$10 copay per visit  
Professional Services
(x-ray, lab, anesthesia, surgeon, etc.) 
No charge for
office visit-related services  
No charge for
office visit-related services  
No charge for office
visit-related services  
Hospital Inpatient
(overnight hospital stays) 
$250 copay per day
up to the first four days,
then 0% of negotiated fee
per admission  
20% of negotiated fee
(after deductible)  
20% of negotiated fee  
Hospital Outpatient
(if you don’t stay overnight) 
20% of negotiated fee
for services;
$250 per surgery  
20% of negotiated fee
(after deductible)  
20% of negotiated fee  
Emergency Room Services 
($100 copay applies for each visit;
waived if admitted as inpatient) 
20% of negotiated fee  
20% of negotiated fee
(after deductible)  
20% of negotiated fee  
Maternity  
Office Visits: $25 copay
Hospital Inpatient: $250 copay
per day up to the first four days,
then 0% of negotiated
fee per admission  
Outpatient Services: 20% of negotiated fee  
Office visits: $10 copay
Inpatient/Outpatient:
20% of negotiated fee (after deductible)  
Office visits: $10 copay
Inpatient: 20% of negotiated fee
Outpatient:
20% of negotiated fee  
Preventive Care 
$25 copay for specific
health maintenance services  
$10 copay for specific
health maintenance services  
$10 copay for specific
health maintenance services  
Ambulance 
$50 copay
(waived if admitted to hospital)  
$50 copay
(waived if admitted to hospital)  
$50 copay
(waived if admitted to hospital)  
Chiropractic Services
(up to 60 consecutive days
following an illness or injury; provided with medical group referral only) 
Inpatient 
$0  
$0  
$0  
Outpatient 
$25 copay per visit  
$10 copay per visit  
$10 copay per visit  
Prescription Drug Benefits 
Generic: $10 copay
Brand-name
: $30 copay after
$250 Brand-name prescription drug
deductible2 (2 member maximum)  
Generic: $10 copay
Brand-name
: $30 copay after
$250 Brand-name prescription drug
deductible2 (2 member maximum)  
Generic: $10 copay
Brand-name
: $30 copay after
$250 Brand-name prescription drug
deductible2 (2 member maximum)  
 

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Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.