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Explains how benefits are provided to eligible Members through Anthem Blue Cross and Blue Shield as administrative claims processor, including coverage conditions, limitations, exclusions, deductibles, and coinsurance. 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You should read this booklet carefully to familiarize yourself with the Plan’s main provisions and keep it handy for reference. A thorough understanding of Your coverage will enable You to use Your benefits wisely. If You have any questions about the benefits as presented in this Benefit Booklet, please contact Your Employer’s Group Health Plan Administrator, or call the Claims Administrator’s Member Services Department.  \nThe Plan provides the benefits described in this Benefit Booklet only for eligible Members. The healthcare services are subject to the Limitations and Exclusions, Deductible, and Coinsurance requirements specified in this Benefit Booklet. Any group plan or certificate which You received previously will be replaced by this Benefit Booklet.  \nYour Employer has agreed to be subject to the terms and conditions of Anthem Blue Cross and Blue Shield’s Provider agreements, which may include Precertification and utilization management requirements, timely filing limits, and other requirements to administer the benefits under this Plan.  \nAnthem Blue Cross and Blue Shield, or “Anthem” is an independent licensee of the Blue Cross and Blue Shield Association. Anthem Blue Cross and Blue Shield is a registered trademark of Anthem Insurance Companies, Inc., designated by Your Employer to provide administrative services for Your Employer’s Group Health Plan. These administrative services may include claims processing, care management, arranging a network of healthcare Providers whose services are covered by the Plan, and other services.  \nImportant: This is not an insured benefit Plan. The benefits described in this Benefit Booklet or any rider or amendments attached hereto are funded by the Employer who is responsible for their payment. Anthem provides administrative claims payment services only and does not assume any financial risk or obligation with respect to claims.  \nAnthem is an independent corporation operating under a license from the Blue Cross and Blue Shield Association, permitting Anthem to use the Blue Cross and Blue Shield Service Marks. Although Anthem is the Claims Administrator, You will have access to Providers participating in the Blue Cross and Blue Shield Association BlueCard® PPO network across the country. Anthem has entered into a contract with the Employer on its own behalf and not as the agent of the Association.  \nMany words used in this Benefit Booklet have special meanings, like Covered Services, Network Provider, and Medical Necessity. These words are capitalized and are described in the Definitions section. Please refer to these definitions for the best understanding of what is being stated. Throughout this Booklet there may be references to “we,” “us,” “our,” “You,” and “Your.” The words “we,” “us,” and “our”mean Anthem or any of its subsidiaries, affiliates, subcontractors, or designees. The words “You” and “Your” mean the Member, Subscriber, and each Covered Dependent.  \nHow to Obtain Language Assistance  \nAnthem is committed to communicating with our Members about their health Plan regardless of their language. Anthem employs a language line interpretation service for use by all of our Member Services Call Centers. Simply call the Member Services phone number on the back of Your Identification Card, and a representative w","cbCaigZaI1Ijcwic","https://ap.wps.com/l/cbCaigZaI1Ijcwic","pdf",2146198,208,"English","# WELCOME\n# How to Obtain Language Assistance\n# Verification of Benefits\n# Schedule of Benefits\n# Total Health and Wellness Solution\n# Eligibility\n# How Your Plan Works\n# Healthcare/Medical Management – Precertification\n# Benefits\n# Limitations and Exclusions\n# Claims Payment\n# Your Right to Appeal\n# Coordination of Benefits (COB)","[{\"question\":\"What is the Healthy Focus Essential HSA Plan benefit booklet used for?\",\"answer\":\"It describes the benefits available while enrolled in the healthcare Plan offered by the Member’s employer, including the plan’s main provisions and how benefits apply to eligible Members.\"},{\"question\":\"Who administers the plan and how does Anthem relate to the coverage?\",\"answer\":\"Anthem Blue Cross and Blue Shield provides administrative claims payment services and does not assume financial risk. The Employer funds the benefits described in the booklet, and Anthem administers based on Provider agreements.\"},{\"question\":\"How can Members get language assistance or verify benefits?\",\"answer\":\"Members can call the Member Services phone number on the Identification Card for language-line interpretation and can also use TTY/TDD via 711. Verification of benefits is available by calling Member Services and is not a guarantee of payment for a specific procedure.\"}]","Medical Benefit Booklet - Healthy Focus Essential HSA Plan - Effective 01/01/2025 | PDF",1790410556,524]