Active Health Summary Plan Description
As of September 1, 2017
En Español (PDF)

Article 6: Comparison of Anthem Blue Cross PPO, Kaiser HMO and UnitedHealthcare HMO Medical Plans

The benefits chart titled "Medical Benefits Comparison: Anthem Blue Cross, Kaiser and UnitedHealthcare" is only a representative summary of the coverage and benefits available under the two HMO plans, Kaiser and UnitedHealthcare and the Anthem Blue Cross PPO plan. It does not fully describe your coverage and benefits under either the PPO or the HMO plans. For details on your coverage and benefits, please refer to the respective PPO or HMO's Evidence of Coverage document. The Evidence of Coverage document is the legal document that describes the benefits, limitations, exclusions, and other coverage provisions provided by either the PPO or HMO to its members. The current Evidence of Coverage document is available directly from the HMO (Kaiser or UnitedHealthcare) or the PPO (Anthem Blue Cross) as well as from the Administrative Office (or on www.scibew-neca.org) upon request.

An HMO physician must determine that the services and supplies are medically necessary to prevent, diagnose, or treat your medical condition. The services and supplies must be provided, prescribed, authorized, or directed by an HMO physician. You must receive the services and supplies at an HMO facility inside the HMO's service area, except where specifically noted to the contrary in the respective HMO's Evidence of Coverage document.

For details on the benefit and claim review and adjudication procedures for either the HMO or the PPO plan, please refer to the respective HMO or PPO's Evidence of Coverage document or contact the HMO or PPO's Membership Services Department at:

Anthem Blue Cross: (800) 543-3037
Kaiser: (800) 464-4000
UnitedHealthcare: (800) 624-8822

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