How is the Anthem PPO different than the Kaiser HMO?

With the Kaiser HMO, you choose a primary care physician (PCP) and can only see providers who participate in Kaiser’s network. The Anthem PPO is more flexible. It doesn’t require you to choose a PCP. It also offers out-of-network coverage for providers who aren’t in Anthem’s PPO network, although your out-of-pocket costs are greater when you use an out-of-network provider.

Also, the Anthem PPO is different in how it covers medical care. For most covered expenses, you pay a calendar year deductible before the PPO starts paying benefits. Then, you and the PPO share expenses (called “coinsurance”) until you reach the plan’s calendar year out-of-pocket maximum. At that point, the PPO pays 100% of covered expenses for the rest of the calendar year.

IMPORTANT: The PPO pays 100% of the cost of in-network routine preventive care (like your annual physical) and related lab fees and tests with no deductible.

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