MMC Benefits Handbook
Networks
Anthem BCBS Blue Card PPO Broad network is available nationally and provides both in-network and out-of-network coverage.
Anthem BCBS National Blue High Performance Network (Blue HPN), the Narrow Network, is available in 50+ locations. There is no coverage outside these locations, except for urgent and emergency care. There are some providers in New Jersey and Philadelphia that are listed as Tier 2 on Anthem BCBS's provider search (National Blue High Performance Network (Blue HPN)) that can be used and are covered at the out-of-network benefit level. Providers not labeled as Tier 2 cannot be used for out of network coverage.
Is there a network of doctors and hospitals that I have to use?
Using the network is not mandatory under the broad network, but generally, you will receive a higher reimbursement when using the network. If you use an in-network provider, you will be reimbursed 80% (70% under the $2,850 Deductible Plan). If you use an out-of-network provider, you will be reimbursed 60% (50% under the $2,850 Deductible Plan) of reasonable and customary charges for covered expenses after the Plan's deductible has been met.
In the event that you receive care from an out-of-network doctor (such as an anesthesiologist) while being treated at an in-network facility, benefits will be paid at the in-network level.
The network includes general practitioners, as well as specialists and hospitals. These network providers are selected by and contracted with the Claims Administrator.
NOTE: Out-of-network services are not covered under the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN)) except for urgent and emergency care. There are some providers in New Jersey and Philadelphia that are listed as Tier 2 on Anthem BCBS's provider search (National Blue High Performance Network (Blue HPN network)) that can be used and are covered at the out-of-network benefit level. Similar to the broad network, if you use an in-network provider, you will be reimbursed 80% (70% under the $2,850 Deductible plan). If you use an out-of-network provider, unlike the broad network, you will not be reimbursed and will be responsible for 100% of the out-of-network charges, except for urgent and emergency care and certain providers in New Jersey and Philadelphia that are listed as Tier 2 on Anthem BCBS's provider search as noted above. Providers not labeled as Tier 2 cannot be used for out of network coverage.
Where can I get a directory that lists all the doctors and hospitals in the network?
The doctors and hospitals in the network are listed in a provider directory. The Claims Administrator provides an online directory of providers or you may call the Claims Administrator.
Network provider lists can change, so take the time to review the networks to determine which networks your health care providers participate in before choosing a carrier and network.
Finding your ZIP code in the provider search does not mean that you are eligible for a narrow network; you must confirm you're eligible for a narrow network in the Mercer Marketplace Benefits Enrollment Website. Anthem BCBS determines the ZIP codes that are included within their narrow network.
Call Member Services at +1 855 570 1150 or visit anthem.com. On the Anthem website:
  • Select Find a Doctor/Find Care.
  • For the Broad and Narrow Network: Select Guests, answer a few questions (listed below) and then select Continue.
    • What type of care are you searching for? Select Medical
    • What state do you want to search with? Select a State
    • What type of plan do you want to search with? Select Medical (Employer-Sponsored)
    • Select a plan/network?
  • For the Narrow Network: Select National Blue High Performance Network (Blue HPN)
  • Note: Providers indicated as Tier 2 represent New Jersey and Philadelphia providers who are subject to the out-of-network benefit.
  • For the Broad Network: Select National PPO (BlueCard PPO)
  • Enter provider's name, specialty or location.
Is there a network of providers for mental health treatment?
There is a network of mental health providers. Providers in the network are listed in a provider directory. The Claims Administrator provides an online directory available at www.anthem.com. You may also call the Claims Administrator.
Is there a network of pharmacies?
There is a pharmacy network associated with this Plan. You may use a pharmacy in the network as well as out-of-network to receive coverage under this Plan.
Note that when you go to a pharmacy that's out-of-network, you need to submit a claim form for reimbursement. Refer to "How do I file a prescription drug claim form?" for more information.
The Pharmacy Benefits Manager provides an online directory of network pharmacies available at http://www.express-scripts.com/.
To locate an in-network retail pharmacy:
Or call Express Scripts at +1 800 987 8360 for more information.