Health Benefits » Medical Insurance

Medical Insurance

 
 

Our current plan is Anthem Blue Cross PPO.  This plan is administered through SISC. 

  • Member and Provider services can be reached at 1-800-322-5709. Please contact them with any eligibility, claims or plan questions.  They will also assist you when needing to order new Medical/Prescription cards.
  • ASH (Physical Medical Authorization) can be reached at 1-800-872-8276.  Please contact them with any physical therapy, occupational therapy or chiropractic care authorizations or concerns.
  • Utilization Review (AIM) can be reached at 1-877-291-0360.  Please contact them regarding any authorization/pre-certification on imaging procedures.  This includes scans-CT, MRI, Petscans.
 

Effective October 1, 2015, our plan will be implementing the following updates:

  • Out Of Network Providers:  X-ray, Lab, Durable Medical Equipment and Physical Medicine provided by non-participating providers will no longer be covered.  Physical Medicine includes chiropractic, physical and occupational therapy.  This change does not apply to emergencies.  To verify if a provider or facility is contracted please contact Member Services at 1-800-322-5709.
  • Hip, Knee and Spine Inpatient Surgical Benefit Update:  The Blue Distinction Specialty Plus program will be implemented for inpatient Hip and Knee replacement procedures and inpatient Spine procedures.  Members considering these types of procedures must contact Member Services to obtain information regarding in-network facilities for the procedure request.  Blue Distinction Specialty Care Program designated facilities must meet quality and cost criteria.  A travel benefit will be available for members who do not have access to a covered facility in their area.  Member Services can be reached at 1-800-322-5709 to provide assistance to members with questions regarding this program.
 
Effective October 1, 2018, our plan will be implementing the following updates:
 
  • The following out patient procedures that do not require an overnight hospital stay will be performed at an ambulatory surgery center, ASC. This includes:  Arthroscopy, Cataract surgery, Colonoscopy, Upper GI Endoscopy with and without Biopsy.  
If you use an in-network outpatient hospital facility you will be responsible for the regular deductible and coinsurance  PLUS any amount by which the hospital charge exceeds the maximum benefit. *The benefit includes a simple process to exempt the member if the physician provides clinical justification for using a hospital.  It also allows exceptions when:  a member lives more than 30 miles from an ASC and a hospital that offers the service for less than the maximum benefit; or if a procedure cannot be scheduled in a medically appropriate timely manner due to available ASC,s not having capacity.  
 
 

Please find the links below for additional information.