Affordable Care Act (ACA)-compliant Health Plans Quick Reference Guide Plans Effective January 2019

ACA-compliant Affordable Care Act (ACA) requires non-grandfathered Individual and Small group health plans to Health Plans provide a specific health benefit package. These health plans are known as “ACA-compliant health plans.” They can be purchased from the state’s Health Insurance Marketplace, which is commonly referred to as “the exchange,” or from traditional sources, such as a sales agent.

Difference between plans purchased “on the exchange” or “off the exchange”:

 Plans purchased on the exchange – refers to individual plans purchased through the Health Insurance Marketplace (Covered California).

 Plans purchased off the exchange - refers to Individual plans purchased through other channels such as a broker, sales agent, or directly through a health insurance company (such as Anthem Blue Cross).

Network Names Network Name for plans sold on the exchange:

 EPO: Pathway X – EPO Network Name for plans sold off the exchange:

 EPO: Pathway – EPO

Alpha Prefixes for Plans purchased on the exchange ACA-compliant Alpha Prefix Health Plan Benefit Option Product Type Network Name Plans YZC Individual EPO Pathway X - EPO

Plans purchased off the exchange

Alpha Prefix Health Plan Benefit Option Product Type Network Name JBE Individual EPO Pathway – EPO

1 Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Rev 10/18

Sample Member Front of member ID card (sample) Pathway X – EPO ID Cards

Back of member ID card (sample) Pathway X - EPO

2 Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Rev 10/18

Health Insurance Toll-free telephone numbers: Marketplace/ACA  Provider Services for exchange plans: 1- 855-854-1438 Plan Contact  Member Services for exchange plans: 1-855-453-7031 Information  UM Pre Authorization: 1-800-274-7767

Claims mailing address: Anthem Blue Cross P.O. Box 60007 Los Angeles, CA 90060-0007

Below is a table showing the counties located in each region where Anthem will be offering 2019 non-grandfathered Individual plans.

EPO Region County 1 Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba 7 Santa Clara 10 Mariposa, Merced, San Joaquin, Stanislaus, Tulare

There is no change for members covered under an Anthem Individual grandfathered plan.

Exchange Indicator Legend:

 Y = ON exchange  N = OFF (non-standard plan)

2019 Contract 2019 Plan Exchange Indicator 2019 Plan Name Metal Level Code Type (Y/N)

36TE $0 Cost Share EPO AI-AN EPO Bronze Y

36TF Anthem Bronze 60 D EPO EPO Bronze N

36TG Anthem Bronze 60 EPO EPO Bronze Y

36TH $0 Cost Share HDHP AI-AN EPO Bronze Y

36TJ Anthem Bronze 60 D HDHP EPO EPO Bronze N

36TK Anthem Bronze 60 HDHP EPO EPO Bronze Y

36TM Anthem Bronze Pathway EPO 5250 EPO Bronze N

36TN Anthem Bronze Pathway EPO 6900 Online Plus EPO Bronze N

36TP Anthem Bronze Pathway EPO 5850 EPO Bronze N

36TX Anthem Bronze 60 EPO AI-AN EPO Bronze Y

3 Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Rev 10/18

36TY Anthem Bronze 60 HDHP EPO AI-AN EPO Bronze Y

36U2 Anthem Silver 70 EPO EPO Silver Y

36U3 $0 Cost Share EPO AI-AN EPO Silver Y

36U4 Anthem Silver 70 EPO AI-AN EPO Silver Y

36U5 Anthem Silver 73 EPO EPO Silver Y

36U6 Anthem Silver 87 EPO EPO Silver Y

36U7 Anthem Silver 94 EPO EPO Silver Y

36UE Anthem Silver 70 Off Exchange EPO EPO Silver N

36TL Anthem Gold 80 D EPO EPO Gold N

36TZ Anthem Gold 80 EPO EPO Gold Y

36U0 $0 Cost Share EPO AI-AN EPO Gold Y

36U1 Anthem Gold 80 EPO AI-AN EPO Gold Y

36TB $0 Cost Share EPO AI-AN EPO Platinum Y

36TC Anthem Platinum 90 D EPO EPO Platinum N

36TD Anthem Platinum 90 EPO EPO Platinum Y

36TW Anthem Platinum 90 EPO AI-AN EPO Platinum Y

36T9 Anthem Minimum Coverage D EPO EPO Catastrophic N 36TA Anthem Minimum Coverage EPO EPO Catastrophic Y

4 Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Rev 10/18