Medical Plan Details

PREFERRED PROVIDER ORGANIZATION (PPO)

PPO

We offer two Preferred Provider Organization (PPO) plans through Anthem Blue Cross for all employees across the country. The PPO plans allow you the opportunity to choose from either a participating provider or to use a provider or hospital that is not contracted with Blue Shield. The network of available providers is extensive. The best means of locating a preferred provider in your area is by using the online provider directory.

To search for providers:

Medical services before July 1, 2025 - Visit HNAS/Anthem page (click here)

Medical services on July 1, 2025 and after - Visit Blue Shield page (click here)

Freedom of Choice

A PPO plan is a program that allows considerable range of freedom. You may make any number of elections as to how and where you receive care. The out-of-pocket expense for the PPO program is best managed by always first seeking care from a contracted PPO preferred provider.

Brief Benefit Description

You have two PPO plan options to choose from.

The Standard PPO plan includes a $20 co-payment for outpatient office-visits. There is a $250/$500 individual/family calendar-year deductible plan or a $500/$1,000 individual/family calendar-year deductible plan. The Plan pays 90% of the negotiated fees for a PPO preferred provider, and 70% of negotiated fees for a non-contracted provider.

Click Here for Anthem Summary of Benefits and Coverage (6-30-2025 and prior)

Click Here for Blue Shield Summary of Benefits and Coverage (7-1-2025 and after)

Haga clic aquí para obtener detalles sobre los beneficios de Blue Shield. (7-2-2025 and after)

Click Here for Plan Details

The Choice PPO plan includes a $30 co-payment for outpatient office-visits. There is a $1,500/$3,000 individual/family calendar-year deductible plan or a $3,000/$6,000 individual/family calendar-year deductible plan. The Plan pays 80% of the negotiated fees for a PPO preferred provider, and 60% of negotiated fees for a non-contracted provider.

Click Here for Anthem Summary of Benefits and Coverage (6-30-2025 and prior)

Click Here for Blue Shield Summary of Benefits and Coverage (7-1-2025 and after)

Haga clic aquí para obtener detalles sobre los beneficios de Blue Shield.

Click Here for Plan Details

Preferred providers accept Anthem’s allowable amount as full payment for covered services. Non-preferred providers can charge more than these amounts. When you use non-preferred providers, you must pay the applicable copayment plus any amount that exceeds Anthem’s allowable amount. Click on the Benefit Summary below for specific details of this plan.

Exclusive Provider Organization

HM.Clause offers a single Exclusive Provider Organization (EPO) plan through Anthem for employees located in California. With an EPO plan, you’re free to choose your doctor without referrals. However, your benefit coverage is limited to only within the PPO network. If you seek care from a provider outside of the EPO network, you may be responsible for the full cost of the services and your services won’t be covered. 

To search for EPO Plan providers:

Medical services before July 1, 2025 - Visit HNAS/Anthem page (click here)

Medical services on July 1, 2025 and after - Visit Blue Shield page (click here)

Limited Freedom of Choice

An EPO plan is a program that allows a limited range of freedom. You may make any number of elections as to how and where you receive care. The limitation to the EPO plan is that you must seek care from a contracted PPO preferred provider, and you cannot receive care from a provider that is out-of-network.

Click Here for Anthem Summary of Benefits and Coverage (6-30-2025 and prior)

Click Here for Blue Shield Summary of Benefits and Coverage (7-1-2025 and after)

Haga clic aquí para obtener detalles sobre los beneficios de Blue Shield.

Click Here for EPO Plan Details

Brief Benefit Description

The EPO plan includes a $20 co-payment for outpatient office-visits. There is a $250/$500 individual/family calendar-year deductible. The Plan offers copays when seeking services through a PPO preferred provider. Click on the Benefit Summary below for specific details of this plan.

This is a High Deductible Health Plan (HDHP) offered by HM.Clause that is designed to work alongside a special Health Care Savings Account (HSA).  The HDHP works much like the PPO plan, in that members have the choice of using in-network PPO providers or providers not contracted with the health plan.  However, there is no first dollar coverage on a HDHP.  The member must first satisfy their deductible.

Consumerism

The intent of the HDHP is to allow the member to see and pay for all claims that are incurred, prior to the deductible.Once the deductible is satisfied, the plan performs much like our traditional PPO plan.

To search for HDHP In-Network providers:

Medical services before July 1, 2025 - Visit HNAS/Anthem page (click here)

Medical services on July 1, 2025 and after - Visit Blue Shield page (click here)

Freedom of Choice

A PPO plan is a program that allows considerable range of freedom. You may make any number of elections as to how and where you receive care. The out-of-pocket expense for the PPO program is best managed by always first seeking care from a contracted PPO preferred provider.

Brief Benefit Description

The HDHP has an in-network $1,650 deductible for individuals and $3,300 for families (out of network deductibles are $3,000/individual and $6,000 for families). All expenses incurred before the deductible are bore by the insured. 

After the deductible, the Plan pays 80% of the negotiated fees for a PPO preferred provider, and 60% of negotiated fees for a non-contracted provider. Preferred providers accept Anthem’s allowable amount as full payment for covered services. 

Non-preferred providers can charge more than these amounts. When you use non-preferred providers, you must pay the applicable copayment plus any amount that exceeds Anthem’s allowable amount. Click on the Benefit Summary below for specific details of this plan.

Click Here for Anthem HDHP Summary of Benefits and Coverage (6-30-2025 and prior)

Click Here for Blue Shield HDHP Summary of Benefits and Coverage (7-1-2025 and after)

Haga clic aquí para obtener detalles sobre los beneficios de Blue Shield.

Click Here for HSA Plan Detail 

Invest in your health, tax-free

A Health Savings Account (HSA) is like an IRA for your healthcare that empowers you to prepare for and manage healthcare costs — both today and tomorrow. The account is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit.

Usage

Your HSA can be used to pay for all eligible expenses (typically, prescribed medical or health-related services). Examples of eligible expenses include medical deductibles, copayments, coinsurance, prescription eye care, and dental care expenses.

Tax Benefit

Participants deposit money into an HSA on a pre-tax basis. Meaning, they won't pay regular federal income tax on the HSA deposit. Additionally, most states will also honor pre-tax deposits into the HSA (California is a state that does not honor HSA deposits). HSA funds spent on eligible expenses are not taxed.

Limits

In 2024, the IRS will allow up to $4,150 for individuals, and $8,300 for families, to be deposited into the HSA account.

Use it or Keep it

Unlike the Flexible Spending Account (FSA), unspent HSA funds are allowed to roll over into the next plan year.

Rules

To participate in the HDHP, the following rules apply:

• You may not participate in any other health plan

• You cannot also participate in the Flexible Spending Account in a year you are depositing into the HSA; nor can your spouse

• You may not be covered by Medicare

• You cannot be claimed as a dependent on anyone else's tax return

Please consult with a tax professional to learn all aspects of participating and using an HSA.