Hospital and Medical Benefits

Learn more about eligibility and enrollment for all Health and Benefit Trust Fund plans.

Membership ID Card When you become eligible to participate in the PPO plan, you receive a membership card from Anthem. Your card has your member ID, group ID and important contact information. If you do not receive a card from Empire after becoming eligible, or to print a temporary card, visit Anthem's website at www.anthembluecross.com.

PPO stands for “Preferred Provider Organization,” which is the network of doctors, specialists, hospitals and other medical providers who offer services at discounted rates for Plan participants. Anthem's PPO network consists of thousands of medical providers in New York State and around the country. While you can visit any medical provider you choose, visiting providers in the PPO network will cost you substantially less than visiting providers outside the network.

Find a Network Provider
To find a network provider in your area, visit Anthem's website at www.anthembluecross.com. You can search for providers by name, address, specialty and hospital affiliation.

Empire’s PPO plan covers many hospital and medical services, including basic preventive screenings, doctor and specialist visits, surgical services and more.

To see a summary of certain current deductibles, coinsurances and copayments for covered hospital and medical services, download and read the schedules of benefits for the Health and Benefit Fund Hospital and Medical Plans.

• Anthem Commercial Division PPO Active & PPO Retirees Summary of Benefits effective 1/1/2022
• Anthem School Division PPO Active & PPO Retirees Summary of Benefits Effective 1/1/2022

As a participant, you share the cost of medical services with the Health and Benefit Trust Fund. There are three main ways you and the Fund split the cost:

• Deductible—A deductible is an initial amount of money you pay for certain medical services out of your own pocket before the Plan starts to pay benefits. You start by paying the full cost of medical services until you meet the deductible.
• Coinsurance—For certain services, you pay a percentage of the cost of the medical service while the Fund pays the rest. Usually, the percentage you pay when going to an In-Network provider is less than going to an Out-of-Network provider. Not every service requires you pay coinsurance.
• Copayments—For some services, you only pay a copayment, or a small, one-time fee that covers the cost of a visit. Copayments do not apply to deductibles and the amount of the copayment may differ depending on the service.

To see a summary of certain current deductibles, coinsurances and copayments for covered hospital and medical services, download and read the schedules of benefits for the Health and Benefit Fund Hospital and Medical Plans.

• Anthem Commercial Division PPO Active & PPO Retirees Summary of Benefits effective 1/1/2022
• Anthem School Division PPO Active & PPO Retirees Summary of Benefits Effective 1/1/2022

Services provided In-Network typically cost you less than if you were to visit an Out-of-Network provider. While some services are covered when going Out-of-Network, other services may not be covered at all, meaning you pay the full cost out of your own pocket.

Typically, an In-Network provider files your medical claims for you. When visiting an Out-of-Network provider, you usually fill out and file the medical claim. You must file your medical claim within one year of your visit in order to be reimbursed.

If you have to file a medical claim with Anthem for reimbursement, download and fill out the Anthem Claim Form (PDF). Once you fill out the form, mail it and any applicable documents to:

Anthem Blue Cross Blue Shield
P.O. Box 1407
Church Street Station
New York, NY 10008-1407

Anthem's member website lets you access tools and information to help you live a healthier life. The site is available 24/7. At Anthem's member website you can:

• Look up your health care claims
• Find a medical provider
• Chat with an Anthem members service representative
• Use Anthem's 360 Health® wellness program
• Visit the MyHealth wellness portal administered by WebMD

To access the site, visit www.anthembluecross.com and click on the “Member” tab. If you haven’t registered, sign up and log in to start enjoying Anthem's online benefits.

To obtain more information on how your hospital and medical benefits works and what the Anthem Blue Cross Blue Shield PPO Plan covers, you can visit the Summary Plan Description (SPD) Active & Retiree Members - Commercial Division or the Summary Plan Description (SPD) Active & Retiree Members - School Division or contact the Fund Office.