Both the Advantage Plus and Advantage Plans are known as “Preferred Provider Organization” (PPO) types of plans whereby certain doctors, hospitals and other providers have agreed to provide services under the plan at negotiated discounted rates. They have also satisfied strict credentialing requirements. Under a PPO plan, you are not required to choose a Primary Care Physician (PCP), however, it is advisable to develop a relationship with a PCP, especially to receive preventive care services on a regular basis. Referrals to specialists are also not necessary and you’ll only need to file a claim form if you or a covered family member uses an out-of-network provider.

Under both medical plan options, every time you need care, you can elect to receive services from three tiers of facilities or providers:

• YNHHS Facility/Provider: Services provided and billed by Yale-New Haven Hospital, Bridgeport Hospital, Greenwich Hospital, NEMG, Grimes Center, Lawrence + Memorial and Westerly Hospitals and their affiliates. Also included is the new Primary Care Preferred Physician Network.

• Anthem PPO Provider: Use Anthem’s “Century Preferred” Network to identify in-network PPO providers or facilities. These providers have agreed to negotiated fees with Anthem, and you’ll generally pay less than you would from a non-PPO provider.

• Out-of-Network Provider: our out-of-pocket costs will be highest if you use a provider or facility that is not in the Anthem “Century Preferred” PPO Network. Anthem will pay a “Maximum Allowable Amount” for such services, and all claims are subject to applicable deductibles and coinsurance. You will be responsible to pay the provider for any amount in excess of the Maximum Allowable Amount.