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Below form for California only

Or you can fill in this form to have your Anthem Blue Cross Health Insurance brochure with pricing & application mailed to you. Further information on our plans is shown below. Or just call us Toll-free at 1-877-Look4Life (1-877-566-5454).

Customer Information
Name
E-mail
Street address
City
County
State
Zip Code
Home Phone
Work Phone
FAX

Coverage Requested - Choose a Plan
My Age
Smoker?	Yes No
Spouse's Age
Spouse Smoker?	Yes No
People Covered	-- Please Select -- Me Only Me and 1 Child Me and Children Me and Spouse Family
PPO	Yes    No    Explanation:   A PPO is a health plan with a list of authorized doctors and hospitals. PPO's pay well if a patient is treated by a doctor or hospital on the authorized list. One usually has many potential choices of doctor and hospital with these plans.
HMO	Yes    No    Explanation:   An HMO is a health plan that requires a patient visit a specific medical facility. One's choice of medical provider (doctor and hospital) is severely curtailed.

If you're single; 19 to 29 and healthy. We have a health plan especially for you. You can get more information and even apply online (new window).

SELECTING A PLAN TYPE
Use the statements below to help determine what plan type best meets your coverage needs.

I want more control over my health care and access to any doctor or specialist I choose.	PPO PLAN
I need a lower monthly premium so I'm willing to pay more for my health care services as they occur throughout the year.	PPO PLAN
I want to pay as little as possible when I see a doctor, so I'm willing to select a specific medical group and physician to coordinate all of my health care needs..	HMO PLAN
I'm willing to pay a higher premium up front so that my costs for health care services are lower as the occur throughout the year.	HMO PLAN

Have you any comments or special instructions?

 

Planscape PPO Share Plans

PPO SHARE PLANS! 30% Copay Doctor Visits $10 Prescription Drug Benefit Low Monthly Premium $500, $1000, $1500, $2500, $5000 Deductible Plans (This means that you pay 30% of Doctor Visits, Professional Services and Hospital up to the Deductible you choose then Anthem Blue Cross pays 100% from then on up to $5,000,000 per member.) Hospital Only plans are also available Anthem Blue Cross HealthyCheck

A PPO (or Preferred Provider Organization) is a health plan with a list of authorized doctors and hospitals. PPO's pay well if a patient is treated by a doctor or hospital on the authorized list. One usually has many potential choices of doctor and hospital with these plans. PPO doctors and hospitals have an incentive to "over treat" patients because the more medical procedures they perform, the more money they make. A PPO with a high deductible will usually cost less than an HMO. Also, if you are looking for major, catastrophic coverage at a low cost, a PPO is usually your best bet.

Individual HMO Plans

$10 Doctor Visits $10 Prescription Drug Benefit 100% Coverage for X-rays and Lab Tests 100% Hospitalization Coverage No Deductibles

Customize your Family Coverage through FamilyElect: Mix & Match...you may choose a different plan for each family member.

An HMO (or Health Maintenance Organization) is a health plan that requires a patient visit a specific medical facility. One's choice of medical provider (doctor and hospital) is severely curtailed. HMO doctors and hospitals have an incentive to " under treat" patients because they are paid whether or not a patient is ill. An HMO will frequently cost more than a PPO, but with an HMO you can often see a doctor for "free" or for a small charge. Especially good for families.

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