How the CAP Works
The CAP is a fee-for-service plan that provides coverage worldwide, so care may be received from any physician or hospital of your choice. Participants of the CAP are not required to go to an Anthem PPO network provider to receive the highest level of Plan benefits and are not required to choose a primary care physician.
In California, Plan members can use the Anthem Blue Cross Prudent Buyer PPO network if they wish. Members who choose to use network providers benefit by having coinsurance based on the negotiated rate, being assured that they will not be balance billed, and being alleviated of the burden of paying up front, since network providers must bill Anthem Blue Cross first. However, there is no penalty for not using a network provider.
Outside of California, Plan members may use the BlueCard PPO network if they wish. These are providers located across the country who have agreed to provide services at negotiated rates. However, there is no penalty for not using BlueCard network providers. These providers participate in one of the local Anthem Blue Cross Blue Shield plan PPO networks and are available to you through the BlueCard Program, although they do not contract directly with Anthem Blue Cross. Also available are traditional providers who might not participate in a BlueCard PPO network, but who have agreed to provide PPO members with health care services at a discounted rate. To locate BlueCard PPO providers, you may call Anthem Blue Cross Member Services at 800-964-0530 or you can visit Anthem Blue Cross' website at www.anthem.com/ca/pge or www.anthem.com/ca/pge.
Outside of the United States, only emergency/urgent care is covered.
Please remember, you have a responsibility to work together with the physician(s) you select to ensure that all your medical needs are appropriately met, and to notify the appropriate Medical Management program when pre-authorization is required. (See "Medical Management Programs" for more information.)