How the Retiree Optional Plan (ROP) Works
The ROP is a fee-for-service plan that provides coverage worldwide, so you can receive care from any licensed doctor or hospital. After you pay an annual deductible, the ROP will pay a percentage of allowed expenses. You are responsible for paying any deductibles, coinsurance, or any fees in excess of the "Customary and Reasonable" Charges (Eligible Expenses).
For Medicare-eligible members, the ROP provides Medicare secondary coverage. Claims are processed in a fashion similar to the way in which the Comprehensive Access Plan (CAP) processes claims for Medicare-eligible members.
In California, non-Medicare ROP members can use the Anthem Blue Cross Prudent Buyer PPO network. There is no penalty for not using these providers. Members who choose to use network providers can benefit by having coinsurance based on the often lower 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. You can locate network providers by calling Anthem Blue Cross directly or by visiting its website.
Outside of California, non-Medicare ROP members may use the BlueCard PPO network. 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 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 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.
Medicare-eligible members need not use Anthem Blue Cross network providers. You will not be financially disadvantaged if you seek eligible care through any licensed provider who accepts Medicare reimbursement rates.
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.)