Care Options cont ’ d.
Services that are available for urgent care may vary per center. If you choose to use an urgent care center, please make sure it is in - network by calling the toll - free number on the back of your medical ID card or visiting Anthem ’ s website at anthem.com .
LAB SERVICES - Both Quest and LabCorp are Anthem preferred labs.
EMERGENCY ROOM - If you think you or your loved one may be experiencing an emergency medical condition, you should go to the nearest emergency room or call 911. An emergency medical condition is any condition (including severe pain), which you believe that without immediate medical care may result in: ■ Serious jeopardy to you or your loved one ’ s health, including the health of a pregnant woman or her unborn child ■ Serious impairment to you or your loved one ’ s bodily functions ■ Serious dysfunction of any of you or your loved one ’ s bodily organ or part
If you obtain care at an emergency room, you will likely pay more out - of - pocket than if you were treated at your doctor ’ s office, a Convenience Care Center or Urgent Care facility.
PRESCRIPTION BENEFITS - Most prescriptions are filled right away when you take them to the pharmacy. However, some drugs need to be reviewed by Anthem and approved before they are covered. This process, called prior authorization , helps ensure drugs are used as recommended by the FDA. Prior authorization focuses mainly on drugs that may have:
■ Risk of serious side effects or dangerous drug interactions ■
Better alternatives that may cost you less
■
■ Restrictions for use with very specific conditions
High potential for incorrect use or abuse
Prior authorization may require you to take an additional step when you are prescribed certain medications, but the long - term gain is lower out - of - pocket prescription costs for you and reduced claims expense for The School District of Clayton and potentially lower future renewal increases. Some prescription drugs are covered only if the physician obtains prior authorization from Anthem. In addition, coverage for some drugs is provided in limited quantities and duration.
This is only a brief summary of benefits. The Certificate, issued when coverage is approved for the group, contains program details, and will, in all cases, have control over any information in this summary. The certificate is available upon request.
PREVENTIVE CARE - Certain preventive services will be covered without charging a deductible, copayment, or coinsurance when these services are provided by a network provider. The types of preventive services covered are defined by federal law and can vary based on your age, gender, and health status. There may be services you had in the past that will now be covered as preventive at no cost to you. The preventive services included in this provision are described at healthcare.gov. WOMEN ’ S PREVENTIVE CARE COVERAGE - Your health plan will provide first dollar coverage for certain women ’ s preventive coverage without any cost sharing requirements (copayment, coinsurance or deductible), when delivered by in - network providers. This includes 100% coverage for FDA - approved tier 1 contraceptive methods for women when filled at an in - network pharmacy.
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